Abstract
Letters to the Editor
Promoting the economic benefits of palliative medicine could promote distrust if clinicians perceive themselves to be working in an environment that devalues compassionate care for the sake of economic benefits. (page 738)
Brief Reports
A single-center, retrospective chart review evaluating adult patients who died while receiving continuous morphine infusion at the end of life. (page 786)
Fast Facts and Concepts
Opioid Induced Constipation Part 1: Established Management Strategies #294 (page 799)
Personal Reflection
Handling the dying process with respect to the patient's wishes is not clearly outlined in my education. Even for patients who have been in the hospital for long periods, we push for aggressive, toxic treatments to keep the patients living longer. (page 803)
Case Discussions in Palliative Medicine
Two terminal cancer patients with severe pain that was unresponsive to escalating doses of opioids and psychological symptoms refractory to various treatments. Pain and psychological symptoms were controlled with intermittent palliative sedation. (page 807)
Book and Media Reviews
(page 811)
Recent Literature
(page 812)
Assessing Variation in Hospice Use by State
In their study of state-level patterns of hospice use, the authors conclude the national percentage of decedents who use hospice may mask important local variation in these patterns, including the timing of hospice enrollment, an important component of the quality of end-of-life care. (page 771)
Understanding Gaps in Oncology Training
In a national survey, hematology-oncology fellows reported more confidence in caring for patients at the end of life after doing a palliative care rotation. However, more than 25% stated they were not explicitly taught how to assess prognosis, when to refer a patient to hospice, or how to conduct a family meeting to discuss treatment options during their fellowship. (page 747)
Framing Goals-of-Care Conversations
In a high-fidelity simulation with a critically and terminally ill patient, a majority of physicians framed the available options by implying life-sustaining treatment as the expected or preferred choice. However, a third of these physicians also felt intubation would be inappropriate in this clinical situation. (page 740)
Screening for Substance Abuse
A majority of palliative care fellowship programs do not have substance abuse policies nor routinely screen patients and caregivers. The authors argue for consensus guidelines to address substance abuse and diversion in palliative care patients to address this growing, national problem. (page 752)
Teaching Primary Palliative Care
The authors of Education in Palliative and End-of-Life Care (EPEC) report on its dissemination in oncology, emergency medicine, care of veterans, and global health, and estimate more than 74,000 learners have been trained in this curriculum. They also found medical school courses, continuing medical education courses, and specialty guidelines that incorporate material from EPEC. (page 765)
Identifying Themes in Good Communication
In interviews and focus groups, patients and caregivers on an inpatient palliative care unit described elements of communication most important to them: (1) building rapport to create trust and kinship; (2) addressing expectations and explaining goals of care; (3) keeping patients and families informed about the patient's condition; (4) listening actively to validate patients' concerns and individual needs; and (5) providing a safe space for conversations about death and dying. (page 758)