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  1. Article ; Online: A Review of Palliative Sedation.

    Bobb, Barton

    The Nursing clinics of North America

    2016  Volume 51, Issue 3, Page(s) 449–457

    Abstract: Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, ... ...

    Abstract Palliative sedation has become a standard practice to treat refractory symptoms at end-of-life. Dyspnea and delirium are the two most commonly treated symptoms. The medications used in palliative sedation are usually benzodiazepines, barbiturates, antipsychotics, and/or anesthetics. Some ethical considerations remain, especially surrounding the use of palliative sedation in psychological distress and existential suffering.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/therapy ; Delirium/diagnosis ; Delirium/drug therapy ; Fatal Outcome ; Female ; Humans ; Hypnotics and Sedatives/therapeutic use ; Male ; Midazolam/therapeutic use ; Middle Aged ; Palliative Care/methods
    Chemical Substances Hypnotics and Sedatives ; Midazolam (R60L0SM5BC)
    Language English
    Publishing date 2016-09
    Publishing country United States
    Document type Case Reports ; Journal Article ; Review
    ZDB-ID 604296-x
    ISSN 1558-1357 ; 0029-6465
    ISSN (online) 1558-1357
    ISSN 0029-6465
    DOI 10.1016/j.cnur.2016.05.008
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Dyspnea and Delirium at the End of Life.

    Bobb, Barton

    Clinical journal of oncology nursing

    2016  Volume 20, Issue 3, Page(s) 244–246

    Abstract: This article focuses on the symptoms of dyspnea and delirium, which can be extremely distressing to patients with cancer at the end of life. Oncology nurses are well suited to detect and treat these symptoms.

. ...

    Abstract This article focuses on the symptoms of dyspnea and delirium, which can be extremely distressing to patients with cancer at the end of life. Oncology nurses are well suited to detect and treat these symptoms.

.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Delirium/diagnosis ; Delirium/nursing ; Dyspnea/diagnosis ; Dyspnea/nursing ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/complications ; Neoplasms/nursing ; Oncology Nursing/methods ; Palliative Care ; Terminal Care
    Language English
    Publishing date 2016-06-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2014665-6
    ISSN 1538-067X ; 1092-1095
    ISSN (online) 1538-067X
    ISSN 1092-1095
    DOI 10.1188/16.CJON.244-246
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  3. Article: When cancer pain breaks through, what can you do?

    Bobb, Barton T / Coyne, Patrick J

    Oncology (Williston Park, N.Y.)

    2010  Volume 24, Issue 10 Suppl, Page(s) 13–18

    Abstract: Breakthrough pain in cancer patients can be very difficult to manage, primarily because of its heterogeneous and fleeting nature, so careful assessment is imperative to finding an adequate treatment regimen. Only a paucity of good research exists to ... ...

    Abstract Breakthrough pain in cancer patients can be very difficult to manage, primarily because of its heterogeneous and fleeting nature, so careful assessment is imperative to finding an adequate treatment regimen. Only a paucity of good research exists to support current interventions, and additional viable options need to be discovered. Oncology nurses must play an integral role in improving the treatment of breakthrough pain-one patient, one in-service for colleagues, and one clinical research study at a time.
    MeSH term(s) Analgesics, Opioid/therapeutic use ; Humans ; Neoplasms/nursing ; Pain/diagnosis ; Pain/drug therapy ; Pain/prevention & control ; Pain Measurement
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2010-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1067950-9
    ISSN 0890-9091
    ISSN 0890-9091
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  4. Article: Guiding patients facing decisions about "futile" chemotherapy.

    Alesi, Erin / Bobb, Barton / Smith, Thomas J

    The journal of supportive oncology

    2011  Volume 9, Issue 5, Page(s) 184–187

    Abstract: Ms. G is a 71-year-old woman with metastatic gastric adenocarcinoma recently diagnosed after an extensive surgical resection for a small bowel obstruction (SBO). She was admitted from the surgery clinic with intractable nausea and vomiting. An abdominal ... ...

