Abstract
Letters to the Editor
Claiming that physician-assisted death somehow improves care for terminally ill and suffering patients is not only factually incorrect but provides spurious support for efforts to legalize the practice in states where hospice care is not as strong and palliative care not nearly as available. (page 479)
Brief Reports
Study assessed patient adherence rates to neuropathic pain medications in a palliative care clinic and compared patient self-reported adherence to pharmacy refill records. (page 538)
Fast Facts and Concepts
Death Disclosure and Delivery of Difficult News in Trauma #305 (page 566)
The Role of Melatonin in Palliative Care #306 (page 568)
Personal Reflection
The surgeon explained to my parents the details of the surgery and outlined the treatment plan using terms like “adherent mass,” “mesenteric lymph nodes,” “consulted an oncologist.” My parents listened quietly, never saying a word. As soon as the surgeon left, my mother turned to me and asked, “What did he say?” (page 574)
Book and Media Reviews
(page 576)
Recent Literature
(page 578)
Surgeons' Perspectives on Nonbeneficial Treatments
In semistructured interviews, emergency general surgeons reported feeling responsible for having preoperative discussions about end-of-life care with seriously ill older patients to avoid nonbeneficial surgery. However, surgeons identified multiple factors that undermine adequate communication and lead to nonbeneficial surgeries. (page 529)
Hospice Visits during the Last Week of Life
In this retrospective study of more than 92,000 hospice patients, the average number of hospice team member visits in the last week of life was 1.36 visits/day. Most were nurse visits, followed by aides, social workers, and chaplains. Visits increased over each day on average across the last week of life. Greater increase in visits was associated with patients who were younger, male, Caucasian, had a spouse caregiver, and with shorter lengths of stay. (page 482)
Reduced Intensity Treatment in Dialysis Patients
This randomized trial assessed the feasibility of low-intensity treatment in end-stage renal disease patients who are not eligible for transplant. Intervention subjects were treated with liberalized goals for serum phosphorus and parathyroid hormone as well as predialysis blood pressure in comparison to usual care subjects. The authors conclude that high-risk hemodialysis patients may benefit from liberalized treatment guidelines, but larger studies are necessary. (page 503)
Hospice Clinicians' Views on Benzodiazepines
In a national survey, most hospice nurses and many hospice physicians viewed benzodiazepines favorably for various indications, despite little supportive clinical evidence. (page 516)
Influence of Spouses on Older Adults' Hospice Use
The authors analyzed data from the Health and Retirement Study, the Dartmouth Atlas of Health Care, and Medicare claims and discovered that a surviving spouse's health was not associated with hospice use by their terminally ill partner. However, the surviving spouse's education level was a predictor of hospice use. (page 509)
Suicidal Ideation in Multiple Sclerosis
Researchers surveyed more than 500 patients with severe multiple sclerosis (MS) and identified risk factors for suicidal ideation, including the extent to which MS affects leisure time, depression, and feeling socially excluded. Factors that reduced suicidal ideation included having a purpose in life, being productive, and having comfort in faith and spiritual beliefs. (page 523)
Impact of Symptom Burden on Place of Death
Researchers examined the association between actual place of death and symptom burden among Japanese patients with advanced cancer living at home. Patients were more likely to die in the hospital when pain and dyspnea were present, but less likely when delirium was present. The authors call for a rapid admission system for inpatient hospice, as well as development of home-based palliative care services. (page 488)