Abstract
Letters to the Editor
Exploring the prevalence of documented do-not-resuscitate orders in advanced cancer patients referred to the Rapid Response Radiotherapy Program for palliative radiotherapy. (page 1296)
Brief Reports
A descriptive pilot study performed to explore the characteristics of death among young adults (18–39 years) with cancer who died in a tertiary academic hospital in order to elucidate their end-of-life trajectory. (page 1359)
Fast Facts and Concepts
#285 Chemotherapy-Induced Nausea and Vomiting (page 1400)
Personal Reflection
The patients come, more and more, as my net of the dying grows ever wider. Bracketing, I'm good at. I choke down tears at family meetings and repress memories of my own family's cancer battle that I see etched in the faces of my patients. I stuff the emotions away for a more appropriate time. It's unbracketing that I find harder. (page 1403)
Recent Literature
(page 1412)
Taking a Snapshot of Outpatient Palliative Care
In a survey of all 377 acute care hospitals in California, very few offered outpatient palliative care services. Among existing programs, adult and pediatric outpatient clinics care mostly for cancer patients, operate part-time with modest staffing, and are funded primarily by their institution. The authors argue that making the case for value to engender institutional support, increasing billing revenue and system initiatives, as well as partnering with insurers may increase access to outpatient palliative care. (page 1311)
Reducing Health Care Costs through Home-Based Palliative Care
A home-based palliative care program, created through a hospice–private payer partnership, reported substantial cost savings in the last three months of life ($6,804 per member per month for palliative care patients versus $10,712 for usual care). The program also enhanced hospice entry (70% versus 25%) and longer lengths of stay in hospice (median 34 versus 9 days). (page 1328)
Assessing Pain among Older Jail Inmates
In a cross-sectional study of 210 older jail inmates, the authors describe high rates of pain in this rapidly growing population, with multimorbidity and functional impairment. They suggest that jails are important sites for assessing symptom burden and developing palliative care services. (page 1336)
Understanding Existential Distress
Researchers report on a novel two-day education program for nurses on the impact of patients' feelings of meaninglessness on nurses' confidence, self-reported practice, burnout, and attitudes toward caring for patients with existential distress. (page 1298)
Surveying Pediatric Palliative Care in California
The authors surveyed all California hospitals and found that every specialty hospital and a few mixed hospitals offered pediatric palliative care services. They advocate for better understanding of the palliative care needs of seriously ill children in mixed hospitals, as well as better assessments of quality of care. (page 1306)
Recommending a “Comfort Care Goal” for Dementia Patients
Results from the Dutch End of Life in Dementia study showed that 56% of 326 patients in 28 nursing facilities had a comfort-care goal upon admission; over time, more than 89% of patients had a comfort-based goal prior to death. Patients with an early comfort-care goal were more likely to be religious and have a short prognosis. Their families were more likely to be satisfied with family-physician communication and have a more highly educated family member. (page 1317)