Abstract
Letters to the Editor
“In order to identify which cohort of patients might best benefit from earlier palliative care interventions, we conducted a chart review of all patients that died in our hospitals during a specified timeframe and noted that dementia was a dominant diagnosis.” (page 3)
Brief Reports
Secondary analysis: Hydration volume may be associated with death rattle development in patients with abdominal malignancies. Volume reduction may alleviate or prevent death rattle. (page 130)
Fast Facts and Concepts
De-Stigmatizing the Language of Addiction #429 (page 155)
Oral Care: Focused History and Examination in Patients with Serious Illness #430 (page 158)
Personal Reflection
Every day, I needed to check in with myself when I left. Six months ago, I entered NICU as a first-time mom to a premature baby. Now, I walked into the NICU as a consulting palliative care physician. (page 163)
Case Discussions in Palliative Medicine
Two cases highlight potential benefits of discussing genetic testing and counseling in the context of palliative care. Incorporating referrals for genetic testing into the palliative care context may provide an opportunity to perform previously missed genetic testing. (page 167)
Book and Media Reviews
(page 172)
Prognostication for Spine Metastases and Radiotherapy
In much of the world, patients with spine metastases are first seen by radiation oncologists. Among 269 patients in this retrospective single-institution study, the median overall survival was five months. Twenty percent, 40%, and 57% of patients died within one, three, and six months of radiation treatment. Analysis resulted in three classes; class I included patients with Karnofsky Performance Status (KPS) ≥80. Class II included patients with KPS <80 and radioresistant or favorable histologies. Class III included all other histologies. Median survival in months was 11.4, 6.3, and 2.0, respectively. (page 21)
Outcomes for Pulmonary Obstruction and Radiotherapy
In a single-institution retrospective analysis of 108 patients, 81% had collapse of an entire lung lobe, 46% had ECOG performance status 3–4, and 64% were inpatient at consultation. Eighty-four patients had follow-up imaging available. Twenty-five (23%) of all patients had lung re-expansion at median time of 35 days. Rates of death without re-expansion were 38% and 65% at 30 and 90 days, respectively. Median overall survival was 56 days. Death within 30 days of radiotherapy occurred in 38%. Inpatients and larger tumors trended toward lower rates of re-expansion. Notable factors associated with overall survival were re-expansion, nonlung histology, tumor size, and performance status. (page 46)
Primary Palliative Care
It has been widely observed that there are not enough specialists in palliative care to meet the need. In this qualitative study of primary palliative care, three themes were identified: (1) Cared for My Psychosocial Needs, (2) Encouraged Self-Management, (3) Medication Recommendations Worked, (4) Facilitated Goal Attainment, (5) Team was Beneficial, and (6) Good Visit Timing. (page 28)
Long-Term Care Workers Communication Skills
Globally, an increasing proportion of the population die in long-term care facilities. The principal professional staff are personal care workers, not nurses or physicians. In this evaluation of a program to teach communication at end-of-life skills, pre- (n = 178) and postworkshop (n = 113) surveys capturing the attitudes and beliefs toward death and dying; relationships with residents and families; and PSWs' participation in end-of-life care showed significant improvements in all three domains, with the greatest increase (11%, p < 0.001) in the proportion of participants who responded “Often” or “Always” in the participation in end-of-life care domain. Specifically, we observed PSWs' elevated confidence in speaking with families of the residents about end of life, discussing goals and plans with the residents, and realizing that a “good death” is possible. Time constraints and staff shortages were recurrent themes that hindered many participants' ability to provide resident-centered care. (page 89)
Allogeneic Hematopoietic Cell Transplant and End-of-Life Care Intensity
The high-tech high-intensity cure-oriented care of patients with hematological malignancies is a new frontier for palliative care. Of 113 patients who received allogeneic transplant and had at least one marker of high-intensity care, 43% received ICU care in the last month of life. Median hospital stay in the last month of life was 15 days. Sixty-five percent patients died with hospice care; median enrollment was four days. Patients with higher education were less likely to have ≥1 intensity marker (OR 0.28, p = 0.02). Patients who died >100 days after HCT were less likely to have ≥1 intensity marker than patients who died in ≤100 days of HCT (p = 0.04). (page 97)