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Article ; Online: e-PainSupport: A Digital Pain Management Application for Home Hospice Care.

Mayahara, Masako / Wilbur, JoEllen / Fogg, Louis / Paice, Judith A / Miller, Arlene M

The American journal of hospice & palliative care

2023 , Page(s) 10499091231211493

Abstract: e-PainSupport is a digital pain management application (app) designed to facilitate better ... knowledge of analgesic management remained low. The purpose of this study was to enhance e-PainSupport ... agencies to facilitate app communication with EHRs. While modification to the e-PainSupport app ...

Abstract	e-PainSupport is a digital pain management application (app) designed to facilitate better pain management in hospice. Early testing revealed caregivers found it was easy to use and successful in communicating patient pain and caregiver administration of analgesics to hospice nurses. However, caregiver knowledge of analgesic management remained low. The purpose of this study was to enhance e-PainSupport by (a) adapting and integrating an evidence-based pain educational intervention; (b) increasing ease of accessing and navigating the app; and (c) facilitating app communication with agency electronic health records (EHRs). An advisory board method, including two key stakeholder groups (an expert panel and a caregiver advisory board), guided the adaptation of an evidence-based pain educational intervention. Further, stakeholders recommended format changes to increase app usability. Study staff worked with four hospice agencies to facilitate app communication with EHRs. While modification to the e-PainSupport app to integrate a pain educational intervention and facilitate usability was successful, EHR integration was challenging. Future evaluation is needed to evaluate the effects of e-PainSupport on pain intensity among home hospice patients.
Language	English
Publishing date	2023-10-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1074344-3
ISSN	1938-2715 ; 1049-9091
ISSN (online)	1938-2715
ISSN	1049-9091
DOI	10.1177/10499091231211493
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Article ; Online: Pain in Cancer Survivors: How to Manage.

Paice, Judith A

Current treatment options in oncology

2019 Volume 20, Issue 6, Page(s) 48

Abstract: ... focuses on pain characteristics (e.g., intensity, quality, location), now incorporating a strong focus ...

Abstract	Opinion statement: 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.
MeSH term(s)	Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Cancer Pain/diagnosis ; Cancer Pain/epidemiology ; Cancer Pain/etiology ; Cancer Pain/therapy ; Cancer Survivors ; Disease Management ; Disease Susceptibility ; Humans ; Neoplasms/complications ; Neoplasms/epidemiology ; Neoplasms/therapy ; Pain Management ; Pain Measurement ; Prevalence
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2019-05-06
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057351-0
ISSN	1534-6277 ; 1527-2729
ISSN (online)	1534-6277
ISSN	1527-2729
DOI	10.1007/s11864-019-0647-0
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Article ; Online: Visual illusions in young people reporting psychotic-like experiences.

Sperandio, Irene / Chouinard, Philippe A / Paice, Emily / Griffiths-King, Daniel J / Hodgekins, Joanne

Journal of behavior therapy and experimental psychiatry

2023 Volume 79, Page(s) 101839

Abstract: Background and objectives: A disruption in the co-ordination of bottom-up and top-down processing is thought to underlie anomalous perceptual experiences in psychosis. Visual illusions represent a valuable methodology in exploring this disruption. Here, ...

Abstract	Background and objectives: A disruption in the co-ordination of bottom-up and top-down processing is thought to underlie anomalous perceptual experiences in psychosis. Visual illusions represent a valuable methodology in exploring this disruption. Here, we examined visual illusions in a group of young people having psychotic-like experiences. We also examined the relationship between illusion susceptibility and appraisal of psychotic-like experiences as well as depression, anxiety and stress levels. Method: 25 young people reporting psychotic-like experiences and 53 healthy participants performed an adjustment task that measured susceptibility to a battery of 13 visual illusions. Levels of depression, anxiety and stress were quantified in both groups. The clinical group also completed measures examining frequency, appraisals and emotional responses to psychotic-like experiences. Results: A general increase of illusion susceptibility was found in the clinical group compared to the control group. However, when depression, anxiety and stress levels were controlled for, this difference disappeared. Stress turned out to be the best predictor of illusion susceptibility in the clinical group, whereas anomalous experiences, depression and anxiety were unrelated to overall illusion strength. Limitations: This study is limited to young participants reporting significant mental health difficulties and psychotic-like experiences. Findings should be replicated in an Ultra High Risk (prodromal) group. Conclusions: Increased levels of stress explained the enhanced vulnerability to illusions in the clinical group. This increased susceptibility suggests a perceptual style that relies too heavily on prior expectations at the expense of the true sensory evidence, potentially leading to an altered perceptual experience of the world.
MeSH term(s)	Humans ; Adolescent ; Illusions/physiology ; Psychotic Disorders/psychology ; Anxiety ; Emotions ; Anxiety Disorders
Language	English
Publishing date	2023-02-04
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	280250-8
ISSN	1873-7943 ; 0005-7916
ISSN (online)	1873-7943
ISSN	0005-7916
DOI	10.1016/j.jbtep.2023.101839
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Article ; Online: Identification and management of the underperforming surgical trainee.

