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Journal of Palliative Medicine

Christine A Haynes, Cody N Dashiell-Earp, Neil S Wenger, Wendy M Simon, Samuel A Skootsky, Robin Clarke, Frances A Watts, Anne M Walling
BACKGROUND: Physician Orders for Life-Sustaining Treatment (POLST) can help ensure continuity of do-not-resuscitate (DNR) decisions and other care preferences after discharge from the hospital. OBJECTIVE: We aimed to improve POLST completion rates for patients with DNR orders who were being discharged to a nursing home (NH) after an acute hospitalization at our institution. DESIGN: We implemented an interprofessional quality improvement intervention involving education, communication skills, and nursing and case manager cues regarding POLST use...
February 14, 2019: Journal of Palliative Medicine
Megan Bannon, Natalie C Ernecoff, J Nicholas Dionne-Odom, Camilla Zimmermann, Jennifer Corbelli, Michele Klein-Fedyshin, Robert M Arnold, Yael Schenker, Dio Kavalieratos
BACKGROUND: In 2016, Kavalieratos and colleagues performed a systematic review of randomized clinical trials (RCTs) of palliative care (PC) interventions. The majority of RCTs included focused on oncology, with fewer in heart failure (HF). Cancer patients' often predictable decline differs from the variable illness trajectories of HF; however, both groups experience similar palliative needs, and accordingly, PC in HF continues to grow. OBJECTIVE: To investigate if PC interventions differ between cancer and HF patients...
February 14, 2019: Journal of Palliative Medicine
Hiroyuki Kawashima, Takashi Ariizumi, Tetsuro Yamagishi, Akira Ogose, Miho Ikoma, Tetsuo Hotta, Naoto Endo
BACKGROUND: Musculoskeletal sarcomas (MSSs) are rare cancers and often aggressive tumors that originate from mesenchymal tissue. Patients with advanced MSS often report difficulties with symptom burden, which can reduce their health-related quality-of-life. OBJECTIVE: The aim of this study was to describe the patterns of the physical symptoms of MSS patients in the palliative setting and to detail the palliative treatment used in the last two weeks of life. DESIGN: Retrospective study using the electronic patient records from a single institution...
February 14, 2019: Journal of Palliative Medicine
Connie Carr, Haley Vertelney, Joshua Fronk, Sandy Trieu
BACKGROUND: Night sweats significantly impact the quality of life for cancer patients and are often resistant to treatment. Cannabinoids have been shown to modulate cytokine activity and produce hypothermia in animal models, suggesting that they may be a promising candidate for palliation of night sweats in patients with oncologic disease. OBJECTIVE: Assess efficacy of the oral cannabinoid, dronabinol, for palliation of night sweats in cancer patients. DESIGN: A retrospective record search identified five cancer patients who had tried oral dronabinol for palliation of their night sweats between 2013 and 2016 and subjectively reported on its efficacy...
February 13, 2019: Journal of Palliative Medicine
Kevin Madden, Maira Magno Charone, Sarah Mills, Seyedeh Dibaj, Janet L Williams, Diane Liu, Eduardo Bruera
BACKGROUND: Systematic symptom assessment is not a standard of care in children with cancer. Many well-known symptom assessment tools are lengthy or difficult to integrate into a daily pediatric palliative care practice. We created a series of brief and simple questions to be systematically given to children and their caregivers. OBJECTIVE: The primary objective was to determine the percentage of eligible children and caregivers exposed to the questions that were able to complete the assessment...
February 13, 2019: Journal of Palliative Medicine
Lindsay Haines, Omari-Khalid Rahman, Justin J Sanders, Kimberly Johnson, Amy Kelley
BACKGROUND: Goal-concordant care (GCC)-care aligned with a patient's known goals and values-is a measure of the quality of end-of-life (EOL) care that can be assessed by surveying family members after a patient's death. It is unknown whether patient characteristics affect this measure. OBJECTIVE: The objective of the article was to examine family report of GCC and its associations with patient characteristics. METHODS: Using the Health and Retirement Study, which is a nationally representative, longitudinal cohort of adults over age 50, we sampled decedents whose family completed the 2014 postdeath interview...
