scholarly journals “No thanks, I don’t want to see snakes again”: A qualitative study of pain management versus preservation of cognition in palliative care patients

2020 ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G Lawlor ◽  
Sarina R Isenberg
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Pain Medications ◽  
Home Based ◽  
Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals “No thanks, I don’t want to see snakes again”: a qualitative study of pain management versus preservation of cognition in palliative care patients

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G. Lawlor ◽  
Sarina R. Isenberg
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Home Based ◽  
Control Pain

Abstract Background Towards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them. Methods We conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis. Results Thirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. Conclusions Decision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals “No Thanks, I Don’t Want to See Snakes Again”: A Qualitative Study of Pain Management Versus Preservation of Cognition in Palliative Care Patients

2020 ◽  
Author(s):  
Pete Wegier ◽  
Jaymie Varenbut ◽  
Mark Bernstein ◽  
Peter G Lawlor ◽  
Sarina R Isenberg
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Pain Management ◽  
Pain Relief ◽  
Decision Aids ◽  
Opioid Analgesics ◽  
Structured Interviews ◽  
Difficult Decision ◽  
Home Based ◽  
Control Pain

Abstract BackgroundTowards the end of life, use of opioid analgesics becomes more common in patients to control pain and improve quality of life. While pain medication may help manage pain, unwanted cognitive side effects are frequently noted. This balancing act presents a trade-off for patients between pain relief and adverse effects, where the desire to relieve pain must be evaluated against the desire to maintain cognitive clarity and may represent a difficult decision for patients receiving palliative care. Our goal was to understand how patients’ decision making about pain medications balances the pain relief from those medications against the cognitive decline often associated with them.MethodsWe conducted qualitative semi-structured interviews with patients receiving home-based palliative care from a program in Toronto, Canada. Interview recordings were transcribed and analyzed using thematic analysis.ResultsThirty-one interviews were conducted. Some patients preferred cognitive preservation over pain management because of a sense that cognition is central to their identity, the desire to maintain lucidity, a desire to continue participating in work or hobbies, and fear of addiction. Conversely, some patients preferred pain management over cognitive preservation because of a desire to avoid suffering, an inability to sleep without medications, or an acceptance of some cognitive compromise. A few patients attempted to find balance through tapering drugs, limiting their use of breakthrough analgesic doses, or using alternative strategies. ConclusionsDecision making around pain and pain management is a highly preference-sensitive process—with no clear right or wrong decisions, only the preferences of each patient. The findings from this study may influence the design of future patient-facing decision aids around pain management. Future studies should pilot interventions to better assist patients with this decision.

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

scholarly journals Multimodal Pain Management in the Setting of Palliative Care

2021 ◽  
Author(s):  
Marija V. Sholjakova ◽  
Vesna M. Durnev
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Side Effects ◽  
Pain Relief ◽  
Additional Treatment ◽  
Therapeutic Approaches ◽  
Multimodal Pain Management ◽  
Addictive Drugs ◽  
Analgesic Therapy ◽  
Good Organization

Pain as an integral part of palliative care (PC) is often present at the end of the life. Today, many different analgesics from opioids and non- opioids origin are in use. The integration of their use is the most effective method for pain relief. The aim of this chapter is to discuss different therapeutic approaches to pain management in palliative care. Palliative care is being confronted between the expectations and the possibilities to provide an efficient relief from the symptoms, the pain and the stress. The possibility to use opioids for pain management, with all side effects, and non-addictive drugs as additional treatment, improves the quality and the duration of life for the patients in palliative care. Since the origin of the pain is different, the use of analgesic therapy should be individualized and adapted to the real need of every person. Finally, only a good organization and institutionalization of palliative care in the society could allow for better prevention of suffering at the end of the life.

