Abstract
Letters to the Editor
Proxy consent may provide the solution to improve the feasibility of end-of-life research. (page 962)
Brief Report
Examination of the dimensions of the Burden Interview conducted with a sample of informal caregivers of terminally ill home care clients. (page 967)
Fast Facts and Concepts
#210 Suicide Attempts in the Terminally Ill (page 1037)
#257 Palliative Care per Rectum (page 1038)
Personal Reflection
“I again marveled at her ability to seek information and address the unimaginable; the joyful expectation of a new life could be only moments of actual experience, and the planning of a burial was in the realm of probability.” (page 1040)
Case Discussion in Palliative Medicine
Case of severe refractory constipation in an adolescent oncology patient with widely metastatic clear cell osteosarcoma who was ultimately found to have Ogilvie Syndrome, also known as Acute Colonic Pseudo-Obstruction (ACPO). (page 1042)
Book and Media Reviews
(page 1047)
Recent Literature
(page 1048)
Latinos' Attitudes about Hospice
The authors conducted a Spanish-language cross-sectional survey of 331 immigrants from Central and South America in safety-net clinics on their knowledge, values, and potential use of hospice. They conclude that knowledge alone will not be sufficient to increase hospice use among immigrant Latinos. (page 984)
Dignity Tool in Cancer Care
Harvey Chochinov and colleagues studied the use of the Patient Dignity Inventory (PDI) among 90 psychosocial oncology clinicians across Canada to assess its utility in cancer care. The PDI revealed one or more previously unreported patient concerns in 78% of cases. (page 998)
Symptom Burden in Lung Cancer
In this secondary analysis of the Hospice and Palliative Care Evaluation (HOPE) study, inpatients with lung cancer or pulmonary metastases were more likely to have dyspnea or confusion, which was difficult to treat and associated with increased risk of death. (page 971)
Prescribing Patterns for Steroids
In this survey of 124 palliative care physicians in Japan, respondents estimated prescribing corticosteroids to 80% of terminally ill cancer inpatients to treat dyspnea, fatigue, and anorexia. Physicians had divergent practices and attitudes about steroids, and the authors recommend further studies to standardize treatment protocols. (page 1011)
Teaching Pediatric Pain Management
In this pilot study, the authors created and assessed a web-based module on pediatric pain management for medical students. Evaluation and pre- and post-surveys (n = 291 students) demonstrated improved knowledge, confidence, attitudes, and self-reported skills. (page 978)
Using Drama To Teach Communication
Walter Baile and colleagues share their use of psychodrama and sociodrama in exploring the emotional aspects of caring for advanced cancer patients. They describe specific techniques of constructing and enacting case scenarios using warm-ups, role creation, doubling, and role reversal. These techniques can reveal and address “hidden” emotions, attitudes, and values that are central to challenging cases. (page 1006)
Interpreters in End-of-Life Discussions
In this national survey of 142 interpreters, the majority had experience with end-of-life discussions but, independent of interpreter training and experience, only half reported these discussions went well. The authors recommend that health systems and interpreter certification programs incorporate specific training on end-of-life issues. (page 1019)
Symptom Burden in Cancer
Patients with advanced cancer experience a wide range of symptoms, but an optimal cutpoint between a low and high number of symptoms remains undefined. In this study, cancer patients (n = 110) completed a symptom assessment scale, and measures of depression, anxiety, and QOL. The authors' analysis found an optimal cutpoint of 12 symptoms, and depression and anxiety were more common in the high symptom group (>12 symptoms). (page 1027)
Targeted Cancer Therapy at End of Life
Researchers in Singapore found that more than half of adult inpatients with advanced solid tumors undergoing cancer treatment received targeted therapy within three months of death. The authors call for a reexamination of the risks, benefits, and decision-making process for targeted therapy in this population. (page 991)