Abstract
Letter to the Editor
“Since Medicare patients living in lower income areas spend more at the end of life, we sought to explore whether local economic distress levels were associated with decedents' spending.” (page 742)
Brief Report
Retrospective analysis to determine the association between high-risk clinical events identified by a simple rules-based algorithm and decreased overall survival to target poor prognosis cancer patients who would urgently benefit from advanced care planning. (page 846)
Fast Facts and Concepts
Subcutaneous Diuretics for End-of-Life Management of Heart Failure #353 (page 879)
Personal Reflection
My interest in medicine began as a grand and cliché delusion. I wanted to vaccinate every child in every third-world country. I wanted to cure all illness. I thought I knew why I wanted to become a physician. As I prepared to enter the beast of medical school, I discovered a lump. Three weeks and two surgeries later, I was discharged from the hospital with a giant stamp on my forehead: cancer patient. (page 884)
Book and Media Reviews
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Recent Literature
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What's in a Name?
This experimental study among breast cancer patients at a major U.S. hospital found educational materials labeled as “supportive” care were most likely to be selected and considered valuable, compared with use of “palliative” or “hospice” terminology. (page 820)
Advance Directive Videos
In this feasibility study, 15 hospitalized patients described their experiences in making videos to articulate their treatment preferences and values. In the videos, most patients described their wishes regarding CPR and intubation, and many discussed their family structure, spiritual well-being, legacy and dignity issues, and physical symptoms. The majority of patients reported the experience as quite a bit or extremely helpful. (page 766)
Fast Facts User Data
In a retrospective analysis, researchers evaluated usage data from Fast Facts Mobile (FFM) to better understand its use as a palliative care educational tool. FFM was downloaded 9409 times in one year with 201,383 articles accessed. They found that 13% of all users comprise 66% of all activity, and the most popular search terms were nausea, methadone, and delirium. The authors predict that the need for useful and scalable tools for primary and specialty palliative care will continue to grow. (page 796)
Opioid Errors in Palliative Care
Australian researchers describe their multiincident analysis of opioid errors reported for three years in two specialist palliative care inpatient services. (page 825)
Surgeons' Views on End-of-Life Care
The authors surveyed members of the American College of Colon and Rectal Surgeons on their experiences with end-of-life care. They reported multiple barriers, including surgeons' lack of knowledge and training, difficulty with prognostication and communication about serious illness, patients' and families' unrealistic expectations, and system issues including poor documentation and lack of resources. (page 780)
Outpatient Drainage of Malignant Ascites
Researchers compare the success of drainage, complications, and survival after paracentesis or insertion of an indwelling tunneled catheter for malignant ascites in the outpatient setting. (page 836)
Using Physician Orders for Life-Sustaining Treatment in Brazil
The authors report on a cross-cultural adaptation of the Physician Orders for Life-Sustaining Treatment paradigm in Brazil. (page 815)
Location Choice for End-of-Life Care
Researchers surveyed almost 1000 cancer patients to better understand the factors influencing their choice of setting for end-of-life care. Most patients desired a social system allowing care at home with family, but had anxiety about worsening symptoms and potential burden on their families. (page 751)
Palliative Care in Pediatric Heart Disease
In cross-sectional surveys, palliative care physicians and pediatric cardiologists shared their perspectives on palliative care for children with heart disease. (page 773)