Abstract
Letters to the Editor
Study analyzing POLST forms of states with “developing,” “regionally endorsed,” “endorsed,” or “mature” programs as designated by the National POLST website, and assessing them for use of the phrase “Allow Natural Death.” (page 695)
Brief Reports
Exploratory study surveying the perspectives on the work life of contemporary palliative care patients. Secondary aims included documenting changes in work status during the illness trajectory and identifying predictors of remaining in employment during treatment and follow-up. (page 770)
Fast Facts and Concepts
Comparison of Fentanyl Oral and Nasal Formulations #331 (page 784)
End-of-Life Care for Patients with Schizophrenia #332 (page 787)
Personal Reflection
It was like watching a train wreck in slow motion. Because her medical course was couched in the language of potential reversibility, we could not get past “maybe it will work.” Much of our time spent together was just listening to her talk—about her fear, her family, her sadness, and her loneliness. (page 791)
Book and Media Reviews
(page 794)
Recent Literature
(page 795)
Impact of Community-Based Palliative Care
In a retrospective study of >28,000 Australian patients who died of cancer for a 10-year period, researchers found that people who had community-based palliative care (CPC) were three times as likely to die outside the hospital. CPC also reduced acute care admissions, bed days, and costs for the last year of life. (page 736)
The Surprise Question
In a hospital setting, clinicians reported that use of the “surprise” question (“would you be surprised if this patient died within the next year?”) was feasible, acceptable, and useful in prompting goals-of-care discussions between medical teams, patients, and families. Many clinicians had concerns about the accuracy of the question, and the authors recommend additional research on its predictive value. (page 729)
Methadone and QTc Prolongation
In this case control study of adult inpatients receiving methadone for pain management, predictors of QTc prolongation included congestive heart failure, peptic ulcer disease, hypokalemia, rheumatological disorders, use of medications with a known risk of QTc prolongation, malignancy, hypocalcemia, and methadone doses >45 mg/day. (page 722)
Early Palliative Care for Veterans
Researchers conducted a retrospective analysis of >5,500 patients who died in a Veterans Administration inpatient palliative care unit and found that earlier palliative care was associated with overall greater family satisfaction with care. (page 745)
Exploring Goals with Chronically Critically Ill Patients
In a survey of patients, family, and staff at a long-term acute care hospital, the authors learned that conversations about goals of care can be accomplished in a relatively short period of time, and are acceptable and perceived as worthwhile by chronically critically ill patients, surrogate decision makers, and clinicians. (page 710)
Evidence to Guide Health Policy on End-of-Life Care
The authors describe their analysis of hospital utilization data in Canada to obtain population-based evidence to inform end-of-life health policy and services planning. (page 752)
Measuring Family Satisfaction
The authors describe a new, brief five-item measure of family satisfaction, and suggest that less lengthy and burdensome surveys of family satisfaction can still be valid and provide high-quality assessments across care settings. (page 716)
Understanding Hospice
In qualitative interviews, patients with metastatic cancer had misunderstandings about hospice and perceived concerns such as fear of suffering, death, and loss of dignity, as well as lack of knowledge as the main barriers to hospice utilization. (page 759)