Abstract
Letters to the Editor
Pilot study shows promising approach to identify patients with unmet palliative care (PC) needs early enough in the course of their disease to benefit from PC. Active involvement of nursing staff helped recognizing and facilitating consequences in terms of palliative support for patients in need who had only a limited lifetime. (page 9)
Brief Reports
Advance care planning (ACP) is valuable before major surgery, but a systematic review found no extant perioperative ACP tools. Patient-Centered Outcomes Research methods and Social Learning Theory can inform the development of an ACP educational video for patients and families preparing for major surgery. (page 89)
Fast Facts and Concepts
Chronic Critical Illness in Adults #343 (page 99)
Opioids for the Seriously Ill during Pregnancy #344 (page 101)
Personal Reflection
Despite my best intentions, I faltered, in part, because I had not fully appreciated the context to my patient's desperate state. She had lost her mother to cancer and was now facing a potentially lethal cancer of her own. (page 105)
Case Discussions in Palliative Medicine
With advanced-stage head and neck cancers, patients may develop large and/or complex wounds despite multiple reconstruction attempts. Wound coverage may require novel approaches to palliate the patient. (page 109)
Book and Media Reviews
(page 114)
Recent Literature
(page 116)
Effectiveness of Haloperidol as Antiemetic
Currow and colleagues conducted a prospective multicenter study in five countries across settings of care and found that haloperidol as an antiemetic provided rapid net clinical benefit with low-grade, short-term harms. (page 37)
Association between Hospice Spending and Hospitalization
Researchers observed a longitudinal cohort of >100,000 Medicare hospice beneficiaries and found hospices that spent more on direct patient care had fewer hospital admissions, fewer emergency department visits, and $1,700 less in nonhospice Medicare expenditures per patient. Ninety percent of hospices with the lowest spending on direct patient care and highest rates of hospital use were for-profit hospices. (page 55)
Inpatient Palliative Care and 30-Day Oncology Readmissions
At a large tertiary cancer hospital, researchers found that the effect of inpatient PC on readmissions in oncology was largely driven by hospice enrollment. They conclude that strategies combining PC consultation with hospice discharge may decrease hospital readmissions and improve cancer care quality. (page 62)
Dementia and Advance Directives
In this cross-sectional study of all licensed nursing homes in five U.S. states, 4 out of 10 patients with dementia lacked any advance directive. (page 16)
Racial Patterns in End-of-Life Treatment Intensity
In Pennsylvania, black-serving hospitals had higher standardized end-of-life treatment intensity than nonblack-serving hospitals, contributing to black patients' relatively higher use of intensive treatment. However, after risk adjustment at the same high-intensity hospitals, blacks were less intensively treated than whites. (page 69)
Prospective Identification of At-Risk Patients
Utilizing a Health and Retirement Study cohort with linked Medicare claims, researchers found indicators of poor health among seriously ill adults were associated with higher costs. Among people with the poorest prognoses, nonmedical characteristics such as race and regional practice patterns had a greater influence on treatment. (page 44)
Early Palliative Care in Pancreas Cancer
The authors report on a randomized pilot trial of early PC for advanced pancreatic cancer that did not meet feasibility goals. Oncologists suggested embedding PC within their clinics to increase acceptability and perceived effectiveness. (page 28)
Using Problem-Based Learning to Teach Palliative Care
The authors describe how a problem-based learning module improved medical students' knowledge and self-assessed competency in pediatric PC. (page 22)