Pain Management

2019 ◽  
pp. 19-29
Author(s):  
Elisha Waldman ◽  
Stefan J. Friedrichsdorf
Keyword(s):  
Palliative Care ◽  
Pain Management ◽  
Opioid Analgesics ◽  
Integrative Therapies

Effective pain management plays a frequent and central role in palliative care, regardless of setting. This chapter addresses assessment of pain in both children and adults, as well as approaches to thoughtful and ongoing management of pain, including basic analgesics, opioid analgesics, adjuvant medications, and integrative therapies.

scholarly journals Children’s satisfaction and dissatisfaction with pain management in a Pediatric Emergency Department

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Débora Astolfo de Lima ◽  
Lisabelle Mariano Rossato ◽  
Danila Maria Batista Guedes ◽  
Elaine Buchhorn Cintra Damião ◽  
Lucía Silva ◽  
...  
Keyword(s):  
Emergency Department ◽  
Pain Management ◽  
Pain Relief ◽  
Thematic Analysis ◽  
Pediatric Emergency ◽  
Point Of View ◽  
Pediatric Emergency Department ◽  
Structured Interviews ◽  
Team Care ◽  
Priority Service

ABSTRACT Objective: To understand children’s satisfaction and dissatisfaction with pain management in the pediatric emergency department. Method: Exploratory-descriptive qualitative study performed with children between 6 and 12 years of age and use of semi-structured interviews and thematic analysis of data. Results: Nineteen children were interviewed. The results were organized in two themes: Theme 1 - Satisfaction perceived by children regarding pain management, which included three subthemes, namely: Priority care and quick pain relief, Basic needs met and Embracement by the team; and Theme 2 - Dissatisfaction perceived by children regarding pain management, which included three subthemes: Painful procedures, Uncomfortable environment and Delay in pain relief. Conclusion: Children’s satisfaction with pain management was observed to be much more than pain relief or priority service, and also included the pediatric emergency department environment and embracement by the team. Care should be directed to children’s singularities, that is, a care built from the understanding of the experience from children’s point of view.

A study of the use of post-operative opioid analgesics following rhinology surgery in 35 patients

2019 ◽  
Vol 133 (12) ◽  
pp. 1050-1052
Author(s):  
S Dodhia ◽  
S Patel ◽  
G Beghal ◽  
K Pandey ◽  
C Hopkins
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Pain Score ◽  
Opioid Analgesics ◽  
Interquartile Range ◽  
Opioid Medication ◽  
Scale Type ◽  
Relieve Pain ◽  
Post Operation ◽  
Median Pain

AbstractObjectiveOpioid analgesics are often prescribed following rhinology surgery. This study aimed to evaluate whether the quantity of opioid analgesics prescribed is justified.MethodsPatients were asked about their pain management post-operatively. Parameters recorded included: current pain (using a 10-point Likert scale); type of operation; the opioid analgesics prescribed; and the quantity of opioid tablets taken and other methods of pain relief used.ResultsThirty-five patients were successfully contacted. The median pain score at one week post-operation was 1 (interquartile range, 0–3). Of these 35 patients, 16 were prescribed opioids, whilst 19 were not. Patients prescribed opioids took a median of 8 tablets (interquartile range, 0.8–10.5) out of the 28 tablets prescribed.ConclusionThe study shows that the quantity of post-operative opioid analgesics prescribed does not compare with the amount consumed by patients to relieve pain, resulting in a surplus of opioid medication which has the potential to be abused.

Acupuncture for Cancer Pain — An Adjuvant Therapy for Cancer Pain Relief

2020 ◽  
Vol 48 (08) ◽  
pp. 1769-1786
Author(s):  
Qi Liang ◽  
Ke Zhang ◽  
Sumeng Wang ◽  
Xian Xu ◽  
Yiqian Liu ◽  
...  
Keyword(s):  
Pain Management ◽  
Pain Relief ◽  
Adjuvant Therapy ◽  
Cancer Pain ◽  
Cancer Patients ◽  
Comprehensive Overview ◽  
Different Types ◽  
Cancer Types ◽  
Zusanli Acupoint ◽  
Control Pain

As current pain management methods cannot effectively control pain among cancer patients, acupuncture has developed as an adjuvant therapy for cancer pain relief. However, the efficacy of acupuncture in treating cancer pain remains controversial. Here, we briefly introduced the development of pain management, analgesic mechanisms, and acupuncture methods. Meanwhile, a comprehensive overview of acupuncture programs was provided in terms of different cancer types, sources, and degrees. Interestingly, acupuncture can treat both tumor-induced pain and therapy-induced pain well among cancer patients. We preliminarily summarized frequently-used acupoints for different types of cancer pain and found that needle retention time was mostly 30 min, and treatment cycle was two weeks. Additionally, clinicians consistently selected Ashi acupoint or bilateral Zusanli acupoint and combined multiple acupuncture methods for different degrees of cancer pain.

