244 results on '"Judith A. Paice"'
Search Results
2. Time to pain relief: A randomized controlled trial in the emergency department during vaso‐occlusive episodes in sickle cell disease
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Paula Tanabe, Hayden B. Bosworth, Regina D. Crawford, Jeffrey Glassberg, Christopher N. Miller, Judith A. Paice, and Susan Silva
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Hematology ,General Medicine - Abstract
Compare time to pain relief (minimum of a 13 mm and 30% reduction) during an Emergency Department (ED) visit among patients with sickle cell disease (SCD) experiencing severe pain associated with a vaso-occlusive episode who were randomized to receive either an individualized or weight-based pain protocol.A randomized controlled trial in two EDs. Adults with sickle cell disease. Research staff recorded pain scores every 30 minutes during an ED visit (up to six hours in the ED) using a 0-100 mm visual analogue scale. Analysis included 122 visits, representing 49 patients (Individualized: 61 visits, 25 patients; standard: 61 visits, 24 patients).Pain reduction across 6-hours was greater for the individualized compared to the standard protocol (protocol-by-time: p=0.02; 6-hour adjusted pain score comparison: Individualized: M=29.2, SD=38.8, Standard: M=45.3, SD=35.6; p=0.03, Cohen d=0.43). Hazards models indicated a greater probability of 13 mm (HR=1.54, 95% CI=1.05, 2.27, p=0.03) and 30% (HR=1.71, 95% CI=1.11, 2.63, p=0.01) reduction in the individualized relative to the standard protocol.Patients who received treatment with an individualized protocol experienced a more rapid reduction in pain, including a 13 mm and 30% reduction in pain scores when compared to those that received weight-based dosing. This article is protected by copyright. All rights reserved.
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- 2023
3. Medicare Part D Coverage Restrictions and Patient Cost-Sharing for Opioids Commonly Used for Cancer Pain, 2015-2021
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Yuhua Bao, Hao Zhang, Daniel M. Hartung, Lisa R. Witkin, and Judith A. Paice
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Analgesics, Opioid ,Prescription Drugs ,Oncology ,Oncology (nursing) ,Neoplasms ,Health Policy ,Medicare Part D ,Humans ,Cancer Pain ,United States ,Aged - Abstract
PURPOSE: Nation-wide rapid declines in prescription opioid dispensing gave rise to concerns regarding restricted access to effective pain management for patients with cancer-related pain. One important mechanism for such restrictions could be through more restrictive insurance coverage for opioids. This study aims to assess recent changes in Medicare Part D formulary designs for opioids commonly used for cancer-related pain. METHODS: We used data from the 2015-2021 Medicare Prescription Drug Plan (PDP) Formulary Files to assess formulary changes for six opioid-dose combinations commonly used for cancer-related pain. We estimated % of PDPs adopting prior authorization, quantity limits (and limits adopted), and a higher cost-sharing tier for each opioid-dose combination. We further estimated median and mean out-of-pocket (OOP) costs across all PDPs for a 30-day supply of the drug. Trends in proportions were tested using the Cochrane-Armitage test; trends in continuous measures were tested using the Jonckheere-Terpstra test. RESULTS: Proportion of PDPs adopting prior authorization increased from close to 0% to about 50% for two long-acting opioids ( P < .001). Distribution of quantity limits across PDPs shifted over time to being more restrictive for all opioids considered ( P < .001). For four of the six opioids, the proportion of PDPs adopting tier 3 or above increased from below or about 50% to well over 70% ( P < .001). For the same four opioids, median OOP costs doubled to quadrupled ( P < .001). CONCLUSION: Medicare PDP coverage has become increasingly restrictive for opioids commonly used for cancer-related pain, with multifold increases in patient OOP costs over the past 7 years. These changes pose concerns for patients with cancer needing opioid therapies for pain control and call for strategies to effectively exempt cancer-related pain from insurance and pharmacy rules intended to apply to opioids for noncancer chronic pain.
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- 2022
4. Cancer pain during an epidemic and a pandemic
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Judith A, Paice
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Analgesics, Opioid ,Oncology ,Oncology (nursing) ,Neoplasms ,COVID-19 ,Humans ,Cancer Pain ,General Medicine ,Chronic Pain ,Opioid-Related Disorders ,Critical Care and Intensive Care Medicine ,Pandemics - Abstract
As our global population ages, cancer has become more prevalent. Thankfully, oncologic treatments are highly effective, leading to significantly improved rates of long-term survival. However, many of these therapies are associated with persistent pain syndromes. Clinicians caring for people with cancer must understand how the influence of the current epidemic of opioid misuse and the coronavirus disease 2019 (COVID-19) pandemic have complicated cancer pain management. Creative solutions can emerge from this knowledge.Persistent pain due to cancer and its treatment can be managed through multimodal care, although efforts to mitigate the opioid misuse epidemic have created challenges in access to appropriate treatment. Isolation measures associated with the COVID-19 pandemic have limited access to nonpharmacologic therapies, such as physical therapy, and have exacerbated mental health disorders, including anxiety and depression.Cancer pain treatment requires more nuanced assessment and treatment decisions as patients live longer. Societal factors multiply existing challenges to cancer pain relief. Research is needed to support safe and effective therapies.
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- 2022
5. Use of Opioids for Adults With Pain From Cancer or Cancer Treatment: ASCO Guideline
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Judith A. Paice, Kari Bohlke, Debra Barton, David S. Craig, Areej El-Jawahri, Dawn L. Hershman, Lynn R. Kong, Geana P. Kurita, Thomas W. LeBlanc, Sebastiano Mercadante, Kristina L. M. Novick, Ramy Sedhom, Carole Seigel, Joanna Stimmel, and Eduardo Bruera
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Cancer Research ,Oncology - Abstract
PURPOSE To provide guidance on the use of opioids to manage pain from cancer or cancer treatment in adults. METHODS A systematic review of the literature identified systematic reviews and randomized controlled trials of the efficacy and safety of opioid analgesics in people with cancer, approaches to opioid initiation and titration, and the prevention and management of opioid adverse events. PubMed and the Cochrane Library were searched from January 1, 2010, to February 17, 2022. American Society of Clinical Oncology convened an Expert Panel to review the evidence and formulate recommendations. RESULTS The evidence base consisted of 31 systematic reviews and 16 randomized controlled trials. Opioids have primarily been evaluated in patients with moderate-to-severe cancer pain, and they effectively reduce pain in this population, with well-characterized adverse effects. Evidence was limited for several of the questions of interest, and the Expert Panel relied on consensus for these recommendations or noted that no recommendation could be made at this time. RECOMMENDATIONS Opioids should be offered to patients with moderate-to-severe pain related to cancer or active cancer treatment unless contraindicated. Opioids should be initiated PRN (as needed) at the lowest possible dose to achieve acceptable analgesia and patient goals, with early assessment and frequent titration. For patients with a substance use disorder, clinicians should collaborate with a palliative care, pain, and/or substance use disorder specialist to determine the optimal approach to pain management. Opioid adverse effects should be monitored, and strategies are provided for prevention and management. Additional information is available at www.asco.org/supportive-care-guidelines .
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- 2022
6. Advancing interprofessional education in communication
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Judith A. Paice, Betty Ferrell, Myra Glajchen, Haley Buller, and Trace Haythorn
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Medical education ,Palliative care ,Quality management ,Social work ,media_common.quotation_subject ,Palliative Care Nursing ,General Medicine ,Interprofessional education ,Experiential learning ,03 medical and health sciences ,Psychiatry and Mental health ,Clinical Psychology ,0302 clinical medicine ,030502 gerontology ,030220 oncology & carcinogenesis ,Quality (business) ,0305 other medical science ,Psychology ,Curriculum ,General Nursing ,media_common - Abstract
ObjectiveThe objective of this training project is to develop and host Interprofessional Communication courses to improve interdisciplinary communication in oncology care. The initial national course was held in a virtual format and included pre- and post-course participant data. The curriculum was developed with support from the National Cancer Institute.MethodsA virtual two-day course was held to equip nurses, social workers, and chaplains with vital communication skills in oncology practice, so that they could return to their home institutions and teach communication skills to other healthcare professionals, with the intention of making improved communication a quality improvement goal. Fifty-two participants were selected through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and chaplain, or social worker and nurse). The Interprofessional Communication Curriculum was based on the National Consensus Project for Quality Palliative Care's eight domains of quality palliative care. The six online modules developed by the investigators were presented in lectures, supplemented by discussion groups, role plays, and other methods of experiential learning.ResultsPre- and post-course results identified areas of communication, which are a priority for improvement by oncology clinicians. Participant goals identified specific strategies to be implemented by participants in their settings.Significance of resultsThe need for communication training was clearly demonstrated across professions in this national training course. Participants were able to apply course content to their goals for quality improvement in cancer settings.
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- 2021
7. Interprofessional communication training to address spiritual aspects of cancer care
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Betty R. Ferrell, Haley Buller, Judith A. Paice, Myra Glajchen, and Trace Haythorn
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Clinical Psychology ,Health (social science) ,Religious studies - Abstract
Effective communication is essential for palliative care clinicians to provide quality spiritual care to cancer patients. Despite attention to spiritual needs having the potential to positively impact a patient's quality of life, clinicians continue to report a lack of confidence in addressing a patient's spiritual distress. This article addresses the development of a 3-day train-the-trainer communication cancer education program (ICC: Interprofessional Communication Curriculum) organized by the 8 domains of the National Consensus Project for Quality Palliative Care. The main objectives of ICC are to train adult oncology clinicians (nurses, social workers, and chaplains) in communication skills across all aspects of palliative care and to help prepare them to provide communication skills training to their colleagues at their home institutions. ICC participants attend in dyads consisting of differing disciplines and create 3 goals for implementing institutional change. To date, 126 participants (69 teams) have attended an ICC training. Pre-course survey results identified spiritual care as participants' least effective area of communication. Immediate post-course evaluation data revealed the spiritual care module and its subsequent lab session as the most useful sessions to participant's practice. Data from the 6-and-12-months post-course follow-up revealed participant's quality improvement projects focused heavily on improving spiritual care.
