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Article: Suffering of gravely ill patients. An important area of intervention for family physicians.

Daneault, Serge / Dion, Dominique

Canadian family physician Medecin de famille canadien

2004 Volume 50, Page(s) 1343–5, 1348–50

MeSH term(s)	Humans ; Palliative Care ; Physician's Role ; Physicians, Family ; Terminally Ill/psychology
Language	French
Publishing date	2004-10
Publishing country	Canada
Document type	Editorial
ZDB-ID	603565-6
ISSN	0008-350X
ISSN	0008-350X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Ultimate journey of the terminally ill: Ways and pathways of hope.

Daneault, Serge / Lussier, Véronique / Mongeau, Suzanne / Yelle, Louise / Côté, Andréanne / Sicotte, Claude / Paillé, Pierre / Dion, Dominique / Coulombe, Manon

Canadian family physician Medecin de famille canadien

2016 Volume 62, Issue 8, Page(s) 648–656

Abstract: Objective: To better understand the role of hope among terminally ill cancer patients.: Design: Qualitative analysis.: Setting: A tertiary specialized cancer centre in Canada.: Participants: Cancer patients in palliative care with an estimated ... ...

Abstract	Objective: To better understand the role of hope among terminally ill cancer patients. Design: Qualitative analysis. Setting: A tertiary specialized cancer centre in Canada. Participants: Cancer patients in palliative care with an estimated remaining life expectancy of 12 months or less (N = 12) and their loved ones (N = 12) and treating physicians (N = 12). Methods: Each patient underwent up to 3 interviews and identified a loved one who participated in 1 interview. Treating physicians were also interviewed. All interviews were fully transcribed and analyzed by at least 2 investigators. Interviews were collected until saturation occurred. Main findings: Seven attributes describe the experiences of palliative cancer patients and their caregivers: hope as an irrational phenomenon that is a deeply rooted, affect-based response to adversity; initial hope for miraculous healing; hope as a phenomenon that changes over time, evolving in different ways depending on circumstances; hope for prolonged life when there is no further hope for cure; hope for a good quality of life when the possibility of prolonging life becomes limited; a lack of hope for some when treatments are no longer effective in curbing illness progression; and for others hope as enjoying the present moment and preparing for the end of life. Conclusion: Approaches aimed at sustaining hope need to reflect that patients' reactions might fluctuate between despair and a form of acceptance that leads to a certain serenity. Clinicians need to maintain some degree of hope while remaining as realistic as possible. The findings also raise questions about how hope influences patients' perceptions and acceptance of their treatments.
MeSH term(s)	Adult ; Aged ; Attitude to Death ; Caregivers/psychology ; Female ; Hope ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Neoplasms/psychology ; Palliative Care ; Physicians, Family ; Qualitative Research ; Quality of Life ; Quebec ; Terminally Ill/psychology ; Tertiary Care Centers
Language	English
Publishing date	2016-06-20
Publishing country	Canada
Document type	Journal Article
ZDB-ID	603565-6
ISSN	1715-5258 ; 0008-350X
ISSN (online)	1715-5258
ISSN	0008-350X
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Article ; Online: A systematic literature review of 10 years of research on sex/gender and pain perception - part 2: do biopsychosocial factors alter pain sensitivity differently in women and men?

Racine, Mélanie / Tousignant-Laflamme, Yannick / Kloda, Lorie A / Dion, Dominique / Dupuis, Gilles / Choinière, Manon

Pain

2012 Volume 153, Issue 3, Page(s) 619–635

Abstract: This systematic review summarizes the results of 10 years of laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian to access multiple databases. A total of 172 articles published between 1998 and ... ...

