MedWorm: Palliative Care

Center to Advance Palliative Care Palliative Care Clinical Care and Customer Satisfaction Metrics Consensus Recommendations

Journal of Palliative Medicine — Wed, 18 Nov 2009 15:37:46 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

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Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?

Journal of Palliative Medicine — Wed, 18 Nov 2009 15:08:09 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

My Lucky Experience with Cats

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:32:58 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1059-1059. (Source: Journal of Palliative Medicine)

News and Views

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:32:53 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 981-981. (Source: Journal of Palliative Medicine)

Physician Self-Disclosure at the End of Life: Is it Beneficial?

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:32:50 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 993-994. (Source: Journal of Palliative Medicine)

Meetings and Events

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:32:14 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1071-1073. (Source: Journal of Palliative Medicine)

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Recent Literature

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:32:07 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1069-1070. (Source: Journal of Palliative Medicine)

A Tale of Two Deaths: A Palliative Care Chaplain Reflects

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:57 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1057-1058. (Source: Journal of Palliative Medicine)

Introduction

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:24 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1067-1067. (Source: Journal of Palliative Medicine)

Toxicity of Bisphosphonates

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:11 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1061-1065. (Source: Journal of Palliative Medicine)

In this issue

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:10 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 979-979. (Source: Journal of Palliative Medicine)

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Malignant Pericardial Effusions #209

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:04 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1052-1053. (Source: Journal of Palliative Medicine)

In Defiance of Death: Exposing the Real Costs of End-of-Life Care

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:31:01 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1068-1068. (Source: Journal of Palliative Medicine)

Malignant Pleural Effusions: Interventional Management #157

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:59 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1051-1052. (Source: Journal of Palliative Medicine)

Critical

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:57 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1067-1068. (Source: Journal of Palliative Medicine)

Legal Issues in the Care of Pressure Ulcer Patients: Key Concepts for Health Care Providers: A Consensus Paper from the International Expert Wound Care Advisory Panel

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:54 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 995-1008. (Source: Journal of Palliative Medicine)

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Decision-Making Capacity

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:49 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1075-1075. (Source: Journal of Palliative Medicine)

Announcements

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:47 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1077-1079. (Source: Journal of Palliative Medicine)

The Psychological Well-Being Scale for Family Caregivers in Palliative Care

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:41 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 985-985. (Source: Journal of Palliative Medicine)

Even in death …

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:30:13 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 983-984. (Source: Journal of Palliative Medicine)

“Desensitization” of Opioids: A Case Study

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:29:47 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 987-987. (Source: Journal of Palliative Medicine)

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Makin' A Doctor

Journal of Palliative Medicine — Wed, 18 Nov 2009 14:29:27 +0100

Journal of Palliative Medicine Nov 2009, Vol. 12, No. 11: 1055-1055. (Source: Journal of Palliative Medicine)

Cultural conceptualizations of hospice palliative care: More similarities than differences.

Palliative Medicine — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Bosma H, Apland L, Kazanjian A The role of culture is significant in hospice palliative care (HPC). While mainstream HPC has been well described in many Western countries, there is no conceptual clarity regarding the meaning of HPC among minority cultures and ethnicities. In this article we describe and critically appraise the findings of a literature synthesis of 15 qualitative studies regarding the conceptualization of HPC among culturally diverse populations. Three primary themes emerged regarding HPC. They highlight: (i) that HPC should attend to the physical, psychosocial and spiritual aspects of death and dying; (ii) that the ideal HPC provider demonstrates excellent knowledge and expertise about end-of-life care, and is respectful, genuine and compassionate; and (iii) t...

Can you hear me now? The experience of a deaf family member surrounding the death of loved ones.

Palliative Medicine — Thu, 12 Nov 2009 00:00:00 +0100

Conclusions These findings provide a framework for future research concerning the needs of Deaf individuals facing the end of life and provide guidance for clinicians. PMID: 19910395 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

The intravenous to oral relative milligram potency ratio of morphine during chronic dosing in cancer pain.

Palliative Medicine — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Lasheen W, Walsh D, Mahmoud F, Sarhill N, Rivera N, Davis M, Lagman R, Legrand S Morphine (M) is the opioid analgesic of choice for severe cancer pain. The IV to PO M equipotent switch ratio (CR) is controversial. We designed this prospective observational cohort to confirm the efficacy and safety of M IV to PO CR of 1:3. Consecutive cancer patients admitted to an inpatient palliative medicine unit were screened for inclusion. Pain was managed by palliative medicine specialists. They were blinded to the patient data collected, and the calculated CR. The switch was considered successful if the following criteria were met: (1) Pain adequately controlled: pain rated as none or mild (2) Number of RD less than 4 (for non incident pain) per 24 hours (3) No limiting side effects. We ...