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- 2022
8. Exploring Factors Associated With Long-Term Opioid Therapy in Cancer Survivors: An Integrative Review
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Christopher Lee, Rachelle Bernacki, Katie Fitzgerald Jones, Lisa Wood, Jessica S. Merlin, Mei R. Fu, and Judith A. Paice
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Biopsychosocial model ,medicine.medical_specialty ,persistent opioid use ,Population ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Neoplasms ,Humans ,Pain Management ,Medicine ,030212 general & internal medicine ,Intensive care medicine ,education ,Socioeconomic status ,General Nursing ,education.field_of_study ,business.industry ,Chronic pain ,opioids ,Cancer ,Opioid-Related Disorders ,medicine.disease ,humanities ,Analgesics, Opioid ,long-term opioid therapy ,chronic cancer pain ,Anesthesiology and Pain Medicine ,Opioid ,030220 oncology & carcinogenesis ,Neurology (clinical) ,Chronic Pain ,business ,Cancer pain ,medicine.drug - Abstract
Context The prevalence of chronic pain in cancer survivors is double that of the general U.S. population. Opioids have been the foundation of cancer pain management for decades; however, there is a paucity of literature on long-term opioid therapy (LTOT) in cancer survivors. An understanding of factors related to LTOT use in cancer survivors is needed to address chronic pain and balance opioid harms in the expanding population of cancer survivors. Objectives To analyze the research of LTOT utilization and factors associated with persistent opioid use in cancer survivors. Methods A five-stage integrative review process was adapted from Whittemore and Knafl. Data sources searched included Web of Science, PubMed, Embase, Cochrane, and Google Scholar. Quantitative research studies from 2010 to present related to cancer survivors managed on LTOT were included. Editorials, reviews, or abstracts were excluded. Results After reviewing 315 articles, 21 articles were included. We found that there were several definitions of LTOT in the reviewed studies, but the duration of opioid use (i.e., more than three months after completion of curative treatment) was the most common. The reviewed literature describes a relationship between LTOT and important biopsychosocial factors (cancer type, socioeconomic factors, and comorbidities). Conclusion The studies in this review shed light on the factors associated with LTOT in cancer survivors. LTOT was common in certain populations of cancer survivors and those with a collection of patient-specific characteristics. This review suggests that there is a critical need for specialized research on chronic cancer pain and opioid safety in cancer survivors.
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- 2021
9. Communication Skills: Use of the Interprofessional Communication Curriculum to Address Physical Aspects of Care
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Haley Buller, Judith A. Paice, and Betty Ferrell
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Medical education ,Palliative care ,business.industry ,media_common.quotation_subject ,education ,Symptom assessment ,Patient care ,Clinical Practice ,General Earth and Planetary Sciences ,Medicine ,Quality (business) ,Communication skills ,business ,Curriculum ,Psychosocial ,General Environmental Science ,media_common - Abstract
Background The literature has emphasized the importance of effective communication regarding psychosocial needs; however, other aspects of patient care, including attention to physical needs, are equally important. Objectives The aims of this article are to (a) describe an Interprofessional Communication Curriculum (ICC) in oncology, (b) detail the curriculum content specifically focused on physical aspects of care, and (c) illustrate the importance of interprofessional care in oncology. Methods The ICC is organized by the 8 domains of the National Consensus Project for Quality Palliative Care and centers on communication skills needed in oncology clinical practice. Findings Based on initial pilot data, oncology clinicians indicate a high level of satisfaction with the ICC. Additional future training courses supported by the National Cancer Institute will prepare oncology teams to enhance communication with patients and families.
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- 2020
10. Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease
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Alyssa A. Schatz, Neha Vapiwala, Robert M. Plovnick, Thomas K. Oliver, Lisa C. Richardson, Katy Winckworth-Prejsnar, Robert A. Swarm, Salimah H. Meghani, Deepika S. Darbari, Judith A. Paice, Deborah Dowell, Clifford A. Hudis, Dana S. Wollins, Robert W. Carlson, and Eduardo Bruera
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medicine.medical_specialty ,Scrutiny ,MEDLINE ,Target audience ,Harmonization ,Anemia, Sickle Cell ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Humans ,Pain Management ,Medicine ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Government ,Oncology (nursing) ,business.industry ,Health Policy ,Chronic pain ,Guideline ,Opioid-Related Disorders ,medicine.disease ,United States ,Analgesics, Opioid ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,business - Abstract
Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and ASCO each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.
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- 2020
11. Pain
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Judith A. Paice
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To provide safe and effective pain relief, the palliative advanced practice registered nurse (APRN) must possess exceptional pain assessment skills, including keen history-taking and physical examination. Biological, psychological, social, and spiritual factors should be considered part of a complete assessment and serve as a guide for development of a comprehensive plan of care. APRNs must have comprehensive knowledge of pain management options including appropriate pharmacologic and nonpharmacologic therapies. The APRN consults colleagues who provide interventions such as physical therapy, interventional techniques, and cognitive-behavioral strategies. APRNs must practice universal precautions to detect aberrant behavior with pain medications. Finally, APRNs must implement safe prescribing practices.
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- 2021
12. Management issues in chronic pain following cancer therapy
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Judith A. Paice
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medicine.medical_specialty ,business.industry ,Chronic pain ,Cancer therapy ,Medicine ,business ,medicine.disease ,Intensive care medicine - Abstract
Extraordinary innovations have led to the introduction of highly effective cancer treatments. These treatments include surgery, radiotherapy, chemotherapy, hormonal therapy, haematopoietic stem cell transplant, and, more recently, immunotherapy. Unfortunately, these remarkable treatments, and resultant improved rates of survival, can be accompanied by significant complications, including chronic pain. The prevalence of pain in the population of cancer survivors is estimated to be greater than 40%, with significant associated impairment of quality of life. It is important to note that cancer survivors may have received more than one of these therapies, considerably increasing the risk of developing chronic pain. The management of pain in cancer survivors requires thorough assessment of pain, function, and risk factors for misuse of opioids or other substances. Awareness of the types of cancer pain syndromes that may occur, along with treatment options, is crucial. Multimodal interventions should be incorporated into the plan of care, including pharmacological, non-pharmacological, cognitive behavioural, interventional, and integrative therapies. Despite the high exposure to these cancer therapies, and the significant prevalence of chronic pain that can occur, little research has been conducted to elucidate the resultant painful syndromes caused by these treatments clearly, much less develop effective management strategies for these disorders. Recent guidelines advance key treatment principles in this evolving population.
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- 2021
13. Occupational and Personal Consequences of the COVID-19 Pandemic on US Oncologist Burnout and Well-Being: A Study From the ASCO Clinician Well-Being Task Force
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Piyush Srivastava, Rebecca Spence, Ray D. Page, Arif H. Kamal, Fay J. Hlubocky, Molly M. McGinnis, Colleen M. Gallagher, Tait D. Shanafelt, Anthony L. Back, John M. Burke, Judith A. Paice, and Daniel C. McFarland
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Oncology ,Adult ,Male ,medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Ethnic group ,Burnout ,Burnout, Psychological ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Pandemic ,medicine ,Ethnicity ,Humans ,030212 general & internal medicine ,Pandemics ,Minority Groups ,Oncologists ,Oncology (nursing) ,Task force ,SARS-CoV-2 ,Health Policy ,COVID-19 ,030220 oncology & carcinogenesis ,Well-being ,Female ,Psychology - Abstract
INTRODUCTION: The COVID-19 pandemic is an unprecedented global crisis profoundly affecting oncology care delivery. PURPOSE: This study will describe the occupational and personal consequences of the COVID-19 pandemic on oncologist well-being and patient care. MATERIALS AND METHODS: Four virtual focus groups were conducted with US ASCO member oncologists (September-November 2020). Inquiry and subsequent discussions centered on self-reported accounts of professional and personal COVID-19 experiences affecting well-being, and oncologist recommendations for well-being interventions that the cancer organization and professional societies (ASCO) might implement were explored. Qualitative interviews were analyzed using Framework Analysis. RESULTS: Twenty-five oncologists were interviewed: median age 44 years (range: 35-69 years), 52% female, 52% racial or ethnic minority, 76% medical oncologists, 64% married, and an average of 51.5 patients seen per week (range: 20-120). Five thematic consequences emerged: (1) impact of pre-COVID-19 burnout, (2) occupational or professional limitations and adaptations, (3) personal implications, (4) concern for the future of cancer care and the workforce, and (5) recommendations for physician well-being interventions. Underlying oncologist burnout exacerbated stressors associated with disruptions in care, education, research, financial practice health, and telemedicine. Many feared delays in cancer screening, diagnosis, and treatment. Oncologists noted personal and familial stressors related to COVID-19 exposure fears and loss of social support. Many participants strongly considered working part-time or taking early retirement. Yet, opportunities arose to facilitate personal growth and rise above pandemic adversity, fostering greater resilience. Recommendations for organizational well-being interventions included psychologic or peer support resources, flexible time-off, and ASCO and state oncology societies involvement to develop care guidelines, well-being resources, and mental health advocacy. CONCLUSION: Our study suggests that the COVID-19 pandemic has adversely affected oncologist burnout, fulfillment, practice health, cancer care, and workforce. It illuminates where professional organizations could play a significant role in oncologist well-being.