Abstract	This systematic review summarizes the results of 10 years of laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian to access multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The second set of results presented in this review (129 articles) examined various biopsychosocial factors that may contribute to differences in pain sensitivity between healthy women and men. The results revealed that the involvement of hormonal and physiological factors is either inconsistent or absent. Some studies suggest that temporal summation, allodynia, and secondary hyperalgesia may be more pronounced in women than in men. The evidence to support less efficient endogenous pain inhibitory systems in women is mixed and does not necessarily apply to all pain modalities. With regard to psychological factors, depression may not mediate sex differences in pain perception, while the role of anxiety is ambiguous. Cognitive and social factors appear to partly explain some sex-related differences. Finally, past individual history may be influential in female pain responses. However, these conclusions must be treated with much circumspection for various methodological reasons. Furthermore, some factors/mechanisms remain understudied in the field. There is also a need to assess and improve the ecological validity of findings from laboratory studies on healthy subjects, and perhaps a change of paradigm needs to be considered at this point in time to better understand the factors that influence the experience of women and men who suffer from acute or chronic pain.
MeSH term(s)	Biological Factors ; Biomedical Research/statistics & numerical data ; Databases, Bibliographic/statistics & numerical data ; Female ; Humans ; Longitudinal Studies ; Male ; Nervous System/physiopathology ; Pain/complications ; Pain/metabolism ; Pain/psychology ; Pain Perception/physiology ; Pain Threshold/physiology ; Psychology ; Sex Characteristics ; Stress, Psychological/physiopathology
Chemical Substances	Biological Factors
Language	English
Publishing date	2012-01-10
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1016/j.pain.2011.11.026
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Article ; Online: A systematic literature review of 10 years of research on sex/gender and experimental pain perception - part 1: are there really differences between women and men?

Racine, Mélanie / Tousignant-Laflamme, Yannick / Kloda, Lorie A / Dion, Dominique / Dupuis, Gilles / Choinière, Manon

Pain

2011 Volume 153, Issue 3, Page(s) 602–618

Abstract: The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple ... ...

Abstract	The purpose of this systematic review was to summarize and critically appraise the results of 10 years of human laboratory research on pain and sex/gender. An electronic search strategy was designed by a medical librarian and conducted in multiple databases. A total of 172 articles published between 1998 and 2008 were retrieved, analyzed, and synthesized. The first set of results (122 articles), which is presented in this paper, examined sex difference in the perception of laboratory-induced thermal, pressure, ischemic, muscle, electrical, chemical, and visceral pain in healthy subjects. This review suggests that females (F) and males (M) have comparable thresholds for cold and ischemic pain, while pressure pain thresholds are lower in F than M. There is strong evidence that F tolerate less thermal (heat, cold) and pressure pain than M but it is not the case for tolerance to ischemic pain, which is comparable in both sexes. The majority of the studies that measured pain intensity and unpleasantness showed no sex difference in many pain modalities. In summary, 10 years of laboratory research have not been successful in producing a clear and consistent pattern of sex differences in human pain sensitivity, even with the use of deep, tonic, long-lasting stimuli, which are known to better mimic clinical pain. Whether laboratory studies in healthy subjects are the best paradigm to investigate sex differences in pain perception is open to question and should be discussed with a view to enhancing the clinical relevance of these experiments and developing new research avenues.
MeSH term(s)	Biomedical Research/statistics & numerical data ; Databases, Bibliographic ; Female ; Humans ; Hyperalgesia/etiology ; Hyperalgesia/physiopathology ; Ischemia/complications ; Longitudinal Studies ; Male ; Pain Perception/physiology ; Pain Threshold/physiology ; Sex Characteristics
Language	English
Publishing date	2011-12-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review ; Systematic Review
ZDB-ID	193153-2
ISSN	1872-6623 ; 0304-3959
ISSN (online)	1872-6623
ISSN	0304-3959
DOI	10.1016/j.pain.2011.11.025
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Management of chronic neuropathic pain with methadone: a review of 13 cases.

Altier, Nadège / Dion, Dominique / Boulanger, Aline / Choinière, Manon

The Clinical journal of pain

2005 Volume 21, Issue 4, Page(s) 364–369

Abstract: The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly ... ...

