Abstract
Letters to the Editor
An online survey to assess symptoms and symptom management of newly diagnosed patients with pancreatic cancer. (page 640)
Brief Reports
Study describing the implementation of the National Quality Forum #0209 measure in 10 hospices and identifying patient characteristics associated with scores. (page 721)
Fast Facts and Concepts
#280 Dexmedetomidine (page 733)
Personal Reflection
“They told her she was dying and recommended that she sign a DNR. CPR would be futile, they said, only leading to further pain and suffering. Ms. A., they explained, would be better served by comfort measures than by aggressive interventions. However, with multiple family members firmly entrenched at her bedside, Ms. A. spoke what turned out to be her last wish. “I want one round,” she muttered. (page 741)
Recent Literature
(page 743)
Goals-of-Care Conversations before High-Risk Surgery
In a small pilot study at a preop testing center, most patients and surrogates found a structured conversation about the patient's goals and preferences for medical treatment helpful before high-risk surgery. (page 701)
Patient Awareness of Prognosis
In this large prospective cohort study, few patients with advanced cancer could articulate an accurate prognosis estimate. Physicians' willingness to discuss prognosis earlier was associated with more accurate patient reports of prognosis. Enhancing the communication skills of providers with important roles in cancer care may help to improve cancer patients' understanding of their prognosis. (page 673)
Medical Students as Hospice Volunteers
The authors describe the utility and impact of exposing first-year medical students to end-of-life care through a hospice volunteer experience. (page 696)
Unmet Needs for Palliative Care
Patients with advanced cancer with unmet symptoms and psychological/emotional needs perceive a high need for palliative care services but may not request them. Efforts to increase appropriate use of subspecialty palliative care for cancer may require oncologist-initiated referrals. (page 667)
Whole-Brain Radiation as Trigger for Palliative Care
In this retrospective study, cancer patients requiring whole-brain radiation (WBRT) had a predictable dying trajectory, but referrals to palliative care occurred late. The authors suggest that WBRT could be used as trigger for initiating end-of-life discussions and involving palliative care sooner. (page 662)
Dignity Therapy and Depression
The authors describe the benefits of dignity therapy on depression and anxiety in patients on a palliative care unit. They found the benefits were sustained over a 30-day period. (page 688)