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- 2021
14. American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access
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Patricia J. Moreland, Polly Mazanec, Harleah G. Buck, Todd B. Monroe, Salimah H. Meghani, Marianne Matzo, Patricia K. Bradley, Tonda L. Hughes, Myrna A. A. Doumit, Dorothy Wholihan, J. Craig Phillips, Constance Dahlin, Cynda Hylton Rushton, Viola Karanja, Elizabeth A. Madigan, Ann R. Knebel, Pam Malloy, Garrett K. Chan, Judith Shamian, Mona Shattell, Deborah J. Kenny, Cynthia R. King, Hester C. Klopper, Pamela S. Hinds, Betty Ferrell, Julia A. Snethen, Pamela Z. Cacchione, Sheila Davis, Nigel Crisp, Pat Daoust, Keela Herr, Connie M. Ulrich, Marie Bakitas, William E. Rosa, Sharon L. Kozachik, Lucia D. Wocial, Regina M. Fink, Allison Squires, Ann E. Kurth, Juli Mc Gowan Boit, Huda Abu-Saad Huijer, Judith A. Paice, and Patricia M. Davidson
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Palliative care ,Consensus ,Statement (logic) ,Universal design ,Context (language use) ,1110 Nursing ,Nursing ,Global Health ,Article ,Political science ,Societies, Nursing ,Humans ,Nurse Administrators ,Healthcare Disparities ,Education, Nursing ,Expert Testimony ,General Nursing ,health care economics and organizations ,Government ,business.industry ,Palliative Care ,International health ,Health equity ,Hospice and Palliative Care Nursing ,Universal Health Care ,Professional association ,business - Abstract
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.
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- 2021
15. Creating a Blueprint of Well-Being in Oncology: An Approach for Addressing Burnout From ASCO's Clinician Well-Being Taskforce
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Deborah A. Boyle, Eric Daniel Tetzlaff, Piyush Srivastava, Anthony L. Back, Denise M. Dudzinski, Tait D. Shanafelt, Arif H. Kamal, Monica Chatwal, Maria M Gonzalez, Daniel C. McFarland, Ted A. James, Fay J. Hlubocky, Judith A. Paice, Joel N. Saltzman, Ray D. Page, John M. Burke, Laurie J. Lyckholm, Colleen M. Gallagher, and Christopher R. Friese
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Oncology ,medicine.medical_specialty ,Psychological intervention ,Burnout ,Burnout, Psychological ,Medical Oncology ,Job Satisfaction ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Patient satisfaction ,Blueprint ,Internal medicine ,Neoplasms ,medicine ,Humans ,Emotional exhaustion ,Burnout, Professional ,Pandemics ,Oncologists ,Internet ,030504 nursing ,SARS-CoV-2 ,COVID-19 ,Social Support ,General Medicine ,United States ,030220 oncology & carcinogenesis ,Workforce ,0305 other medical science ,Psychology ,Psychosocial ,Stress, Psychological - Abstract
Optimizing the well-being of the oncology clinician has never been more important. Well-being is a critical priority for the cancer organization because burnout adversely impacts the quality of care, patient satisfaction, the workforce, and overall practice success. To date, 45% of U.S. ASCO member medical oncologists report experiencing burnout symptoms of emotional exhaustion and depersonalization. As the COVID-19 pandemic remains widespread with periods of outbreaks, recovery, and response with substantial personal and professional consequences for the clinician, it is imperative that the oncologist, team, and organization gain direct access to resources addressing burnout. In response, the Clinician Well-Being Task Force was created to improve the quality, safety, and value of cancer care by enhancing oncology clinician well-being and practice sustainability. Well-being is an integrative concept that characterizes quality of life and encompasses an individual's work- and personal health–related environmental, organizational, and psychosocial factors. These resources can be useful for the cancer organization to develop a well-being blueprint: a detailed start plan with recognized strategies and interventions targeting all oncology stakeholders to support a culture of community in oncology.
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- 2021
16. Palliative Nursing
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Kelly Greer, Cheryl Thaxton, Judith A. Paice, William E. Rosa, Polly Mazanec, Constance Dahlin, Carol O. Long, and Dorothy Wholihan
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Advanced and Specialized Nursing ,Community and Home Care ,Palliative Nursing ,2019-20 coronavirus outbreak ,palliative care ,Palliative care ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,MEDLINE ,COVID-19 ,Special Article: COVID-19 ,nursing ,Nursing ,Hospice and Palliative Care Nursing ,Core (graph theory) ,Humans ,Medicine ,business - Published
- 2020
17. Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology
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Lydia J. Hammond, Heather Greenlee, Bcps, M. Rachel McDowell, Lisa A. Gurski, Jeanie Youngwerth, Suzanne A. Nesbit, Arif H. Kamal, Susan G. Urba, Michael W. Rabow, Nina O'Connor, Doralina L. Anghelescu, David S. Craig, Judith A. Paice, Madhuri Are, Sean Mackey, Lisle Nabell, Natalie Moryl, Jill E. Sindt, Justine Yang Bruce, Marcin Chwistek, Eric Hansen, Sorin Buga, Susan LeGrand, Mihir Kamdar, Elizabeth Rickerson, Ellin Gafford, Charles S. Cleeland, Rebecca Shatsky, and Robert A. Swarm
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Adult ,Oncology ,medicine.medical_specialty ,business.industry ,Age Factors ,Specialty ,MEDLINE ,Cancer ,Cancer Pain ,medicine.disease ,Combined Modality Therapy ,Clinical Practice ,Pain assessment ,Neoplasms ,Internal medicine ,Pain crisis ,Humans ,Pain Management ,Medicine ,Medical prescription ,business ,Cancer pain - Abstract
In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.
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- 2019
18. Risk Assessment and Monitoring of Patients with Cancer Receiving Opioid Therapy
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Judith A. Paice
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Cancer Research ,medicine.medical_specialty ,Referral ,media_common.quotation_subject ,Pain ,Urine toxicology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,Opioids, Substance use disorder ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Risk management ,Cancer ,media_common ,Cancer Care and the Opioid Crisis ,business.industry ,Addiction ,Risk mitigation ,Chronic pain ,Prescription drug monitoring ,medicine.disease ,Analgesics, Opioid ,Substance abuse ,Oncology ,Universal precautions ,030220 oncology & carcinogenesis ,Cancer pain ,business ,Risk assessment - Abstract
To provide safe and effective management of cancer pain, a thorough risk assessment is needed when conducting a comprehensive pain evaluation. This information provides the basis for decisions about appropriate pain relief interventions and for measures that can be taken to mitigate the potential for misuse of opioids and other substances., The primary objective of this article is to assist oncologists and advanced practice prescribers to safely and effectively minimize risk when providing opioids for cancer pain relief. The majority of people with cancer are unlikely to misuse or divert opioid medications, yet the prescriber is often unaware of those who are at risk for these behaviors. To provide skillful pain management to each patient in the oncology setting, while limiting harm to the community, all prescribers must consider the potential for risk of misuse, addiction, or diversion. To minimize this risk to the greatest degree possible, it is imperative to include a thorough risk assessment when conducting a comprehensive pain evaluation. This information is then used to triage pain relief interventions based upon the degree of risk, including whether or not to incorporate opioids into the plan of care. Risk mitigation strategies, incorporating universal precautions, are implemented to assess, monitor, and reduce the potential for opioid misuse. Universal precautions include strategies such as the use of urine toxicology, state prescription drug monitoring programs, and agreements. Ongoing monitoring is conducted with the goal being to identify aberrant behaviors early so that they can be addressed and managed appropriately. Referral to addiction specialists may be warranted when substance use disorder precludes safe use of opioids. Implications for Practice. Throughout the trajectory of cancer care, opioid use is often indicated, and, in fact, it may be unethical to limit or prohibit the use of opioids when pain is severe. Oncologists face the significant challenge of providing cancer pain control that is safe and effective, while limiting individual risk for abuse or overdose and keeping the community free of diverted substances. Most oncology providers report inadequate training in chronic pain principles and in managing addiction. Risk assessment and mitigation measures can be incorporated within oncology care to enhance effective pain management while reducing the potential for harm.
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- 2019
19. Managing Chronic Pain in Cancer Survivors Prescribed Long-Term Opioid Therapy: A National Survey of Ambulatory Palliative Care Providers
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Jessica S. Merlin, Joanna L. Starrels, Jane M. Liebschutz, Yael Schenker, Judith A. Paice, Jennifer Kapo, Julie Childers, Christine S. Ritchie, Kanan Patel, F.J. Keefe, Tamara J. Somers, and Nicole Thompson
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Adult ,Male ,medicine.medical_specialty ,Palliative care ,media_common.quotation_subject ,Context (language use) ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Physicians ,Naloxone ,Ambulatory Care ,medicine ,Humans ,Pain Management ,Nurse Practitioners ,030212 general & internal medicine ,Practice Patterns, Physicians' ,General Nursing ,media_common ,Cancer survivor ,business.industry ,Addiction ,Palliative Care ,Chronic pain ,Middle Aged ,Opioid-Related Disorders ,medicine.disease ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Family medicine ,Practice Guidelines as Topic ,Female ,Neurology (clinical) ,Chronic Pain ,business ,Cancer pain ,Buprenorphine ,medicine.drug - Abstract
Context Chronic pain, or pain lasting more than three months, is common among cancer survivors, who are often prescribed long-term opioid therapy (LTOT). Objective Our objective was to explore palliative care providers' experiences with managing chronic pain in cancer survivors prescribed LTOT, specifically in ambulatory palliative care settings, and their strategies for overcoming challenges. Methods We recruited providers through leading national palliative care organizations who manage chronic pain in cancer survivors. Asked to consider only cancer survivors with chronic pain when responding, participants completed an online survey that included questions about use of opioid risk mitigation tools, confidence in addressing opioid misuse behaviors and discussing/recommending management approaches, and access to addiction treatment. Results Of 157 participants, most were physicians (83%) or nurse practitioners (15%). Most reported using opioid risk mitigation tools such as urine drug testing (71%), opioid treatment agreements (85%), and practitioner database monitoring programs (94%). Participants were confident (7–8/10) managing the most commonly encountered opioid misuse behaviors (missing appointments, marijuana use, and using more opioids than prescribed) and in their ability to recommend nonpharmacologic and nonopioid pharmacologic treatments for chronic pain (10/10). They were least confident prescribing naloxone or managing addiction (5/10); only 27% reported having training or systems in place to address addiction. Only 13% had a waiver to prescribe buprenorphine. Conclusion Palliative care providers are comfortable with many aspects of managing chronic pain in cancer survivors on LTOT, although challenges persist, including the lack of systems-based approaches and training in addiction treatment.