Abstract	The synthetic opioid methadone has generated much interest in recent years among clinicians involved in the management of intractable chronic cancer pain. Its use as an analgesic is starting to extend to the treatment of noncancer pain, particularly neuropathic pain. Unfortunately, the evidence for its use in the management of neuropathic pain is limited to a few case studies. We examined retrospectively during a 12-month study period the clinical response of all 13 patients at our pain clinic who were prescribed methadone in an attempt to control neuropathic pain resistant to conventional analgesics. A questionnaire was also administered to the 9 patients who continued to take methadone at 12 months posttreatment. A total of 4 patients (31%) discontinued it by the end of the 12-month study period. Patients discontinued methadone due to the absence of pain relief and due to various intractable, undesirable side effects. Somnolence was the most common adverse effect reported, followed by nausea, constipation, and vomiting. All patients took coanalgesics (eg, amitriptyline, gabapentin) or other analgesics (eg, morphine, nonsteroidal anti-inflammatory drugs) during methadone treatment to control pain. The 9 patients who continued to take methadone at 12 months reported experiencing on average 43% pain relief (range 0-80%), 47% improvement in quality of life (range 0-100%), and 30% improvement in quality of sleep (range 0-60%). Methadone was effective at relieving pain and ameliorating quality of life and sleep in 62% of patients. These findings suggest that methadone can offer an acceptable success rate for the treatment of neuropathic pain. Prospective randomized, placebo-controlled studies are now needed to examine more rigorously the benefits of methadone for this type of pain.
MeSH term(s)	Adult ; Aged ; Analgesics, Opioid/therapeutic use ; Chronic Disease ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Humans ; Male ; Methadone/therapeutic use ; Middle Aged ; Neuralgia/drug therapy ; Pain Measurement/drug effects ; Quality of Life ; Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors ; Retrospective Studies ; Sleep Wake Disorders/prevention & control ; Surveys and Questionnaires ; Treatment Outcome
Chemical Substances	Analgesics, Opioid ; Receptors, N-Methyl-D-Aspartate ; Methadone (UC6VBE7V1Z)
Language	English
Publishing date	2005-06-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	632582-8
ISSN	0749-8047
ISSN	0749-8047
DOI	10.1097/01.ajp.0000125247.95213.53
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The treatment of chronic pain in Québec: a study of hospital-based services offered within anesthesia departments.

Veillette, Yves / Dion, Dominique / Altier, Nadège / Choinière, Manon

Canadian journal of anaesthesia = Journal canadien d'anesthesie

2005 Volume 52, Issue 6, Page(s) 600–606

Abstract: Purpose: Little or no information exists on the services that are currently available for the treatment of chronic pain across the different regions of Canada. As a first step, this study documented the hospital-based resources and services offered for ... ...

Abstract	Purpose: Little or no information exists on the services that are currently available for the treatment of chronic pain across the different regions of Canada. As a first step, this study documented the hospital-based resources and services offered for the management of chronic non-cancer pain within anesthesia departments in Québec. Methods: In collaboration with the Association of Anesthesiologists of Québec and the Société québécoise de la douleur, a provincial survey was conducted to assess the availability of services for chronic pain management within hospital-based anesthesia departments along with the volume of clinical activities, staff composition, treatments offered and space facilities. Results: The response rate was 100%. Fifty of the 69 departments (73%) offered services for the management of chronic non-cancer pain but the services were often limited. Twenty-six percent (13/50) of the departments provided some form of multidisciplinary assessment and treatment but only three had a core team comprised of an anesthesiologist, a nurse, a psychologist, and a physical therapist. Examination of patient waiting lists of the surveyed departments revealed disturbing results: approximately 4,500 patients were waiting for their first appointment to see a pain consultant, and nearly 3,000 (67%) had been waiting for nine months or more. Conclusion: Although this survey did not include the services offered in departments other than anesthesia, the results show the extent to which the province of Québec is under-resourced for the management of chronic pain patients both in terms of access to treatment and quality of the services offered.
MeSH term(s)	Anesthesia Department, Hospital/manpower ; Anesthesia Department, Hospital/statistics & numerical data ; Chronic Disease ; Health Care Surveys ; Pain/nursing ; Pain Clinics/manpower ; Pain Clinics/statistics & numerical data ; Pain Management ; Physical Therapy Department, Hospital ; Physicians ; Psychology ; Quebec/epidemiology ; Surveys and Questionnaires
Language	English
Publishing date	2005-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	91002-8
ISSN	1496-8975 ; 0832-610X
ISSN (online)	1496-8975
ISSN	0832-610X
DOI	10.1007/BF03015769
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Hope and noncurative chemotherapies: which affects the other?

