The use of access devices in cancer pain control

Anesthesia practitioner involvement, invasive treatments, and need in hospice pain management: a survey of patient care coordinators

Pain management is one of the major concerns for the terminal patient. The hospice care team is a highly trained group of health care providers in the area of symptom control, including pain management, for the dying patient. Anesthesia providers also specialize in pain control. The purposes of this study were to survey hospice patient care coordinators to gain an understanding of anesthesia practitioners' involvement with hospice patients, hospice patients' access to anesthesia pain management services, and hospice patient care coordinators' attitudes toward the necessity of anesthesia pain management services for the hospice community. A questionnaire was developed to assess these issues. In general, the findings reflected minimal anesthesia practitioner involvement in the hospice community. Fifty-two percent reported that patients could benefit from invasive treatments offered by anesthesia practitioners. Forty percent responded that more patients could be considered as candidates for invasive pain management techniques if procedures were performed in the patient's home or hospice. Access to anesthesia pain management services was limited by distance to pain clinics and anesthesia practitioners, and more anesthesia pain management services were needed for hospice patients in smaller communities. Cost of anesthesia pain management was frequently proposed as a prohibitive factor.

Making the transition from hospital to home: caring for the newly diagnosed child with cancer

Current trends in the management of health care show increasing pressure for earlier discharge of children, and their families may or may not be ready to continue the child's care at home. This article provides information that helps the home care provider bridge the transition from hospital care to home care. Care frequently is coordinated by a hospital-based clinical nurse specialist who provides psychosocial support, reinforces teaching, minimizes risks for complications, and performs home infusion therapy, such as antibiotics, chemotherapy, analgesics, total parenteral nutrition, and biologic therapy.

Home infusion therapy

OBJECTIVES

To examine issues related to the planning of an effective home infusion therapy program and to provide an overview of specific home infusion therapies for patients with cancer.

DATA SOURCES

Published articles, research studies, guidelines, and standards pertaining to infusion therapies.

CONCLUSIONS

Advances in technology have expanded and increased the scope and success of home infusion therapy. Antimicrobial therapy, chemotherapy, pain management, total parenteral nutrition, and blood transfusion therapy are commonly administered to cancer patients at home.

IMPLICATIONS FOR NURSING PRACTICE

A competent and experienced nursing staff is the cornerstone of a successful home infusion program. Safe provision of infusion therapy and care can be assured through selection of appropriate patients, effective patient education, well-defined agency policies, and effective coordination of home care services.

Advances in supportive care

A range of distressing symptoms, such as nausea and vomiting, dyspnoea and pain, which invariably impair quality of life, may develop in cancer patients as a result of their disease and treatment. The side-effects of cancer treatments place additional burdens on the patient. Patients indicate that they find nausea and vomiting and fatigue to be the most distressing symptoms. The burden of distressing symptoms and the side-effects of cancer treatments may be so great for some patients that they make a decision not to continue with treatment. Developing better methods of managing these complaints is critical for improving both quality of life and treatment outcome. Over the past two decades there have been dramatic advances in supportive care. The most significant advances have occurred in the general approach to symptom management and in the development of new pharmacological agents. Advances have also occurred in non-pharmacological approaches to supportive care and it is now acknowledged that interventions such as patient education and complementary therapies have an important role to play in ameliorating distressing symptoms.