- Published
- 2019
20. Prescription Opioids Dispensed to Patients with Cancer with Bone Metastasis: 2011-2017
- Author
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Eduardo Bruera, Russell K. Portenoy, M. Carrington Reid, Judith A. Paice, Yuhua Bao, and Hao Zhang
- Subjects
Cancer Research ,medicine.medical_specialty ,Bone Neoplasms ,Medicare Advantage ,Medicare ,Opioid prescribing ,Internal medicine ,medicine ,Humans ,Claims database ,Medical prescription ,Practice Patterns, Physicians' ,Aged ,business.industry ,Cancer ,Bone metastasis ,medicine.disease ,United States ,Analgesics, Opioid ,Prescriptions ,Oncology ,Opioid ,Morphine ,business ,Brief Communications ,medicine.drug - Abstract
Opioid therapy is a first-line approach for moderate-to-severe pain associated with cancer with bone metastasis (CBM). The decade-long decline in opioid prescribing in the U.S. would not be expected to affect patients with CBM. We investigated trends in opioids dispensed to patients with CBM using data from a large commercial claims database. From 2011 quarter 2 to 2017 quarter 4, the percentage of patients with CBM prescribed at least 1 day of opioids in a quarter declined from 28.1% to 24.5% (p < .001) for privately insured patients aged 18–64 years and from 39.1% to 30.5% (p < .001) for Medicare Advantage (MA) patients aged 65 years or older. Among patients with at least 1 day of opioids in a quarter, the average morphine milligram equivalents dispensed declined by 37% and 11% (p < .001 for both) for privately insured and MA patients, respectively. Our findings raise concerns about potential unintended consequences related to population-level reduction in opioid prescribing.
- Published
- 2021
21. AAAPT Diagnostic Criteria for Acute Neuropathic Pain
- Author
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Rosemary C. Polomano, Roy Freeman, Tina L. Doshi, Robert R. Edwards, Nanna B. Finnerup, Judith A. Paice, Daniel B. Carr, Robert H. Dworkin, Srinivasa N. Raja, and Steven J. Weisman
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Pain medicine ,media_common.quotation_subject ,Analgesic ,MEDLINE ,Public-Private Sector Partnerships ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Acute pain ,media_common ,Pain Measurement ,business.industry ,United States Food and Drug Administration ,Addiction ,General Medicine ,Acute Pain ,United States ,Clinical trial ,Anesthesiology and Pain Medicine ,Amputation ,030220 oncology & carcinogenesis ,Neuropathic pain ,Physical therapy ,Neuralgia ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Objective Acute neuropathic pain is a significant diagnostic challenge, and it is closely related to our understanding of both acute pain and neuropathic pain. Diagnostic criteria for acute neuropathic pain should reflect our mechanistic understanding and provide a framework for research on and treatment of these complex pain conditions. Methods The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) public–private partnership with the U.S. Food and Drug Administration (FDA), the American Pain Society (APS), and the American Academy of Pain Medicine (AAPM) collaborated to develop the ACTTION-APS-AAPM Pain Taxonomy (AAAPT) for acute pain. A working group of experts in research and clinical management of neuropathic pain was convened. Group members used literature review and expert opinion to develop diagnostic criteria for acute neuropathic pain, as well as three specific examples of acute neuropathic pain conditions, using the five dimensions of the AAAPT classification of acute pain. Results AAAPT diagnostic criteria for acute neuropathic pain are presented. Application of these criteria to three specific conditions (pain related to herpes zoster, chemotherapy, and limb amputation) illustrates the spectrum of acute neuropathic pain and highlights unique features of each condition. Conclusions The proposed AAAPT diagnostic criteria for acute neuropathic pain can be applied to various acute neuropathic pain conditions. Both the general and condition-specific criteria may guide future research, assessment, and management of acute neuropathic pain.
- Published
- 2021
22. Palliative Care for People With COVID-19–Related Symptoms
- Author
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Kelly Greer, Dorothy Wholihan, Carol O. Long, Constance Dahlin, Polly Mazanec, Judith A. Paice, and Cheryl Thaxton
- Subjects
medicine.medical_specialty ,Palliative care ,Coronavirus disease 2019 (COVID-19) ,Pneumonia, Viral ,MEDLINE ,Betacoronavirus ,Pandemic ,medicine ,Humans ,Advanced and Specialised Nursing ,Intensive care medicine ,Pandemics ,Advanced and Specialized Nursing ,Community and Home Care ,biology ,SARS-CoV-2 ,business.industry ,Palliative Care ,COVID-19 ,biology.organism_classification ,medicine.disease ,Pneumonia ,Hospice and Palliative Care Nursing ,Anxiety ,Delirium ,medicine.symptom ,Coronavirus Infections ,business - Published
- 2020
- Full Text
- View/download PDF
23. Bridging the Gap Among Clinical Practice Guidelines for Pain Management in Cancer and Sickle Cell Disease
- Author
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Judith A. Paice, Thomas K. Oliver, Deborah Dowell, Robert A. Swarm, Lisa C. Richardson, Eduardo Bruera, Dana S. Wollins, Robert M. Plovnick, Clifford A. Hudis, Salimah H. Meghani, Deepika S. Darbari, Katy Winckworth-Prejsnar, Robert W. Carlson, Neha Vapiwala, and Alyssa A. Schatz
- Subjects
Government ,medicine.medical_specialty ,Scrutiny ,business.industry ,MEDLINE ,Chronic pain ,Target audience ,Harmonization ,Guideline ,Disease ,medicine.disease ,Article ,Oncology ,Family medicine ,medicine ,business - Abstract
Opioids are a critical component of pain relief strategies for the management of patients with cancer and sickle cell disease. The escalation of opioid addiction and overdose in the United States has led to increased scrutiny of opioid prescribing practices. Multiple reports have revealed that regulatory and coverage policies, intended to curb inappropriate opioid use, have created significant barriers for many patients. The Centers for Disease Control and Prevention, National Comprehensive Cancer Network, and American Society of Clinical Oncology each publish clinical practice guidelines for the management of chronic pain. A recent JAMA Oncology article highlighted perceived variability in recommendations among these guidelines. In response, leadership from guideline organizations, government representatives, and authors of the original article met to discuss challenges and solutions. The meeting featured remarks by the Commissioner of Food and Drugs, presentations on each clinical practice guideline, an overview of the pain management needs of patients with sickle cell disease, an overview of perceived differences among guidelines, and a discussion of differences and commonalities among the guidelines. The meeting revealed that although each guideline varies in the intended patient population, target audience, and methodology, there is no disagreement among recommendations when applied to the appropriate patient and clinical situation. It was determined that clarification and education are needed regarding the intent, patient population, and scope of each clinical practice guideline, rather than harmonization of guideline recommendations. Clinical practice guidelines can serve as a resource for policymakers and payers to inform policy and coverage determinations.
- Published
- 2020
24. Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update
- Author
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Mary Lou Smith, Cynthia Chauhan, Judith A. Paice, Christina Lacchetti, Maryam B. Lustberg, Ellen M. Lavoie Smith, Jonathan Bleeker, Antoinette Lavino, Thomas J. Smith, Mark R. Kelley, Charles L. Loprinzi, Nina D. Wagner-Johnston, Dawn L. Hershman, Bryan P. Schneider, Guido Cavaletti, Daniel L. Hertz, Loprinzi, C, Lacchetti, C, Bleeker, J, Cavaletti, G, Chauhan, C, Hertz, D, Kelley, M, Lavino, A, Lustberg, M, Paice, J, Schneider, B, Lavoie Smith, E, Smith, M, Smith, T, Wagner-Johnston, N, and Hershman, D
- Subjects
0301 basic medicine ,Oncology ,Cancer Research ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Antineoplastic Agents ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Internal medicine ,Neoplasms ,medicine ,Humans ,Chemotherapy ,Extramural ,business.industry ,Cancer ,Peripheral Nervous System Diseases ,Guideline ,medicine.disease ,030104 developmental biology ,Peripheral neuropathy ,Chemotherapy-induced peripheral neuropathy ,neuropathy, chemotherapy, guidelines, therapy ,030220 oncology & carcinogenesis ,Neurotoxicity Syndromes ,business ,Systematic Reviews as Topic - Abstract
PURPOSE To update the ASCO guideline on the recommended prevention and treatment approaches in the management of chemotherapy-induced peripheral neuropathy (CIPN) in adult cancer survivors. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS The search strategy identified 257 new references, which led to a full-text review of 87 manuscripts. A total of 3 systematic reviews, 2 with meta-analyses, and 28 primary trials for prevention of CIPN in addition to 14 primary trials related to treatment of established CIPN, are included in this update. RECOMMENDATIONS The identified data reconfirmed that no agents are recommended for the prevention of CIPN. The use of acetyl-l-carnitine for the prevention of CIPN in patients with cancer should be discouraged. Furthermore, clinicians should assess the appropriateness of dose delaying, dose reduction, substitutions, or stopping chemotherapy in patients who develop intolerable neuropathy and/or functional impairment. Duloxetine is the only agent that has appropriate evidence to support its use for patients with established painful CIPN. Nonetheless, the amount of benefit from duloxetine is limited. Additional information is available at www.asco.org/survivorship-guidelines .
