Abstract
Letters to the Editor
The pros, cons, and a brief cost analysis of cataract surgery in the hospice population are presented. After cataract surgery, improved quality of life may improve vision, which may permit hospice patients to see loved ones, increase independence, and ambulate without navigational assistance. (page 1245)
Brief Reports
Evaluation of a novel program in which a nurse conducts scripted pre-Ventricular Assist Device visits to promote advance care planning and triage the need for a full palliative care consult.
(page 1312)
Fast Facts and Concepts
Palliation of Neurogenic Bowel #317 (page 1341)
Prophylactic Feeding Tubes in Head and Neck Cancers #318 (page 1343)
Personal Reflection
“I thought that my strength was tested as a resident doing Q4 call and then as a nervous, new attending, but nothing has prepared me for having a toddler while watching toddlers die of cancer.” (page 1349)
Case Discussions in Palliative Medicine
Three cases highlighting the use of low-dose adjuvant methadone to manage complex neuropathic pain in the frail elderly. (page 1351)
Book and Media Reviews
(page 1356)
Recent Literature
(page 1357)
State Reporting on Palliative Care
In this cross-sectional study of 203 hospitals in California, self-reported palliative care program characteristics in a statewide database were associated with significantly lower inpatient utilization by Medicare decedents. (page 1281)
Prognostic Accuracy in Oncology
In a multicenter prospective, longitudinal study of patients with advanced cancer, oncologists were able to estimate patients' prognoses within a year. This prognostic accuracy was associated with higher rates of do-not-resuscitate order completion, advance care planning, and lower likelihood of chemotherapy use near death. (page 1296)
Communication in Nursing Homes
In an analysis of communication processes and quality metrics among more than 1200 nursing homes, researchers found that better communication between providers and residents/family members was associated with fewer in-hospital deaths. However, better communication among providers was significantly associated with lower use of hospice. (page 1304)
Pain and Heart Failure
In this prospective cohort study, heart failure patients reported that pain was common and persistent, mostly because of noncardiac causes. Pain was also associated with depression in these patients and negatively impacted their quality of life. (page 1254)
Geriatric Burn Deaths
The authors found the vast majority of geriatric deaths at their Level 1 Burn Center occurred after discussions about end-of-life care. The timing of these discussions was driven by severity of injury, but did not lead to higher rates of immediate decisions for comfort care. They argue the presence and timing of end-of-life discussions should be considered quality metrics for geriatric burn patients. (page 1275)
Home-Based Palliative Care
In this retrospective population-based study, integrated primary and specialist home-based palliative care for chronic diseases was associated with a reduction in hospital stays near the end of life and in-hospital deaths. (page 1260)
Head and Neck Lymphedema
The authors interviewed 20 patients with head and neck cancer who described multiple physical symptoms and psychosocial concerns because of lymphedema. The authors advocate for early assessment to initiate lymphedema management to help reduce long-term symptom burden and functional deficits. (page 1267)
Symptoms at the Very End of Life
This prospective study analyzed the symptom assessments of almost 19,000 patients likely to die within hours to days to better understand the prevalence, intensity, and associations of physical symptoms in different settings of care. Although the majority of patients appeared to have good symptom control, people who died at home were more likely to have severe symptoms. (page 1288)