Paice, Elisabeth

ANZ journal of surgery

2009 Volume 79, Issue 3, Page(s) 180–4; discussion 185

Abstract: Most surgical trainee make steady progress, delivering a safe and reliable service at an appropriate level at the same time as they as learn new skills under supervision. Trainees learn at different rates, and progress that is safe and steady although ... ...

Abstract	Most surgical trainee make steady progress, delivering a safe and reliable service at an appropriate level at the same time as they as learn new skills under supervision. Trainees learn at different rates, and progress that is safe and steady although slower than the norm should not be classed as underperformance. Clinical performance issues may arise at any stage of a doctor's cancer, and should be addressed promptly and constructively. Factors that may impact on performance, such as the personality of the trainee, their personal pressures, and the training and working environment, should be considered and where possible mitigated. Enhanced supervision; regular constructive feedback; psychological support; coaching and mentoring may all be required. A change of trainer or working environment may sometimes be necessary, and the duration of training may need to be extended. A supportive working and learning environment with a sound educational framework will help to ensure that trainees in difficulty are identified early and managed supportively and constructively.
MeSH term(s)	Attitude of Health Personnel ; Clinical Competence ; Education, Medical, Graduate ; Educational Measurement ; Educational Status ; General Surgery/education ; Humans ; Morals ; Remedial Teaching
Language	English
Publishing date	2009-03
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2050749-5
ISSN	1445-2197 ; 1445-1433 ; 0004-8682
ISSN (online)	1445-2197
ISSN	1445-1433 ; 0004-8682
DOI	10.1111/j.1445-2197.2008.04837.x
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Article: Co-Production at the Strategic Level: Co-Designing an Integrated Care System with Lay Partners in North West London, England.

Morton, Michael / Paice, Elisabeth

International journal of integrated care

2016 Volume 16, Issue 2, Page(s) 2

Abstract: In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, ... ...

Abstract	In North West London, health and social care leaders decided to design a system of integrated care with the aim of improving the quality of care and supporting people to maintain independence and participation in their community. Patients and carers, known as 'lay partners,' were to be equal partners in co-production of the system. Lay partners were recruited by sending a role profile to health, social care and voluntary organisations and requesting nominations. They formed a Lay Partners Advisory Group from which pairs were allocated to system design workstreams, such as which population to focus on, financial flow, information technology and governance. A larger and more diverse Lay Partners Forum provided feedback on the emerging plans. A key outcome of this approach was the development of an integration toolkit co-designed with lay partners. Lay partners provided challenge, encouraged innovation, improved communication, and held the actions of other partners to account to ensure the vision and aims of the emerging integrated care system were met. Key lessons from the North West London experience for effective co-production include: recruiting patients and carers with experience of strategic work; commitment to the vision; willingness to challenge and to listen; strong connections within the community being served; and enough time to do the work. Including lay partners in co-design from the start, and at every level, was important. Agreeing the principles of working together, providing support and continuously recruiting lay representatives to represent their communities are keys to effective co-production.
Language	English
Publishing date	2016-05-03
Publishing country	England
Document type	Journal Article
ISSN	1568-4156
ISSN	1568-4156
DOI	10.5334/ijic.2470
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Article ; Online: Cancer pain management: safe and effective use of opioids.

Bruera, Eduardo / Paice, Judith A

American Society of Clinical Oncology educational book. American Society of Clinical Oncology. Annual Meeting

2016 , Page(s) e593–9

Abstract: Pain remains a serious consequence of cancer and its treatment. Although significant advances have been made in providing effective cancer pain control, barriers persist. Lack of knowledge, limited time, financial restrictions, and diminished ... ...

Abstract	Pain remains a serious consequence of cancer and its treatment. Although significant advances have been made in providing effective cancer pain control, barriers persist. Lack of knowledge, limited time, financial restrictions, and diminished availability of necessary medications serve as significant obstacles. Safe and effective opioid use in a patient with cancer requires skill to overcome these challenges. Understanding the mechanism of action, along with the pharmacokinetics and pharmacodynamics, of opioids will lead to appropriate selection, dosing, and titration of these agents. Rotation from one opioid or route to another is an essential proficiency for oncologists. As opioid-related adverse effects often occur, the oncology team must be expert in preventing and managing constipation, nausea, sedation, and neurotoxicities. An emerging concern is overtreatment-the excessive and prolonged use of opioids in patients when these agents may produce more harm than benefit. This can occur when opioids are used inappropriately to treat comorbid psychologic issues such as anxiety and depression. Recognizing risk factors for overuse along with key components of universal precautions will promote safe use of these medications, supporting adherence and preventing diversion, thereby protecting the patient, the prescriber, and the community. Because substance use disorders are not rare in the oncology setting, attention must be given to the balance of providing analgesia while limiting harm. Caring for patients with substance misuse requires compassionate, multidisciplinary care, with input from supportive oncology/palliative care as well as addiction specialists.
MeSH term(s)	Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/adverse effects ; Analgesics, Opioid/therapeutic use ; Drug Overdose ; Humans ; Neoplasms/complications ; Opioid-Related Disorders ; Pain/drug therapy ; Pain/etiology ; Pain Management/methods ; Prescription Drug Misuse ; Treatment Outcome
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2016-07-10
Publishing country	United States
Document type	Journal Article ; Review
ISSN	1548-8756 ; 1092-9118 ; 1548-8748
ISSN (online)	1548-8756
ISSN	1092-9118 ; 1548-8748
DOI	10.14694/EdBook_AM.2015.35.e593
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Article ; Online: Prescription Opioids Dispensed to Patients with Cancer with Bone Metastasis: 2011-2017.

