ABSTRACT
Optimal involvement of palliative care (PC) services in the management of patients with decompensated cirrhosis and end-stage liver disease (ESLD) is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life (QoL) by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease. This review provides an evidence-based analysis of the benefits of the integration of palliative care into the management of patients with ESLD. Liver Transplantation 24 961-968 2018 AASLD.
Subject(s)
End Stage Liver Disease/therapy , Liver Cirrhosis/therapy , Palliative Care/methods , Quality of Life , Delivery of Health Care, Integrated/methods , Delivery of Health Care, Integrated/trends , End Stage Liver Disease/diagnosis , End Stage Liver Disease/pathology , Evidence-Based Medicine/methods , Evidence-Based Medicine/trends , Humans , Liver Cirrhosis/diagnosis , Liver Cirrhosis/pathology , Liver Transplantation , Palliative Care/trends , Severity of Illness Index , Treatment OutcomeABSTRACT
The aim of this study was to use both quantitative and qualitative data to assess pain in idiopathic Parkinson's disease (IPD) and classify it according to cause. In this descriptive cross-sectional study, 123 patients were interviewed and pain was assessed using patient descriptions, the Brief Pain Inventory, and Visual Analogue Scales. Patients reported 285 pains (median 2 per patient), and 22.8% had 4 or more pains. Pain was reported as a problem in 85% and was IPD-related in 62.6% of patients, unrelated to IPD in 64.2%, indirectly related to IPD in 8.1%, related to multiple causes in 4.1%, and treatment related in 0.8%. Pain unrelated to IPD was more common, more constant, and more severe than IPD-related pain. Overall, analgesic use was low. This study demonstrates the benefits of adopting a systematic and logical approach to the assessment of pain in IPD and the merits of a simple new classification system.
Subject(s)
Pain/classification , Pain/etiology , Parkinson Disease/complications , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Health Surveys , Humans , Male , Middle Aged , Pain Management , Pain MeasurementABSTRACT
The purpose of this study was to assess quality of life (QoL) of patients with idiopathic Parkinson's disease (IPD). The Parkinson's Disease Questionnaire (PDQ-39) was compared with an individualized QoL tool: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW). One hundred twenty-three patients underwent interviews using these tools, together with the Mini Mental State examination, Beck Depression Inventory, a qualitative pain assessment, and the Palliative Care Assessment tool (for symptoms). The SEIQoL-DW was well tolerated and demonstrated that QoL not only was broad and highly individualistic but also was determined more by psychosocial than physical issues. Of the 87 domains nominated by patients, the most common were family (87.8%), health (52.8%), leisure activities (36.6%), marriage (35%), and friends (30.9%). The SEIQoL index score was predicted by depression but not by disease stage. However, the PDQ-39 was predicted by disease stage, the number of symptoms, and depression. Direct comparison of the tools confirmed that the SEIQoL index score was predicted by the PDQ-39 domains of social support, cognitive impairment, and emotion. The use of the SEIQoL-DW challenges current thinking within IPD research regarding QoL and its assessment using the PDQ-39.