Challenging Symptoms

2017 ◽  
Author(s):  
Barton T. Bobb ◽  
Devon Fletcher
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Sleep Disorders ◽  
Assessment Tools ◽  
Dry Mouth ◽  
Advanced Practice ◽  
Medication Side Effects ◽  
Medication Side

Dry mouth, hiccups, fevers, pruritus, and sleep disorders are symptoms often found in palliative care patients. These symptoms can be challenging to treat, and they require that the advanced practice registered nurse (APRN) has a working knowledge of the causative conditions in order to effectively manage the symptoms. Appropriate assessment tools for these common symptoms are reviewed, as are their various causes, from medication side effects, systemic illness, and physical and psychological causes. Pharmacological, nonpharmacological, and interventional treatments are offered, with the caveat that all interventions must be individualized to the patient’s care goals and with quality of life in mind.

Disease-modifying therapies in advanced cancer

2021 ◽  
pp. 800-807
Author(s):  
Olav Dajani ◽  
Karin Jordan
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Well Being ◽  
Patient Comfort ◽  
Optimal Care ◽  
Disease Modifying ◽  
Critical Components ◽  
Improve Patient

In many situations, anticancer therapies may be critical components when optimizing patient comfort, function, quality of life, and duration of survival. Optimal care requires the integration of oncological and palliative care and it is very important for palliative care clinicians to be familiar with oncological approaches to improve patient well-being, and also the limitations of such approaches. This integrative role requires that palliative care clinicians have a basic literacy regarding anticancer therapies and the expectations and side effects of their treatments. Together with anticancer therapies, medical oncology should encompass patient-centred care by providing supportive and palliative interventions at all stages of the disease, from the time of diagnosis.

Reduction of Opioid Side Effects by Prophylactic Measures of Palliative Care Team May Result in Improved Quality of Life

2010 ◽  
Vol 13 (4) ◽  
pp. 401-406 ◽  
Author(s):  
Michiaki Myotoku ◽  
Akiko Nakanishi ◽  
Miwa Kanematsu ◽  
Noriko Sakaguchi ◽  
Norio Hashimoto ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Palliative Care Team ◽  
Care Team ◽  
Prophylactic Measures

Assessment tools for palliative care.

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 66-66
Author(s):  
Sarina Isenberg ◽  
Rebecca Aslakson ◽  
Sydney Morss Dy ◽  
Renee Wilson ◽  
Julie Waldfogel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Clinical Practice ◽  
Quality Indicators ◽  
Systematic Reviews ◽  
Grey Literature ◽  
Care Quality ◽  
Assessment Tools ◽  
Patient Reported

66 Background: Recent reviews have not comprehensively addressed palliative care (PC) assessment tools. This project summarizes the extent of evidence about PC assessment tools for patients and families, and how tools have been used for clinical care, quality indicators, and evaluation of interventions. Methods: We searched MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews for systematic reviews of assessment tools for PC, from January 2007 to March 2016. We searched the grey literature for domains without systematic reviews, and for domains with systematic reviews > three years old. Paired investigators independently screened search results and grey literature to determine eligibility, and assessed risk of bias of systematic reviews. The team selected the most recent and highest-quality systematic reviews for each domain. One investigator abstracted information, and a second investigator checked the information. Results: Using the National Consensus Project Palliative Care Guidelines domains, we included nine systematic reviews with 167 tools, and six tools from grey literature. Most tools were in physical, psychological, psychiatric, and social aspects of care, care at the end of life, and tools that cross domains (quality of life and caregiver-reported experience). Only two tools directly addressed spiritual aspects and none addressed cultural or patient-reported experience. Internal consistency reliability was evaluated for almost all tools; most reported construct validity; and few reported responsiveness (sensitivity to change). Few studies evaluated the use of assessment tools in quality indicators or clinical practice. A systematic review of 38 PC interventions and the assessment tools used found that at least 25 interventions included physical, psychosocial and psychiatric, and quality of life tools, but the tools varied extensively, and only nine included patient experience tools. Conclusions: Although assessment tools exist in many PC domains, tools are needed to assess spiritual and cultural aspects of care, and patient-reported experience. Research is needed concerning: tools in clinical practice and quality of care; comparison of existing tools; and evaluation and dissemination tools with evidence of responsiveness.

What Matters Most for Patients, Parents, and Clinicians in the Course of Juvenile Idiopathic Arthritis? A Qualitative Study

2014 ◽  
Vol 41 (11) ◽  
pp. 2260-2269 ◽  
Author(s):  
Jaime Guzman ◽  
Oralia Gómez-Ramírez ◽  
Roman Jurencak ◽  
Natalie J. Shiff ◽  
Roberta A. Berard ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Juvenile Idiopathic Arthritis ◽  
Clinical Features ◽  
Health Professionals ◽  
Global Assessment ◽  
Active Joint ◽  
Allied Health Professionals ◽  
Medication Side Effects ◽  
Medication Side

Objective.To assess which clinical features are most important for patients, parents, and clinicians in the course of juvenile idiopathic arthritis (JIA).Methods.Forty-nine people participated in 6 audience-specific focus group discussions and 112 reciprocal interviews in 3 Canadian cities. Participants included youth with JIA, experienced English- and French-speaking parents, novice parents (< 6 mos since diagnosis), pediatric rheumatologists, and allied health professionals. Participants discussed the importance of 34 JIA clinical features extracted from medical literature. Transcripts and interview reports underwent qualitative analysis to establish relative priorities for each group.Results.Most study participants considered medication requirements, medication side effects, pain, participant-defined quality of life, and active joints as high priority clinical features of JIA. Active joint count was the only American College of Rheumatology core variable accorded high or medium priority by all groups. Rheumatologists and allied health professionals considered physician global assessment as high priority, but it had very low priority for patients and parents. The parent global assessment was considered high priority by clinicians, medium to high by parents, and low by patients. Child Health Assessment Questionnaire scores were considered low priority by patients and parents, and moderate or high by clinicians. The number of joints with limited motion was given low to very low priority by all groups. Parents gave high priority to arthritis flares.Conclusion.If our findings are confirmed, medication requirements, medication side effects, pain, participant-defined quality of life, and active joint counts should figure prominently in describing the course of JIA.