    Abstract Ms. G is a 71-year-old woman with metastatic gastric adenocarcinoma recently diagnosed after an extensive surgical resection for a small bowel obstruction (SBO). She was admitted from the surgery clinic with intractable nausea and vomiting. An abdominal computerized tomographic (CT) scan revealed a partial SBO and peritoneal carcinomatosis. Given her recent surgery, the extent of her disease, and high likelihood of recurrent SBO, the surgical team decided that Ms. G was no longer a surgical candidate. When her symptoms did not improve with conservative measures, both oncology and palliative medicine were consulted to assist with symptom management and goals of care. The oncology team stated that Ms. G was still a chemotherapy candidate and suggested that she attend her new patient evaluation in oncology clinic the following week. The palliative medicine team then met with the patient to discuss management options and her preferences for care. The palliative care team explained ways to control her nausea and vomiting without using a nasogastric tube, and the patient agreed to transfer to their service for symptom management. The palliative team explained that her cancer was incurable but that chemotherapy options existed to help control her disease and possibly prolong her life. They also explained that the chemotherapy has side effects and that the patient would need to decide if she wanted to undergo treatment and accept potential side effects for the possibility of prolonging her life by weeks to months and improving her symptoms. As an alternative, she was told that she could focus solely on symptom control with medications and allow her disease to take its natural course. Ms. G was asked to think about how she wanted to spend the time she had left. Prior to discharge, as her symptoms improved, Ms. G was evaluated by another oncologist, who, after consulting the expert gastrointestinal cancer team, explained to her that the current chemotherapy options available for metastatic gastric cancer were rarely, if ever, successful at reversing malignant obstruction. With this information, the patient decided to be discharged home with hospice and spend time with her family. She died peacefully at her home approximately two weeks later.
    MeSH term(s) Adenocarcinoma/drug therapy ; Aged ; Decision Making ; Female ; Humans ; Palliative Care ; Stomach Neoplasms/drug therapy
    Language English
    Publishing date 2011-09-24
    Publishing country United States
    Document type Case Reports ; Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2394158-3
    ISSN 1879-596X ; 1544-6794
    ISSN (online) 1879-596X
    ISSN 1544-6794
    DOI 10.1016/j.suponc.2011.04.001
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  5. Article ; Online: Oral ketamine for sickle cell crisis pain refractory to opioids.

    Jennings, Cara A / Bobb, Barton T / Noreika, Danielle M / Coyne, Patrick J

    Journal of pain & palliative care pharmacotherapy

    2013  Volume 27, Issue 2, Page(s) 150–154

    Abstract: There is literature demonstrating that the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has analgesic properties that can be used as an adjuvant to opiates for pain relief in multiple various conditions and pain states. However, there is a ... ...

    Abstract There is literature demonstrating that the N-methyl-d-aspartate (NMDA) receptor antagonist ketamine has analgesic properties that can be used as an adjuvant to opiates for pain relief in multiple various conditions and pain states. However, there is a lack of published information on ketamine used in persons with sickle cell disease in acute pain crises. The Virginia Commonwealth University Palliative Care team was consulted on a 38-year-old African American female with sickle cell thalassemia in severe acute pain crisis overlying chronic pain related to her disease. Pain control was unable to be achieved with escalating doses of opiates and other adjuvant medications. The patient responded well to an intravenous test dose of ketamine and was subsequently placed on an oral regimen of ketamine in addition to opiates. In the 24-hour period following ketamine initiation, the patient's pain was able to be controlled on decreased amounts of opiates. She was eventually transitioned to an oral opiate and ketamine regimen, which allowed her to be discharged home with pain levels close to her baseline and the ability to function and perform all activities of daily living.
    MeSH term(s) Activities of Daily Living ; Acute Pain/drug therapy ; Acute Pain/etiology ; Administration, Oral ; Adult ; African Americans ; Analgesics/administration & dosage ; Analgesics/therapeutic use ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/therapeutic use ; Anemia, Sickle Cell/complications ; Chronic Pain/drug therapy ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Humans ; Ketamine/administration & dosage ; Ketamine/therapeutic use ; Palliative Care/methods ; Thalassemia/complications
    Chemical Substances Analgesics ; Analgesics, Opioid ; Ketamine (690G0D6V8H)
    Language English
    Publishing date 2013-06
    Publishing country England
    Document type Case Reports ; Journal Article
    ZDB-ID 2078852-6
    ISSN 1536-0539 ; 1536-0288
    ISSN (online) 1536-0539
    ISSN 1536-0288
    DOI 10.3109/15360288.2013.788599
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  6. Article ; Online: Managing pain with algorithms: an opportunity for improvement? Or: the development and utilization of algorithms to manage acute pain.

    Coyne, Patrick / Lyckholm, Laurie / Bobb, Barton / Blaney-Brouse, Donna / Harrington, Sarah / Yanni, Leanne

    Pain management nursing : official journal of the American Society of Pain Management Nurses

    2013  Volume 14, Issue 4, Page(s) e185–e188

    Abstract: Pain management in a hospital setting remains a challenge today. Many health care providers remain anxious and uninformed regarding analgesic titration within a hospital setting. Overcoming the potential risks to obtain the benefits of opiate titration ... ...