February 13, 2019: Journal of Palliative Medicine
Jeanne Chirico, James P Donnelly, Alyssa Gupton, Philene Cromwell, Marla Miller, Carol Dawson, David N Korones
BACKGROUND: Children with complex chronic conditions (CCCs) are dying at home with increased frequency, yet the number of studies on the financial feasibility of community-based pediatric palliative care is limited. OBJECTIVE: The objectives of this study were to (1) describe characteristics of patients who died in a community-based palliative care program and (2) evaluate cost differences associated with participant characteristics and location of death. DESIGN: A retrospective cohort analysis of administrative and electronic medical record data was employed...
February 7, 2019: Journal of Palliative Medicine
Olaf P Geerse, Daniela J Lamas, Justin J Sanders, Joanna Paladino, Jane Kavanagh, Natalie J Henrich, Annette J Berendsen, Thijo J N Hiltermann, Erik K Fromme, Rachelle E Bernacki, Susan D Block
BACKGROUND: Conversations with seriously ill patients about their values and goals have been associated with reduced distress, a better quality of life, and goal-concordant care near the end of life. Yet, little is known about how such conversations are conducted. OBJECTIVE: To characterize the content of serious illness conversations and identify opportunities for improvement. DESIGN: Qualitative analysis of audio-recorded, serious illness conversations using an evidence-based guide and obtained through a cluster randomized controlled trial in an outpatient oncology setting...
February 6, 2019: Journal of Palliative Medicine
Heather M Derry, Paul K Maciejewski, Andrew S Epstein, Manish A Shah, Thomas W LeBlanc, Valerie Reyna, Holly G Prigerson
BACKGROUND: Routine imaging ("scan") results contain key prognostic information for advanced cancer patients. Yet, little is known about how accurately patients understand this information, and whether psychological states relate to accurate understanding. OBJECTIVE: To determine if patients' sadness and anxiety, as well as results showing poorer prognosis, are associated with patients' understanding of scan results. DESIGN: Archival contrasts performed on multi-institutional cohort study data...
February 6, 2019: Journal of Palliative Medicine
Priyal P Fadadu, Joy C Liu, Brenda M Schiltz, Tran Dang Xoay, Phan Huu Phuc, Ashok Kumbamu, Yves Ouellette
BACKGROUND: Although the need for palliative care is gaining recognition in Southeast Asia, knowledge about how decisions are made for children near the end of life remains sparse. OBJECTIVE: To explore pediatric intensivists' attitudes and practices surrounding end-of-life care in Vietnam. METHODS: This is a mixed-methods study conducted at a tertiary pediatric and neonatal intensive care unit in Hanoi. Physicians and nurses completed a quantitative survey about their views on end-of-life care...
February 6, 2019: Journal of Palliative Medicine
Quentin Reuter, Alison Marshall, Hashim Zaidi, Priyanka Sista, Emilie S Powell, Danielle M McCarthy, Scott M Dresden
BACKGROUND: Patients with cancer and palliative care needs frequently use the emergency department (ED). ED-based palliative services may extend the reach of palliative care for these patients. OBJECTIVE: To assess the feasibility and reach of an ED-based palliative intervention (EPI) program. DESIGN: A cross-sectional descriptive study of ED patients with active cancer from January 2017 to August 2017. SUBJECTS: Patients with palliative care needs were identified using an abbreviated 5-question version of the screen for palliative and end-of-life care needs in the ED (5-SPEED)...
February 5, 2019: Journal of Palliative Medicine
Sachiko Okayama, Yoshinobu Matsuda, Yoshito Yoshikawa
BACKGROUND: Methadone may play a role in the control of refractory cancer pain in opioid switching, although some cases fail to switch to methadone. OBJECTIVE: To evaluate the differences in the clinical aspects in switching to methadone between successful cases (SCs) and unsuccessful cases (UCs). DESIGN: This was a retrospective study of the clinical aspects of cancer patients who experienced opioid switching from other opioids to methadone...
February 4, 2019: Journal of Palliative Medicine
Teresa M Cooney, Adam Shapiro, Channing E Tate
BACKGROUND: As the U.S. population ages, dramatic shifts are occurring in the proportion of older adults who are divorced and widowed. Health status and behaviors are known to differ across marital status groups, yet research on end-of-life (EOL) care planning has only compared married and unmarried persons, overlooking differences between divorced and widowed individuals, by gender. OBJECTIVE: This study aimed to examine marital status differences in EOL care planning by comparing the likelihood of discussions about EOL care, designation of medical durable power of attorney (MDPOA) for health care decisions, and completion of a living will for married, divorced, and widowed older adults, by gender...
