MedWorm: Palliative Care

Professional-patient boundaries in palliative care #172

Journal of Palliative Medicine — Tue, 01 Jul 2008 12:30:09 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 777-778. (Source: Journal of Palliative Medicine)

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In this issue

Journal of Palliative Medicine — Sat, 28 Jun 2008 03:04:14 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 667-667. (Source: Journal of Palliative Medicine)

Dog with a bone

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:45 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 696-699. (Source: Journal of Palliative Medicine)

The palliative care team

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:45 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 677-681. (Source: Journal of Palliative Medicine)

Announcements

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:44 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 807-809. (Source: Journal of Palliative Medicine)

Challenges faced by informal caregivers of hospice patients in uganda

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:44 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 746-753. ABSTRACT Background: Serious illness can cause economic devastation for families. Locally run patient day care programs, or programs for training caregivers for future caregiving employment, could provide a measure of economic resilience. We sought to ... (Source: Journal of Palliative Medicine)

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Geography decides destiny

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:41 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 694-695. (Source: Journal of Palliative Medicine)

Suddenly, too sentimental

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:41 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 670-670. (Source: Journal of Palliative Medicine)

Tools for determining life expectancy in end-stage dementia: validation studies

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:38 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 673-673. (Source: Journal of Palliative Medicine)

Meetings and events

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:37 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 802-804. (Source: Journal of Palliative Medicine)

U.s. medical students' perceptions of the adequacy of their schools' curricular attention to care at the end of life: 1998–2006

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:25 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 707-716. ABSTRACT Background: Little is known about the long-term effectiveness of recent efforts to improve end-of-life care education at U.S. medical schools. Objective and design: Longitudinal, observational study using national data from the Graduation ... (Source: Journal of Palliative Medicine)

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Dignity. dignity? dignity!

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:22 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 674-675. (Source: Journal of Palliative Medicine)

The highest honor

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:21 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 779-780. (Source: Journal of Palliative Medicine)

Opioid allergic reactions #175

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:21 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 776-777. (Source: Journal of Palliative Medicine)

Reliability assessment and findings of a newly developed quality measurement instrument: quality indicators of end-of-life cancer care from medical chart review at a japanese regional cancer center

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:17 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 729-737. ABSTRACT Objectives: To assess the reliability of quality indicators of end-of-life cancer care (QI-EOL) and evaluate the quality of end-of-life cancer care in general wards by using QI-EOL. Methods: A retrospective chart review study was conducted on ... (Source: Journal of Palliative Medicine)

Current diagnosis and treatment: pain

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:16 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 792-793. (Source: Journal of Palliative Medicine)

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Palliative care research in latin america: results of a survey within the scope of the declaration of venice

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:16 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 717-722. ABSTRACT Background: In recent years, there has been an increase in the amount of palliative care research in developing countries. However, it is still very limited in the developing regions of the world, including Latin America. Objective: To determine ... (Source: Journal of Palliative Medicine)

Can physicians accurately predict survival time in patients with metastatic cancer? analysis of rtog 97-14

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:12 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 723-728. ABSTRACT Purpose: To determine if physician prediction of survival duration (PSD) is accurate for patients with metastatic breast or prostate cancer. Methods: Radiation Therapy Oncology Group 9714 (RTOG 9714) was a randomized comparison of radiotherapy ... (Source: Journal of Palliative Medicine)

Progress in measuring and improving palliative and end-of-life quality

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:12 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 682-684. (Source: Journal of Palliative Medicine)

Acetylcholinesterase inhibitor and n-methyl-d-aspartic acid receptor antagonist use among hospice enrollees with a primary diagnosis of dementia

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:11 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 738-745. ABSTRACT Objectives: To describe acetylcholinesterase inhibitor (AChEI) and memantine use among persons over the age of 65 admitted to hospice with a primary diagnosis of dementia and identify patient and hospice program characteristics associated with ... (Source: Journal of Palliative Medicine)

Cancer pain management

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:10 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 791-792. (Source: Journal of Palliative Medicine)

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Endovascular carotid reconstruction in palliative head and neck cancer patients with threatened carotid blowout presents a beneficial supportive care measure

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:10 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 784-789. ABSTRACT Carotid blowout is a devastating complication in patients with head and neck malignancy. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. ... (Source: Journal of Palliative Medicine)

Never mind

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:09 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 669-670. (Source: Journal of Palliative Medicine)

Health literacy not race predicts end-of-life care preferences

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:08 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 754-762. ABSTRACT Background: Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life. Objective: Since the medical information presented to subjects is frequently complex, we ... (Source: Journal of Palliative Medicine)