Daneault, Serge / Dion, Dominique / Sicotte, Claude / Yelle, Louise / Mongeau, Suzanne / Lussier, Véronique / Coulombe, Manon / Paillé, Pierre

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

2010 Volume 28, Issue 13, Page(s) 2310–2313

MeSH term(s)	Adaptation, Psychological ; Antineoplastic Agents/therapeutic use ; Attitude of Health Personnel ; Attitude to Death ; Cost of Illness ; Decision Making ; Emotions ; Humans ; Neoplasms/drug therapy ; Neoplasms/psychology ; Palliative Care/psychology ; Patient Participation ; Physician-Patient Relations ; Quality of Life ; Spirituality ; Terminally Ill/psychology ; Treatment Failure ; Truth Disclosure
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2010-05-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604914-x
ISSN	1527-7755 ; 0732-183X
ISSN (online)	1527-7755
ISSN	0732-183X
DOI	10.1200/JCO.2009.26.8425
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Article ; Online: Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients.

Daneault, Serge / Lussier, Véronique / Mongeau, Suzanne / Hudon, Eveline / Paillé, Pierre / Dion, Dominique / Yelle, Louise

Canadian family physician Medecin de famille canadien

2006 Volume 52, Issue 12, Page(s) 1574–1575

Abstract: Objective: To explore terminally ill patients' perceptions of their own suffering in order to describe, from these patients' perspective, some elements of health care providers' response to suffering.: Design: Qualitative study using content analysis ...

Abstract	Objective: To explore terminally ill patients' perceptions of their own suffering in order to describe, from these patients' perspective, some elements of health care providers' response to suffering. Design: Qualitative study using content analysis methods suited to a grounded theory approach. Setting: Teaching and nonteaching hospital oncology clinics, palliative care services (both ambulatory and in-unit), and family practices. Participants: Twenty-six patients diagnosed with terminal cancer. Methods: Interviews were audiotaped and transcribed verbatim. Data from each interview were coded and categorized to identify and define themes. Themes were discussed and refined until those rating them agreed on them. Data were collected until saturation of emerging issues was reached. Main findings: In our health care system, patients are caught in a pervasive pattern of suffering avoidance, which in turn contributes to increased suffering. Health care services are perceived as a battlefield where physicians and patients are engaged in a losing struggle to ward off illness and death. Both physicians and patients engage in avoiding skepticism and muffling distress. The unavoidable avowal of powerlessness in the face of terminal disease is perceived as capitulation and therapeutic abandonment. Budgetary restraints and understaffing, along with a pervasive culture that implicitly denies death, produce an environment conducive to the avoidance of suffering. To counter this, health care practices that foster increased overlap and continuity between the spheres of oncology, palliative care, and family medicine seem worth developing. Conclusion: The suffering of gravely ill patients might be hard to alleviate in the context of modern health care organizations. In some cases, health care delivery directly contributes to increased suffering. Providing support while also helping patients and their families to face upcoming harsh realities is a delicate balancing act that needs to be further explored.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Beneficence ; Family Practice/standards ; Female ; Humans ; Interviews as Topic ; Male ; Middle Aged ; Neoplasms/physiopathology ; Neoplasms/psychology ; Oncology Service, Hospital/standards ; Palliative Care/standards ; Physician-Patient Relations ; Qualitative Research ; Stress, Psychological/etiology ; Terminally Ill/psychology
Language	English
Publishing date	2006-12
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2146676-2
ISSN	1715-5258 ; 0008-350X
ISSN (online)	1715-5258
ISSN	0008-350X
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Article: The nature of suffering and its relief in the terminally ill: a qualitative study.

