Abstract
Letters to the Editor
Improved diagnostic and therapeutic approaches have yielded a growing population of newborns with highly complex care needs. This population of newborns includes both extremely preterm infants and those with incurable diseases and poor prognosis. (page 600)
Brief Reports
Exploring the impact of Urban Zen Integrative Therapy on pulmonary hypertension-related symptoms. (page 703)
Fast Facts and Concepts
Yoga for Cancer-Related Symptoms #391 (page 719)
Physical Examination of the Dying Patient #392 (page 721)
Personal Reflection
The sad-eyed dog had been pushed into the background during Mark's illness and death. She was likely a nuisance. Yet now, she initiated the closing of the chasm between life and death on which Juan teetered. I can only imagine that she continues to breathe life into Juan, by insisting that they go out, eat, and engage with the world. (page 729)
Case Discussions in Palliative Medicine
Research on terminally ill patients' will to live has revealed important insights into its fluctuations over time and its correlated factors. We report an N-of-1 case. (page 733)
Book and Media Reviews
(page 738)
Recent Literature
(page 739)
Palliative Care and Lung Transplant
The majority (36/38) of transplant pulmonologists among 9 high-volume North American transplant centers with specialist palliative care teams have referred patients. Concerns about one-year survival metrics and use of addicting medications for symptom palliation were barriers to referral. (page 619)
Deprescribing Combination Oxycodone–Naloxone
Oxycodone–naloxone combinations are prescribed to reduce opioid-induced constipation while maintaining analgesia. The main reasons for deprescribing were poor pain control and impaired hepatic function. (page 656)
Teaching Nephrologists to Communicate
In this pilot study, 15 of 16 nephrologists obtained competence with a communication tool. In evaluating nine nephrologists with real patients, a change in communication from only laboratory results and preparation for dialysis to communicating declining kidney function as “bad news” and presenting dialysis and no-dialysis as treatment options was observed. Patients whose nephrologist used the tool were less likely to make a decision to initiate dialysis and were more likely to be referred to palliative care. (page 627)
Population-Based Palliative Care Referral for Lung Cancer
Four diagnoses or prognosis-based and two symptom-based screening criteria were operationalized for a population of 38,851 lung cancer patients in the province of Ontario, Canada. Of these 28,164 were eligible and 23,199 (82%) received palliative care. (page 670)
Cannabinoids in Palliative Care
This was a prospective two-arm open-label pilot trial of escalating doses of cannabidiol (CBD) and tetrahydrocannabinol (THC) oils in patients with advanced cancer and cancer-related symptoms in an Australian cancer center. The median maximum tolerated doses were CBD 300 mg/day (range 100–600 mg/day) and THC 10 mg/day (range 5–30 mg/day). In total, 43% responded therapeutically. Drowsiness was the most common adverse effect. (page 650)
Telehealth Acceptability for Children
Telehealth offers the potential to reach children in rural geographies who need hospice care. Fifteen patients with a mean age of seven years were enrolled. Home distance averaged 172 miles from the hospital-based program. Telehealth acceptability was higher with family caregivers than with hospice nurses. All the children “liked” the telehealth. (page 641)