- Published
- 2020
25. Cancer pain management and the opioid crisis in America: How to preserve hard-earned gains in improving the quality of cancer pain management
- Author
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Judith A. Paice
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,Unintended consequences ,Public health ,Psychological intervention ,Cancer ,Disease ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Sobriety ,Oncology ,Opioid ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,Cancer pain ,Intensive care medicine ,business ,medicine.drug - Abstract
Cancer pain remains a feared consequence of the disease and its treatment. Although prevalent, cancer pain can usually be managed through the skillful application of pharmacologic and nonpharmacologic interventions. Unfortunately, access to these therapies has been hampered by interventions designed to contain another serious public health problem: the opioid misuse epidemic. This epidemic and the unintended consequences of efforts to control this outbreak are leading to significant barriers to the provision of cancer pain relief. Oncologists and other professionals treating those with cancer pain will require new knowledge and tools to provide safe and effective pain control while preventing additional cases of substance use disorders (SUDs), helping patients in recovery to maintain sobriety, and guiding those not yet in recovery to seek treatment. How do these 2 serious epidemics intersect and affect oncology practice? First, oncology professionals will need to adopt practices to prevent SUDs by assessing risk and providing safe pain care. Second, oncology practices are likely to see an increased number of patients with a current or past SUD, including opioid misuse. Few guidelines exist for the direct management of pain when opioids may be indicated in these individuals. Third, modified prescribing practices along with the education of patients and families are warranted to prevent the exposure of these medications to unintended persons. Finally, advocacy on behalf of those with cancer pain is imperative to avoid losing access to essential therapies, including opioids, for those who might benefit. Cancer 2018;124:2491-7. © 2018 American Cancer Society.
- Published
- 2018
26. American Society for Pain Management Nursing and Hospice and Palliative Nurses Association Position Statement: Pain Management at the End of Life
- Author
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Patrick J. Coyne, Judith A. Paice, and Carol Mulvenon
- Subjects
Advanced and Specialized Nursing ,Position statement ,Terminal Care ,business.industry ,MEDLINE ,Pain ,Pain management ,United States ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Ethical obligation ,Societies, Nursing ,030220 oncology & carcinogenesis ,Terminal care ,Humans ,Pain Management ,Vulnerable population ,Medicine ,030212 general & internal medicine ,business - Abstract
Pain at the end of life continues to be of great concern as it may be unrecognized or untreated. Although nurses have an ethical obligation to reduce suffering, barriers remain regarding appropriate and adequate pain management at the end of life. This joint position statement from the American Society for Pain Management Nursing and Hospice and Palliative Nurses Association contains recommendations for nurses, prescribers, and institutions that would improve pain management for this vulnerable population.
- Published
- 2018
27. Justice in America
- Author
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Judith A. Paice and Patrick J. Coyne
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,medicine.medical_specialty ,Ethical issues ,business.industry ,Control (management) ,Opioid abuse ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,Justice (ethics) ,Psychiatry ,business ,Cancer pain - Abstract
Pain is common in those with a life-threatening illness, yet barriers to adequate treatment persist. New challenges add to the well-known barriers of limited education, lack of time, and impaired access to expert treatment. The opioid abuse epidemic and the rising rate of deaths related to misuse of
- Published
- 2017
28. Advancing interprofessional education in communication – ADDENDUM
- Author
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Haley Buller, Betty R. Ferrell, Judith A. Paice, Myra Glajchen, and Trace Haythorn
- Subjects
Psychiatry and Mental health ,Clinical Psychology ,General Medicine ,General Nursing - Published
- 2021
29. ELNEC-APRN: Meeting the Needs of Advanced Practice Nurses Through Education
- Author
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Pam Malloy, Judith A. Paice, Amy Haskamp, Constance Dahlin, Patrick J. Coyne, and Cheryl Thaxton
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,Palliative care ,030504 nursing ,business.industry ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,Medicine ,Advanced Practice Nurses ,Program development ,030212 general & internal medicine ,0305 other medical science ,business - Abstract
As care providers across the health continuum for patients with serious illness, advanced practice registered nurses (APRNs) are essential to quality palliative care. Many APRNs, however, lack palliative care education and training. To promote palliative-specific education for practicing APRNs, the
- Published
- 2017
30. Pain and Opioids in Cancer Care: Benefits, Risks, and Alternatives
- Author
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Judith A. Paice, Michael I. Bennett, and Mark S. Wallace
- Subjects
medicine.medical_specialty ,Population ,Psychological intervention ,MEDLINE ,Pain ,Pharmacy ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,medicine ,Humans ,Pain Management ,030212 general & internal medicine ,Adverse effect ,Intensive care medicine ,education ,Reimbursement ,education.field_of_study ,biology ,business.industry ,General Medicine ,biology.organism_classification ,Analgesics, Opioid ,030220 oncology & carcinogenesis ,Anesthesia ,Cannabis ,business ,Cancer pain - Abstract
Pain remains common in the setting of malignancy, occurring as a consequence of cancer and its treatment. Several high-quality studies confirm that more than 50% of all patients with cancer experience moderate to severe pain. The prevalence of pain in cancer survivors is estimated to be 40%, while close to two-thirds of those with advanced disease live with pain. Progress has occurred in the management of cancer pain, yet undertreatment persists. Additionally, new challenges are threatening these advances. These challenges are numerous and include educational deficits, time restraints, and limited access to all types of care. New challenges to access are occurring as a result of interventions designed to combat the prescription drug abuse epidemic, with fewer clinicians willing to prescribe opioids, pharmacies reluctant to stock the medications, and payers placing strict limits on reimbursement. A related challenge is our evolving understanding of the risks of long-term adverse effects associated with opioids. And reflective of the opioid abuse epidemic affecting the general population, the potential for misuse or abuse exists in those with cancer. Guidelines have been developed to support oncologists when prescribing the long-term use of opioids for cancer survivors. The challenges surrounding the use of opioids, and the need for safe and effective alternative analgesics, are leading to intense interest in the potential benefits of cannabis for cancer-related pain. Oncologists are faced with questions regarding the types of cannabis available, differences between routes of administration, data concerning safety and efficacy, and legal and regulatory dynamics.
- Published
- 2017
31. Let's Play Hot Potato! Controversial Topics in the Pharmacopalliation of Serious Illness (P03)
- Author
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Akhila Reddy, Mellar P. Davis, Jeremy M. Hirst, Judith A. Paice, Kathryn Walker, Mary Lynn McPherson, Kasey L. Malotte, and Amy L. Davis
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,medicine ,Neurology (clinical) ,Psychiatry ,business ,General Nursing - Published
- 2020
32. A delicate balance: risks vs benefits of opioids in cancer pain
- Author
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Judith A. Paice
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Balance (accounting) ,Neurology ,business.industry ,Physical therapy ,Medicine ,Neurology (clinical) ,Cancer pain ,business - Published
- 2019
33. MASCC recommendations on the management of constipation in patients with advanced cancer
- Author
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Andrew Davies, Judith A. Paice, David Fuchs, Anton Emmanuel, Charlotte Leach, Andrew Dickman, and Ricardo Caponero
- Subjects
medicine.medical_specialty ,Palliative care ,Constipation ,MEDLINE ,Medical Oncology ,03 medical and health sciences ,0302 clinical medicine ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Societies, Medical ,business.industry ,Nursing research ,Palliative Care ,Cancer ,Guideline ,Evidence-based medicine ,medicine.disease ,Systematic review ,Oncology ,030220 oncology & carcinogenesis ,Evidence-Based Practice ,Disease Progression ,medicine.symptom ,business - Abstract
The Palliative Care Study Group of the Multinational Association for Supportive Care in Cancer formed a subgroup to develop evidence-based recommendations on the management of constipation in patients with advanced cancer. These recommendations were developed in accordance with the MASCC Guidelines Policy. A search strategy for Medline was developed, and the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were explored for relevant reviews/trials respectively. The recommendations were categorised by the level of evidence and a “category of guideline” based on the level of evidence (i.e. “recommendation”, “suggestion”, or “no guideline possible”). The group produced 15 recommendations, with varying levels of evidence and so varying categories of guideline. The recommendations relate to the assessment, the treatment, and the re-assessment of constipation. These recommendations provide a framework for the management of constipation in advanced cancer, although every patient needs individualised management.
- Published
- 2019
34. Managing Pain in Patients and Survivors: Challenges Within the United States Opioid Crisis
- Author
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Judith A, Paice
- Subjects
Analgesics, Opioid ,Cancer Survivors ,Neoplasms ,Practice Guidelines as Topic ,Humans ,Pain Management ,Cancer Pain ,Drug Overdose ,Opioid-Related Disorders ,United States - Abstract
Advances in cancer treatment have led to a growing number of survivors. At least 40% of those survivors live with chronic pain and need pain control medication. This coincides with an epidemic of opioid misuse and overdose deaths, resulting in restrictive practices that can impact patients who experience severe pain. Oncologists and other healthcare professionals who treat patients with cancer need to balance considerations of opioid misuse with effective pain control and become better educated about risk factors and management of opioids in cancer survivors.
- Published
- 2019
35. Pain in Cancer Survivors: How to Manage
- Author
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Judith A. Paice
- Subjects
0301 basic medicine ,Drug ,medicine.medical_specialty ,media_common.quotation_subject ,Psychological intervention ,Disease ,Patient acceptance ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Neoplasms ,Prevalence ,medicine ,Humans ,Pain Management ,Pharmacology (medical) ,Intensive care medicine ,Pain Measurement ,media_common ,business.industry ,Disease Management ,Cancer ,Cancer Pain ,medicine.disease ,Analgesics, Opioid ,Substance abuse ,030104 developmental biology ,Oncology ,Opioid ,Universal precautions ,030220 oncology & carcinogenesis ,Disease Susceptibility ,business ,medicine.drug - Abstract
Managing pain in cancer survivors requires that oncologists understand the common painful syndromes that can occur from treatment or disease. Assessment no longer singularly focuses on pain characteristics (e.g., intensity, quality, location), now incorporating a strong focus on functional impairment and potential improvement that might occur with adequate treatment. Improvement in function is now the goal used to measure success. In addition, assessment must incorporate risk factors that might predispose patients to substance use disorder so that interventions can be implemented to mitigate this risk. Universal precautions are measures that help assess and ensure adherence to the treatment plan and may include the use of agreements, urine toxicology, and review of dispensing information derived from state prescription drug monitoring program (PDMP). These are generally obtained annually for all individuals, although some states have instituted mandatory review of the PDMP whenever prescribing an opioid. For patients at moderate to high risk for misuse of opioids, where opioids are warranted for the treatment of their pain syndrome, universal precautions are instituted more frequently. Other measures may include prescribing a 1- to 2-week supply of medications if compulsive use leads the patient to running out of drug early, and in some cases, family members may be employed to dispense daily allotments of the medication. When opioids are no longer indicated, gradual tapering of the drug by approximately 10% per month is generally sufficient to prevent withdrawal symptoms and ensure patient acceptance.
