Abstract
Letters to the Editor
Compared to ten eligible participants per year at our institution who met the same inclusion criteria, Facebook advertising was a feasible and effective strategy to quickly recruit a diverse sample of children with advanced cancer and their parents. (page 692)
Brief Reports
Although an interdisciplinary approach is considered best practice for caring for patients at the end of life, or in need of palliative care, there is growing tension between healthcare organizations' need to contain costs and the provision of this beneficial, yet resource-intensive service. (page 767)
Fast Facts and Concepts
Pharmacologic Management of Depression in Advanced Illness #309 (page 783)
The Oncology-ICU-Palliative Care Interface #310 (page 785)
Personal Reflection
Sitting next to Margaret's bed, I watched her interact with others in the room, others who only she could see. Her oxygen tubes now lay off to the side of the bed and I watched her turn her head toward various places around the room, just as someone might if they were surrounded by loved ones talking around them. (page 788)
Book and Media Reviews
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Recent Literature
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Assessing Students' Competency in Palliative Care
The authors describe a new observed structured clinical examination (OSCE) for assessing palliative care competencies in medical students who have completed a four-year, longitudinal palliative care curriculum at Yale Medical School. They found the OSCE was feasible to implement with high inter-rater reliability and evidence supporting validity, and moderate internal consistency. (page 706)
Training APRNs in Primary Palliative Care
The authors designed a week-long intensive externship for advanced practice registered nurses in primary palliative care across disease populations at an academic medical center. The externship included didactic, experiential, and clinical components to meet the needs of APRNs with minimal palliative care education and/or experiences. Pre- and post-survey results demonstrated increased knowledge, skills, and confidence in palliative care among attendees. (page 753)
Gender and DNR Orders
In this retrospective cohort study of more than 4000 inpatients with cancer and their physicians, researchers found that female patients were more likely to receive early do-not-resuscitate (DNR) orders from their female physicians. The authors conclude that gender and gender interaction between physician and patients may potentially influence the timing of receiving a DNR order. (page 728)
Training Residents in ACP Discussions
A multimodal curriculum including self-directed learning, lectures, and practice with simulated and actual outpatients with active reflection and feedback was effective in improving resident comfort level and formal training in ACP. (page 734)
Measuring Patient and Family Experience
This pilot study tested the feasibility of a standardized, common instrument to measure patients' and families' care experiences across multiple settings in the last three months of life. (page 712)
Communication Training for Interprofessional Teams
Interprofessional, hospital-based, palliative care team members were competitively selected to participate in a two-day training using a new communication curriculum. Participants included 28 nurses, 16 social workers, 8 physicians, 5 chaplains, and 1 psychologist. Participants then taught an additional 962 providers and initiated institution-wide training for clinical staff, new hires, and volunteers. This training improved communication processes and increased attention to communication with family caregivers. (page 746)
Messaging Palliative Care
The authors surveyed more than 300 clinicians at a large private Australian tertiary hospital and conducted focus groups that revealed a lack of understanding of palliative care. The clinicians expressed a desire for education in end-of-life communication skills, ethical issues, and delirium management, among other needs. (page 720)