Oncologist patient-centered communication with patients with advanced cancer: Exploring whether race or socioeconomic status matter.

Palliative Medicine — Thu, 12 Nov 2009 00:00:00 +0100

Authors: Pollak K, Alexander SC, Grambow SC, Tulsky JA PMID: 19910397 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

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European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care

Palliative Care JournalClub - Selected Articles — Mon, 09 Nov 2009 06:06:59 +0100

Palliat Med 2009;23(7):581-93 (Source: Palliative Care JournalClub - Selected Articles)

RCGP launches 'ante-mortal' End of Life Care Strategy

NeLM - Palliative care — Fri, 06 Nov 2009 00:00:00 +0100

Source: RCGP Area: News The Royal College of General Practitioners (RCGP) has published a new UK-wide strategy aimed at improving the standards of care for those in the last stages of life. The strategy identifies 10 recommended areas for further work, including the establishment of a new End of Life Care Working Group to oversee and report on their progress. The recommendations include: . Recognising and rewarding best practice . Reviewing and refinement of existing educational resources . Supporting research and development of best practice models . Endorsing the use of advance care planning . Improving out of hours palliative care . Strengthening team-working with nurses, as part of the primary healthcare team (Source: NeLM - Palliativ...

Unbearability of suffering at the end of life: the development of a new measuring device, the SOS-V

BMC Palliative Care - Latest articles — Tue, 03 Nov 2009 00:00:00 +0100

Conclusions: The SOS-V is an instrument for measuring the unbearability of suffering in end-stage cancer patients with good content validity and psychometric properties, which is feasible to be used in practice. This structured instrument makes it possible to identify and study unbearable suffering in a quantitative and patient-oriented way. (Source: BMC Palliative Care - Latest articles)

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Journal of Pain and Symptom Management)

Editorial Board

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Journal of Pain and Symptom Management)

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Pc-facs

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Journal of Pain and Symptom Management)

Responding to Suffering: Providing Options and Respecting Choice

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

Abstract: Voluntary stopping of eating and drinking (VSED) as a legal means to hasten death has been discussed by some as an option for persons who wish to end their lives. A case is presented of a woman who elected to forgo eating and drinking to end intractable suffering. The potential for benefit and harm in physicians discussing VSED is discussed. Physicians working with terminally ill patients need to consider the discussion of VSED as a therapeutic tool in their support and care of patients with intractable suffering. (Source: Journal of Pain and Symptom Management)

Validation of a Simplified Anorexia Questionnaire

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

Abstract: Context: Anorexia is a common symptom in cancer and is usually assessed by multiple questions and multidimensional questionnaires. A simplified questionnaire would be less burdensome to patients and abbreviate the process.Objectives: We compared the reliability at one point in time, sensitivity to change over time, and prognostic accuracy of a two-item questionnaire with the Functional Assessment of Anorexia and Cachexia Therapy shortened 12-question version (A/CS-12).Methods: Individuals with cancer, who were cognitively intact and verbally agreed to participate, completed a two-item questionnaire and A/CS-12 in random order and again seven days later. We compared the direction of response to the summated two-item questionnaire to the validated A/CS-12 score at a single point in...

Efficacy of Dexmethylphenidate for the Treatment of Fatigue After Cancer Chemotherapy: A Randomized Clinical Trial

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

Abstract: Cancer and its treatment can induce subjective and objective evidence of diminished functional capacity encompassing physical fatigue and cognitive impairment. Dexmethylphenidate (d-MPH; the d-isomer of methylphenidate) was evaluated for treatment of chemotherapy-related fatigue and cognitive impairment. A randomized, double-blind, placebo-controlled, parallel-group study evaluated the potential therapeutic effect and safety of d-MPH in the treatment of patients with chemotherapy-related fatigue. Change from baseline in the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-F) total score at Week 8 was the primary outcome measure. One hundred fifty-four patients (predominantly with breast and ovarian cancers) were randomized and treated. Compared with placeb...

Attitudes of Patients with Advanced Cancer Toward Research

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

There is a great need for an improved evidence base to guide clinical practice and service provision in palliative care, yet research in palliative care has been notoriously difficult, with poor trial accrual and high attrition rates. It is therefore of vital importance to design “patient-friendly” studies that will encourage participation and improve accrual and retention. To design such trials, the views of potential participants need to be known. The systematic review by Todd et al., recently published in this journal, includes studies published up to 2007 and highlights some of the views of advanced cancer patients toward research participation, including altruism, the desire for personal benefit, and the potential for hope. It also points to some of the potential deterrents, for ...

