Abstract
Letters to the Editor
Description of a safe approach to implant an intrathecal port in patients with refractory pain in the pelvis and limbs.
(page 1424)
Brief Reports
A scoring system to determine whether continuous deep sedation is proportionally appropriate can be constructed, and a further study to develop a clinical tool is promising.
(page 1539)
Fast Facts and Concepts
#423: Clinician Tips for Virtually Connecting Dying Patients with Loved Ones
(page 1568)
#424: Fecal Incontinence in Palliative Care Settings
(page 1570)
Personal Reflection
Through her bravery, Genesis showed us the importance of discovery even in the face of overwhelming adversity. Her final wish, while giving her the comfort she needed at the end of life, inspired other patients to leave their own legacy and left a significant impact on the medical world.
(page 1572)
Case Discussions in Palliative Medicine
The novel use of Scrambler Therapy for a patient with 13 years of neuropathic pain related to amyloidosis and worsened by chemotherapy.
(page 1579)
Book and Media Reviews
(page 1585)
Telemedicine Saves Money in U.S. Hospice Care
In the United States, hospice care is paid for with a routine per diem payment. Provision of required services in rural areas is challenging due to vast geographical service areas. In 2015, the University of Kansas Medical Center (Kansas City, KS, USA) partnered with Hospice Services, Inc. (HSI) (Phillipsburg, KS, USA) to supplement traditional face-to-face care with care delivered through mobile tablets. The average time for a TeleHospice call was 18 and 17 minutes for nursing and physician calls, respectively. Overall, US$115,000 in staff travel time and mileage reimbursement was saved. When the interdisciplinary team meeting was held virtually, US $29,869 of staff travel time and mileage reimbursement was saved.
(page 1461)
Palliative Care Response to COVID-19 in a New York City Public Hospital
The 844-bed Bellevue Hospital in New York City is the quintessential urban public hospital. In the face of the COVID-19 epidemic, the palliative care team focused on three key elements: surge staffing, support, and scale. Three individual teams accommodated daily rounds with the medical intensive care and general medicine teams. Nonpalliative care trained community volunteers and internally redeployed physicians and nurse practitioners received targeted training in advanced care planning and were subsequently embedded within the three teams, each led by a specialist palliative medicine physician. A total of 12 volunteers joined the palliative care team. During eight weeks of the surge, the service cared for a total of 276 patients, 111 of whom were seen by volunteers. Over 50% of the palliative care patients had limited English proficiency.
(page 1474)
Cost Saving from Hospital Palliative Care
In a case–control study of inpatients who received specialist palliative care consultation compared with propensity-matched controls in a large U.S. health care system, 1404 patients with specialist palliative care consultations were matched with 2806 controls. Total operating costs were lower when the consultation occurred within 0–1 days of admission ($6,924 vs. $7,635, p = 0.002). Likewise, length of stay was shorter (4.3 days vs. 4.7 days, p < 0.001). When stratified by reason for consultation, goals-of-care consultations early in the hospital stay (day 0–1) were associated with reduced total operating costs ($7,205 vs. $8,677, p < 0.001). Costs were higher for pain management consultations ($7,727 vs. $6,914, p = 0.047). Consultation for hospice evaluation was associated with lower costs, particularly when early (hospital day 0–1: $4,125 vs. $7,415, p < 0.001).
(page 1525)
Trigger Tool to Identify Unmet Palliative Care Needs in Surgical Patients
All adult patients (≥18 years) on General Surgery, Neurosurgery, and Orthopedic Surgery wards were enrolled over a four-month period. In total, 411 patients were included for analysis. Survey questions with the highest overall impact included “would you be surprised if the patient died within 12 months,” “are there uncontrolled symptoms,” and “is there functional decline/wasting?”
(page 1455)
Improving Resiliency in Parents of Children with Cancer
In this randomized trial of the “Promoting Resilience in Stress Management for Parents” (PRISM-P) intervention, the 94 participating parents were median aged 35–38 years and predominantly white college-educated mothers. At six months, there was no statistically significant difference between one-on-one and group intervention.
(page 1505)