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Robin L Fainsinger

Publications and source records attributed to Robin L Fainsinger.

18 recordsLinked to original sources
PubMed2005

A multicenter study of the revised Edmonton Staging System for classifying cancer pain in advanced cancer patients.

The comparative analysis of analgesic interventions for cancer pain is greatly compromised by the lack of well-validated and clinically acceptable tools, which allow a composite classification of pain and patient population characteristics. Although the Edmonton Staging System (ESS) for cancer pain was developed for this purpose, clinical and research utility has been limited due to problems associated with the assessment of some items, especially in relation to definitions and terminology. To overcome these limitations, we designed a revised ESS (rESS) and conducted a multicenter study to determine its inter-rater reliability and predictive value. In revising the rESS, we hypothesized that patients with less problematic pain features would require a shorter time to achieve stable pain control, require less complicated analgesic regimens, be more responsive to opioid therapy, and use lower opioid doses. The rESS items include mechanism of pain, presence or absence of incidental pain, presence or absence of psychological distress and addictive behavior, and level of cognitive function. Patients with cancer pain who were consecutively admitted to two different hospice centers, an acute care consultation service in a teaching hospital or a tertiary palliative care unit in a second teaching hospital were evaluated for study entry. Two independent palliative care specialists completed the rESS where possible within 24 hours of each other. Patients' pain ratings and opioid consumption were recorded daily until the study endpoint (i.e. achievement of stable pain control, discharge or death). Seven hundred and forty-six patients were eligible for study entry and of these, 619 (83%) had a pain syndrome. Inter-rater reliability estimates ranged from 0.67 (pain mechanism) to 0.95 (presence of addiction). In the univariate Cox regression analysis, younger patients (<60), as well as patients with neuropathic pain, incidental pain, psychological distress, or co-morbid psychological distress and addiction, required a significantly longer time to achieve stable pain control (P<0.05). In the multivariate Cox regression analysis, only age (<60), neuropathic pain and incidental pain were significantly associated with time to reach stable pain control (P<or=0.05). Patients with neuropathic or incidental pain used significantly more modalities to achieve stable pain control (P<0.01). Patients with neuropathic pain, incidental pain, as well as the presence of psychological distress or addiction, required a higher final mean morphine equivalent daily dose (MEDD) (P<0.001). A comparison of the rESS with the ESS demonstrated the ineffectiveness of the ESS prognostic staging system for predicting achievement of stable pain control. These findings confirm the study hypothesis, suggesting that the rESS appears to have good predictive value and a moderate to high inter-rater reliability. We suggest the rESS should prove to be a useful tool in clinical practice, and in the comparison of cancer pain populations in research studies.

Aged↗
PubMed2005

Parenteral nutrition in advanced cancer: indications and clinical practice guidelines.

Cachexia is a disturbing and disfiguring aspect of many advanced cancers. Parenteral nutrition (PN) is a controversial and expensive treatment for cancer cachexia. Guidelines for the use of PN for these patients have been suggested. These two case reports will highlight some of the issues around the etiology of cancer cachexia, the clinical dilemmas and the use of clinical practice guidelines.

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PubMed2005

A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for Cancer Pain.

The purpose of this study was to gather construct validity evidence for a pain classification system for advanced cancer patients using content experts. Two expert panels, representing regional (Panel A, n = 18) and national/international (Panel B, n = 52) palliative medicine and pain specialists, were purposefully selected to participate in a modified Delphi survey technique, to evaluate an existing pain classification system, the Revised Edmonton Staging System (rESS). Each panel participated in two survey rounds, with response rates of 67% (Panel A, Round 1), 39% (Panel A, Round 2), 56% (Panel B, Round 1) and 64% (Panel B, Round 2). The rESS consists of five features: mechanism of pain, incidental pain, psychological distress, addictive behavior and cognitive function. Most participants either agreed or strongly agreed with including the five existing rESS features in a pain classification system, ranging from 67% (Panel A, cognitive function) to 100% (Panel B, mechanism of pain). Most participants suggested keeping the current definitions for these features, with some revisions. Based on participant feedback, definitions for incidental pain, psychological distress, addictive behavior and cognitive function were revised, including the development of guidelines for use. To reflect its intended use as a classification system, the name of the instrument was changed to the Edmonton Classification System for Cancer Pain (ECS-CP).

Humans↗
PubMed2004

Palliation of malignant bowel obstruction using a percutaneous cecostomy.

Bowel obstruction is a common complication of metastatic gastrointestinal and ovarian cancers, and can cause distressing symptoms. Along with medical options, surgical options should be considered in all patients with bowel obstruction, including percutaneous gastrostomy. We report the case of a patient with metastatic colon cancer with an obstructing recurrence at the primary site who was not eligible for major surgery or percutaneous gastrostomy and was managed with a percutaneous cecostomy for symptom control.

