Abstract
Special Report
Discovering some of the impact of the hidden curriculum while doing a postgraduate diploma in pediatric palliative care in South Africa, six graduates reflected on their formal and informal learning. (page 720)
Brief Report
Description of development of the Supportive Oncology Collaborative, built upon the tenants of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. (page 789)
Fast Facts
When Is the Optimal Time to Refer Patients with End-Stage Liver Disease to Palliative Care Specialists? #481
Alpha(α)-2 Receptor Agonists in Palliative Care #482 (page 813)
Personal Reflection
She told me that she did not wish to enter hospital-based intensive care, which would only stave off inevitable death. Instead, she would seek what she called “a prelude to eternity.” She elected to spend her last days in the household she had built, treasuring her family. She savored the sun and our sun-bathed garden. (page 820)
Case Discussions
Case demonstrates the effect of off-hour, phone consultations by palliative care clinicians in reducing the family and clinician distress when non-goal-concordant care is expected in the emergency department. (page 823)
Book and Media
(page 830)
Original Article Key Points
In the United States, palliative care utilization among patients with metastatic breast cancer significantly increased from 2004 to 2020. Racial/ethnic minority patients were less likely to receive palliative care services, and Black patients had worse survival than White patients, suggesting the need for improving equitable access and reducing survival disparities in this patient population.
Global Trigger Tool (GTT) is a tool used for the detection of patient harm. In a palliative population, GTT triggers were infrequent and/or had a poor positive predictive value for the identification of patient harm. Disease-specific tools are required for studies of patient harm in palliative patients.
Two-thirds of the patients with advanced cancer at the end of life were under polypharmacy, and half of them were prescribed at least one potentially inappropriate medication. Medication reconciliation is recommended especially for older patients with advanced cancer who were referred from an outpatient setting with more comorbidities and prescriptions.
This qualitative analysis revealed that palliative care social workers may enhance prognostic understanding, improve serious illness communication, and provide decision-making support during a time when the patient and the caregiver are reassessing preferences for care, offering the potential to improve goal-concordant care.
Telecritical care (TCC) is heralded as a means of expanding critical care resources across health systems; however, the role of remote critical care consultants upon delivery of goal-concordant care in critical illness is unknown. In this retrospective cohort study, the authors demonstrated an association between TCC implementation and increased palliative care consultation rates in critical illness.
Among Medicare beneficiaries, using home health care at any point during the last three years of life was strongly associated with the later use of hospice. Clinical and policy implications include the need to preserve access to essential home health care services (S.2137/H.R.5159) and value their upstream role in increasing hospice use.