News and views

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:07 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 668-668. (Source: Journal of Palliative Medicine)

Finding a good night's sleep: understanding insomnia

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:06 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 805-806. (Source: Journal of Palliative Medicine)

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Cancer-related breakthrough pain

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:06 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 790-791. (Source: Journal of Palliative Medicine)

Lessons learned as a third-year medical student on a rotation in palliative medicine

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:12:06 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 781-782. (Source: Journal of Palliative Medicine)

Update in palliative medicine 2008

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:59 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 769-775. (Source: Journal of Palliative Medicine)

Racial/ethnic disparities in hospice care: a systematic review

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:59 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 763-768. ABSTRACT Context: Access to hospice is a growing public health matter given that quality care at the end of life should be provided to all individuals regardless of race, ethnicity, or socioeconomic status. Health care disparities, particularly among ... (Source: Journal of Palliative Medicine)

Recent literature

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:58 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 799-801. (Source: Journal of Palliative Medicine)

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Overcoming educational barriers for advance care planning in latinos with video images

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:54 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 700-706. ABSTRACT Background: Studies of end-of-life care have shown that Latino patients want more aggressive care compared to white patients. While this has been attributed to aspects of ethnicity, national origin, and religion, it is possible that limited ... (Source: Journal of Palliative Medicine)

Pc-facs

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:53 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 794-798. (Source: Journal of Palliative Medicine)

Strengthening communities

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:53 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 671-672. (Source: Journal of Palliative Medicine)

Introduction

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:52 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 790-790. (Source: Journal of Palliative Medicine)

Statins in the last six months of life: a recognizable, life-limiting condition does not decrease their use

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:50 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 685-693. ABSTRACT Background: Some have advocated discontinuing statins in patients with life-limiting conditions. However, the extent of statin use at the end of life has yet to be described and whether statin prescribing may already be influenced by the ... (Source: Journal of Palliative Medicine)

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Accentuate the positive

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:47 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 676-676. (Source: Journal of Palliative Medicine)

The last rose of summer

Journal of Palliative Medicine — Fri, 27 Jun 2008 12:11:46 +0100

Journal of Palliative Medicine Jun 2008, Vol. 11, No. 5: 783-783. (Source: Journal of Palliative Medicine)

A systematic review of opioid conversion ratios used with methadone for the treatment of pain

Palliative Care JournalClub - Selected Articles — Sun, 22 Jun 2008 05:05:52 +0100

Pain Med (new issue) (Source: Palliative Care JournalClub - Selected Articles)

Management of venous thromboembolism in patients with advanced cancer: a systematic review and meta-analysis

Palliative Care JournalClub - Selected Articles — Mon, 09 Jun 2008 05:05:51 +0100

Lancet Oncol 2008;9(6):577-84 (Source: Palliative Care JournalClub - Selected Articles)

A double-blind, randomized, crossover comparison between single-dose and double-dose immediate-release oral morphine at bedtime in cancer patients

Palliative Care JournalClub - Selected Articles — Sun, 01 Jun 2008 05:05:58 +0100

J Pain Symptom Manage (new issue) (Source: Palliative Care JournalClub - Selected Articles)

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Editorial: palliative care research - time to intensify international collaboration.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Editorial: Palliative care research - time to intensify international collaboration.

Palliat Med. 2008 Jun;22(4):301-2

Authors: Kaasa S

PMID: 18541633 [PubMed - in process]

(Source: Palliative Medicine)

Opioids in context: relieving the pain of cancer. the role of comprehensive cancer management.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Opioids in context: relieving the pain of cancer. The role of comprehensive cancer management.

Palliat Med. 2008 Jun;22(4):303-9

Authors: Hoskin P

Optimal pain control requires detailed appraisal of each symptom; in many cases definitive treatment of the underlying cause will be the most effective means of pain control. As an example back pain may be due not only to bone metastases but also enlarging lymph nodes, renal pain or retroperitoneal tumour. Benign causes including degenerative joint disease should also be considered and each cause treated specifically alongside the use of analgesics.

PMID: 18541634 [PubMed - in process]

(Source: Palliative Medicine)

Variable response to opioid treatment: any genetic predictors within sight?

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Variable response to opioid treatment: any genetic predictors within sight?