Adenocarcinoma↗
PubMed2004

Hydration management at the end of life.

The management of parenteral hydration at the end of life remains controversial. The debate centers on whether and/or how often patients should be hydrated, the volume of hydration received, and the benefit verses side effects of parenteral hydration. In order to clarify the routine practice of physicians involved in the end-of-life care in Edmonton, Alberta, Canada, we investigated the routine management of hydration by attending physicians caring for patients dying in a palliative care unit (PCU) at Norwood Capital Care, and in acute care wards at the Royal Alexandra Hospital (RAH) both while receiving and while not receiving consult advice from the Palliative Care Program. We conducted a retrospective chart review of 50 consecutive patients who died in each of the 3 sites included in the study. Data from the last 7 days prior to and including the date of death (day 0) was recorded. The majority of patients at all sites received hydration. The volume of hydration ordered in the Norwood PCU site was significantly different compared to both RAH groups on all days studied (p < 0.005). The RAH palliative care group showed a trend for lower hydration volumes compared to the RAH acute care group with significant differences on days 1 and 2 (p < 0.05). Throughout the week, for all of the hydrated patients in the Norwood PCU site, hypodermoclysis (HDC) was ordered; for nearly all of the hydrated patients in the RAH acute care group, intravenous (IV) hydration was ordered; and for approximately one third of the hydrated RAH palliative care consult group HDC was ordered, and for the remainder IV hydration was ordered. The RAH acute care group represented the largest percentage of hydrated patients receiving diuretics while the Norwood hospice site represented the lowest. The data raise the possibility that more patients in the RAH acute care group were overhydrated and may have developed symptoms such as edema, ascites, and respiratory distress. This study suggests that hydration at the end of life is managed differently in different settings of care and highlights areas for education to improve management.

Aged↗
PubMed2004

Thrombosis and anticoagulation in palliative care: an evolving clinical challenge.

There is a clear recognition of the relationship between thrombosis and neoplastic diseases. In recent years, there have been a few reports dealing with some of the features of clinical progression and management of venous thromboembolism (VTE) in palliative care patients. In this report, we present four cases that describe some of the diverse aspects of this clinically challenging area to illustrate the symptom and quality of life issues for patients, and the management challenge for palliative care clinicians. Perhaps the most important issue in the palliative care setting is the need to balance the inconvenience of the various diagnostic and therapeutic options, particularly in settings where progression has resulted in a deteriorated physical and cognitive condition. We need to recognize that VTE does cause significant problems for some of our patients. We will always need to balance issues of life expectancy, comfort and quality of life, and risk and benefits of anticoagulation, and align these problems with the individual patient, and the family dynamics and desires we encounter.

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PubMed2003

Evaluation of a data collection tool (TELEform) for palliative care research.

INTRODUCTION: The Alberta Cancer Board Palliative Care Research Initiative (ACBPCRI) encourages province-wide collaboration on palliative care research projects. Because of geographic differences in information system infrastructure, it is necessary to evaluate and adopt a data collection tool that will span the variability in system hardware and software. We assessed TELEform (Cardiff Sofware Inc., Vista CA), an optical recognition-based technology that scans data collection paper forms and exports data to a computer database. We examined work place suitability, data quality, and effective resource utilization (time and cost) during the data collection tool evaluation. METHODS: Two hospices and two hospitals from the cities of Edmonton and Calgary participated in the revised Edmonton Staging System (rESS) project that used TELEform as its data collection tool. The evaluation was conducted over a period of 7 months. Data source such as e-mail and summary notes collected primarily through meetings and discussions with management, caregivers, researchers, and clerical staff was used to assess work practice and resource utilization. Descriptive statistics was employed to examine data quality and resource utilization. RESULTS: One hundred seventy eight patients were recruited during the 7-month trial. The costs and time involved in staff training, logistic support, and equipment startup were found to be reasonable. Data error and missing data were 0.4% and 0.6%, respectively. We initially encountered several problems with TELEform. The optical recognition tool could not easily pick up handwritten data. Furthermore, it was unforgiving in the sense that an error was not correctable by an eraser on the paper form. Data collectors found TELEform usage to be easy and simple because it retained the familiarity of paper-based recording. CONCLUSION: It is important to develop an information infrastructure to support research project data collection for different health settings across health regions. The TELEform based on optical recognition was able to respond to the need for current information processing. We believe that TELEform is a useful tool in terms of work practice, data quality, and resource utilization.

Data Collection↗
PubMed2003

Checking the facts.

Explore the source record for details and available documents.

Acute Kidney Injury↗
PubMed2003

The cultural differences in perceived value of disclosure and cognition: Spain and Canada.