Barriers, Facilitators and Recommended Strategies for Implementing a Home-Based Palliative Care Intervention in Kolkata, India

2020 ◽  
pp. 104990912096912
Author(s):  
Suparna Qanungo ◽  
Alejandra Calvo-Schimmel ◽  
Shannon McGue ◽  
Pooja Singh ◽  
Rakesh Roy ◽  
...  
Keyword(s):  
Palliative Care ◽  
Rural Areas ◽  
Care Delivery ◽  
Optimal Strategies ◽  
Medical Community ◽  
Cancer Center ◽  
Structured Interviews ◽  
Medical Practitioners ◽  
Care Intervention ◽  
Home Based

Background: 40 million people in the world are in need of palliative care, but only one-seventh of that population receive services. Underuse of palliative care in low resource countries exacerbates suffering in patients with life limiting illnesses such as cancer. Objectives: The current study was conducted to identify barriers, facilitators and recommended strategies for informing development of a home-based palliative care intervention for poor and medically underserved rural patients in Kolkata, India. Methods: Semi-structured interviews were conducted with 20 clinical and patient stakeholders in Kolkata, India. Questions queried current practices for delivering palliative care, along with barriers, facilitators and optimal strategies for implementing homebased palliative care. Results: We identified some key barriers to palliative care delivery in rural areas: lack of access to palliative care till late stages; patients unaware of their cancer stage; lack of affordability of medication and treatment costs; transportation challenges to access care; strict morphine distribution regulations making it challenging for patients to obtain morphine; cultural factors discouraging patients from seeking palliative care; resistance from medical community to use “rural medical practitioners (RMPs)” to deliver care. We also identified important facilitators, including availability of existing palliative care infrastructure at the cancer center, network of RMPs to serve as CHWs to facilitate palliative care delivery, low morphine cost and family support system for patients. Conclusion: Our findings provide evidence that a palliative care intervention which leverages an existing CHW infrastructure may be a feasible model for expanding the reach of palliative care to rural underserved patients.

scholarly journals Managing Pain in Chronically Ill Homebound Patients Through Home-Based Primary and Palliative Care

2018 ◽  
Vol 36 (4) ◽  
pp. 333-338
Author(s):  
Hannah Major-Monfried ◽  
Linda V. DeCherrie ◽  
Ania Wajnberg ◽  
Meng Zhang ◽  
Amy S. Kelley ◽  
...  
Keyword(s):  
Older Adults ◽  
Palliative Care ◽  
Pain Management ◽  
Severe Pain ◽  
Psychosocial Care ◽  
Symptom Burden ◽  
Chronically Ill ◽  
Assessment System ◽  
Home Based ◽  
Study Population

Background: Many older adults are homebound due to chronic illness and suffer from significant symptoms, including pain. Home-based primary and palliative care (HBPC), which provides interdisciplinary medical and psychosocial care for this population, has been shown to significantly reduce symptom burden. However, little is known about how pain is managed in the homebound. Objective: This article describes pain management for chronically, ill homebound adults in a model, urban HBPC program. Design/Measurements: This was a prospective observational cohort study of newly enrolled HBPC patients, who completed a baseline Edmonton Symptom Assessment System (ESAS) survey during the initial HBPC visit (N = 86). Baseline pain burden was captured by ESAS and pain severity was categorized as none, mild, or moderate-severe. All pain-related assessments and treatments over a 6-month period were categorized by medication type and titration, referrals to outside providers, procedures, and equipment. Results: At baseline, 55% of the study population had no pain, 18% had mild pain, and 27% had moderate-severe pain. For those with moderate-severe pain at baseline (n = 23), prescriptions for pharmacological treatments for pain, such as opiates and acetaminophen, increased during the study period from 48% to 57% and 52% to 91%, respectively. Nonpharmacological interventions, including referrals to outside providers such as physical therapy, procedures, and equipment for pain management, were also common and 67% of the study population received a service referral during the follow-up period. Conclusions: Pharmacological and nonpharmacological treatments are widely used in the setting of HBPC to treat the pain of homebound, older adults.

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