    Abstract Pain management in a hospital setting remains a challenge today. Many health care providers remain anxious and uninformed regarding analgesic titration within a hospital setting. Overcoming the potential risks to obtain the benefits of opiate titration is a challenge within any health care setting. Virginia Commonwealth University, a tertiary medical center which houses schools of medicine, nursing, and pharmacy, evaluated the use of algorithms for managing acute pain. This article describes the Pain Committee's efforts and offers one potential intervention for safe analgesic opioid titration, an algorithm for acute pain management.
    MeSH term(s) Acute Pain/drug therapy ; Acute Pain/nursing ; Adult ; Algorithms ; Analgesics/therapeutic use ; Analgesics, Opioid/therapeutic use ; Hospitals, Teaching ; Humans ; Organizational Policy ; Outcome and Process Assessment (Health Care) ; Pain Management/methods ; Pain Management/standards ; Patient Safety/standards ; Quality Improvement
    Chemical Substances Analgesics ; Analgesics, Opioid
    Language English
    Publishing date 2013-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2213260-0
    ISSN 1532-8635 ; 1524-9042
    ISSN (online) 1532-8635
    ISSN 1524-9042
    DOI 10.1016/j.pmn.2011.10.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Development of the CASH assessment tool to address existential concerns in patients with serious illness.

    Alesi, Erin R / Ford, Timothy R / Chen, Christina J / Fletcher, Devon S / Morel, Thomas D / Bobb, Barton T / Lyckholm, Laurel J

    Journal of palliative medicine

    2015  Volume 18, Issue 1, Page(s) 71–75

    Abstract: Introduction: Existential suffering in patients with serious illness significantly impacts quality of life, yet it remains a challenge to define, assess, and manage adequately. Improving upon understanding and practice in the existential domain is a ... ...

    Abstract Introduction: Existential suffering in patients with serious illness significantly impacts quality of life, yet it remains a challenge to define, assess, and manage adequately. Improving upon understanding and practice in the existential domain is a topic of interest for palliative care providers.
    Methods: As a quality improvement project, our palliative care team created an existential assessment tool utilizing a dialogue-oriented approach with four questions designed to identify sources of existential distress as well as strengths and challenges in coping with this distress. The tool utilized the mnemonic CASH, with each letter representing the core objective of the question. Providers who requested the palliative care consult were asked to evaluate the CASH assessment. On completion of the project, palliative care consultants evaluated the appropriateness of the CASH assessment tool.
    Results: Patient responses to the CASH questions were insightful and reflected their beliefs, priorities, and concerns. Eight of nine providers found that the assessment enabled understanding of their patient. Seven noted a positive impact on their practice, and five reported an improvement in patient care after the assessment. The palliative care consultants who used the tool enjoyed using it, and half of them suggested changes to patient care based on their assessment. The most common reasons for not using the CASH assessment were inappropriateness to the consult, lack of perceived patient/caregiver receptiveness, or consultation service too busy.
    Conclusion: Our quality improvement project demonstrated that the CASH assessment tool is useful in ascertaining existential concerns of patients with serious illness. It enhances patient care by the primary team as well as the palliative care team. As a brief set of questions with an easy-to-remember mnemonic, the CASH assessment tool is feasible for a busy palliative consult service. Furthermore, the positive results of this project merit more rigorous evaluation of the CASH assessment tool in the future.
    MeSH term(s) Adaptation, Psychological ; Adult ; Aged ; Aged, 80 and over ; Existentialism ; Female ; Humans ; Male ; Middle Aged ; Needs Assessment ; Palliative Care/methods ; Palliative Care/psychology ; Program Development ; Program Evaluation ; Stress, Psychological/psychology ; Surveys and Questionnaires
    Language English
    Publishing date 2015-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2014.0053
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  8. Article ; Online: Epidural screening before intrathecal analgesia.

