American Journal of Hospice and Palliative Medicine®

The Medical Literature Analysis and Retrieval System Online (MEDLINE) database provides many references for reviews, but many relevant articles are missed, especially when the topic is complex. Reported here is the detailed methodology of a PubMed search of MEDLINE augmented by a related articles link search. Of 1181 citations identified, through a PubMed search, 10 articles met the inclusion criteria. Fifty-one were identified through the related articles link; of which 43 were not detected by standard searches using medical subject heading terms. More than 50% were identified using the related articles link. Only 14% of relevant articles were identified using the standard PubMed MEDLINE search. The related articles link is not included in methodologic recommendations for systematic literature reviews but this experience suggests that it is a useful tool in PubMed for reviewing complex evidence. Related links searches are proposed in any systematic PubMed MEDLINE literature review in palliative medicine.

This study explored the role of health status, as measured by the Palliative Performance Score, in shaping patient preferences for end-of-life care. Scores were correlated with 3 potential goals of care: prolonging life, maintaining function, and maximizing comfort among patients seen in palliative care consultation. Eighty-six patients expressed treatment preferences: 16 (19%) preferred prolonging life, 23 (27%) preferred maintaining function, and 47 (54%) preferred maximizing comfort (P < .0001); their average scores ± standard deviation were, respectively, 51.9 ± 19.4, 56.5 ± 16.7, and 45.3 ± 14.1 (P = .0459). There was a significant relationship between patient preferences and Palliative Performance Score, with lower scores indicating preferences for comfort and higher scores indicating a preference for maintaining function and life expectancy. Further research is needed to test the sensitivity of health status, as measured by the Palliative Performance Score, in affecting patient preferences.

The provision of high-quality palliative care services to dying children and their families often requires extensive collaboration between hospital-based and community-based care teams. This article describes the origins and development of the Partners in Pediatric Palliative Care program, which has provided pediatric-specific educational offerings and fostered joint endeavors between a palliative care service located in a tertiary care children's hospital and a wide range of hospice and home care agencies in 5 states. The Partners in Pediatric Palliative Care program is evaluated in terms of the favorable ratings that attendees have given the educational components, the relatively modest direct costs of mounting the regional meetings, and the expanded capacity to provide home-based palliative services to children and families who desire them. The Partners in Pediatric Palliative Care program provides another feasible means for hospitals and community agencies to work together to improve pediatric palliative care.

This study summarized the social work services provided in an acute inpatient cancer rehabilitation program. Reviewed were 49 consecutive social worker assessments from February 2003 to March 2003. The social worker was consulted mostly for discharge planning (40/49, 82%) and helping patients cope (23/49, 47%). Sixty-seven percent of the patients (33/49) were coping well. Sixty-five percent of patients (32/49) had an identified caregiver. Most patients planned to go home (33/49, 67%) after their discharge. Interventions provided by the social worker included counseling (100% of patients/ families), referral to financial resources (24/49, 49%) and transportation services (21/49, 43%), and other resources (37/49, 76%). Age, gender, and identified caregiver did not show significant association with the coping status or referrals. The social worker is important in assessing cancer patients' coping and providing support.

