Early Guided Palliative Care Communication for Patients With COVID-19 Receiving ECMO.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) combined with COVID-19 presents challenges (eg, isolation, anticipatory grief) for patients and families. OBJECTIVE: To (1) describe characteristics and outcomes of patients with COVID-19 receiving ECMO, (2) develop a practice improvement strategy to implement early, semistructured palliative care communication in ECMO acknowledgment meetings with patients' families, and (3) examine family members' experiences as recorded in clinicians' notes during these meetings. METHODS: Descriptive observation of guided, in-depth meetings with families of patients with COVID-19 receiving ECMO, as gathered from the electronic medical record of a large urban academic medical center. Most meetings were held within 3 days of initiation of ECMO. RESULTS: Forty-three patients received ECMO between March and October 2020. The mean patient age was 44 years; 63% of patients were Hispanic/Latino, 19% were Black, and 7% were White. Documentation of the ECMO acknowledgment meeting was completed for 60% of patients. Fifty-six percent of patients survived to hospital discharge. Family discussions revealed 7 common themes: hope, reliance on faith, multiple family members with COVID-19, helping children adjust to a new normal, visitation restrictions, gratitude for clinicians and care, and end-of-life discussions. CONCLUSION: Early and ongoing provision of palliative care is feasible and useful for highlighting a range of experiences related to COVID-19. Palliative care is also useful for educating patients and families on the benefits and limitations of ECMO therapy.

An Overview of Cancer Pain: Epidemiology and Pathophysiology.

OBJECTIVE: To present an overview of the epidemiology and pathophysiology of cancer pain related to disease and treatment. DATA SOURCES: Published manuscripts, Web sites, and textbook chapters. CONCLUSION: Current knowledge of cancer pain epidemiology and pathophysiology widens and focuses the opportunities to prevent, limit, and treat cancer pain. IMPLICATIONS FOR NURSING PRACTICE: Nurses' knowledge of transduction, transmission, perception, and modulation in cancer pain pathophysiology outlines pathways for multimodal approaches to treat complex and diverse pain experiences. Use of standard vocabulary of pain terms and definitions facilitates pain assessment and management across different disciplines.

Measuring Acute Pain Over Time in the Critically Ill Using the Multidimensional Objective Pain Assessment Tool (MOPAT).

BACKGROUND: A valid and reliable instrument is needed to assess acute pain in critically ill patients unable to self-report and who may be transitioning between critical care and other settings. AIM: To examine the reliability, validity, and clinical utility of the Multidimensional Objective Pain Assessment Tool (MOPAT) when used over time by critical care nurses to assess acute pain in non-communicative critically ill patients. METHODS: Twenty-seven patients had pain assessed at two time points (T1 and T2) surrounding a painful event for up to 3 days. Twenty-one ICU nurses participated in pain assessments and completed the Clinical Utility Questionnaire. RESULTS: Internal consistency reliability coefficient alphas for the MOPAT were .68 at T1 and .72 at T2. Inter-rater agreement during painful procedures or turning was 68% for the behavioral dimension and 80% for the physiologic dimension. Validity was evidenced by decreases (p < .001) in the MOPAT total and behavioral and physiologic dimension scores when comparing T1 and T2. Nurses found the tool clinically useful. CONCLUSION: The MOPAT can be used in the critical care setting as a helpful tool to assess pain in non-communicative patients. The MOPAT is unique in that the instrument can be used over time and across settings.

Meeting survivors' unmet needs: an integrated framework for survivor and palliative care.

OBJECTIVES: To propose an integrated framework for survivorship care and palliative care, explore application of this framework in cancer patients, and identify research opportunities to expand the evidence base for practice. DATA SOURCES: Peer-reviewed literature, online documents from the National Quality Forum and National Consensus Project for Quality Palliative Care, and reports from the Centers for Disease Control and the Institute of Medicine. CONCLUSION: The interface between palliative care domains and survivorship care results in prioritizing needs and coordination of care along the cancer trajectory. IMPLICATIONS FOR NURSING PRACTICE: Principles of the proposed model may be incorporated into survivorship care plans and assist with multidisciplinary care of these complex patients.