Journal of Pain and Symptom Management
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Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned from Two Pragmatic Randomized Trials
Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives.
Effects of End-of-Life Discussions on the Mental Health of Bereaved Family Members and Quality of Patient Death and Care
End-of-life discussions are crucial for providing appropriate care to patients with advanced cancer at the end of their lives.
Hospice Enrollment After Referral to Community-Based, Specialist Palliative Care: Impact of Telephonic Outreach
In the United States, palliative care programs improve access to hospice through enhanced communication and efficiencies in hospice eligibility review and enrollment. For community-based programs, this task may begin with telephone contact.
Feasibility and pilot study designs are common in palliative care research. Finding standard guidelines on the structure and reporting of these study types is difficult.
Terminally Ill Taiwanese Cancer Patients’ and Family Caregivers’ Agreement on Patterns of Life-Sustaining Treatment Preferences Is Poor to Fair and Declines Over a Decade: Results from Two Independent Cross-Sectional Studies
/Objective: Temporal changes have not been examined in patient-caregiver agreement on life-sustaining treatment (LST) preferences at end of life (EOL). We explored the extent of and changes in patient-caregiver agreement on LST-preference patterns for two independent cohorts of Taiwanese cancer patient-family caregiver dyads recruited a decade apart.
Discharge to Subacute Rehabilitation Facilities Does Not Benefit Patients Hospitalized With Progressive Gastrointestinal Cancer
Subacute rehabilitation (SAR), which is generally provided in skilled nursing facilities, involves less rigorous rehabilitation than inpatient (“acute”) programs (1) and does not routinely incorporate specialized pain management or palliative care. If a patient’s prognosis is poor, especially if there are significant symptoms such as debilitating pain or exhaustion that make participation in physical therapy difficult, a hospice program may be more clinically appropriate. Nonetheless, hospitalized patients and/or their families may sometimes decline a recommendation for a hospice discharge plan for a multitude of reasons, including a hope for further productive anticancer treatment.
U.S. nursing home (NH) residents with dementia have limited access to specialty palliative care beyond Medicare hospice.
Strategies for enhancing family participation in research in the ICU: Findings from a qualitative study
Family members of critically ill patients who participate in research focused on palliative care issues have been found to be systematically different from those who do not. These differences threaten the validity of research and raise ethical questions about worsening disparities in care by failing to represent diverse perspectives.
Many Palliative Medicine Team Recommendations Are Not Implemented by the Consulting Team. A Study of One Academic Medical Center
Palliative medicine consult teams (PMCT) support patients with life-limiting illness, their families and consulting clinicians by providing recommendations about symptom management and goals of care. These recommendations, in turn, may improve patient quality of life and symptom burden. Although there is a large body of work describing the demographic and symptom profiles of patients seen by palliative medicine teams, there are few studies describing the rate of implementation of recommendations.
Intranasal Vinegar as an Effective Treatment for Persistent Hiccups in a Patient with Advanced Cancer Undergoing Palliative Care
Hiccups are defined as “repeated spasms of the diaphragm, followed by sudden closure of the glottis” that occur at a rate of 2 to 60 per minute (1). Persistent or intractable hiccups occur when episodes continue for more than 48 hours or one month (1). A survey by Cymet et al. reported that approximately 54 of 110,000 (0.00055%) individuals had visited a hospital for hiccups between 1995 and 2000. Among them, 52% presented with persistent or intractable hiccups (0.000264%) (2). Persistent or intractable hiccups are rare clinical symptoms; however, in patients with advanced cancer, the incidence of persistent or intractable hiccups has been reported to be between 3.9% and 4.5% (3).
We thank Serin et al. for their probing questions about our study 1 and appreciate this opportunity to respond and to clarify our results. We agree that age is an important consideration, as associated comorbidities and physiology may impact functional reserve and, potentially, tolerance to radiation therapy (RT). Indeed, epidemiologic data demonstrating 60% of cancer diagnoses, and 70% of all cancer deaths, occur in individuals age 65 or older.2,3 In our study, we did not exclude patients based on age.