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Axonal Common Peroneal Nerve Palsy and Delayed Proximal Motor Radial Conduction Block Following Infliximab Treatment

Journal of Pain and Symptom Management — Sun, 01 Nov 2009 00:00:00 +0100

A 38-year-old female, treated with infliximab (3mg/kg) for a two-year history of psoriatic arthritis, was referred with a sudden onset of left foot drop. At referral, eight courses of infliximab (anti-tumor necrosis factor [anti-TNF] monoclonal antibody) had already been infused. Her past medical history was otherwise unremarkable. No familial history of hereditary neuropathies, that is, hereditary neuropathy with liability to pressure palsy, was reported. (Source: Journal of Pain and Symptom Management)

Transdermal fentanyl as a front-line approach to moderate-severe pain: a meta-analysis of randomized clinical trials

Palliative Care JournalClub - Selected Articles — Sat, 24 Oct 2009 05:06:55 +0100

J Palliat Care 2009;25(3):172-80 (Source: Palliative Care JournalClub - Selected Articles)

Treatment of Malignant Pleural Effusion: PleuRx® Catheter or Talc Pleurodesis? A Cost-Effectiveness Analysis

Journal of Palliative Medicine — Tue, 20 Oct 2009 01:57:22 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Evaluation of quality-of-life measures for use in palliative care: A systematic review.

Palliative Medicine — Mon, 19 Oct 2009 23:00:00 +0100

Conclusions: Many measurement instruments were identified, but most had not yet been adequately evaluated. The evaluation of existing instruments with good content validity should have priority over the development of new instruments. PMID: 19843620 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

Creating social work competencies for practice in hospice palliative care.

Palliative Medicine — Mon, 19 Oct 2009 23:00:00 +0100

This article describes and critically appraises the findings of a literature synthesis of 15 qualitative studies regarding the conceptualization of HPC among culturally diverse populations. Three primary themes emerged regarding HPC. They highlight i) that HPC should attend to the physical, psychosocial and spiritual aspects of death and dying; ii) that the ideal HPC provider demonstrates excellent knowledge and expertise about end of life care, and is respectful, genuine and compassionate; and (iii), that HPC should include a range of resources that alleviate the potential burdens associated with end of life care. The synthesis of this knowledge suggests that expectations regarding the scope of HPC across ethnic and cultural groups have more similarities than differences to the goals of m...

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The pragmatic use of apomorphine at the end of life.

Palliative Medicine — Thu, 15 Oct 2009 23:00:00 +0100

Authors: Dewhurst F, Lee M, Wood B Parkinson's Disease (PD) is an irreversible degenerative neurological disorder with no known cure. Apomorphine is a potent short-acting D1/D2 dopamine agonist administered sub-cutaneously that is used in the treatment of PD. Optimising PD medication is an important aspect of end of life care. There are no previously reported cases of apomorphine providing symptom relief in terminal care of PD patients. This case highlights its potential benefits for symptom control at the end of life. PMID: 19837701 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

Costs associated with resource utilization during the palliative phase of care: a Canadian perspective.

Palliative Medicine — Thu, 15 Oct 2009 23:00:00 +0100

Conclusion: Such results provide a comprehensive picture of costs related to palliative care in Canada, by specifying the cost sharing between the PHCS, the family, and NFPO. PMID: 19837702 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices.

Palliative Medicine — Thu, 15 Oct 2009 23:00:00 +0100

The objectives of this study were to establish the extent to which UK primary care has adopted recommended practices on supportive and palliative care of adults with cancer, and to relate this to participation in national initiatives. We conducted a cross-sectional postal questionnaire survey of a random sample of UK general practices. In total, 60.0% of practices (2096 of 3495) responded to the survey: 61.5% reported involvement with the Gold Standards Framework (GSF); 24.4% with the Liverpool or other End of Life Care Pathway; 12.3%, with the Preferred Place of Care (PPC) initiative; and 8.4% with Advance Care Planning (ACP). Participation in GSF contributed most to the variance in practice organization scores; and practice organization scores contributed most to the variance in clinical...