- Published
- 2019
36. End-of-Life Nursing and Education Consortium Communication Curriculum for Interdisciplinary Palliative Care Teams
- Author
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Wendy G. Anderson, Betty Ferrell, DorAnne Donesky, Judith A. Paice, and Haley Buller
- Subjects
Adult ,Male ,Palliative care ,Health Personnel ,California ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,030502 gerontology ,Health care ,Curriculum development ,business.product_line ,Medicine ,Humans ,Curriculum ,General Nursing ,Patient Care Team ,Terminal Care ,Interdisciplinary education ,Education, Medical ,business.industry ,Palliative Care ,General Medicine ,Middle Aged ,Communication skills training ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Hospice and Palliative Care Nursing ,Female ,Interdisciplinary Communication ,Communication skills ,0305 other medical science ,business - Abstract
Background: Expert communication skills are essential for the delivery of effective palliative care across the domains of care. However, few health care providers receive formal communicat...
- Published
- 2019
37. Pain Management
- Author
-
Judith A. Paice
- Abstract
Pain is one of the most common and most feared symptoms experienced by those with serious illness. The nurse’s role begins with assessment and continues through the development of a plan of care and its implementation. During this process, the nurse provides education and counseling to the patient, family, and other team members. Nurses also are critical for developing institutional policies and monitoring outcomes that ensure good pain management for all patients within their palliative care program. To provide optimal pain control, all healthcare professionals must understand the frequency of pain at the end of life, the barriers that prevent good management, the comprehensive assessment of this syndrome, and the treatments used to provide relief. Effective pain control and alleviation of suffering is highly dependent upon the strength of clinician, patient, and family communication and relationship. These are key strengths of nursing, at all phases of palliative care.
- Published
- 2019
38. The National Cancer Institute Clinical Trials Planning Meeting for Prevention and Treatment of Chemotherapy-Induced Peripheral Neuropathy
- Author
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Ann M. O'Mara, Michelle C. Janelsins, Ellen M. Lavoie Smith, Judith O. Hopkins, Andrea G. Hohmann, Rosalind A. Segal, Judith A. Paice, Ahmet Hoke, Ian R. Kleckner, Debra L. Barton, Guido Cavaletti, Suzanne C. Danhauer, Karen M. Mustian, Daniela Salvemini, Worta Mc Caskill Stevens, Diane St. Germain, Charles L. Loprinzi, Dawn L. Hershman, Howard L. McLeod, Katherine Patterson Kelly, Julia H. Rowland, Supriya G. Mohile, and Susan G. Dorsey
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,Psychological intervention ,MEDLINE ,Cancer ,medicine.disease ,law.invention ,Clinical trial ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Oncology ,Randomized controlled trial ,Chemotherapy-induced peripheral neuropathy ,law ,030220 oncology & carcinogenesis ,medicine ,Commentary ,Working group ,Intensive care medicine ,business ,030217 neurology & neurosurgery - Abstract
Although recent scientific advances have improved our understanding of basic biological mechanisms underlying chemotherapy-induced peripheral neuropathy (CIPN), few interventions are available to prevent or treat CIPN. Although some biological targets from preclinical studies show promise in nonhuman animal models, few targets have been translated to successful clinical trials. To address this problem, the National Cancer Institute’s Symptom Management and Health-Related Quality of Life Steering Committee convened a meeting of experts in the CIPN and oncology symptom management fields to participate in a Clinical Trials Planning Meeting (CTPM). Investigators presented data from preclinical and translational studies for possible CIPN interventions; these were evaluated for readiness of randomized clinical trial testing by experts, and recommendations were provided. Breakout sessions were convened to discuss and develop future studies. The CTPM experts concluded that there is compelling evidence to move forward with selected pharmacological and nonpharmacological clinical trials for the prevention and treatment of CIPN. Several key feasibility issues need to be addressed, however. These include identification of optimal outcome measures to define the CIPN phenotype, establishment of parameters that guide the evaluation of clinically meaningful effects, and adoption of approaches for inclusion of translational and biomarker and/or genetic measures. The results of the CTPM provide support for conducting clinical trials that include both pharmacological and nonpharmacological approaches, alone or in combination, with biomarkers, genetics, or other measures designed to inform underlying CIPN mechanisms. Several working groups were formed to design rigorous CIPN clinical trials, the results of which are ongoing.
- Published
- 2019
39. End-of-Life Nursing and Education Consortium Communication Curriculum for Nurses
- Author
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Pam Malloy, Judith A. Paice, Haley Buller, and Rose Virani
- Subjects
Advanced and Specialized Nursing ,Community and Home Care ,Palliative care ,Practice Patterns, Nurses' ,Communication ,education ,Palliative Care ,Palliative Care Nursing ,MEDLINE ,Education, Nursing, Baccalaureate ,Communication skills training ,InformationSystems_GENERAL ,Nursing ,Communication education ,Hospice and Palliative Care Nursing ,ComputingMilieux_COMPUTERSANDEDUCATION ,Curriculum development ,business.product_line ,Humans ,Curriculum ,Communication skills ,Psychology ,business - Abstract
Nurses have unique clinical responsibilities and opportunities with patients that require strong communication skills. However, many nurses lack effective communication skills and often receive inadequate palliative care communication training and education. To promote communication education for palliative care nurses, the End-of-Life Nursing and Education Consortium created a Communication Curriculum for nurses and developed an in-person train-the-trainer course. Organized by the 8 domains of the National Consensus Project Guidelines for Quality Palliative Care, a 1-day course was provided in August 2018 to 46 nurses representing 38 institutions. Completion of precourse surveys demonstrated participants' institutional resources for palliative care communication education and their greatest communication challenges. Immediate postcourse evaluations demonstrated that the course improved nurses' knowledge and confidence in communication and their ability to educate others. Palliative care nurses can incorporate communication skills into their practice and provide communication skills training to their institution.
- Published
- 2019
40. EXPLORING EMERGENCY DEPARTMENT PROVIDER EXPERIENCES WITH AND PERCEPTIONS OF WEIGHT-BASED AND INDIVIDUALIZED VASO-OCCLUSIVE TREATMENT PROTOCOLS IN SICKLE CELL DISEASE
- Author
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Christopher N. Miller, LaʼKita M J Knight, Hayden B. Bosworth, Jeffrey Glassberg, Lynne D. Richardson, Regina D. Crawford, Elijah O. Onsomu, Paula Tanabe, Theresa DeMartino, and Judith A. Paice
- Subjects
Male ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,MEDLINE ,Disease ,Anemia, Sickle Cell ,Emergency Nursing ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Clinical Protocols ,law ,Surveys and Questionnaires ,medicine ,Humans ,Pain Management ,030212 general & internal medicine ,Dosing ,Pain Measurement ,Protocol (science) ,business.industry ,Body Weight ,030208 emergency & critical care medicine ,Emergency department ,medicine.disease ,Analgesics, Opioid ,Family medicine ,Emergency Medicine ,Female ,business ,Emergency Service, Hospital ,Vaso-occlusive crisis ,Weight based dosing - Abstract
INTRODUCTION: Treatment of vaso-occlusive episodes (VOE) are the most common reason for ED treatment of sickle cell disease (SCD). We 1) compared perceptions of the usability and ability to manage VOE pain between ED nurses and other ED provider types, ED sites, and VOE protocols (individualized versus weight-based), and 2) identified ED nurse and other provider protocol suggestions. METHODS: A secondary analysis of provider survey data collected immediately after caring for a patient enrolled in a randomized control trial comparing weight based vs. individualized opioid dosing for VOE. Research staff asked the ED nurse and other ED providers (nurse practitioners [NPs], physician assistants [PAs], residents and attending physicians) five questions related to the protocol’s ease of use and ability to manage pain. RESULTS: There were 236 surveys completed. Attending physicians (n=15), residents (n=88), PAs (n=21), and NPs (n=1) were more satisfied than nurses (n=111) with the clarity of the analgesic ordering (97.6% vs. 0%, p = 0.0001), and ability to manage the patient’s VOE pain (91% vs. 0%, p = 0.0001). When comparing both protocols with the usual ED strategy in their ED to manage VOE, more nurses than other ED providers perceived the study patients’ pain management protocol as better (100% vs. 35.2%, p = 0.0001).Other ED providers perceived the individualized versus weight-based protocol as better at managing pain than their usual ED strategy (70.3% vs. 59.5%, p = 0.04). CONCLUSION: The individualized protocol was perceived as better in managing VOE than the weight-based ED strategy. While physicians were satisfied with the clarity of the protocols, nurses were not. Improved protocol usability is required for widespread ED implementation.
