Abstract
Letters to the Editor
Case of an elderly cancer patient whose blood levels of fentanyl increased to toxic levels with increasing body temperature. Physicians and other medical staff need to monitor the change in temperature and fentanyl blood concentration; extra caution is necessary when fentanyl is coadministered with benzodiazepines. (page 1006)
Brief Reports
Study to evaluate the safety of a Butrans (buprenorphine) transdermal system patch for analgesia in a pediatric palliative care setting. (page 1094)
Fast Facts and Concepts
The Psychosocial Assessment in Palliative Care #396 (page 1125)
Nonantipsychotics/Nonbenzodiazepines in the Management of Agitated Delirium #397 (page 1127)
Personal Reflection
Over the past year, I have gone back to this experience many many times. It was a profound lesson in embodiment that I am still unraveling. I was unlearning what medical training taught me about my body that I had absorbed unconsciously. (page 1130)
Case Discussions in Palliative Medicine
Case of a 36-year-old female with metastatic breast cancer who was the single mother of four children. Despite significant concerns about her children's well-being, the patient did not complete legal guardianship processes. (page 1134)
Book and Media Reviews
(page 1139)
Recent Literature
(page 1140)
Ovarian Cancer Survival
In a single institution study, higher performance status and home hospice were independent predictors of longer survival for refractory disease after discontinuation of chemotherapy. An intriguing finding that correlates with other data that patients enrolled in hospice care live longer. The study sets up a nice hypothesis for a prospective study. (page 1060)
Decompensated Liver Cirrhosis
Palliative care and hospice care for noncancer diagnoses are increasing. In this study, only 25% were referred for palliative care or hospice. Referrals for either occurred late in the course of illness. Late referrals were associated with younger age, married status, and recent alcohol use. (page 1066)
Managing Medications
The inability of an informal caregiver to manage medications for someone ill at home in the last months and years of life has been reported. In this population-based study, 7% of 1,068 respondents to an annual omnibus health survey identified that additional support with medication management would have been beneficial in caring for someone who is expected to die. (page 1084)
Concurrent Care
In this study in the Veterans Health Affairs system, facilities offering concurrent palliative care along with standard cancer care for stage IV nonsmall cell lung cancer doubled from 20% in 2006 to 2012. Although this correlated with an increase in referral for hospice care, it did not have any effect on hospital admissions, intensive care use, and chemotherapy. (page 1038)
Eliciting Goals of Care
In this randomized clinical trial from Japan, there was no difference between simple nurse-initiated verbal engagement versus the inclusion of visual materials, in eliciting preferences for a health care proxy and eliciting those who did not want CPR. At baseline, <5% wanted life-prolonging care. (page 1076)
Location of Communication
Most pediatric communication research focusses on care conferences with parents. Yet, in this prospective series, clinicians report the majority of communication occurs at the bedside in the ICU, not in care conferences. Yet, quality of care was rated higher when there were care conferences. (page 1052)