Psychometric assessment of the Chinese version of the Abbreviated Expanded Prostate Cancer Index Composite (EPIC-26) and the Clinical practice version (EPIC-CP) in Chinese men with prostate cancer
The Expanded Prostate Cancer Index Composite (EPIC) instrument was designed to assess a range of health-related quality of life issues specifically relevant to patients with prostate cancer. This study examined the validity and reliability of Chinese versions of the 26-item EPIC and of the 16-item EPIC for clinical practice (EPIC-CP) in Chinese patients with prostate cancer.
Inferring Palliative Intent from Administrative Data: Validation of a Claims-Based Case Definition for Venting Gastrostomy Tube
Malignant bowel obstruction (MBO) is associated with limited survival and a high burden of suffering in patients with incurable intra-abdominal malignancies.1 The prevalence of MBO is estimated to be 3-15% in patients with cancer.2 Early evidence suggests that palliative treatment with venting gastrostomy tube (VGT) alleviates symptoms and facilitates hospital discharge.3 However, the literature predominantly consists of small, single institution observational studies. Outcomes data from large, population-based studies are needed to inform management decisions for MBO.
Most palliative care patients enter a phase of unconsciousness before death. The time from unresponsiveness until death varies and the decline is occasionally interrupted by episodes of unexpected lucidity even in the final moments of life.1 Visible evidence includes a fleeting smile, eye opening, gestures, shedding of tears (lacrima mortis) and “deathbed” visions. These occurrences are sometimes viewed by grieving families with disbelief and a concern their loved one may be distressed. This prospective study employed the Bispectral Index monitor to investigate whether changes in the Bispectral Index score (BIS) occurred around the time of death and factors that may influence such a change.
Symptom Trajectories in Children Receiving Treatment for Leukemia: A Latent Class Growth Analysis with Multitrajectory Modeling
Cancer treatment symptoms play a major role in determining the health of children with cancer. Symptom toxicity often results in complications, treatment delays, and therapy dose reductions that can compromise leukemia therapy and jeopardize chances for long-term survival. Critical to understanding symptom experiences during treatment is the need for exploration of “why” inter-individual symptom differences occur; this will determine who may be most susceptible to treatment toxicities.
Seizures in the end-of-life setting can be traumatic and upsetting events; therefore, when a patient is no longer able to swallow, the majority of guidelines recommend replacing oral with subcutaneous (SC) anticonvulsant medications such as midazolam 20-30mg in 24h, clonazepam 1-4mg/24h or phenobarbitol 200-600mg/24h (1-4). Alternative recommendations include sublingual lorazepam 1mg every 8 hours or rectal diazepam 10-20mg twice daily. All of these options, however, usually result in some degree of sedation and a dilemma may arise if the patient is unable to take oral medications but sedation is not required or appropriate.
We greatly appreciate the debate on the use of sedatives in palliative care and welcome the perspective of Dr. Twycross. In our response, we would like to add some comments from a research perspective.
Thank you for the practical and thoughtful comments from Rady and Verheijde on our proposal paper for empirical research on sedation 1. We agree with their suggestion that the RASS is one of the most valuable candidates used in palliative sedation therapy. The authors indicated that we misused the RASS to define light sedation. That was not our intention. Such confusion among researchers is widespread throughout the world and, in our opinion, the main cause is the lack of consensus about whether deep sedation is an intended phenomenon or a result.
PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PC-FACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at firstname.lastname@example.org.
Who am I to write this reflection? I have been a chaplain for 35 years whose passion is palliative care and the art of dying well. These ramblings, original and not, are the gleanings of my ministry. Many have I companioned whose journey was not in solitude but included others. Their values and goals of care were the affirmation of their faith. Quality of life was loving care that they embraced to provide meaning that persists after death.