February 4, 2019: Journal of Palliative Medicine
Michael J Tatterton, Charlotte Walker
BACKGROUND: Almost 50,000 children and young people are affected by life-limiting conditions in the United Kingdom, around a third of which use children's hospices. Anecdotal evidence suggests that cannabinoid-based medicines (CBMs), specifically cannabis oil (CO), are being used by families with increasing frequency to manage distressing symptoms. The use of most nonprescription CBMs in the United Kingdom remains illegal. OBJECTIVE: The objective of the study was to identify the prevalence of CO use by families who use children's hospices in the United Kingdom, and the approaches taken by those services to manage it...
February 4, 2019: Journal of Palliative Medicine
Jordana L Meyerson, Kelly J McKinell, Lara Michal Skarf, Susan N Nathan, Kate L M Hinrichs
Requests for hastened death and suicidal ideation may be more prevalent in populations approaching the end of life. Often these wishes and thoughts occur in the context of concurrent psychiatric disorders and emotional suffering. We discuss the case of a veteran with terminal lung cancer and comorbid psychiatric illness who attempted suicide while under the care of an inpatient interdisciplinary hospice team and describe our team's response to this suicide attempt. We review risk factors for suicidality at end of life, challenges of distinguishing desire for hastened death from suicidality, and the ethics of resuscitation of a dying patient after a suicide attempt...
January 31, 2019: Journal of Palliative Medicine
Toluwalase A Ajayi, David Shaw, Kyle P Edmonds
BACKGROUND: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together. There is an imperative to teach young physicians early in their training the importance of engaging in a shared decision-making process to define overall goals of care (GOC). The PERSON mnemonic proposes a structured format that allows providers to evaluate GOC across the spectrum of serious illnesses, outside of breaking bad news or end-of-life planning...
January 31, 2019: Journal of Palliative Medicine
Lilia Cervantes, Michel Chonchol, Romana Hasnain-Wynia, John F Steiner, Edward Havranek, Madelyne Hull, John Rice, Jessica Kendrick, Xochilt Alamillo, Claudia Camacho, Stacy Fischer
BACKGROUND: Latinos with end-stage renal disease (ESRD) have worse mental and kidney composite health-related quality of life (HRQOL) scores compared to non-Latino ESRD patients. Latino ESRD patients uniquely report that social factors (e.g., lack of care coordination, food insecurity, and low health literacy) and mental health influence their HRQOL. We developed a culturally tailored peer navigator (PN) intervention to improve the HRQOL of Latinos on hemodialysis. OBJECTIVE: To determine the feasibility of the PN intervention...
January 31, 2019: Journal of Palliative Medicine
Joshua R Lakin, Emily Benotti, Joanna Paladino, Natalie Henrich, Justin Sanders
BACKGROUND: Evidence demonstrates that discussion between clinicians and seriously ill patients about their goals and preferences, or serious illness communication, is a high-value intervention, resulting in growing demand for improvement in this area. Promising efforts address this demand utilizing interprofessional teams; yet, we lack insight into how different professions work together to deliver better serious illness communication. OBJECTIVE: To explore the perceptions of primary care clinicians about interprofessional work in serious illness communication...
January 28, 2019: Journal of Palliative Medicine
Kazuyuki Niki, Yoshiaki Okamoto, Isseki Maeda, Ichiro Mori, Ryouhei Ishii, Yoshinobu Matsuda, Tatsuya Takagi, Etsuko Uejima
BACKGROUND: Some terminal cancer patients wish to "go to a memorable place" or "return home." However, owing to various symptom burdens and physical dysfunction, these wishes are difficult for them to realize. OBJECTIVE: The aim of the study is to verify whether simulated travel using virtual reality (VR travel) is efficacious in improving symptoms in terminal cancer patients. DESIGN: This is a prospective, multicenter, single-arm study...
January 24, 2019: Journal of Palliative Medicine
Liesbeth M van Vliet, Anke J E de Veer, Natasja J H Raijmakers, Anneke Francke
BACKGROUND: Cancer patients with advanced disease are confronted with increasingly complex life-prolonging/symptom-relieving treatment decisions. Being informed of treatment benefits and risks is important, but information provision might be suboptimal. OBJECTIVE: To assess the extent to which patients with incurable cancer feel informed about benefits and risks of possible treatments, and whether this relates to their self-perceived receipt of person-centered care...
January 24, 2019: Journal of Palliative Medicine
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