Zhang, Hao / Paice, Judith / Portenoy, Russell / Bruera, Eduardo / Reid, M Carrington / Bao, Yuhua

The oncologist

2021 Volume 26, Issue 10, Page(s) e1890–e1892

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 ... ...

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.
MeSH term(s)	Aged ; Analgesics, Opioid/therapeutic use ; Bone Neoplasms/drug therapy ; Humans ; Medicare ; Practice Patterns, Physicians' ; Prescriptions ; United States/epidemiology
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-07-21
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1409038-7
ISSN	1549-490X ; 1083-7159
ISSN (online)	1549-490X
ISSN	1083-7159
DOI	10.1002/onco.13898
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Article ; Online: Expert consensus-based guidance on approaches to opioid management in individuals with advanced cancer-related pain and nonmedical stimulant use.

Jones, Katie Fitzgerald / Khodyakov, Dmitry / Han, Benjamin H / Arnold, Robert M / Dao, Emily / Morrison, Jeni / Kapo, Jennifer / Meier, Diane E / Paice, Judith A / Liebschutz, Jane M / Ritchie, Christine S / Merlin, Jessica S / Bulls, Hailey W

Cancer

2023 Volume 129, Issue 24, Page(s) 3978–3986

Abstract: ... stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance ...

Abstract	Background: Clinicians treating cancer-related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence-based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer-related pain with nonmedical stimulant use according to prognosis. Methods: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9-point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three-step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. Results: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer-related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. Conclusion: Study findings provide urgently needed consensus-based guidance for clinicians managing cancer-related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. Plain language summary: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer-related pain and nonmedical stimulant use. Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis.
MeSH term(s)	Humans ; Female ; Male ; Analgesics, Opioid/adverse effects ; Cancer Pain/drug therapy ; Cancer Pain/etiology ; Consensus ; Buprenorphine/therapeutic use ; Naloxone/therapeutic use ; Neoplasms/complications ; Neoplasms/drug therapy
Chemical Substances	Analgesics, Opioid ; Buprenorphine (40D3SCR4GZ) ; Naloxone (36B82AMQ7N)
Language	English
Publishing date	2023-09-11
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.34921
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Article ; Online: Advancing interprofessional education in communication.

Buller, Haley / Ferrell, Betty R / Paice, Judith A / Glajchen, Myra / Haythorn, Trace

Palliative & supportive care

2021 Volume 19, Issue 6, Page(s) 727–732

Abstract: ... through an application process to attend the virtual course in two-person interprofessional teams (e.g., nurse and ...

Abstract	Objective: The 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. Methods: A 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. Results: Pre- 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 results: The 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.
MeSH term(s)	Humans ; Communication ; Curriculum ; Interprofessional Education/organization & administration ; Palliative Care ; Hospice and Palliative Care Nursing/education ; Social Workers/education ; Social Workers/psychology ; Social Workers/statistics & numerical data ; Clergy/education ; Clergy/psychology ; Clergy/statistics & numerical data ; Quality Improvement ; Cancer Care Facilities ; United States ; Male ; Female
Language	English
Publishing date	2021-06-11
Publishing country	England
Document type	Journal Article
ZDB-ID	2454009-2
ISSN	1478-9523 ; 1478-9515
ISSN (online)	1478-9523
ISSN	1478-9515
DOI	10.1017/S1478951521000663
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Article: Modernising medical careers: is it good for patients?

Paice, Elisabeth

British journal of hospital medicine (London, England : 2005)

2005 Volume 66, Issue 8, Page(s) Suppl M2

MeSH term(s)	Career Choice ; Curriculum/trends ; Education, Medical, Graduate/trends ; Family Practice/education ; Family Practice/trends ; Humans ; Patient Care/standards ; Patient Care/trends ; State Medicine/trends ; United Kingdom
Language	English
Publishing date	2005-08
Publishing country	England
Document type	Editorial
ISSN	1750-8460
ISSN	1750-8460
DOI	10.12968/hmed.2005.66.Sup1.18522
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