The aim of this study was to clarify the relationship of nursing autonomy and other factors related to attitudes toward caring for dying patients. A cross-sectional survey of nurses was conducted in November 2003 using a self-administered questionnaire. We collected demographic data from 178 (75%) participants and used the Frommelt Attitude Toward Care of the Dying scale, Form B, Japanese version (FATCOD-Form B-J), the Pankratz Nursing Questionnaire (PNQ), and the Death Attitude Inventory (DAI). FATCOD-Form B-J measures nurse's attitude toward caring for dying patients. It includes two subscales: positive attitude toward caring for the dying patient and perception of patient- and family-centered care. The PNQ measures nursing autonomy of individual nurses and has three subscales: nursing autonomy and advocacy, patients' rights, and rejection of traditional role limitations. The DAI measures attitudes toward death in context of Japanese cultural characteristics. It includes seven subscales: afterlife beliefs, death anxiety, death relief, death avoidance, life purpose, death concern, and supernatural beliefs. We investigated the factors associated with the FATCOD-Form B-J. Support of a mentor regarding end-of-life issues (β = .19, P = .001), death avoidance domain of the DAI (β = —.14, P = 0.03), life purpose domain of the DAI (β = .23, P = .001), and rejection of traditional role limitations domain of the PNQ (β = .51, P = .001) were selected as significant independent variables by multivariate analysis to evaluate nurses' positive attitudes toward caring for dying patients. Death anxiety domain of the DAI (β = —.17, P = .02), patients' rights domain of the PNQ (β =.46, P = .001), and rejection of traditional role limitations domain of the PNQ (β = .34, P = .001) were selected as significant independent variables by multivariate analysis to evaluate the nurses' perception of patient-and family-centered care. In conclusion, nursing autonomy plays an important role in the attitudes of Japanese nurses who care for dying patients. Educational and administrative efforts to strengthen nursing autonomy are necessary.

The aim of palliative medicine is to provide multidisciplinary comprehensive care in advanced illness. Patient and family utilization of various product service lines offered by the Harry R Horvitz Center for Palliative Medicine at the Cleveland Clinic Foundation was studied. Newly referred patients were followed up prospectively until 85% had either died or been lost to follow-up. Demographic, clinical, and referral data were recorded; subsequent product service line utilization was updated daily. The total study period was 171 days, and 238 patients entered. Acute care inpatient unit, outpatient clinic visits, and 24-hour phone contacts were the most frequently used product service lines. Patients had a median of 3 contacts (range, 1 to 27) with individual service lines. Multiple palliative medicine product service lines were utilized often, with repeated use of the individual service lines. A comprehensive integrated palliative medicine program is necessary to fully meet the complex needs of those with advanced disease.

Presented is a case report of a 55-year-old man with a suspected diagnosis of pancreatic malignancy who was referred for pain management to the pain and palliative care clinic. A diagnosis of pain originating from a malignancy was later ruled out. The patient was referred for psychiatric evaluation, where his pain symptoms were confirmed to be somatoform in origin. This case highlights the importance of ruling out somatization as the cause of symptoms in difficult pain patients.

Cancer is the second leading cause of death in the United States, with most of these deaths taking place in the hospital setting. Discussions on end-of-life care and on cardiopulmonary resuscitation in particular are an important component in the management of patients with cancer. Clinical decision making and respect for patient autonomy dictate that health care providers provide their patients with accurate information on the expected outcomes of cardiopulmonary resuscitation. This article reviews those factors that affect the outcome of cardiopulmonary resuscitation in patients with cancer and provides recommendations on obtaining do-not-resuscitate orders in these patients.

Quality-of-life assessment can be a helpful tool in ensuring optimal palliative care. To adequately assess quality of life, it must be first defined and subsequently measured. This article outlines several of the instruments available to measure quality of life, including the Karnofsky Score, Edmonton Symptom Assessment, Memorial Symptoms Assessment Scale, European Organization for Research and Treatment of Cancer Questionnaire, Quality and Quantity of Life Short Questionnaire, and Cambridge Palliative Assessment Schedule. Use of these instruments in the context of goal-setting and family meetings as well as common pitfalls in quality-of-life assessment are outlined.

Falls prevention is a critical priority in hospice and palliative care settings. To keep patients safe and comply with national standards, hospice professionals must have available appropriate assessment, prevention, and intervention tools. Existing procedures engaging patients in strengthening exercises and reducing or eliminating medications that cause dizziness, imbalance and confusion are fitting and useful in environments where first-line fall reduction efforts are possible. These current tools are based on research in facilities for nonhospice patients and run counter to the goals of palliative care. By definition, hospice patients have a terminal illness and are, or will become, too weak to manage strengthening exercises. Without their medications, many would experience intolerable pain and unmanageable anxiety and depression. This article proposes assessment guidelines and pragmatic interventions to reduce the risk of falling that are consistent with the hospice philosophy of comfort.