Abstract
Letters to the Editor
Creating a consensus document on early palliative and continuing care. (page 466)
Brief Reports
Analysis of data for referrals to palliative care service, to assess trends in the number and proportion of referrals received from hematology, and changes in the characteristics of these referrals. (page 537)
Fast Facts and Concepts
#266 Consultation Etiquette in Palliative Care (page 578)
#267 Writing the Consultation Note(page 579)
Personal Reflection
“It seems the hardest answer in medicine is ‘I don't know,’ but, I must admit, even in the age of nanotechnology, stem cells, and molecular pharmacology, this answer isn't all that uncommon.” (page 586)
Case Discussion in Palliative Medicine
A case illustrates some of the challenges that patients, families, caregivers, and medical teams face with life-limiting illness in the disenfranchised poor. (page 587)
Book and Media Reviews
(page 591)
Informed Consent in Palliative Care Research
This paper outlines ethically valid consent approaches and discusses their applicability to hospice and palliative care research trials. The authors argue increased use of the less-traditional modes of informed consent may lead to greater participation rates in hospice and palliative care trials. (page 485)
Caring for Children on Life Support
Extracorporeal life support (ECLS) is complex, life-sustaining therapy that creates stressful dilemmas for families. At Seattle Children's Hospital, the Pediatric Advanced Care Team sees all ECLS cases through automatic referral. The authors describe their framework for providing palliative care for ECLS patients and families. (page 492)
Use of Health Services along Illness Trajectory
In this prospective cohort study researchers looked at predictors of health service use across the trajectory of illness. Their findings may help case managers, health administrators, and policy decision makers to better allocate resources to palliative care patients. (page 524)
Patients Still Prefer To Die at Home
Researchers surveyed more than 1200 adults in Alberta, Canada, by phone and found 70.8% preferred to be at home near death. The authors conclude this widespread preference indicates a public health need to promote good home deaths. (page 502)
Developing an International Standard for Assessing Pain
In a multisite European study, the authors evaluated the Edmonton Classification System for Cancer Pain (ECS-CP) as a first step towards developing a standardized international system for assessing and classifying cancer pain. They describe the prevalence of five ECS-CP features—pain mechanism, incident pain, psychological distress, addictive behavior, and cognition—in a diverse international sample of advanced cancer patients. (page 516)
Training International Medical Graduates
Holly Yang, Frank Ferris, and colleagues describe how a four-week course in palliative medicine can improve the attitudes, knowledge, and self-assessed competence in international medical graduates to the level of U.S. trainees. (page 471)
Does a Half-Day Course in Palliative Care Matter?
Swedish researchers offered a half-day course in palliative care to clinicians and evaluated its usefulness to attendees immediately and at three months. The attendees felt it improved their management of symptoms, support for families, and teamwork; however they reported moral distress about barriers to changing end-of-life care practices in general. (page 496)
Prognosis in Congestive Heart Failure
Veterans Administration researchers collected data on 386 people with advanced congestive heart failure to trace mortality risk in their last 12 months of life. They found most decedents had predictable and gradual progressions towards death. They conclude that recognizing these trajectories can help clinicians create a plan of care to better meet the patients' needs. (page 478)