ABSTRACT
Pain is a common symptom associated with advanced cancer. An estimated 66.4% of people with advanced cancer experience pain from their disease or treatment. Pain management is an essential component of palliative care. Opioids and adjuvant therapies are the mainstay of cancer pain management. Nevertheless, a proportion of patients may experience complex pain that is not responsive to conventional analgesia. Interventional analgesia procedures may be appropriate and necessary to manage complex, cancer-related pain. This narrative review uses a theoretical case to highlight core principles of palliative care and interventional anesthesia, and the importance of collaborative, interdisciplinary care. An overview and discussion of pragmatic considerations of peripheral nervous system interventional analgesic procedures and neuraxial analgesia infusions are provided.
Subject(s)
Anesthesia , Cancer Pain , Neoplasms , Palliative Care , Cancer Pain/drug therapy , Humans , Neoplasms/complications , Pain , Pain ManagementABSTRACT
La détresse physique et émotionnelle que peuvent causer au patient et à sa famille les plaies malignes dues à un cancer est souvent négligée. Malheureusement, nous ne disposons pas d'outils de dépistage et d'évaluation fiables et valides pouvant aider à mieux traiter ces plaies. Cette étude a cherché à valider un outil de mesure des résultats rapportés par les patients : le Malignant Wound Assessment Tool - Research (MWAT-R). Pour ce faire, huit patients ont été recrutés et interrogés selon la méthodologie de l'entretien cognitif. La compréhension et l'impression générale des patients vis-à-vis de cet outil ont été analysées. Nous avons constaté que la formulation et les choix de réponse posaient problème aux patients. En général, les participants ont néanmoins trouvé que les questions saisissaient bien les principaux enjeux relatifs aux plaies malignes et tenaient compte du point de vue du patient. Le fait d'établir la validité apparente et de contenu du MWAT-R du point de vue des patients par la technique d'entretien cognitif vient étayer la validité de cet outil.
ABSTRACT
Malignant wounds as a result of cancer are under-recognized for the physical and emotional distress they cause patients and their families. Unfortunately, there is a lack of valid and reliable screening and assessment tools to aid in the management of malignant wounds. This study aims to validate a patient-reported outcome measurement tool, Malignant Wound Assessment Tool - Research (MWAT-R). Eight patients were recruited and interviewed using the cognitive interviewing methodology to validate this tool. Patients' understanding and overall impression of the MWAT-R were explored. Our findings showed that the wording and response options posed challenges for patients in completing the tool. Overall, participants felt that questions captured the key issues related to dealing with a malignant wound and accounted for the patients' perspective. Establishing the content and face validity of the MWAT-R from the patients' perspectives using cognitive interviews has provided further evidence to the validity of this tool.
ABSTRACT
PURPOSE: We examined administrative outcomes after opening an oncology acute palliative care unit (APCU), to determine attainment of administrative targets related to the unit's function of acute palliation. METHODS: We retrospectively reviewed the administrative database for our APCU for the 5 years following its opening in 2003. Data were abstracted on demographic information, as well as source of admission, primary reason for admission, discharge destination, inpatient death rate, and length of stay. Linear regression and the Cochran-Armitage trend test were used for analysis. In keeping with targets set at the unit's opening, our primary hypotheses were that outpatient admissions, admissions for symptom control, and discharges home would increase over the study period; secondary hypotheses were that length of stay and inpatient death rate would decrease. RESULTS: There were 1748 admissions during the study period: the median age was 64, 54% were women, and the most common cancer sites were gastrointestinal (24%), lung (20%), and gynecologic (13%). There were significant changes for all primary endpoints: outpatient admissions increased from 47% to 70% (p < 0.0001), admissions for symptom control increased from 42% to 75% (p < 0.0001), and discharges home increased from 18% to 39% (p < 0.0001). The secondary end points of death rate and length of stay decreased from 65% to 40% (p < 0.0001) and 12 to 11 days (p = 0.54), respectively. CONCLUSION: Setting and adhering to administrative targets for an APCU is possible with appropriate admission criteria, adequate community resources, and education of patients, families and health professionals regarding the model of care.
