A more balanced approach to opioid use and management is also needed in end-of-life care

2016 ◽  
Vol 12 (6) ◽  
pp. 371
Author(s):  
Sydney Morss Dy, MD, MSc ◽  
Cynda Hylton Rushton, PhD, RN, FAAN
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Multidisciplinary Teams ◽  
Life Care ◽  
Physical Pain ◽  
Opioid Use ◽  
Balanced Approach ◽  
Psychosocial Consequences ◽  
Increase Risk ◽  
Pain And Suffering

Significant pain and suffering are frequent at the end-of-life, and opioids are often essential for relief. Although opioids must be readily available when appropriate, particularly for unbearable physical pain, some of the same issues causing current reconsideration of aggressive opioid guidelines for chronic pain1 also apply at the end of life. These patients may be given opioids when other potentially beneficial treatments should be tried first or for reasons other than physical pain, prescribed excessive doses, and insufficiently counseled or supported. Opioids are easy to start but challenging to discontinue and can cause dependence and psychosocial consequences, and vulnerability at end-of-life may increase risk of and burden from harms and side effects. These patients and their families usually also have multifactorial suffering requiring multidisciplinary teams and approaches other than or in addition to opioids.

PAIN AND SUFFERING IN PEDIATRIC END-OF-LIFE CARE: PROVIDER PERCEPTIONS OF SYMPTOMS AND MANAGEMENT.

2004 ◽  
Vol 52 ◽  
pp. S103
Author(s):  
A. R. Aminoff ◽  
R. Kramer ◽  
B. A. Cooper ◽  
J. C. Partridge ◽  
B. Davies
Keyword(s):  
End Of Life ◽  
Care Provider ◽  
End Of Life Care ◽  
Life Care ◽  
Provider Perceptions ◽  
Pain And Suffering

scholarly journals End-of-Life Services Among Patients With Cancer: Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims

2017 ◽  
Vol 13 (11) ◽  
pp. e889-e899 ◽  
Author(s):  
Cara L. McDermott ◽  
Catherine Fedorenko ◽  
Karma Kreizenbeck ◽  
Qin Sun ◽  
Bruce Smith ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Clinical Information ◽  
The United States ◽  
Life Care ◽  
Insurance Claims ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Patients With Cancer ◽  
Regional Collaboration

Purpose: Despite guidelines emphasizing symptom management over aggressive treatment, end-of-life care for persons with cancer in the United States is highly variable. In consultation with a regional collaboration of patients, providers, and payers, we investigated indicators of high-quality end-of-life care to describe patterns of care, identify areas for improvement, and inform future interventions to enhance end-of-life care for patients with cancer. Methods: We linked insurance claims to clinical information from the western Washington SEER database. We included persons ≥ 18 years of age who had been diagnosed with an invasive solid tumor between January 1, 2007, and December 31, 2015, and who had a recorded death date, were enrolled in a commercial plan for the last month of life, and made at least one insurance claim in the last 90 days of life. Results: In the last month of life, among 6,568 commercially insured patients, 56.3% were hospitalized and 48.6% underwent at least one imaging scan. Among patients younger than 65 years of age, 31.4% were enrolled in hospice; of those younger than 65 years of age who were not enrolled in hospice, 40.5% had received an opioid prescription. Over time, opioid use in the last 30 days of life among young adults not enrolled in hospice dropped from 44.7% in the period 2007 to 2009 to 42.5% in the period 2010 to 2012 and to 36.7% in the period 2013 to 2015. Conclusion: Hospitalization and high-cost imaging scans are burdensome to patients and caregivers at the end of life. Our findings suggest that policies that facilitate appropriate imaging, opioid, and hospice use and that encourage supportive care may improve end-of-life care and quality of life.

138 PAIN AND SUFFERING IN PEDIATRIC END-OF-LIFE CARE: PROVIDER PERCEPTIONS OF SYMPTOMS AND MANAGEMENT.

2004 ◽  
Vol 52 (Suppl 1) ◽  
pp. S103.1-S103
Author(s):  
A. R. Aminoff ◽  
R. Kramer ◽  
B. A. Cooper ◽  
J. C. Partridge ◽  
B. Davies
Keyword(s):  
End Of Life ◽  
Care Provider ◽  
End Of Life Care ◽  
Life Care ◽  
Provider Perceptions ◽  
Pain And Suffering

Opioid Use in End-of-Life Care in Patients With Interstitial Pneumonia Associated With Respiratory Worsening

2013 ◽  
Vol 27 (3) ◽  
pp. 214-219 ◽  
Author(s):  
Hiroaki Tsukuura ◽  
Koichi Nishimura ◽  
Hiroyuki Taniguchi ◽  
Yasuhiro Kondoh ◽  
Tomoki Kimura ◽  
...  
Keyword(s):  
End Of Life ◽  
Interstitial Pneumonia ◽  
End Of Life Care ◽  
Life Care ◽  
Opioid Use

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

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