Abstract
Brighton LJ, Bristowe K: Communication in palliative care: Talking about the end of life, before the end of life. Postgrad Med J 2016;6:466–470.
Increasing evidence demonstrates the benefits of early end-of-life care discussions with patients with life-threatening illness and their families. However, these conversations often do not occur. This review explores some of the many barriers faced by clinicians in relation to end-of-life care discussions, including prognostic uncertainty, fear of causing distress, navigating patient readiness, and feeling unprepared for these conversations. The value of core clinical communication skills, potential strategies for improvement, and areas for future research are also discussed. It is essential that clinicians offer patients facing life-threatening illness, and those close to them, the opportunity to discuss end-of-life issues in line with their information and decision-making preferences. With a growing and aging global population, supporting both generalist and specialist providers of palliative care in this task is key. With careful preparation, fears of undertaking these discussions should not be a barrier to initiating them.
Latifyan L, Genot MT, Klastersky J: Bisphosphonate-related osteonecrosis of the jaw: A review of the potential efficacy of low-level laser therapy. Support Care Cancer 2016;24:3687–3693.
Osteonecrosis of the jaw (ONJ) resulting from administration of bisphosphonates (BP) or denosumab is a rare but severe complication in cancer patients. Complete remission depends on the stage of ONJ; it can be estimated in the range of 20%–30%. Low-level laser therapy (LLLT) is a logical additional option, as it has been recognized effective for the management of chemotherapy and/or radiotherapy-induced mucositis. LLLT irradiation has anti-inflammatory actions and thus can help to control pain, as well as biostimulating properties with favorable actions on bacterial control and wound healing. The authors reviewed the results of seven published studies of LLLT in BP-associated ONJ. LLLT results in an overall response rate of 55%, superior to that observed in controls (30%). Their review suggests that there might be an advantage to add LLLT to the “classical” management of ONJ. This therapy is easy to administer and is not associated with any known side effects. Further research is needed to remove any doubt of protection or enhancement of carcinogenic processes. The authors believe that prospective well-controlled studies of LLLT in ONJ are warranted. If the positive results are confirmed, it would represent a great improvement for the quality of life of many patients.
Lene Moestrup RN, Hvidt NC: Where is God in my dying? A qualitative investigation of Faith Reflections among hospice patients in a secularized society. Death Stud 2016. [Epub ahead of print]; https://dx-doi-org.web.bisu.edu.cn/10.1080/07481187.2016.1200160
Despite increased focus on the role of spiritual care in palliative care, there is limited knowledge about spirituality/religiosity among dying patients in secularized cultures such as in Denmark. This study aims through semistructured interviews with Danish hospice patients and participant observation to elucidate how hospice patients reflect and act upon their potential faith. The results demonstrated three dimensions of faith: (1) “knowing” (cognition), (2) “doing” (praxis), and (3) “being” (meaning). The authors conclude that most patients had a hesitant but, according to their situation, important faith although it was not something they knew much about, let alone discussed or practiced much.
Putman MS, Tak HJ, Curlin FA, Yoon JD: Quality of life and recommendations for further care. Crit Care Med 2016. [Epub ahead of print]; DOI: 10.1097/CCM.0000000000001846.
Physician recommendations for further medical treatment or palliative treatment only at the end of life may influence patient decisions. Little is known about the patient characteristics that affect physician-assessed quality of life or how such assessments are related to subsequent recommendations. A 2010 mailed survey of 1878 practicing U.S. physicians was undertaken; 1156 or 62% of eligible physicians responded. Measures included an end-of-life vignette with five experimentally varied patient characteristics: setting, alimentation, pain, cognition, and communication. Physicians rated vignette patient quality of life on a scale from 0 to 100 and indicated whether they would recommend continuing full medical treatment or palliative treatment only. Cognitive deficits and alimentation had the greatest impacts on recommendations for further care, but pain and communication were also significant (all p < 0.001). Physicians who recommended continuing full medical treatment rated quality of life three times higher than those recommending palliative treatment only (40.41 vs. 12.19; p < 0.01). Religious physicians were more likely to assess quality of life higher and to recommend full medical treatment. The authors conclude that physician judgments about quality of life are highly correlated with recommendations for further care, and patients and family members might consider these biases when negotiating medical decisions.
Chidiac C, Connolly M: Considering the impact of stigma on lesbian, gay and bisexual people receiving palliative and end-of-life care. Int J Palliat Nurs 2016;22:334–340.
Stigma is a common characteristic among lesbian, gay, and bisexual (LGB) people's lives. The LGB population faces a challenge in finding ways to adapt to its stigmatized identity. Stigma and its related processes can have an isolating and negative affect on LGB individuals, who are seen as and often perceive themselves as different. Stigma can also have a negative effect on health and well-being and can influence the type of care received from health and social care professionals, including those working in palliative care. This article presents a discussion of the impact that stigma has on LGB people who access and receive palliative and end-of-life care.
Morin L, Beaussant Y, Aubry R, et al.: Aggressiveness of end-of-life care for hospitalized individuals with cancer with and without dementia: A Nationwide Matched-Cohort Study in France. J Am Geriatr Soc 2016. [Epub ahead of print]; DOI: 10.1111/jgs.14363.
The objective of this study was to compare the aggressiveness of end-of-life care in hospitalized individuals with cancer with and without dementia in France. The study was a nationwide register-based matched-cohort study of hospitals in France. All individuals with cancer aged 65 and older with a diagnosis of dementia who died between January 1, 2010, and December 31, 2013, were matched one-to-one with individuals with cancer without dementia (n = 26,782 matched pairs). Results demonstrated that older individuals with cancer and dementia were less likely to receive aggressive treatment in their last month of life than those with cancer who were not diagnosed with dementia. Individuals with dementia were also less likely to receive radiation therapy, blood transfusions, artificial nutrition, and invasive ventilation, although they were more likely to remain hospitalized over their entire last month of life and to have more than one emergency department visit. The authors conclude that older hospitalized adults with cancer and dementia are less likely to receive aggressive cancer treatment near the end of life than those with cancer and without dementia, and that this discrepancy raises important ethical questions for clinicians and healthcare policy makers.