Abstract
Letter to the Editor
“We prospectively evaluated terminally ill patients where the implantable cardioverter-defibrillator was actively deactivated.” (page 1291)
Brief Report
Assessment of impact of a palliative care intervention that facilitates preparedness planning on attitudes and completion of advance directives in patients hospitalized for heart failure exacerbation. (page 1316)
Fast Facts and Concepts
#259 Modafinil (page 1388)
#260 Opioid Use in Liver Failure (page 1389)
Personal Reflection
“Mr. A called from their home pleading with me to tell the rescue personnel to not perform CPR. The rescue personnel repeatedly stated that as there was no durable DNR in place, they were obligated to initiate CPR.” (page 1396)
Case Discussions in Palliative Medicine
Highlights of expanding role of the palliative care consultant and the complexities associated with
earlier referrals by describing the case of a patient with an uncertain diagnosis. (page 1400)
Book and Media Reviews
(page 1404)
Recent Literature
(page 1405)
Reducing Hospital Readmissions
In this retrospective cohort study of more than 400 palliative care inpatients from 2007 to 2009, 10% of discharged patients were readmitted within 30 days. Risk of readmission was higher when patients had no services at home or transitioned to a nursing facility. Hospice or home-based palliative care after discharge was associated with significantly lower odds of hospital readmission. (page 1356)
Using Video To Support CPR Decision Making
Angelo Volandes and colleagues studied the impact of a CPR video decision support tool upon knowledge about CPR among surrogate decision makers for critically ill adults. In this pre-post intervention study, surrogates who viewed the video had more knowledge about CPR (p = 0.008) and would recommend it to others. (page 1382)
Supporting Children of Seriously Ill Adults
Communicating openly with children of seriously ill adults can reduce their anxiety and depression, but adult palliative care teams may feel ill equipped to work with children. The authors report their experience with developing a child-life consultation service for adult patients, and summarize the common needs of children, their families, and medical staff caring for them. (page 1362)
Hospice Care for Infants
Infant mortality is a persistent problem in the U.S., but hospice is rarely provided for infants at end of life. In this secondary data analysis, researchers found only 13% of California hospices provided care to infants. Nonprofit hospices were more likely to have a specialized pediatric program and more experience with dying infants and children. (page 1369)
Debriefing after a Child Dies
The authors describe a unique multidisciplinary forum for debriefing after a child dies in the ICU. In a survey, pediatric residents reported it helped them with processing, understanding, and resolving their experiences of a child's death. (page 1329)
Palliative Grief Depression Scale
V. J. Periyakoil looks at the validity of the Palliative Grief Depression Scale, a brief and psychometrically robust screening tool designed to differentiate between preparatory grief and depression in palliative care clinic patients. (page 1350)
Routes of Drug Delivery for Acute Dyspnea
Researchers interviewed patients with advanced disease about their preferences for taking opioids by oral, inhaled, sublingual, intranasal, buccal, and transmucosal routes for dyspnea. Inhalation was the most accepted, but no route seemed to be acceptable to all patients. The authors recommend patient preference should be explored before drug prescription to enhance compliance and convenience. (page 1374)
Chronic Pain in Palliative Care
Researchers collected data on more than 3000 community-based palliative care patients to describe the prevalence, intensity, progression, and associations of self-reported pain scores. They found that pain is an ongoing problem with varying causes and contributors in life-limiting illnesses. (page 1335)
Prognostic Disclosure in Japan
The authors conducted interviews with 60 bereaved family members of cancer patients in Japan. In their analysis they describe the pros and cons of disclosing prognosis from the grieving family's point of view. (page 1342)