Abstract
Letters to the Editor
In hospice and palliative care, Phase III studies are crucial to improving the quality of evidence for day-to-day practice, yet acceptance of their role is still limited to a relatively small number of clinical units. (page 986)
Fast Facts and Concepts
#164 and #165: Informed Consent in Palliative Care, Parts I & II (page 1065)
Personal Reflection
I maintain patient confidentiality always, yet find it very difficult to know that I have spoken to my patient about her fears and expectations of death and the family hasn't had that experience. (page 1072)
Case Discussions in Palliative Medicine
Ketamine may have a role in the treatment of nonneuropathic pain syndromes as well as an adjuvant role in opioid therapy by reducing opioid tolerance while enhancing efficacy. (page 1074)
Book and Media Reviews
(page 1078)
Recent Literature
(page 1079)
Neuroexcitation with Hydromorphone
This retrospective chart review of inpatient hospice patients found parenteral hydromorphone was associated with tremor, myoclonus, agitation, and cognitive dysfunction in higher doses. (page 1029)
Spirituality and Quality of Life
Researchers at Dana Farber Cancer Institute surveyed cancer patients receiving palliative radiation about their spiritual concerns, including struggles (such as feeling abandoned by God) and seeking (including forgiveness and finding meaning). Younger age and total number of spiritual concerns were associated with worse psychological quality of life. Most patients (86%) felt it was important for clinicians to attend to spiritual issues. (page 1022)
Symptoms and Prognosis
Do changes in symptoms in advanced cancer help predict death? A retrospective chart review of 166 patients in an inpatient palliative care unit at M. D. Anderson Cancer Center found persistent delirium, ongoing severe dyspnea, and worsening depression were risk factors for inpatient death. (page 1034)
Reducing PEG Tubes in Dementia Patients
The authors describe an educational-consultation intervention to reduce PEG tube placements in patients with end-stage dementia at a single urban hospital, with positive initial results. (page 1017)
Assessing Parental Self-Efficacy in Palliative Care
Caring for a child with a life-threatening illness is a challenge for parents or caregivers. The authors developed a survey asking parents their levels of confidence in medical discussions/decisions, symptom control, daily activities, feelings/concerns, spirituality, and end-of-life care. Focus groups of parents rated almost all questions as “important” and they were “comfortable being asked.” (page 1009)
Treatment and Outcomes in Malignant Bowel Obstruction
Which variables are associated with survival in malignant bowel obstruction? A retrospective data analysis of 191 patients with gastric outlet (21%), small bowel (64%), or large bowel (15%) obstruction found multiple sites of disease on imaging predicted shorter survival. Overall median survival was 3.5 months. (page 990)
Effect of a Cancer Cachexia Clinic
Clinicians at a cancer cachexia clinic at M. D. Anderson reviewed cases of 151 patients to determine the prevalence of secondary factors on weight loss, including nausea, constipation, hypogonadism, and hypermetabolism. After pharmacologic and nonpharmacologic interventions, patients' appetite improved and one third had gained weight by their second clinic visit. (page 1004)
Truth-Telling in Hong Kong
Researchers mined the records of 935 cancer patients who died in a palliative care unit in a Hong Kong hospital. Patients and families who did not have a clear awareness of prognosis seemed to have more anxiety and difficulty communicating with each other. (page 997)