Christian Sinclair | University of Kansas Medical Center (original) (raw)

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Papers by Christian Sinclair

J Pain Symptom Management, 2019

Context. Patients with cancer experience many symptoms that disrupt quality of life, and symptom ... more Context. Patients with cancer experience many symptoms that disrupt quality of life, and symptom communication and management can be challenging. The Edmonton Symptom Assessment System (ESAS) was developed to standardize assessment and documentation of symptoms, yet research is needed to understand patients' and caregivers' experiences using the tool and its ability to impact patient-provider aligned care.

J Pain Symptom Management, 2016

Context. Many clinical disciplines report high rates of burnout, which lead to low quality of car... more Context. Many clinical disciplines report high rates of burnout, which lead to low quality of care. Palliative care clinicians routinely manage patients with significant suffering, aiming to improve quality of life. As a major role of palliative care clinicians involves educating patients and caregivers regarding identifying priorities and balancing stress, we wondered how clinician self-management of burnout matches against the emotionally exhaustive nature of the work.

Clinics of Geriatric Medicine, 2015

Palliative care End-of-life care Urinary symptoms Urology Geriatrics Chronic illness Hospice Death

NEJM, 2010

1 report a significant improvement in the quality of life and survival free from stroke and devic... more 1 report a significant improvement in the quality of life and survival free from stroke and device failure among patients with advanced heart failure who underwent implantation of a continuous-flow left ventricular assist device as compared with a pulsatile-flow device. This is great news, but while celebrating this progress, the risk of stroke, infection, and device malfunction leading to complications or death remains a reality. In this study, 59 of 134 patients (44%) receiving the continuousflow device had a disabling stroke or died within 2 years. Though left ventricular assist devices are increasingly helpful and reliable, they still represent a form of life support with a specific set of burdens and complications, particularly as patients die: difficult decisions for patients, families, and doctors surrounding planned device discontinuation; device failure; symptom-management issues; and coordinating end-of-life care that honors patients' wishes and values. 2 As such, attention should be paid to end-of-therapy considerations for this population of patients. 3 Knowing when and how to stop therapy deserves as much deliberation as when and how to start a therapy. We encourage this important aspect to be included in any future reviews of left ventricular assist devices.

Journal of Supportive Oncology, 2006

Journal of Palliative Medicine, 2005

JAMA, 2004

a more concentrated delivery of the drugs can be obtained with an intracoronary bolus (if used wi... more a more concentrated delivery of the drugs can be obtained with an intracoronary bolus (if used with the standard weightadjusted regimen), which makes an improved effect on thrombus, distal emboli, and microcirculation plugging credible. However, this effect (and the absence of toxicity of such elevated intracoronary concentrations) has not yet been demonstrated in properly controlled trials. Fortunately, a randomized evaluation is under way with the revised version of the TITAN (Time to Integrilin in Acute Myocardial Infarction] study, which now incorporates a third arm with an intracoronary administration of a Gp IIb/IIIa inhibitor. 4 With respect to Dr Klein's concerns, the primary angiographic end point was TIMI 2 or 3 flow and was available in all 6 studies; we did not combine angiographic and electrocardiographic end points. The results remained similar and significant when we performed sensitivity analyses excluding any of the 6 studies, including Zorman et al. With regard to safety, none of the 6 studies of this meta-analysis reported an excess of bleeding. This is not surprising since the important triggers of bleeding (Gp IIb/IIIa inhibitors, heparin, and catheterization) were identical in both the early and late groups of these studies. 1. Wohrle J, Grebe OC, Nusser T, et al. Reduction of major adverse coronary events with intracoronary compared with intravenous bolus of abciximab in patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty.

European Journal of Cancer, 2008

Prognostication is an important clinical skill for all clinicians, particularly those clinicians ... more Prognostication is an important clinical skill for all clinicians, particularly those clinicians working with patients with advanced cancer. However, doctors can be hesitant about prognosticating without a fundamental understanding of how to formulate a prognosis more accurately and how to communicate the information with honesty and compassion. Irrespective of the underlying type of malignancy, most patients with advanced cancer experience a prolonged period of gradual decline (months/years) before a short phase of accelerated decline in the last month or two. The main indicators of this final phase are poor performance status, weight loss, symptoms such as anorexia, breathlessness or confusion and abnormalities on laboratory parameters (e.g. high white cell count, lymphopaenia, hyopalbuminaemia, elevated lactate dehydrogenase or C-reactive protein). The clinical estimate of survival remains a powerful independent prognostic indicator, often enhanced by experience, but research has only begun to understand the different biases affecting clinicians' estimates. More recent research has shown probabilistic predictions to be more accurate than temporal predictions. Simple, reliable and valid prognostic tools have been developed in recent years that can be used readily at the bedside of terminally ill cancer patients. The greatest accuracy occurs with the use of a combination of subjective prognostic judgements and objective validated tools.

Journal of Palliative Medicine, 2008

Prognostication, along with diagnosis and treatment, is a traditional core clinical skill of the ... more Prognostication, along with diagnosis and treatment, is a traditional core clinical skill of the physician. Many patients and families receiving palliative care want information about life expectancy to help plan realistically for their futures. Although underappreciated, prognosis is, or at least should be, part of every clinical decision. Despite this crucial role, expertise in the art and science of prognostication diminished during the twentieth century, due largely to the ascendancy of accurate diagnostic tests and effective therapies. Consequently, "Doctor, how long do I have?" is a question most physicians find unprepared to answer effectively. As we focus on palliative care in the twentyfirst century, prognostication will need to be restored as a core clinical proficiency. The discipline of palliative medicine can provide leadership in this direction. This paper begins by discussing a framework for understanding prognosis and how its different domains might be applied to all patients with life limiting illness, although the main focus of the paper is predicting survival in patients with cancer. Examples of prognostic tools are provided, although the subjective assessment of prognosis remains important in the terminally ill. Other issues addressed include: the importance of prognostication in terms of clinical decision-making, discharge planning, and care planning; the impact of prognosis on hospice referrals and patient/family satisfaction; and physicians' willingness to prognosticate.