Opiod Induced Pruritus: The Need for Palliative Care for a Palliative Medicine (S707)

Abstract

ObjectivesUnderstand the advantages of one type of decision support tool (DST) over another for advance care planning (ACP). Compare these two types of DST's for ACP and match a tool type to their own and their patient's needs.Original Research Background. Multiple paperbased and video-based decision support tools (DST) for advance care planning (ACP) exist and the advantages of one type or the other are unclear.Research Objectives. To explore the comparative effectiveness of video and paper DST for ACP.Methods. Researchers conducted a patient-centered multiple criteria decision analysis to compare video ACP DST against paper ACP DST across four broadly conceptualized outcome categories: (i) informed treatment choice; (ii) ACP status; (iii) opinions regarding ACP instrument; and (iv) patient-centered outcomes. Researchers identified studies that evaluated video or paper ACP DST, assigned each study a quality rating, and abstracted and categorized study outcome data. Using study quality ratings and the categorized study outcome data, researchers calculated an outcome category score and a standard error for the video DST and the paper DST. Differences between the video and paper outcome category scores were taken to indicate the DST format that favored a particular outcome category.Results. Three outcome categoriesdinformed treatment choice, opinion of ACP instrument, and patient-centered outcomesdeach favored the video DST format (p<0.001). The outcome category for ACP status favored the paper DST format (p<0.001).Conclusions. While video ACP DST formats were favored over paper DST formats for three out of the four outcome categories, the analysis does not account for patient preferences among the four outcome categories. The choice to use a video or paper ACP DST could vary depending on how patients prioritize the four different outcomes. Future research needs to identify patient preferences for these outcome categories to meaningfully assess which format best meets patient needs.Implications for Research, Policy, or Practice. The optimal type of decision support toold video as compared to paperdwill vary with the goals of the provider and the patient. ObjectivesGive the prevalence of opioid induced pruritus in a pediatric population. List at least 3 main risk factors for the development of opioid induced pruritus (OIP).Original Research Background. Opioids are frequently utilized in the pediatric hematology and oncology population for pain control. Pruritus from opioids can be as distressing and debilitating as pain. Little is known about opioid-induced pruritus (OIP) in the pediatric population, and even less in the pediatric hematology and oncology population.Research Objectives. This study sought to assess the prevalence and characteristics of OIP in the pediatric hematology and oncology population admitted to Virginia Commonwealth University Health System between June 2008 and December 2012. Methods. A retrospective chart review was per-formed. Descriptive statistics were calculated for pruritus, predictor v...

Evaluation of the palliative symptom burden score (PSBS) in a specialised palliative care unit of a university medical centre - a longitudinal study

“…Whilst significant, it is unclear whether these findings have clinical relevance given that the psychosomatic symptom burden remained at a high level, itching remained at a very low level overall, and changes were measured after the decimal point [ 40 ]. From a clinical perspective, it is not surprising to observe a tentative increase in pruritus given the difficult and complex nature of its pathophysiology and treatment, including opioid-induced pruritus (OIP), and its increase in end-stage presentations of malignancy, cholestasis and uraemia [ 41 , 42 ]. Psychological assessment in palliative care is inherently complex given the high level of confusion and low functioning of patients and the limited uptake of self-reported measures [ 43 ].…”