Abstract
Letters to the Editor
Case study reporting on the feasibility and utility of concurrently delivering dignity therapy and family therapy and adapting to match the patient's level of physical functioning and psychological needs. (page 115)
Brief Reports
Retrospective review of clinical data of all patients who received palliative radiotherapy for bleeding from unresectable gastric cancer. (page 177)
Fast Facts and Concepts
Deprescribing #321 (page 197)
Discontinuation of Statins at the End of Life #322 (page 199)
Personal Reflection
“I'm sorry. I forgive you.
Thank you. I love you.” Some people hold their last breath hoping and waiting for days, hours, minutes, even to the very last second to hear these words. Unfortunately, for some, they may never come. They wait for death with their hearts as vacant as the cold chair next to the bed. (page 202)
Case Discussions in Palliative Medicine
A case of an 86-year-old woman with dry gangrene of her foot admitted to hospice for end-of-life care and, after a trial period on hospice, chose to pursue further treatment. The case illuminates the need for concurrent care for hospice patients with serious illness, exemplifies the gap, and offers a framework for managing patients in transition between disease-modifying therapies and hospice care. (page 207)
Book and Media Reviews
(page 211)
Quality of Decision Making through Physician Orders for Life-Sustaining Treatment
In interviews with nursing home patients and their healthcare agents, researchers evaluated the quality of conversations leading to physician orders for life-sustaining treatment (POLST) decisions. Current treatment preferences were initially discordant with one or more POLST for 64% of participants, but half of these discordances were resolved with further discussion. Discordance by treatment decision was as follows: CPR (7%), level of medical intervention (18%), antibiotics (21%), and artificial nutrition (11%). (page 155)
Readmissions in Heart Failure
In this retrospective cohort study with propensity matching, there was no reduction in the risk of 30-day readmission among heart failure patients seen by palliative care in the hospital compared with controls. The subgroup analysis suggested that the difference between the palliative care and control groups may reflect residual confounding. (page 163)
Impact of a Pediatric “Reflection Room”
The authors describe the creation and use of a “reflection room” for children who are actively dying and their families in the hospital. A staff survey was overwhelmingly positive, citing advantages of increased privacy, allowance for more visitors, and a quieter, calmer environment. There was a measureable decrease in number of deaths in the intensive care unit, which was a significant change in hospital practice. (page 120)
Perspectives on Advance Care Planning
The authors interviewed 25 people with serious physical disabilities to understand their perspectives on the value of advance care planning (ACP). Participants wished to engage in a relationship-centered approach to ACP, yet voiced hesitation because of experiences of medical bias and mistreatment, often surrounding judgments about their quality of life. (page 127)
Medical Student Reflections on Palliative Care
Final-year medical students completed a mandatory, brief clinical experience in palliative care followed by a reflective writing assignment, which was analyzed by the authors. They found this intervention provided the students with a deeper understanding of palliative care as well as a life-changing personal experience. (page 147)
Mortality in Pulmonary Fibrosis
Researchers examined the characteristics of patients with idiopathic pulmonary fibrosis (IPF) admitted to an intensive care unit, as well as the frequency and timing of referral to palliative care. Most patients displayed a gradually progressive course, but a significant minority experienced acute deterioration with high mortality. The authors conclude that patients and families should be informed early about palliative care after diagnosis of IPF. (page 134)
Hope after Acute Brain Injury
Researchers interviewed families, nurses, and physicians in a neurointensive care unit about the palliative care needs of patients with acute brain injury and their families. They found that clinicians used hope as an object that can be given or taken away, generally in the process of conveying prognosis, while families expressed hope as an action that supported coping with their loved one's acute illness and its prognostic uncertainty. Participants described the loss of personhood through brain injury, and the importance of relatedness and connection. (page 170)