Palliat Med. 2008 Jun;22(4):310-327

Authors: Skorpen F, Laugsand E, Klepstad P, Kaasa S

The aim of this literature review is to summarize and discuss the available evidence for a relationship between polymorphisms in human genes and variability in opioid analgesia and side effects among patients treated for moderate or severe pain. The evidence supporting a role of certain alleles, genotypes or haplotypes in modulation of opioid analgesia is derived from a limited number of studies, a limited number of genes and a limited number of opioids. Although several interesting candidates have emerged as potentially relevant factors, only for one polymorphism, the prevalent 118A>G of the mu-opioid receptor, the accumulated evidence is sufficient to suggest a clinically relevant effect for an opioid used for moderate or severe pain. Still the data are valid only at the group level and cannot be used to predict treatment outcome in individual patients. Only a few of the symptoms often seen as opioid adverse effects in palliative care, such as nausea, vomiting, constipation and sedation, have been associated with genetic variants in various genes, but the results have been based on case reports, healthy volunteers or post-operative patients. So far, there is no clear evidence that genetic markers can be used to predict opioid efficacy or adverse effects in palliative care patients. This reflects the general lack of studies performed in the context of palliative care, the lack of sufficiently scaled studies and the lack of international standards for the assessment of subjective symptoms.

PMID: 18541635 [PubMed - as supplied by publisher]

(Source: Palliative Medicine)

Global warming in the palliative care research environment - adapting to change.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Global warming in the palliative care research environment - adapting to change.

Palliat Med. 2008 Jun;22(4):328-35

Authors: Fainsinger R

Advocates of palliative care research have often described the cold and difficult environment that has constrained the development of research internationally. The development of palliative care research has been slow over the last few decades and has met with resistance and sometimes hostility to the idea of conducting research in 'vulnerable populations'. The seeds of advocacy for research can be found in palliative care literature from the 1980s and early 1990s. Although we have much to do, we need to recognize that palliative care research development has come a long way. Of particular note is the development of well-funded collaboratives that now exist in Europe, Canada, Australia and the USA. The European Association for Palliative Care and the International Association for Hospice and Palliative Care has recognized the need to develop and promote global research initiatives, with a special focus on developing countries. Time is needed to develop good research evidence and in a more complex healthcare environment takes increasingly more resources to be productive. The increased support (global warming) evident in the increased funding opportunities available to palliative care researchers in a number of countries brings both benefits and challenges. There is evidence that the advocacy of individuals such as Kathleen Foley, Neil MacDonald, Balfour Mount, Vittorio Ventafridda, Robert Twycross and Geoff Hanks is now providing fertile ground and a much friendlier environment for a new generation of interdisciplinary palliative care research. We have achieved many of the goals necessary to avoid failure of the 'palliative care experiment', and need to accept the challenge of our present climate and adapt and take advantage of the change.

PMID: 18541636 [PubMed - in process]

(Source: Palliative Medicine)

Research methodologies in palliative care: a bibliometric analysis.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Research methodologies in palliative care: a bibliometric analysis.

Palliat Med. 2008 Jun;22(4):336-42

Authors: Payne S, Turner J

The aspiration to design and conduct high-quality research in palliative care has been an important but elusive goal. The article evaluates the nature of research methodologies presented in published research within the broad remit of palliative care. A systematic search of the Medline database between 1997 and 2006, using the keywords 'palliative care' or 'end-of-life care' and 'research methodology', identified over 318 publications. A bibliometric analysis indicates an incremental increase in published outputs per year, from 27 countries, with articles widely distributed across 108 journals. The heterogeneity of the research methodologies and the journals publishing them, present challenges in defining what constitutes 'high quality'. We argue that although this diversity leads to a lack of coherence for a single disciplinary paradigm for palliative care, there is a greater acknowledgement of the differing epistemological and theoretical frameworks used by researchers. This could be regarded as enriching our understanding of what it means to be dying in contemporary society.

PMID: 18541637 [PubMed - in process]

(Source: Palliative Medicine)

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Use of a palliative care order set to improve resident comfort with symptom management in palliative care.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Use of a palliative care order set to improve resident comfort with symptom management in palliative care.

Palliat Med. 2008 Jun;22(4):343-349

Authors: Jarabek B, Jama A, Cha S, Ruegg S, Moynihan T, McDonald F

Although one-fourth of all medicare dollars are spent during the last year of life, symptom management for terminal hospitalized patients has continued to be inadequate. Quality end-of-life care is often overlooked, seldom taught and rarely measured within Internal Medicine Residency Programmes. We studied the effects of a palliative care order set and educational e-mail on resident comfort. Survey of residents showed that only 54% were comfortable across nine aspects of palliative care. Three months after release, 88% of residents were using the order set and 63% believed it increased their comfort with palliative care. Resident comfort managing palliative symptoms increased an average 10% (P = 0.02). First-year residents exposed to this order set increased in comfort from 40% to 65% (P < 0.0001), which significantly surpassed the 48% of second-year residents who reported being comfortable (P = 0.002). Introducing a palliative care order set improves resident comfort with symptom management in dying patients.