- Published
- 2019
41. Quality of Life of Family Caregivers of Patients With Cancer in Korçe, Albania
- Author
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Jonathon Judkins, Priya Kumthekar, Irena Laska, and Judith A. Paice
- Subjects
Adult ,Male ,medicine.medical_specialty ,Palliative care ,Lung Neoplasms ,Population ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Quality of life (healthcare) ,030502 gerontology ,Surveys and Questionnaires ,Adaptation, Psychological ,Cancer Family ,Medicine ,Humans ,Family ,Prospective Studies ,education ,Aged ,Aged, 80 and over ,education.field_of_study ,business.industry ,Family caregivers ,Palliative Care ,Cancer ,General Medicine ,Middle Aged ,medicine.disease ,humanities ,Caregivers ,030220 oncology & carcinogenesis ,Family medicine ,Albania ,Quality of Life ,Female ,0305 other medical science ,business ,Stress, Psychological - Abstract
Purpose: The primary objective of this study was to quantify cancer family caregiver (FCG) quality of life (QOL) in a Southern Albanian population and to determine whether differences exist between 4 domains of QOL (physical, psychological, social, and spiritual). This study also sought to compare QOL in our cohort to QOL in historical studies that used the same survey instrument, and to examine correlations between demographic characteristics and QOL to identify any high-risk groups. Methods: A sample of 40 FCGs was recruited at the Mary Potter Palliative Care Clinic in Korçe, Albania. Each participant completed the City of Hope Quality of Life (Family Version), a validated 37-question instrument that measures caregiver well-being in 4 domains: physical, psychological, social, and spiritual well-being. Results: There were no significant differences between the composite scores of the 4 QOL domains in our study. However, there were differences when comparing self-reported QOL between domains (“Rate your overall physical/psychological/social/spiritual well-being”). The QOL measured in our study was significantly lower than in 3 studies from the United States that used the same questionnaire. There were no significant correlations between demographic groups and QOL. Conclusions: This study examines the impact that the paucity of palliative services has on the QOL of Albanian cancer FCGs. Although there were no domains of QOL or demographic groups identified in our study that were faring significantly worse than others, the poor overall QOL provides further evidence to support the continued development of palliative services for both patients and family members in Albania.
- Published
- 2018
42. Cancer and Opioids: Patient Experiences With Stigma (COPES)-A Pilot Study
- Author
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David S. Craig, Sahana Rajasekhara, Heather S.L. Jim, Margarita Bobonis, Young D. Chang, Hailey W. Bulls, Ritika Oberoi-Jassal, Diane Portman, Brian D. Gonzalez, Judith A. Paice, Aasha I. Hoogland, and Meghan Haas
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,media_common.quotation_subject ,Population ,Social Stigma ,Pain relief ,Psychological intervention ,Pilot Projects ,Article ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Humans ,Pain Management ,030212 general & internal medicine ,Medical prescription ,Practice Patterns, Physicians' ,Psychiatry ,education ,General Nursing ,media_common ,Aged ,education.field_of_study ,business.industry ,Addiction ,Cancer Pain ,Middle Aged ,Stigma (anatomy) ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Opioid ,030220 oncology & carcinogenesis ,Female ,Neurology (clinical) ,Cancer pain ,business ,medicine.drug - Abstract
Context Cancer-related pain is a common symptom that is often treated with opioids. However, legislation aimed at containing the opioid crisis, coupled with public fears about opioid risks, may contribute to opioid stigma in cancer patients. To our knowledge, no prior research has examined opioid stigma and stigma-related behavior in this population. Objective The objectives of this study were to describe opioid use, including reasons for use and overuse and underuse behavior; characterize opioid stigma; and identify potentially maladaptive stigma-related behaviors. Methods Participants were 125 adults undergoing active cancer treatment seen at the Moffitt Supportive Care Medicine Clinic. Patients completed a brief, anonymous questionnaire evaluating opioid use, opioid stigma, and stigma-related behaviors. Results Patients were primarily women (65%) aged 45-64 years (49%), most commonly diagnosed with breast (23%) and hematologic (15%) cancer. Among patients who reported opioid use (n = 109), the most common reason for use was pain relief (94%), followed by improved sleep (25%). A subset of patients reported using less (13%) or more (8%) opioid medication than advised. Opioid stigma was endorsed by 59/97 patients prescribed opioids (61%), including fear of addiction (36%), difficulty filling prescriptions (22%), and awkwardness communicating with providers (15%). Stigma-related behaviors were endorsed by 28 (29%) respondents prescribed opioids, with "taking less opioid medication than needed" as the most commonly endorsed behavior (20%). Conclusion To our knowledge, this study provides the first evidence of opioid stigma and its consequences in cancer patients and offers potential targets for interventions aimed at reducing stigma and encouraging safe, effective opioid use.
- Published
- 2018
43. Trial design of comparing patient-specific versus weight-based protocols to treat vaso-occlusive episodes in sickle cell disease (COMPARE-VOE)
- Author
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Caroline E Freiermuth, Stephanie O Ibemere, Sarah B. Dubbs, Huiman X. Barnhart, Paula Tanabe, John J. Strouse, R. Gentry Wilkerson, Jacqueline L Brown, Judith A. Paice, Patricia L. Kavanagh, and Compare-Voe study investigators
- Subjects
medicine.medical_specialty ,Population ,Pain ,Anemia, Sickle Cell ,Disease ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Clinical endpoint ,Humans ,Pain Management ,Pharmacology (medical) ,030212 general & internal medicine ,education ,Pain Measurement ,Randomized Controlled Trials as Topic ,Analgesics ,education.field_of_study ,030505 public health ,business.industry ,General Medicine ,Emergency department ,medicine.disease ,Clinical trial ,Emergency medicine ,Population study ,0305 other medical science ,business ,Vaso-occlusive crisis - Abstract
Objectives Painful vaso-occlusive episodes (VOE) are the most common reason for emergency department (ED) visits experienced by patients with sickle cell disease (SCD). The National Heart, Lung and Blood Institute (NHLBI) evidence-based recommendations for VOE treatment are based primarily on expert opinion. In this randomized controlled trial (RCT), we will compare changes in pain scores between patients randomized to a patient-specific analgesic protocol versus those randomized to a weight-based analgesic protocol, as recommended by the NHLBI guidelines. Methods We report the rationale and design of a multi-site, phase III, single-blinded, RCT to be conducted in six EDs in the United States. Eligible participants will be randomized after providing consent, anticipating 50% of those randomized would have an ED visit during the enrollment period. A total of 230 participants with one VOE ED visit provides sufficient power to detect a clinically significant difference in pain score reductions of 14 between groups with 0.05 type I error. Uniquely, this trial randomizes participants in a larger population than the study population, given the impossibility of consenting and randomizing participants during emergencies. The primary endpoint is the change in pain scores in the ED from time of placement in treatment area to time of disposition (hospitalization, discharged home, or assigned to observation status) or a maximum treatment duration of 6 hours. Additional outcomes include hospitalizations and ED visits seven days post enrollment, side effects, and safety assessments. Conclusions The COMPARE-VOE study design will provide high-level evidence to support the NHLBI VOE treatment guidelines.
- Published
- 2021
44. Oxford Textbook of Palliative Nursing
- Author
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Betty Rolling Ferrell, Judith A. Paice, Betty Rolling Ferrell, and Judith A. Paice
- Subjects
- Hospice and Palliative Care Nursing--methods, Palliative Care, Terminal Care
- Abstract
The Oxford Textbook of Palliative Nursing remains the most comprehensive treatise on the art and science of palliative care nursing available. Dr. Betty Rolling Ferrell and Dr. Judith A. Paice have invited 162 nursing experts to contribute 76 chapters addressing the physical, psychological, social, and spiritual needs pertinent to the successful palliative care team. Organized within 7 Sections, this new edition covers the gamut of principles of care: from the time of initial diagnosis of a serious illness to the end of a patient's life and beyond. This fifth edition features several new chapters, including chapters on advance care planning, organ donation, self-care, global palliative care, and the ethos of palliative nursing. Each chapter is rich with tables and figures, case examples for improved learning, and a strong evidence-based practice to support the highest quality of care. The book offers a valuable and practical resource for students and clinicians across all settings of care. The content is relevant for specialty hospice agencies and palliative care programs, as well as generalist knowledge for schools of nursing, oncology, critical care, and pediatric. Developed with the intention of emphasizing the need to extend palliative care beyond the specialty to be integrated in all settings and by all clinicians caring for the seriously ill, this new edition will continue to serve as the cornerstone of palliative care education.
- Published
- 2019
45. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
- Author
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Paul Glare, Eduardo Bruera, F.J. Keefe, Russell K. Portenoy, Christina Lacchetti, Judith A. Paice, Lakshmi Koyyalagunta, Marc L. Citron, Louis S. Constine, Paul A. Sloan, Toby C. Campbell, Shirley Otis-Green, Michael H. Levy, Andrea L. Cheville, Andrea Cooper, and Christine Miaskowski
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,MEDLINE ,Chronic pain ,Cancer ,Cancer Pain ,Guideline ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Oncology ,030220 oncology & carcinogenesis ,medicine ,Physical therapy ,Humans ,Pain Management ,030212 general & internal medicine ,Chronic Pain ,Intensive care medicine ,Risk assessment ,business ,Cancer pain ,Adverse effect - Abstract
Purpose To provide evidence-based guidance on the optimum management of chronic pain in adult cancer survivors. Methods An ASCO-convened expert panel conducted a systematic literature search of studies investigating chronic pain management in cancer survivors. Outcomes of interest included symptom relief, pain intensity, quality of life, functional outcomes, adverse events, misuse or diversion, and risk assessment or mitigation. Results A total of 63 studies met eligibility criteria and compose the evidentiary basis for the recommendations. Studies tended to be heterogeneous in terms of quality, size, and populations. Primary outcomes also varied across the studies, and in most cases, were not directly comparable because of different outcomes, measurements, and instruments used at different time points. Because of a paucity of high-quality evidence, many recommendations are based on expert consensus. Recommendations Clinicians should screen for pain at each encounter. Recurrent disease, second malignancy, or late-onset treatment effects in any patient who reports new-onset pain should be evaluated, treated, and monitored. Clinicians should determine the need for other health professionals to provide comprehensive pain management care in patients with complex needs. Systemic nonopioid analgesics and adjuvant analgesics may be prescribed to relieve chronic pain and/or to improve function. Clinicians may prescribe a trial of opioids in carefully selected patients with cancer who do not respond to more conservative management and who continue to experience distress or functional impairment. Risks of adverse effects of opioids should be assessed. Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences. Additional information is available at www.asco.org/chronic-pain-guideline and www.asco.org/guidelineswiki .
