Institutional Subscriptions   Individual Subscriptions 
Editors/Authors   Librarians   Newsletter   Site Tour   A-Z Index   About   Contact Us   Help 
Log In | Log In via Athens
Disable Autosuggest
Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part G Cross-Cultural and Special Populations Issues
Chapter 34. End-of-Life Care for Homeless Patients: “She Says She Is There to Help Me in Any Situation”
Margot B. Kushel, MD, Christine Miaskowski, RN, PhD
Legal Issues

Topics Discussed: homeless persons, homelessness, opioids, pain management

Excerpt: "A critical component of the management of cancer pain in this patient population is trust, beginning with the physician's acceptance of the patient's self-report of pain and distress. Performing a comprehensive pain assessment and substance abuse assessment is important, as is assessing for comorbid psychiatric disorders,52-55 because treating depression and anxiety may improve pain management and reduce the risk of relapse.An effective pain management plan requires a complete assessment of the pain (ie, description, intensity, location, aggravating and relieving factors, and impact on function). Patients who use illicit drugs may be tolerant to the therapeutic effects of opioid analgesics,57 but there are no systematic investigations of this phenomenon. Clinicians may initiate a conservative dose to start, but if the patient has ceased using illicit opioids, clinicians must monitor patients frequently to facilitate rapid-dose titration and to prevent withdrawal. To treat poorly controlled pain in patients who have been receiving regularly scheduled opioids for at least 5 days, a 30% to 50% increase in dose is appropriate as frequently as every 5 half-lives of the medication.56,58 Dosages must be reduced for patients with impaired hepatic or renal function.56..."
Log in to read the full chapter:
Subscriber Log In
Forgot your username/password?
Get full access to JAMAevidence two ways:
Subscribe to JAMAevidence
JAMAevidence is a subscription-
based website dedicated to the learning, teaching, and practicing of evidence-based medicine.
Pay Per View
Timed access to all of JAMAevidence
24 hours for $34.95
48 hours for $54.95
Copyright © American Medical Association. All rights reserved.  |  JAMA  |  McGraw-Hill Global Education Holdings, LLC.
Privacy Notice. Any use is subject to the Terms of Use and Notice. Additional Credits and Copyright Information.
Your IP address is