Abstract
Letters to the Editor
A good time was had by all at the annual laxative tasting. (page 268)
Brief Reports
A series of small-scale projects aimed at developing and refining an instrument to assess acute pain in noncommunicative hospice patients. (page 287)
Fast Facts and Concepts
#237–238: Evaluation and Management of Spinal Cord Compression. (page 361)
Personal Reflection
The team had been using Sandra as the interpreter, putting her in the position to break the bad news. Doing this over and over had made her a target in the family. (page 369)
Case Discussions in Palliative Medicine
Experience using dexmedetomidine as an adjuvant analgesic for intractable cancer pain in a palliative care unit. (page 371)
Book and Media Reviews
(page 375)
Recent Literature
(page 376)
Family Opinion and Quality
Quality is in the eye of the beholder. Interviews with family members showed an approximately fivefold variation in the importance that families placed on aspects of palliative care (low: pain management, weight = 0.54; high: providers were “kind, caring, and respectful,” weight = 2.46). (page 301)
Adverse Events in Hospice and Palliative Care
What is the feasibility of collecting symptomatic adverse events in hospice and palliative care and assessing their incidence? Seventy-eight percent of patients had events precipitating admission, of whom 31 (62%) had at least one further event during admission. Eleven of 15 people who were admitted without an event experienced at least one during their admission. Only 4 did not have an adverse event. Given the frailty of hospice and palliative patients, any adverse event is likely to accelerate irreversibly toward death. (page 309)
Symptom Assessment Scale
A new Symptom Assessment Scale (SAS) uses a 0–10 numerical scale, is brief and clinically useful, and was administered with minimal missing data. Internal consistency reliability estimates of the scale ranged from 0.64 to 0.92 as measured by the Cronbach's α coefficient. The instrument does not provide an in-depth assessment of individual symptoms, but serves as a screening tool to identify troublesome symptoms that warrant attentive and immediate investigation and comprehensive assessment. (page 315)
Primary GP Palliative Care
Between January and December 2008, GPs participating in a nationally representative sentinel surveillance network of GPs were asked to register, using standardized forms, the extent of discussing 10 end-of-life issues with patients. GPs often waited until very close to death before they discussed end-of-life issues with patients, and discussed spiritual and social issues less than physical symptoms, diagnoses, and psychological problems. (page 323)
Teaching Advance Care Planning
Physicians-in-training struggle with advance care planning (ACP) discussions in the inpatient setting, and may not be aware of newer models for ACP that stress the importance of giving prognostic information and making a recommendation about cardiopulmonary resuscitation to patients and families. Patients on the intervention floor were more likely to have a discussion about goals of care (33.8%) than patients on the control floor (21.2%, p = <0.001)) and more likely to have a limitation of life-sustaining treatment upon discharge (19.1% vs. 13.9%, p = 0.04), but there is clearly a long way to go. (page 331)
Prognostic Importance of Symptoms
Patients completed the Edmonton Symptom Assessment Scale (ESAS) prior to palliative radiotherapy consultation and at follow-up at the Odette Cancer Centre between 1999 and 2009. All nine ESAS symptoms significantly deteriorated in the last 4 weeks immediately before death when compared with those scores in the preceding months. At one week prior to death, the worst ESAS symptoms experienced by patients were fatigue, appetite, and well-being. (page 337)