A previous multicentre international study on sedation at the end of life has detected major differences between Canadian and Spanish patients. This was particularly evident in the need to sedate Spanish patients for psychological/existential distress. This study was designed to explore the hypothesis that marked differences in the value patients and families attach to disclosure and cognition were a factor. The study population included patients referred to two palliative care consulting services based in acute care hospitals in Madrid, Spain (M), and in Edmonton, Canada (E). Questions addressed the issue of clear thinking, pain/nausea-medication-induced somnolence/confusion, anxiety/antidepressant-medication-induced somnolence/confusion, details of diagnosis. One hundred patients were evaluated on each site. Patients and families in E placed a higher value on clear thinking, change in medication causing somnolence/confusion, and wanting full disclosure. Patients and families in E agreed almost 100% of the time, while agreement in M varied from 42% to 67%. These results suggest major differences in the perceived value of clear cognition and disclosure of information between patients and families in E and M. The lack of agreement between patients and families in M is a further significant factor that may complicate communication with patients and families, as well as medical management.

Aged↗
PubMed2002

Twentieth-century social and health-care influences on location of death in Canada.

Providing the right care, in the right place, to dying persons is hampered by a lack of understanding of where death and dying normally take place and ignorance about what influences location of death. This paper reports the findings of a multidisciplinary historical investigation of 20th-century influences on location of death in Canada. It builds on a study that found a hospitalization-of-death trend in Canada over much of the 20th century but a reduction in hospital deaths beginning in 1994. This study found 2 key influences on location of death: (1) health-care and health-system developments that consolidated care in hospitals while also raising and sustaining public expectations of beneficial if not curative hospital care--the rising hospital-death rate throughout the 20th century can thus be considered an outcome of the shift of illness care from the home to the hospital; and (2) reduced availability of home-based caregivers. A number of developments limited the availability of home care for chronically ill and terminally ill persons, including the increased participation of women in the workforce and the shift in nursing from private home duty to hospitals. Although some health and social support for home care has developed recently, this support clearly does not match that for hospital care. These findings indicate that location of death is an important focal point for studying and planning improvements in end-of-life care.

Canada↗
PubMed2002

Developing palliative care surveillance in Canada: results of a pilot study.

OBJECTIVE: A pilot study compiled data from six palliative care centres across Canada to assess the feasibility of developing a national surveillance system. METHODS: Data provided for the three-year period between 1993-1997 were combined into a comparative minimum data set. Analyses included 6,369 care episodes from five centres, plus 948 patients from one centre. RESULTS: Care was provided in various settings including acute care wards, dedicated palliative care units, tertiary care, chronic care, and at home. Palliative care patients comprised equal numbers of men and women, with a median age of 69 years; 92% had cancer diagnoses. Median length of stay (LOS) for each care episode was 13 days, increasing to 40-43 days for a patient's entire time in care. LOS varied greatly, by care setting, from seven days (dedicated unit), to 19 days (tertiary unit), 37 days (home), and 54 days (chronic care). Our findings are similar to those reported from national surveys in Australia and the United Kingdom. SUMMARY: This study generated useful baseline data and identified key issues requiring resolution before establishing a national surveillance system, including the need to track patients across care settings.

Adolescent↗
PubMed1995

Custom-made capsules and suppositories of methadone for patients on high-dose opioids for cancer pain.

In a prospective, open study, 37 advanced cancer patients in poor pain control receiving high doses of subcutaneous hydromorphone (mean daily dose: 276 +/- 163 mg) were switched to methadone by use of custom-made capsules (21 patients) or suppositories (16 patients). The change in opioid took place over 6.5 +/- 3.6 days (oral) and 3.2 +/- 2.7 days (rectal). The methadone/hydromorphone dose ratios were 1.2 +/- 1.3 and 3 +/- 2 for the oral and rectal routes, respectively (P = 0.03) as compared to an expected ratio of 5-7, based on single dose available data. Pain intensity (VAS 0-100 mm) and the number of extra doses of analgesic per day were 51 +/- 22 and 3.2 +/- 2.7 with hydromorphone, versus 34 +/- 21 (P < 0.001) and 2.1 +/- 1.9 (P = 0.03) with methadone, respectively. The total cost of treatment was Canadian $148 +/- 202 with methadone as compared to Canadian $2135 +/- 472 with hydromorphone (P < 0.001). Toxicity was limited to mild sedation in all patients and proctitis in 2 patients on suppositories (one of whom required discontinuation of methadone). Plasma levels obtained in 6 patients on suppositories revealed large inter-individual variation in methadone level (ng/ml) to dose (mg/day) ratio (range: 0.8-8.5). Within individuals, the ratio remained constant over a range of doses. We conclude that a slow switch-over to methadone is a safe, effective and low cost alternative in selected cancer patients receiving high doses of opioids for poor prognostic pain syndromes.

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