Abstract
Letters to the Editor
Intrathecal drug delivery systems are an accepted therapy in cancer patients for the treatment of uncontrolled pain refractory to oral opioid therapies and intolerable side effects. However, significant barriers to early consultation and implantation exist. (page 126)
Brief Reports
The study describes current access to specialty palliative care consultation and advance care planning for inpatients with high-risk leukemia. (page 225)
Fast Facts and Concepts
Intimate Partner Violence #345 (page 255)
Seriously Ill Pediatric Patients Who Transition to Adulthood #346 (page 257)
Personal Reflection
Reading this now it's hard to believe that I couldn't make meaning of my own journey until I found the clarity this Sunday morning offered. I anticipate that many of us are encased in our own beliefs about success and failure in the medical profession. The forces that drove all of us here were clearly powerful or we would not have endured the rigors of training. If you too find an apology entering conversations about your career, consider that the regret can be reframed. (page 264)
Case Discussions in Palliative Medicine
Case of a patient with progressive, debilitating central pain that was refractory to multimodal pharmacologic and nonpharmacologic therapies but that ultimately responded to electroconvulsive therapy. (page 266)
Book and Media Reviews
(page 269)
Recent Literature
(page 271)
NIH Research Funding for Palliative Medicine
Laura Gelfman and colleagues reviewed the current National Institutes of Health funding for palliative care research, and found that early stage career development awards and original palliative medicine research articles have doubled since 2010. (page 182)
Palliative Care in U.S. Nursing Homes
In a longitudinal study of 54 nursing homes (NHs) using Medicare data, researchers found high rates of NH care and six-month survival among residents who received palliative care consults, demonstrating the utility of these consults before Medicare hospice eligibility. (page 188)
Partial Do-Not-Resuscitate Orders
In a survey, researchers presented patient scenarios involving full versus partial do-not-resuscitate (DNR) orders to medical students, residents, and hospitalists. They found respondents more willing to provide nonarrest procedures but also CPR for patients with a partial DNR order. Of note, the most experienced respondents were more likely not to perform CPR in patients with partial DNR orders. (page 143)
Methadone as Coanalgesic
The authors describe how the addition of low-dose oral methadone to regular high-dose opioid treatment in 80 cancer patients with complex pain close to death improved pain control but also increased the risk for sedation and delirium. (page 177)
Medication Use in the Last Days of Life
Dutch researchers found patients who died an expected death at home or in the hospital received many medications in the last week of life, including analgesics and psychotropics. The mean number of medications per patient was nine on day 7 before death and six on the day of death. Of note, 26% of patients were given medication to try and prevent symptoms on the day of death. (page 149)
Trajectory of Dyspnea at End of Life
This prospective study of 91 patients measured self-reported dyspnea from hospice enrollment until death. Patients' respiratory distress escalated in their last days. The authors conclude that patients' inability to self-report raises concerns about under-recognition and undertreatment of respiratory distress. (page 194)
Identifying Pediatric Palliative Care Needs
In a survey of 208 patients at a tertiary pediatric hospital, a substantial proportion of children suffered from life-threatening or life-limiting diseases, as well as rare diseases, indicating a high burden of symptoms and a high need for additional care. (page 169)
Modifying Risk Factors for Complex Grief
The authors surveyed bereaved siblings of children with cancer and found higher rates of unresolved grief among siblings who perceived their loved one died in distress as well as poor communication among family, friends, and the healthcare team. (page 156)