The personalized pain goal is a feasible outcome measure for cognitively intact patients. The Edmonton Classification System for Cancer Pain definition closely resembles patient-reported personalized pain goals for stable pain and would be appropriate for research purposes. For clinical pain management, it would be important to include the personalized pain goal as standard practice.
Mr. I.M. was a 62-year-old man with a presumptive diagnosis of non-small-cell lung cancer. He also had a long history of alcohol and street drug use, including cocaine and morphine. His other comorbidities included: COPD, liver disease secondary to alcohol use, hepatitis C, peptic ulcer disease, degenerative disc disease, and chronic pain after a remote traumatic episode. A left upper lobe lesion was first noted on chest x-ray in October 2002. Over the following year, he was investigated on two different admissions for weight loss and hemoptysis, but each time he refused biopsy of the lung mass. During the second admission, appointments were made for the patient to follow up with oncology, but he did not attend these appointments. Three years after the initial abnormal chest x-ray, he was assessed for hospice placement. At this time, Mr. I.M. was staying at a single men's shelter in the inner city area. Each day he had been dispensed eight tablets of MS Contin 60 mg and eight tablets of Percocet by the nurse at the single men's shelter. He was assessed by the regional palliative care team (5). It was felt that he would benefit from admission to the tertiary palliative care unit for further workup and symptom control prior to transfer to a hospice. The patient agreed to this and was admitted the following day. On arrival, when asked what his expectations were of this stay, he stated only that he just needed a place to stay. When assessed on admission, he complained of pain, his description of which was vague in location and nature. He also had shortness of breath on exertion, cough, and hemoptysis. Drowsiness and myoclonus suggestive of opioid-induced neurotoxicity were observed. It was suggested that he be rotated to methadone. He agreed and a three-day methadone rotation was begun.
Most studies examining the institution of handover protocols in the health care setting have failed to harness the power of pictures and other representative images. This study demonstrates the ability of pictorial displays to improve both immediate and delayed recall of patient histories without increasing review time. These types of displays may be amenable to generation by software programs and have the potential to enhance information transfer in various settings.
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