Daneault, Serge / Lussier, Véronique / Mongeau, Suzanne / Paillé, Pierre / Hudon, Eveline / Dion, Dominique / Yelle, Louise

Journal of palliative care

2004 Volume 20, Issue 1, Page(s) 7–11

Abstract: The essential mandate of medicine is the relief of suffering. However, the quest for an integrated model towards a conceptualization of suffering is still ongoing and empirical studies are few. Qualitative inquiry using 31 in-depth interviews and content ...

Abstract	The essential mandate of medicine is the relief of suffering. However, the quest for an integrated model towards a conceptualization of suffering is still ongoing and empirical studies are few. Qualitative inquiry using 31 in-depth interviews and content analysis was carried out between 1999 and 2001 in 26 patients diagnosed with terminal cancer. The suffering experience was described through a multiplicity of heterogenous elements from the physical, psychological, and social spheres. Systematic synthesis of interview material yielded three apparently irreducible core dimensions. Respondents defined their suffering in terms of 1) being subjected to violence, 2) being deprived and/or overwhelmed, and 3) living in apprehension. Cassell wrote, in 1991, that to know the suffering of others demands an exhaustive understanding of what makes them the individuals they are (1). Our model can be of use in structuring and eliciting this necessary information. Understanding how a particular patient feels harmed, deprived or overburdened, and overtaken by fear, provides a lever for action tailored to the specifics of that person's experience.
MeSH term(s)	Adaptation, Psychological ; Adult ; Aged ; Aged, 80 and over ; Attitude to Death ; Attitude to Health ; Fear ; Female ; Humans ; Male ; Middle Aged ; Neoplasms/complications ; Qualitative Research ; Quality of Life ; Stress, Psychological/etiology ; Stress, Psychological/prevention & control ; Stress, Psychological/psychology ; Surveys and Questionnaires ; Terminal Care/methods ; Terminal Care/psychology ; Terminally Ill/psychology ; Violence/psychology
Language	English
Publishing date	2004
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639326-3
ISSN	0825-8597
ISSN	0825-8597
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Article: Disclosure of Alzheimer's disease. Senior citizens' opinions.

Ouimet, Marie-Andrée / Dendukuri, Nandini / Dion, Dominique / Beizile, Eric / Elie, Michel

Canadian family physician Medecin de famille canadien

2004 Volume 50, Page(s) 1671–1677

Abstract: Objective: To determine the proportion of elderly people without dementia who would want disclosure of a diagnosis of Alzheimer's disease (AD), for themselves or for their spouses, and to verify whether the availability of medication would influence ... ...

Abstract	Objective: To determine the proportion of elderly people without dementia who would want disclosure of a diagnosis of Alzheimer's disease (AD), for themselves or for their spouses, and to verify whether the availability of medication would influence their decision. Design: A cross-sectional survey with a semistructured questionnaire completed during face-to-face interviews. Setting: Medical and surgical outpatient clinics in St Mary's Hospital Center. Participants: 204 subjects 65 years or older with at most mild cognitive impairment. Main outcome measures: Percentage of positive responses for disclosure of a diagnosis of AD to self or to spouse, with or without medication. Results: Nearly all (98%) subjects wanted disclosure for themselves. Most (78%) wanted disclosure for their potentially afflicted spouses when medication was said to be unavailable. This proportion increased to 97%, however, if medication was available. Conclusion: Most participants requested honesty for themselves. Most wanted disclosure to a potentially affected spouse when medication is said to be available.
MeSH term(s)	Aged ; Aged, 80 and over ; Alzheimer Disease/drug therapy ; Attitude to Health ; Cross-Sectional Studies ; Female ; Humans ; Interviews as Topic ; Male ; Marital Status ; Spouses ; Surveys and Questionnaires ; Truth Disclosure
Language	English
Publishing date	2004-12
Publishing country	Canada
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	603565-6
ISSN	0008-350X
ISSN	0008-350X
Database	MEDical Literature Analysis and Retrieval System OnLINE

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