scholarly journals Home Use of Intranasal Dexmedetomidine in a Child With An Intractable Sleep Disorder

2020 ◽  
Vol 25 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Lucia De Zen ◽  
Irene Del Rizzo ◽  
Margherita Robazza ◽  
Francesca Barbieri ◽  
Marta Campagna ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Side Effects ◽  
Sleep Disorder ◽  
Sleep Disturbances ◽  
Pediatric Palliative Care ◽  
Children And Families ◽  
Blood Oxygen Saturation ◽  
Dystrophic Epidermolysis Bullosa

Sleep disturbance is a crucial issue in pediatric palliative care, with a dramatic impact on the quality of life of children and families. Dexmedetomidine (DEX) is a selective α-2 agonist, with anxiolytic, hypnotic, and analgesic properties, that could play a role in the management of refractory sleep disturbances. We describe the use of intranasal DEX as a sleep inductor in a 10-year-old female with dystrophic epidermolysis bullosa and a severe sleep disorder. After treatment with melatonin, benzodiazepines, and niaprazine had failed, she was admitted to the hospital where 3 mcg/kg/day of intranasal DEX was administered before bedtime. She received 0.7 mL of the IV formulation at a concentration of 100 mcg/mL with half the dose given in each nostril via a Mucosal Atomization Device. During this time, she was also monitored for potential side effects (e.g., bradycardia, blood pressure derangements). After 2 weeks of hospitalization, she was discharged with ready-to-use doses of DEX for home treatment. The child's heart rate and blood oxygen saturation were monitored at home. There was a definite improvement in sleep quality and duration, daytime alertness, pain control, and quality of life. No side effects were reported and the drug retained its effect over time (the patient is currently taking the drug). Intranasal DEX could be a safe and effective strategy to manage refractory sleep disturbances in children in pediatric palliative care.

scholarly journals ‘Was it worth it?’ Intrathecal analgesia for cancer pain: A qualitative study exploring the views of family carers

2017 ◽  
Vol 32 (1) ◽  
pp. 287-293
Author(s):  
Nishi Patel ◽  
Melanie Huddart ◽  
Helen Makins ◽  
Theresa Mitchell ◽  
Jane L Gibbins ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Drug Delivery ◽  
Palliative Care ◽  
Side Effects ◽  
Cancer Pain ◽  
Family Carers ◽  
Incurable Cancer ◽  
Intrathecal Drug Delivery ◽  
The Individual

Background: Intrathecal drug delivery is known to reduce pain in patients where conventional systemic analgesia has been ineffective or intolerable. However, there is little information regarding the effects of intrathecal drug delivery on quality of life and function in those with advanced, incurable cancer. Aim: Retrospective exploration of the views of bereaved carers regarding the physical and psychosocial effects of external tunnelled intrathecal drug delivery in patients with advanced incurable cancer. Design: Thematic analysis of qualitative interviews with carers of deceased individuals who received percutaneous external tunnelled intrathecal drug delivery as part of their pain management, within two UK centres. Setting: A total of 11 carers were recruited from two UK Palliative Care centres. Family carers of adult patients who had received external tunnelled intrathecal drug delivery analgesia for cancer pain and had died between 6 and 48 months prior to contact were included. Carer relatives who were considered likely to be too vulnerable or who had lodged a complaint about treatment within the recruiting department or who had been treated directly by the interviewer were excluded. Results: In total, 11 interviews took place. The emerging themes were (1) making the decision to have the intrathecal – relatives described desperate situations with severe pain and/or sedation, meaning that the individual would try anything; (2) timing and knowing they were having the best – an increased access to pain and palliative care services, meant carers felt everything possible was being done, making the situation more bearable; (3) was it worth it? – the success of the external tunnelled intrathecal drug delivery was judged on its ability to enable the individual to be themselves through their final illness. Side effects were often considered acceptable, if the external tunnelled intrathecal drug delivery enabled improvements in quality of life. Conclusion: Carers perceived external tunnelled intrathecal drug delivery as most valuable when it improved quality of life towards the end of life, by reducing pain and side effects of conventional systemic analgesia to enable individuals ‘to be themselves’. Under these circumstances, the carers judged significant side effects to be acceptable.

Effects of zopiclone on quality of life in insomnia

1995 ◽  
Vol 10 (S3) ◽  
pp. 91s-94s ◽  
Author(s):  
I Hindmarch
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Sleep Disorders ◽  
International Study ◽  
Double Blind ◽  
Sleep Parameters ◽  
Hypnotic Efficacy ◽  
Double Blind Design

SummaryAll of the components of quality of life can be altered in insomniacs because of sleep disorders themselves but theoretically also in consequence to side effects from hypnotic agents. The presented international study, carried out with a multicentre, randomised and double-blind design, investigated zopiclone effects on quality of life in insomniac patients as compared to placebo. A total of 458 patients completed the study, 231 receiving zopiclone 7.5 mg and 227 receiving placebo, with mean treatment durations of 48 and 44 days. Sleep parameters and quality of life, measured with extensive and validated scales, were assessed at baseline and at 14, 28 and 56 days after admission. Zopiclone showed hypnotic efficacy and significantly greater improvement of quality of life as compared to placebo, both at 14 days and at endpoint.

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