Abstract
Letters to the Editor
I was prohibited from assisting Debra's death by prescribing medication that she could take, but I could order an intravenous medication that would end her life in hours to days. The incongruity seemed absurd. (page 587)
Brief Reports
Single center, prospective cohort study to determine the feasibility of embedding palliative medicine consultations in the hemodialysis unit during treatment runs and the impact of this intervention on advance care planning (ACP) and symptom management. (page 652)
Fast Facts and Concepts
Opioid Pharmacokinetics #307 (page 668)
Tunneled Indwelling Catheters for Malignant Ascites #308 (page 671)
Personal Reflection
Why practice? A structured discussion about death can be emotionally overwhelming. Certainly the intensity of the subject matter contributes to feeling overwhelmed, and fast approaching death is an emotional subject; however, that is not the main reason for practicing. Practicing provides us a chance to examine and manage our own emotions before we meet with patients. We need to process our personal experiences with death. (page 675)
Book and Media Reviews
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Recent Literature
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Cost Savings from Advanced Illness Management Program
The authors measured the economic impact of a proprietary advanced illness behavioral consultation program for enrolled members in a Medicare Advantage plan. The mean cost reduction for treatment members compared with matched control group members was $13,956 (p < 0.001) during the last 6 months of life and $9,285 (p < 0.001) during the last 3 months of life. (page 622)
Parents' Responses to Poor Prognosis
In this qualitative study, many parents of children with cancer considered prognostic communication to be both difficult and necessary. Although upsetting, prognostic information engendered hope by helping parents feel prepared to do their best for their children in the difficult days ahead. (page 626)
Advance Directives in the Emergency Room
In a survey of emergency medicine physicians, electronic medical records (EMRs) do not provide critical information on ACP. Dedicated ACP information on the EMR home screen plus tailored training for staff may help physicians find, use, and discuss ACP documentation to provide care aligned with patients' goals. (page 632)
Hospice Training for Family Caregivers
Joan Teno and colleagues developed and validated a survey of hospice training for caregivers to ensure safe, high-quality care in the home setting. They found sufficient reliability and validity that warrants further testing of this survey for examining the adequacy of training provided to family members. (page 639)
Medical Wishes Versus Real-World Care
The authors analyzed prospective data on written preferences and active clinical decision making among 45 patient–surrogate dyads. They found that simply comparing documented preferences for end-of-life care and medical records of care delivered did not adequately reflect process of ACP and treatment decision making at the end of life. (page 610)
Palliative Care in the Emergency Room
In this systematic review, there was no evidence that palliative care in the emergency department (ED) impacts patient outcomes, except for a possible reduction in length of stay if palliative care is introduced early in the ED rather than after hospital admission. (page 601)
Assessing Constipation with Plain Films
Researchers compared clinician reports of fecal loading on radiographs with radio-opaque marker transit studies and patients' self-reported constipation symptoms. They found systematic disagreement between observers, and poor correlations between fecal loading scores, colon transit times, and patients' symptoms. (page 617)