Abstract
Letters to the Editor
As part of a larger Ph.D. study, the authors conducted a retrospective audit of one UK hospice to examine to what extent Preferred Place of Death was documented. (page 1196)
Brief Reports
A one-group, intervention-only feasibility study of a telephone cognitive-behavioral stress-management intervention. (page 1200)
Fast Facts and Concepts
#120 Physicians and Prayer Requests (page 1259)
# 244 Screening for Opioid Misuse and Abuse (page 1260)
Personal Reflection
“Yes, she was stable, but what did it mean? Nothing that was being done would change the outcome. It is the family that is the problem. They yanked her out of hospice care.” (page 1264)
Case Discussions in Palliative Medicine
Results suggest that subcutaneous neostigmine could be an alternative choice in a group of selected patients with advanced cancer and opioid-induced constipation. (page 1270)
Book and Media Reviews
(page 1274)
Recent Literature
(page 1275)
Risk Factors for Terminal Secretions
In this retrospective analysis of 199 deaths in a palliative care unit, researchers found a high anticholinergic load from medications was not protective but predictive of a need for treatment of noisy respiratory secretions at end of life. (page 1211)
State-Funded Pediatric Palliative Care
Joanne Wolfe, MD, and colleagues describe the success of a statewide pediatric palliative care program in Massachusetts. In 2010, 11 hospice agencies provided care to 227 children, with a median length of stay of 233 days. There were 11 deaths, all of which occurred in the family's requested location. Families mostly sought psychosocial and case management services, complementary therapies, and volunteer services. (page 1217)
Advance Care Planning in Heart Failure
Heart failure patients referred for disease-specific advance care planning (DS-ACP) in a large health care system had a greater likelihood of completing a health directive (94% compared with 25% among controls) and entering hospice care (56% versus 37%) at the end of life. (page 1224)
Palliative Care and Cancer Treatment Intensity at the VA
The authors performed a retrospective chart review of cancer patients who died in 2002 and 2008 to analyze the impact of a new palliative care service (in 2008) on the intensity of treatment at end of life. Overall, they found increased use of chemotherapy, lengthy hospital stays, ICU admissions, and hospital deaths in 2008 compared with 2002. However, timely palliative care consults in 2008 decreased these trends somewhat, and resulted in earlier and most frequent hospice referrals. (page 1231)
Effect of Hospice on Nursing Home Staffing
A 1997 Office of the Inspector General report warned of possible kickbacks that might be provided by hospices to nursing homes in exchange for referrals, including additional staff at no cost. This study examined the longitudinal relationship between changing hospice volume and certified nursing assistant (CNA)-minutes-per-resident day in free-standing nursing homes between 1999 and 2006. The authors found no decrease, but instead a small increase, in nursing home staffing with higher hospice volume. (page 1236)
Mandated Advisory Council on Palliative Care Policy
The authors describe the experiences and public-policy impact of the Maryland State Advisory Council on Quality of Care at the End of Life, enacted by the state legislature and a permanent part of state government. (page 1240)
Symptom Cluster Analysis in Cancer Patients
Are there patients with “symptom clusters” who are at higher risk of poor quality of life and performance status? This longitudinal study of 221 cancer patients generated two-, three-, and four-cluster subgroups and examined the relationship between cluster membership and patient outcomes. (page 1246)
Medical Student Education in Code Status Discussions
In a survey, third-year medical students reported “on the job training” as their primary education in code status discussions, and only 5% were “extremely comfortable” in having these conversations. Nearly all students stated their discussions should be supervised, and stressed the need for role models. (page 1254)