7 research outputs found
Pain Management in Patients with Cancer: Focus on Opioid Analgesics
Cancer pain is generally treated with pharmacological measures, relying on using opioids alone or in combination with adjuvant analgesics. Weak opioids are used for mild-to-moderate pain as monotherapy or in a combination with nonopioids. For patients with moderate-to-severe pain, strong opioids are recommended as initial therapy rather than beginning treatment with weak opioids. Adjunctive therapy plays an important role in the treatment of cancer pain not fully responsive to opioids administered alone (ie, neuropathic, bone, and visceral colicky pain). Supportive drugs should be used wisely to prevent and treat opioidsâ adverse effects. Understanding the pharmacokinetics, pharmacodynamics, interactions, and cautions with commonly used opioids can help determine appropriate opioid selection for individual cancer patients
Pain Management with Opioid Analgesics - How to Improve Efficacy, while Reducing Adverse Effects and Improve Patientsâ Quality of Life
Comparison of the Quality of Life of Cancer Patients with Pain Treated with Oral Controlled-Release Morphine and Oxycodone and Transdermal Buprenorphine and Fentanyl
Analgesic Effects of Tramadol in Combination with Adjuvant Drugs: An Experimental Study in Rats
Assessing quality of care for the dying from the bereaved relativesâ perspective: Using pre- testing survey methods across seven countries to develop an international outcome measure
Background: The provision of care for dying cancer patients varies on a global basis. In order to improve care, we need to be able to
evaluate the current level of care. One method of assessment is to use the views from the bereaved relatives.
Aim: The aim of this study is to translate and pre-test the âCare Of the Dying Evaluationâ (CODETM) questionnaire across seven
participating countries prior to conducting an evaluation of current quality of care.
Design: The three stages were as follows: (1) translation of CODE in keeping with standardised international principles; (2) pre-testing
using patient and public involvement and cognitive interviews with bereaved relatives; and (3) utilising a modified nominal group
technique to establish a common, core international version of CODE.
Setting/participants: Hospital settings: for each country, at least five patient and public involvement representatives, selected by
purposive sampling, fed back on CODETM questionnaire; and at least five bereaved relatives to cancer patients undertook cognitive
interviews. Feedback was collated and categorised into themes relating to clarity, recall, sensitivity and response options. Structured
consensus meeting held to determine content of international CODE (i-CODE) questionnaire.
Results: In total, 48 patient and public involvement representatives and 35 bereaved relatives contributed to the pre-testing stages.
No specific question item was recommended for exclusion from CODETM. Revisions to the demographic section were needed to be
culturally appropriate.
Conclusion: Patient and public involvement and bereaved relativesâ perceptions helped enhance the face and content validity of
i-CODE. A common, core international questionnaire is now developed with key questions relating to quality of care for the dying
Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relativesâ Survey within Seven Countries
Background. Recognized disparities in quality of end-of-life
care exist. Our aim was to assess the quality of care for patients
dying from cancer, as perceived by bereaved relatives, within
hospitals in seven European and South American countries.
Materials and Methods. A postbereavement survey was
conducted by post, interview, or via tablet in Argentina,
Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next
of kin to cancer patients were asked to complete the inter-
national version of the Care Of the Dying Evaluation (i-
CODE) questionnaire 6â8 weeks postbereavement. Pri-
mary outcomes were (a) how frequently the deceased
patient was treated with dignity and respect, and (b) how
well the family member was supported in the patientâs
last days of life.
Results. Of 1,683 potential participants, 914 i-CODE
questionnaires were completed (response rate, 54%).
Approximately 94% reported the doctors treated their fam-
ily member with dignity and respect âalwaysâ or âmost of
the timeâ; similar responses were given about nursing staff
(94%). Additionally, 89% of participants reported they were
adequately supported; this was more likely if the patient
died on a specialist palliative care unit (odds ratio, 6.3; 95%
confidence interval, 2.3â17.8). Although 87% of participants
were told their relative was likely to die, only 63% were
informed about what to expect during the dying phase.
Conclusion. This is the first study assessing quality of care for
dying cancer patients from the bereaved relativesâ perspective
across several countries on two continents. Our findings suggest
many elements of good care were practiced but improvement in
communication with relatives of imminently dying patients is
needed. (ClinicalTrials.gov Identifier: NCT03566732)