    Coyne, Patrick J / Smith, Thomas J / Bobb, Barton / Lyckholm, Laurie J

    Journal of pain & palliative care pharmacotherapy

    2008  Volume 22, Issue 1, Page(s) 69–70

    MeSH term(s) Algorithms ; Analgesia, Epidural ; Analgesics, Opioid/administration & dosage ; Analgesics, Opioid/therapeutic use ; Drug Administration Schedule ; Drug Monitoring ; Humans ; Injections, Epidural ; Pain Measurement ; Pain, Intractable/drug therapy ; Pain, Intractable/etiology ; Palliative Care
    Chemical Substances Analgesics, Opioid
    Language English
    Publishing date 2008-11-27
    Publishing country England
    Document type Letter
    ZDB-ID 2078852-6
    ISSN 1536-0539 ; 1536-0288
    ISSN (online) 1536-0539
    ISSN 1536-0288
    DOI 10.1080/15360280801989559
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  9. Article ; Online: Dexmedetomidine: exploring its potential role and dosing guideline for its use in intractable pain in the palliative care setting.

    Coyne, Patrick J / Wozencraft, Colin P / Roberts, Seth B / Bobb, Barton / Smith, Thomas J

    Journal of pain & palliative care pharmacotherapy

    2010  Volume 24, Issue 4, Page(s) 384–386

    Abstract: Intractable pain continues to pose problems for patients with life-limiting disease. The authors review the potential role of dexmedetomidine (Precedex), an α(2)-adrenergic agonist, as a bridge to obtaining effective analgesia. The authors offer criteria ...

    Abstract Intractable pain continues to pose problems for patients with life-limiting disease. The authors review the potential role of dexmedetomidine (Precedex), an α(2)-adrenergic agonist, as a bridge to obtaining effective analgesia. The authors offer criteria to consider in utilizing this medication within the context of palliative care.
    MeSH term(s) Analgesics, Non-Narcotic/administration & dosage ; Analgesics, Non-Narcotic/therapeutic use ; Dexmedetomidine/administration & dosage ; Dexmedetomidine/therapeutic use ; Humans ; Pain, Intractable/drug therapy ; Palliative Care/methods ; Practice Guidelines as Topic
    Chemical Substances Analgesics, Non-Narcotic ; Dexmedetomidine (67VB76HONO)
    Language English
    Publishing date 2010-12
    Publishing country England
    Document type Journal Article
    ZDB-ID 2078852-6
    ISSN 1536-0539 ; 1536-0288
    ISSN (online) 1536-0539
    ISSN 1536-0288
    DOI 10.3109/15360288.2010.518227
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  10. Article ; Online: The "PSOST": Providers' Signout for Scope of Treatment.

    Newport, Kristina Braine / Patel, Shejal / Lyckholm, Laurie / Bobb, Barton / Coyne, Patrick / Smith, Thomas J

    Journal of palliative medicine

    2010  Volume 13, Issue 9, Page(s) 1055–1058

    Abstract: Palliative care provides open and honest communication, medically appropriate goal setting, and meticulous attention to symptom assessment and control. The Physicians Orders for Life Sustaining Treatment (POLST) is a growing movement to allow health care ...

    Abstract Palliative care provides open and honest communication, medically appropriate goal setting, and meticulous attention to symptom assessment and control. The Physicians Orders for Life Sustaining Treatment (POLST) is a growing movement to allow health care providers to indicate, with their patients, what they want done in specific situations, such as feeding tubes, mechanical ventilation, or transfer to an intensive care unit. We have developed an internal signout tool used by palliative medicine fellows in our institution to specify similar interventions-or not-with seriously ill palliative care patients, the Providers Signout for Scope of Treatment (PSOST). We have found that this situation-specific tool enables smooth transitions of care on nights and weekends, especially when the patient is near death, and may help prevent both overescalation of care and underuse of life saving treatments such as resuscitation. The PSOST differs from other signout tools in that it gives clear direction regarding the patient's medical goals and desire for escalation of care, or not. We present it here for open access and use anywhere. This tool has also assisted in building team communication with the nursing shifts, especially nights and weekends, as all team members are able to deliver a consistent message, while meeting the goals of care for patients and families. We believe this tool could be useful with a broader patient population, outside of Palliative Medicine, to provide clearer direction for hospitalized or nursing home patients whose care is often directed by multiple providers. It could also be used as a template for signouts on other inpatient services, as care goals are important for all patients.
    MeSH term(s) Advance Directives ; Continuity of Patient Care/organization & administration ; Efficiency, Organizational ; Humans ; Life Support Care ; Medical Records ; Palliative Care ; Patient Care Planning ; Patient Care Team ; Process Assessment (Health Care) ; Software ; Terminal Care
    Language English
    Publishing date 2010-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1427361-5
    ISSN 1557-7740 ; 1096-6218
    ISSN (online) 1557-7740
    ISSN 1096-6218
    DOI 10.1089/jpm.2010.0103
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