PMID: 18541638 [PubMed - as supplied by publisher]

(Source: Palliative Medicine)

Cultural meanings of pain: a qualitative study of black caribbean and white british patients with advanced cancer.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Cultural meanings of pain: a qualitative study of Black Caribbean and White British patients with advanced cancer.

Palliat Med. 2008 Jun;22(4):350-359

Authors: Koffman J, Morgan M, Edmonds P, Speck P, Higginson I

Pain is a common cancer-related symptom, but little research has been conducted that explores the meanings of this symptom across different ethnic groups. This study involved qualitative interviews to explore and compare the meanings of pain among 26 Black Caribbean and 19 White patients with advanced cancer. Patients were recruited from oncology outpatient clinics, a lung clinic and palliative care teams. Interview transcripts were analysed using the framework approach. A total of 23/26 Black Caribbean and 15/19 White patients reported cancer-related pain. Accounts of Black Caribbean and White patients identified pain as a 'challenge' that needed to be mastered by the individual, not necessarily by drugs and identified pain as an 'enemy' that represented an unfair attack. Two further meanings of pain emerged from Black Caribbean patients' accounts: pain as a 'test of faith' that referred to confirmation and strengthening of religious belief, and pain as a 'punishment' that was associated with wrongdoing. These meanings influenced the extent patients were able to accommodate their distress. Pain assessment needs to consider the patients' narratives that include the meanings they attribute to this symptom, and which may be governed by culture.

PMID: 18541639 [PubMed - as supplied by publisher]

(Source: Palliative Medicine)

A delphi study to develop the association for palliative medicine consensus syllabus for undergraduate palliative medicine in great britain and ireland.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

A Delphi study to develop the Association for Palliative Medicine consensus syllabus for undergraduate palliative medicine in Great Britain and Ireland.

Palliat Med. 2008 Jun;22(4):360-4

Authors: Paes P, Wee B

The Association for Palliative Medicine (APM) produced a previous undergraduate palliative medicine syllabus in 1992. This study describes the process of developing the new APM consensus syllabus against the background of changes in medical education and palliative medicine since 1992. The syllabus was derived by means of a Delphi study carried out amongst experts in palliative medicine across Britain and Ireland. Forty-three participants agreed to take part. Three rounds of the Delphi study took place. Consensus (75% agreement) was achieved in over 90% of the outcomes. The new syllabus is broken down into the following sections: basic principles, physical care, psychosocial care, culture, language, religious and spiritual issues, ethics and legal frameworks. Learning outcomes are categorised as essential or desirable. Using a Delphi study, we have developed a consensus syllabus for undergraduate palliative medicine. This is sufficiently flexible to allow all medical schools to ensure that their students achieve the essential learning outcomes by the time they graduate, whereas those with more generous curricular space will additionally be able to deliver selected desirable learning outcomes.

PMID: 18541640 [PubMed - in process]

(Source: Palliative Medicine)

Effectiveness of a three-day communication skills course in changing nurses' communication skills with cancer/palliative care patients: a randomised controlled trial.

Palliative Medicine — Sun, 01 Jun 2008 04:00:00 +0100

Effectiveness of a three-day communication skills course in changing nurses' communication skills with cancer/palliative care patients: a randomised controlled trial.

Palliat Med. 2008 Jun;22(4):365-75

Authors: Wilkinson S, Perry R, Blanchard K, Linsell L

This multi-centre, two-armed parallel-group pragmatic randomised controlled trial (RCT) evaluated the effectiveness of a 3-day communication skills course in changing nurses' communication skills. The primary outcome was the change in the nurses' communication skills score from pre-course to 12 weeks post-course. The main secondary outcome was the change in the nurses' level of confidence in communicating with patients. A total of 172 nurses were randomised to the course or control. The communication skills score for the intervention group increased by 3.4 points post-course but decreased in the control by 0.05 points (between-group difference in change: 3.41, 95% CI: 2.16-4.66, P < 0.001). Confidence scores increased by 18.16 points for the intervention group but decreased 0.7 points in the control (between-group difference in change: 18.86, 95% CI: 13.39-24.34, P < 0.001). This RCT contributes to the evidence base on the effectiveness of communication skills training in cancer and palliative care.

PMID: 18541641 [PubMed - in process]

(Source: Palliative Medicine)