- Published
- 2016
46. Management of Chronic Pain in Survivors of Adult Cancers: ASCO Clinical Practice Guideline Summary
- Author
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Eduardo Bruera, Christina Lacchetti, and Judith A. Paice
- Subjects
medicine.medical_specialty ,education.field_of_study ,Oncology (nursing) ,business.industry ,Health Policy ,Population ,Analgesic ,Chronic pain ,Cancer ,Guideline ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Oncology ,030220 oncology & carcinogenesis ,Family medicine ,medicine ,030212 general & internal medicine ,Cancer pain ,Intensive care medicine ,education ,business ,Psychosocial - Abstract
As a result of extraordinary advancements in diagnosis and treatment, approximately 14million individuals are living in the United States with a history of cancer (excluding nonmelanomatous skin cancers). Two thirds of these individuals are surviving 5 or more years after diagnosis. Unfortunately, these impressive outcomes in survival often come with physical, psychosocial, and financial burdens as a result of the tumor, exposure to cancer treatment, or other medical comorbidities. Chronic pain can be a serious, negative consequence of surviving cancer. Although estimates vary, the prevalence of pain in cancer survivors has been reported to be as high as 40%. Predictors include the type and invasiveness of the tumor, the treatment regimen used, time since cancer treatment, and the efficacy of initial pain therapy. Significant pain is associated with impaired quality of life in this population. Many guidelines and recommendations have been advanced to support the management of cancer pain, yet the focus of these documents has been primarily on relieving acute pain or pain associatedwith advanced disease. Few evidence-based cancer pain guidelines address the more nuanced care required when pain persists formonths or years. This situation is in part a result of the relative absenceof studies exploring the experiences of chronic pain in cancer survivors or the long-term safety and effectiveness of analgesic interventions. Whereas opioid-based pharmacotherapy is widely accepted as the foundation of care for acute pain or pain associated with advanced cancer, the management of patients who are free of cancer after treatment or are living with cancer as a chronic illness is not grounded in broad consensus. The management of these populations with chronic cancer pain requires greater consideration of a multimodality plan of care that balances pharmacologic and nonpharmacologic techniques and may necessitate the involvement of an interdisciplinary team. The goals of treatment in these populations should focus on improving function and limiting longterm adverse effects of pain and its treatment as much as or more than they do on improving comfort. As the population of cancer survivors expands, all clinicians who interact with these individuals, including oncologists, advanced practice providers, and primary care physicians, will require the knowledge and skills to implement best practices in the management of chronic pain. When analgesic drugs are used, the imperative to prescribe safely must expand beyond immediate adverse effects, such as respiratory depression or constipation associated with opioids, to incorporate awareness and mitigation of long-term consequences of these and other analgesic agents. The purpose of this guideline summary is to provide guidance to
- Published
- 2016
47. Quantitative Sensory Testing at Baseline and During Cycle 1 Oxaliplatin Infusion Detects Subclinical Peripheral Neuropathy and Predicts Clinically Overt Chronic Neuropathy in Gastrointestinal Malignancies
- Author
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Halla Sayed Nimeiri, Nancy Kwon, Mary F. Mulcahy, Sangeetha M. Reddy, Irene Helenowski, Judith A. Paice, Robert N Harden, Al B. Benson, and Maxwell T. Vergo
- Subjects
Male ,Organoplatinum Compounds ,Colorectal cancer ,Digestive System Neoplasms ,Gastroenterology ,0302 clinical medicine ,Sensory threshold ,Prospective Studies ,Prospective cohort study ,Subclinical infection ,Neurologic Examination ,Peripheral Nervous System Diseases ,Common Terminology Criteria for Adverse Events ,Middle Aged ,Oxaliplatin ,Oncology ,Motor Skills ,Sensory Thresholds ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Female ,Neurotoxicity Syndromes ,Colorectal Neoplasms ,medicine.drug ,Adult ,medicine.medical_specialty ,Antineoplastic Agents ,Vibration ,Hypesthesia ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,Aged ,Rectal Neoplasms ,business.industry ,Neurooncology ,Proprioception ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,Patient Outcome Assessment ,Peripheral neuropathy ,Touch ,Asymptomatic Diseases ,Chronic Disease ,Somatosensory Disorders ,business ,030217 neurology & neurosurgery - Abstract
Purpose Oxaliplatin neurotoxicity has a spectrum of manifestations from an often reversible acute neurotoxicity to a more irreversible “stocking and glove” chronic neuropathy that is associated with high morbidity. Quantitative sensory testing (QST) is a noninvasive psychometric testing method that can potentially be used in the clinic setting to measure subclinical neurologic changes early on to identify patients that will experience chronic oxaliplatin-induced peripheral neuropathy at 1 year. Patients and Methods Thirty patients with gastrointestinal malignancies who were receiving oxaliplatin were recruited. QST and patient-reported outcomes were assessed at baseline; during infusion cycles 1, 2, 4, and 6; and at 1 year. National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE), version 4.0, chronic neuropathy scores were assessed at the 1-year time point. The variables at each time point were evaluated for prediction of 1-year chronic neuropathy scores. Results We found that patients with preexisting subclinical neuropathy were more likely to experience grades 2 and 3 chronic neuropathy than were those who did not have this condition (heat detection threshold, Spearman correlation coefficient (r s ) = 0.39; P = .037; pellet retrieval time, r s = 0.47; P = .024). Patients in whom thermal and cutaneous sensory deficits developed with cycle 1 infusion were also more likely to experience grades 2 and 3 neuropathy at 1 year (cold detection threshold, r s = 0.50; P = .007; heat detection threshold, r s = 0.39; P = .042; cutaneous detection threshold, r s = 0.42; P = .043). Conclusion QST provides a noninvasive, commercially available, and feasible clinical test to select patients, even before oxaliplatin treatment, who are likely to experience moderate to severe chronic peripheral neuropathy.
- Published
- 2016
48. Annual trends in opioid prescribing for patients (Pts) with metastatic non-small cell lung cancer (mNSCLC): Cancerlinq data analysis, 2010 to 2017
- Author
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Liya Wang, Danielle Potter, Mark Riffon, Kristina L. M. Novick, Karen S Hagerty, Whitney Rhodes, Judith A. Paice, Elizabeth Garrett-Mayer, Li Chen, and Suanna S. Bruinooge
- Subjects
Cancer Research ,medicine.medical_specialty ,business.industry ,Opioid use ,medicine.disease ,Opioid prescribing ,Oncology ,Opioid ,medicine ,Non small cell ,Intensive care medicine ,Lung cancer ,Cancer pain ,business ,medicine.drug - Abstract
2076 Background: Despite opioid misuse and abuse, opioids remain a mainstay for management of cancer pain. Government, payers, and institutions have implemented policies to reduce opioid use. The impact of these restrictions on oncologist prescriptions (Rx) of opioids and management of cancer pain in pts with cancer is not well known. Methods: A retrospective, observational analysis used deidentified EHR data from ASCO’s CLQ Discovery database. Study cohort included pts with mNSCLC diagnosis and >1 clinical encounter (including opioid Rx) from CLQ clinician during 2010-2017. Opioids included DEA schedule II and III opioid drugs prescribed for cancer pain, excluding cough suppressants. Annual Rx rates were defined as the number of mNSCLC pts who had ≥ 1 opioid Rx dated 2010-2017 per CLQ total mNSCLC pts who had ≥1 clinical encounter in the year. Annual rates demonstrate trends in opioid prescribing patterns over time. Results: 18,106 pts with mNSCLC clinical activity between 2010 and 2017 were identified. Overall, 39.8% of pts had opioid Rx in 2010-2017. Annual Rx rates increased from 2010-2015 and fell 2016-2017 (see table). Hydrocodone was the second most frequently prescribed opioid overall (N=4211 pts), but Rx rates began to decline in 2012. Tramadol and acetaminophen + codeine Rx rates gradually increased throughout the time period. DEA initially scheduled Tramadol as schedule IV in 2014. Conclusions: Opioids are commonly prescribed by oncologists for patients with mNSCLC. Rx rates have declined since 2015, likely due to increased government, payer, and institutional restrictions on access. Hydrocodone Rx declined since 2012, perhaps exacerbated by reclassification from schedule III to schedule II by the DEA (October 2014). Rxs for schedule IV and III opioids (known to be of lower potency) increased modestly, likely due to comparatively fewer prescribing restrictions. Additional research is needed to understand whether the decline continues and the impact on management of cancer pain, particularly among metastatic patients. [Table: see text]
- Published
- 2020
49. Educating Nurses on Palliative Care Interventions for COPD Patients in a Medical Intensive Care Unit (MICU): A Quality Improvement Project (QI623)
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Judith A. Paice and Mary Clare Houlihan
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,Palliative care ,Quality management ,Copd patients ,Medical intensive care unit ,business.industry ,medicine ,Psychological intervention ,Neurology (clinical) ,Intensive care medicine ,business ,General Nursing - Published
- 2020
50. Navigating Cancer Pain Management in the Midst of the Opioid Epidemic
- Author
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Judith A, Paice
- Subjects
Analgesics, Opioid ,Risk Factors ,Prevalence ,Humans ,Cancer Pain ,Chronic Pain ,Epidemics ,Opioid-Related Disorders - Abstract
Cancer pain remains prevalent throughout the course of the disease, and it can be challenging to manage adequately. The challenge is compounded by the current opioid misuse epidemic. Substance use disorders (SUDs), including opioid use disorder, are common in the general population and may be seen with greater frequency in oncology settings. Risk factors contributing to the development of cancer, such as smoking or excessive drinking of alcohol, may place some patients at increased risk for SUDs. Additionally, cancer patients have a higher rate of psychological distress than the general population; psychological distress is an important risk factor for SUDs. Careful assessment of pain, function, and risk factors for SUDs, along with physical examination and review of imaging findings, are strategies to define the etiology of pain and guide development of a treatment plan. Multimodal pain therapies are warranted to reduce reliance solely on opioids, and universal precautions are essential to mitigate risk of misuse. Complex care is required for those with comorbid chronic noncancer pain or with past or current SUDs.
- Published
- 2018
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