Opioid Management of Dyspnea at End of Life: A Systematic Review.

Objective: The objective of this systematic review is to consolidate the existing evidence on opioid use, including administration, dosing, and efficacy, for the relief of dyspnea at end of life. The overarching goal is to optimize clinical management of dyspnea by identifying patterns in opioid use, improving opioid management of dyspnea, and to prioritize future research. Background: Opioids are commonly used in the management of dyspnea at end of life, yet specific administration guidelines are limited. A greater understanding of the effectiveness of opioids in relieving end-of-life dyspnea with consideration of study design, patients, and opioids, including dyspnea evaluation tools and outcomes, will leverage development of standardized administration and dosing. Methods: A PRISMA-guided systematic review using six databases identified quality studies of opioid management for patients with dyspnea at end of life. Results: Twenty-three references met review inclusion criteria, which included terminally ill cancer and noncancer patients with various diagnoses. Studies included two randomized controlled trials, and three nonrandomized experimental, three prospective observational, one cross-sectional, and one case series. Thirteen retrospective chart reviews were also included due to the limited rigorous studies rendered by the search. Thirteen studies evaluated morphine, followed by fentanyl (6), oxycodone (5), general opioid use (4), and hydromorphone (2). Routes of administration were parenteral, oral, combination, and nebulization. Dyspnea was evaluated using self-reporting and non-self-reporting evaluation tools. Sedation was the most reported opioid-related adverse effect. Discussion: Challenges persist in conducting end-of-life research, preventing consensus on standardization of opioid treatment for dyspnea within this specific palliative time frame. Future robust prospective trials using specific, accurate assessment with reassessment of dyspnea/respiratory distress, and consideration of opioid tolerance, polypharmacy, and comorbidities are required.

Dyspnea in Patients with Advanced Stage Cancer: A Nurses Guide to Assessment and Treatment.

OBJECTIVE: To provide oncology nurses with education on the specific distressing symptom of dyspnea in patients with advanced cancer, including proper assessment and a hierarchical approach to both nonpharmacologic and pharmacologic dyspnea interventions. DATA SOURCES: Sources include published research findings, literature reviews, and guidelines, as well as professional opinion from practicing nurses and clinicians. CONCLUSION: Individuals with advanced cancer often experience the distressing respiratory symptom, dyspnea. Assessment tools and treatment recommendations and guidelines are available for clinicians to appropriately evaluate and treat dyspnea. Improved awareness of symptom presence and treatment options will assist nurses in advocating for their patients with advanced cancer and obtaining and delivering the necessary treatments for dyspnea relief. IMPLICATIONS FOR NURSING: Published evidence supports the many treatment options available for dyspnea relief at varying levels. Assessment, individualized treatment, education, and reassessment are key and ongoing to assist patients with advanced cancer to achieve respiratory comfort.

Eating Disorder Behaviors Among Transgender Individuals: Exploring the Literature.

BACKGROUND: Many transgender individuals of varying ages are at risk of developing eating disorder behaviors or unhealthy weight management behaviors. AIMS: This article reports the results of a review of the current literature on eating disorder behaviors among transgender individuals. METHODS: A literature search using CINAHL Complete, PubMed, and PsychInfo was conducted using key words "eating disorder," "eating disorder behaviors," and "transgender." Results were narrowed through author review and concurrence to eight peer-reviewed English language articles from 2013 to 2018. RESULTS: Four main themes emerged across the articles reviewed: gender characteristics and body dissatisfaction, public affirmations and stigma, amenorrhea, and mental health treatment and therapies. CONCLUSIONS: There is still much exploration needed to better care for this population in a sensitive and timely manner. Many valuable clinical implications have emerged from the current literature, which provide a positive step toward optimal individualized patient care.