Would You Refer This Patient With Cancer to a Palliative Care Specialist?

ObjectiveDiscussing the potential deterioration of a child who has a life-limiting condition has recognised benefits for future care, but can be challenging in a clinical context where uncertain illness trajectories are common. Existing research is restricted to indirect forms of evidence such as self-report data from clinicians and families. This study directly explores how discussions about deterioration are managed within actual paediatric palliative care consultations.Methods9 consultations were video recorded in an Australian paediatric palliative care service. Each consultation involved the same paediatric palliative care specialist. Conversation analysis was used to identify and explore recurrent ways in which discussions about deterioration came to be realised.FindingsThe study identified two communicative practices used by a paediatric palliative care specialist that afforded opportunities to discuss deterioration: (1) soliciting the family's agenda for the consultation; (2) initiating and maintaining topics where discussing deterioration is a relevant possibility. Across these different practices, a common feature was indirect initiation of discussions about deterioration. This approach made such discussions possible, but without mandating or even suggesting that such discussion must occur.ConclusionsThese communicative practices balance the benefit of discussing deterioration against a recognised importance of allowing discussions to be directed by a child's family. This was achieved by creating opportunities for discussing deterioration, without making such discussions necessary.

Download Full-text

HSR19-076: A Prospective Study of the Usage of Pain Medication, Cost, Alternative Medication Use, and Outcome by Cancer Patients in Real World

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7117 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-076

Author(s):

Praveen Adusumilli ◽

Vidya Viswanath ◽

Raghunadha Rao Digumarthi

Keyword(s):

Palliative Care ◽

Side Effects ◽

Cancer Patients ◽

Average Cost ◽

Pain Medication ◽

Cancer Center ◽

Medication Cost ◽

Palliative Care Specialist ◽

Care Specialist ◽

A Prospective Study

Introduction: Perception of pain and the need to treat it is highly variable, even amongst oncologists. Availability of pain specialists is an added advantage. This is an analysis of prescription patterns of pain medication and its outcome in cancer patients. Materials and Methods: The center has 8 oncologists and a pain and palliative care specialist. All the patients presenting to the outpatient department of our institute with a diagnosis of cancer were prospectively analyzed for usage of pain medication using a structured questionnaire. Data on diagnosis, stage, treatment given, and outcomes were analyzed. Pain intensity was recorded on visual analogue scale, types of pain medicines used, and their side effects were noted. The average cost of the pain medication purchased in our pharmacy was calculated. Use of alternative medicines was also noted. Results: A total of 1,098 cancer patients were evaluated. Pain was a prominent complaint in 64.6% of patients. Of these, only 89.5% received pain medication. Mild, moderate, and severe pain was seen in 52.1%, 26.7%, and 21.2% respectively. The 3 most common diagnoses were breast cancer in 19.7%, gastrointestinal cancer in 14%, and 12.1% with head and neck cancers. Weak opioids and NSAIDS were most commonly prescribed analgesics in 44.2% and 42.1%, respectively. Morphine was prescribed for 13.7% of patients. The average cost of pain medicines is Re 148 (US $2.25 a month). Side effects from medication were seen in 13.5% of patients, with constipation being the most common. Alternative forms of medicine were reportedly used by 148 patients: Ayurveda by 20.8%, and homeopathy by 12.9%, native medication by 6.1%, Unani by 1.8%. Good relief of pain was reported by 66%, fair relief by 27%, no relief by 6.1%, and worsening by <1%. Conclusion: Pain management is near ideal with the availability of services of pain and palliative care specialist in a cancer center.

Download Full-text