Abstract
Letters to the Editor
Pontifical Academy for Life (Vatican City) has launched a new project on the care for the dying, called “PAL-LIFE: International Advisory Working Group on the Diffusion and Development of Palliative Care in the World.”
(page 913)
Brief Reports
A web-based survey of a national sample of hospitalists aimed at understanding hospitalists' experiences and needs in serious illness communication.
(page 1013)
Fast Facts and Concepts
Single Radiation Treatment for Uncomplicated Bone Metastases
#335 (page 1032)
Rapid Radiation Therapy for Advanced Cancer of the Head and Neck
#336 (page 1034)
Personal Reflection
He was back at the bedside, holding James' hand and praying in a flowing cadence, James' eyes closed and head nodding in rhythm, as if the words were a river bearing him on its current. I saw the chaplain in a different light, saw how he—not the doctors—had positioned himself to help the man at the very crux of his suffering. He was in the right place. And the clearer the light, the sharper the shadow. For the first time, I recognized that for many patients, we doctors, whether we perceive it or not, live in the chaplain's shadow.
(page 1036)
Book and Media Reviews
(page 1045)
Recent Literature
(page 1046)
Clinician Attitudes About Palliative Sedation
The authors surveyed almost 1000 hospice and palliative care clinicians about their experiences with palliative sedation (PS). A majority felt that PS is a bioethically appropriate treatment for refractory symptoms in dying patients. Hospice clinicians used PS more consistently and with less distress than nonhospice clinicians. However, there was a lack of clear agreement about what is included in PS and how it should be best delivered in different clinical scenarios.
(page 915)
The Letter Project for Advance Care Planning
In a web-based, randomized controlled trial, patients reported the Letter Advance Directive to be a better alternative to traditional advance directive forms.
(page 954)
ACP for Older Latino Patients
The authors describe the feasibility of implementing an advance care planning (ACP) intervention for older Latino patients with one or more chronic diseases. The intervention included emotional support, help with navigating resources, and interactive decision support using motivational interviewing methods. Based on enrollment, completion rates, and feedback from qualitative interviews, the intervention was feasible and effective.
(page 984)
Impact of Pediatric Palliative Care on Healthcare Utilization
In this retrospective study of 109 patients at a large quaternary children's hospital, pediatric palliative care was associated with decreased hospital and ED use, without escalating costs.
(page 946)
MOLST Form Use in Maryland
The authors performed almost 2000 chart reviews to gather data on Maryland's Medical Orders for Life-Sustaining Treatment (MOLST) form use to evaluate performance and inform future research and practice.
(page 939)
Translation of Symptom Assessment Tool
In a pilot study, the French version of the Edmonton Symptom Assessment System-Revised was a credible tool for use by Francophone patients. The results provide a vital step in developing a standardized translation protocol that can be applied to other languages.
(page 966)
Palliative Care in Parkinson's Disease
In qualitative interviews, caregivers of patients with Parkinson's disease wanted access to emotional support and education about the disease course and how to handle emergent situations (such as falls and psychosis) and medications. Participants discussed concerns about the future, including finances, personal relationships, living situation, and caretaking challenges. All caregivers expressed interest in multidisciplinary approaches to address these needs.
(page 930)
Standardizing Comfort Care Order Sets
The authors describe how they developed and implemented a comfort care order set with opioid dosing that reflects expert recommendations. Educational tools and reference materials were embedded within the order set in the electronic medical record, as well as prompts for improved collaboration between ordering clinicians, nurses, and the palliative care team.
(page 922)
Palliative Care before LVAD Implantation
A retrospective chart review found that palliative care consultation was feasible for patients considering left ventricular assist devices (LVAD) for either as a bridge to transplant or as destination therapy. These interventions may increase family awareness of the patient's unique concerns and may have an impact on decision making at the end of life.
(page 977)