Top Ten Tips Palliative Care Clinicians Should Know About Diagnosing, Categorizing, and Addressing Fatigue 2024 Robbins-Welty et al

Andy

Andy

Retired committee member
Abstract

Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients’ and families’ overall quality of life.

Mod note: We suggest reading the thread rather than opening the link.
Paywall,
Code: 
https://www.liebertpub.com/doi/10.1089/jpm.2024.0232
 
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So no one can read it

but I’m wondering given this is palliative care whether even when people are dying this area is giving short shrift to the kind concept of just just taking people at their word for how they feel snd listening to their bodies

From the references there seems to be some drugs like methylphenidate and modafinil research is cited on .

but the rest is depression and exercise based references.

heartbreaking that someone dying can’t be assumed that exercise won’t cure them. The ultimate sadly in the ‘don’t have to follow it up long term’ and just chivvy the ‘let’s be positive’ short term people pleasing out of them? No one’s going to know as something else has made them terminal if these ‘interventions’ hastened reduction in quality of life 6months in or not.

I have a real problem with this potentially
 
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I had a quick flick through. I don't think it's worth bothering with as very little of relevance.

Tip 1: Fatigue Should Be Considered “a Fever of Unknown Origin,” with a Large Differential, and Is Often Accompanied by Other Symptoms
Tip 2: Don’t Assess Fatigue Without Also Assessing a Person’s Sleep Quality and Habits
Tip 3: Use Validated Scales to Regularly Assess Fatigue Among People with Cancer
Tip 4: Providing Education About Fatigue to Patients and Caregivers Can Reduce Distress and Normalize Symptoms
Tip 5: First Prescribe Regular Sessions of Moderate Physical Activity Which Can Enhance Energy Levels, Improve Sleep, and Reduce Fatigue
Tip 6: Behavioral Strategies such as Energy Prioritization and Sleep Hygiene Can Be Useful as Symptomatic Treatments for Fatigue
Tip 7: After Exercise and Behavioral Interventions, Consider Nonprescription and Integrative Treatment Options with Minimal or Mild Side Effects such as Caffeine, Ginseng, Yoga, Acupuncture, and Reflexology
Tip 8: Though Psychostimulants Are Pharmacological Options for Treating Fatigue, Evidence Backing Their Use Is Limited
Tip 9: Medications such as Corticosteroids, Bupropion, and Solriamfetol Can Also Be Pharmacological Treatment Options, Though Caution Is Needed as Supporting Data Are Limited
Tip 10: Don’t Just Add More Medications; Reducing Polypharmacy and Stopping Certain Medications such as Gabapentinoids and Anticholinergics Can Improve Fatigue
 
I'm happy to see caffeine gets first mention on the list of non-prescription "After Exercise and Behavioral Interventions" treatment options (which include ginseng, yoga, acupuncture, and reflexology.)

They may have left out ubiquitously offered Tai chi.
 
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Putting aside that most pharmaceuticals here are useless, this isn't any different than what a physician from antiquity may work with. It's not fundamentally different anyway. Like maybe the difference that a plow with metal at the right places vs a fully wooden one. Most of it is simply not useful either, so it's more like having one of several plows with bits of metal, and once it breaks you're right back to basically a stick.

This little progress in literally millennia and it doesn't seem to bother anyone other than the patients. Extremely embarrassing.
 
Since the lead author's name is unusual, I googled it without opening the article link. I assume this is him:

Duke University School of Medicine
Gregg Robbins-Welty
robbins-welty_headshot_854x854_300.jpg
Gregg Robbins-Welty, MD, MS, HEC-C is a PGY-5 and chief resident of the combined internal medicine and psychiatry residency program at Duke University Medical Center. Dr. Robbins-Welty obtained his medical doctorate and a master’s in clinical research at the University of Pittsburgh, where he will return for palliative medicine fellowship in 2024. He is an awardee of the Association of Medicine and Psychiatry Fenton Med/Psych resident-of-the-year award, a FASPE fellowship at Auschwitz for the Study of Professional Ethics, the American College of Psychiatrists Laughlin Fellowship, and the American Psychiatric Associations Leadership Fellowship. He serves as the chair-elect of the American Academy of Hospice and Palliative Medicine’s early career SIG and, locally, as vice-chair of the Duke graduate medical education residency council. Dr. Robbins-Welty is an accredited healthcare ethics consultant (HEC-C) by the American Society for Bioethics and Humanities and is passionate about mental health and end-of-life ethics.
 
So he is a trainee who has been asked by a commercial outfiit, that trawls for peoples names to SPAM, to write a review - or just wants to appear to have lots of papers. We don't need to pollute our forum with drivel like this to be honest. Likely nobody will read it and if they do I am not sure what we can do about it.
Like bad music I would just turn it off.
 
Well, until I magically know what constitutes a 'real' journal or not, I'll continue using my best but inevitably flawed judgement as to what papers are worth posting or not, especially when they are paywalled. Luckily the format of the forum enables other forum members to flag the, seemingly, very few occasions when what I post is unhelpful.
 
I appreciate your efforts Andy.

There is something about the way this one ca.e up on the link that looked worrying. I shut it so didn't discover much more. I read one or two other forums - mostly academic neuro stuff - and I got caught recently by opening a link someone had posted that ended up with me having to take my laptop in to Mac and have the disc erased and re-written. It was annoying for me but for people unable to get out it would be worse.

Just in the last year or so there seems to be stuff around that looks bona fide but very much isn't.
 
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