Impact of Writing “Comfort Measures Only” Orders in a Community Teaching Hospital

Journal of Palliative Medicine — Thu, 15 Oct 2009 02:24:41 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Propofol for Terminal Sedation in Palliative Care: A Systematic Review

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:29:18 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

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Care for the Bodies of Deceased Cancer Inpatients in Japanese Palliative Care Units

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:27:17 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

A Study into the Children's Palliative Care Educational Needs of Health Professionals in Uganda

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:25:15 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

“Love Your Neighbor Like Yourself”: A Jewish Ethical Approach to the Use of Pain Medication with Potentially Dangerous Side Effects

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:22:45 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Effect of Topical Morphine (Mouthwash) on Oral Pain Due to Chemotherapy- and/or Radiotherapy-Induced Mucositis: A Randomized Double-Blinded Study

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:20:56 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

A Medical–Legal Partnership as a Component of a Palliative Care Model

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:18:40 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

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A Chemical Hemostatic Technique for Bleeding from Malignant Wounds

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:16:47 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Benefits and Challenges in Use of a Standardized Symptom Assessment Instrument in Hospice

Journal of Palliative Medicine — Wed, 14 Oct 2009 22:14:59 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Palliative Care Provision by Rural General Practitioners in New Zealand

Journal of Palliative Medicine — Tue, 13 Oct 2009 16:17:28 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

The Effect of Oral Methadone on the QTc Interval in Advanced Cancer Patients: A Prospective Pilot Study

Journal of Palliative Medicine — Tue, 13 Oct 2009 16:10:12 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

Journal of Palliative Medicine — Tue, 13 Oct 2009 15:37:17 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

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Descriptive Analysis of the In-Hospital Course of Patients who Initially Survive Out-of-Hospital Cardiac Arrest but Die In-Hospital

Journal of Palliative Medicine — Tue, 13 Oct 2009 15:34:16 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Preliminary report of the integration of a palliative care team into an intensive care unit.

Palliative Medicine — Mon, 12 Oct 2009 23:00:00 +0100

Authors: O'Mahony S, McHenry J, Blank AE, Snow D, Karakas SE, Santoro G, Selwyn P, Kvetan V Nearly half of Americans who die in hospitals spend time in the intensive care unit (ICU) in the last 3 days of life. Minority patients who die in the ICU are less likely to formalize advance directives and surviving family members report lower satisfaction with the provision of information and sensitivity to their cultural traditions at the end-of-life. This is a descriptive report of a convenience sample of 157 consecutive patients served by a palliative care team which was integrated into the operations of an ICU at Montefiore Medical Center in the Bronx, New York, from August 2005 until August 2007. The team included an advance practice nurse (APN) and social worker. A separate case-control ...

Depression assessment and classification in palliative cancer patients: a systematic literature review.

Palliative Medicine — Mon, 12 Oct 2009 23:00:00 +0100

The objective of this study was to review the literature on depression in palliative cancer care in order to identify which assessment methods and classification systems have been used in studies of depression. Extensive electronic database searches in PubMed, CancerLit, CINAHL, PsychINFO, EMBASE and AgeLine as well as hand search were carried out. In the 202 included papers, 106 different assessment methods were used. Sixty-five of these were only used once. All together, the Hospital Anxiety and Depression Scale (HADS) was the most commonly used assessment method. However, there were regional differences and while the HADS dominated in Europe it was quite seldom used in Canada or in the USA. Few prevalence and intervention studies used assessment methods with an explicit reference to a d...

Collaborating or co-existing: a survey of attitudes of medical oncologists toward specialist palliative care.

Palliative Medicine — Mon, 12 Oct 2009 23:00:00 +0100

This study is the first to specifically investigate the views of Australian medical oncologists toward collaboration with specialist palliative care. While positive attitudes have been expressed, identified barriers to collaboration need attention. PMID: 19825895 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

Intranasal alfentanil for severe intractable angina in inoperable coronary artery disease.

Palliative Medicine — Mon, 12 Oct 2009 23:00:00 +0100

We describe a case study where intranasal alfentanil provided rapid relief of symptoms preventing repeated hospital admissions. PMID: 19825896 [PubMed - as supplied by publisher] (Source: Palliative Medicine)

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Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying.

Palliative Medicine — Mon, 12 Oct 2009 23:00:00 +0100

This study explores the experiences of patients with COPD, particularly fears surrounding death and dying. Semi-structured interviews were conducted with 21 patients with moderate or severe COPD. Findings revealed that patient understanding of COPD was poor, most patients were unaware of the progressive nature of the condition, and few were aware they could die of COPD. Despite this, patients often expressed concerns that their condition might deteriorate. Patients had particular concerns regarding the manner of their death; the overriding fear was dying of breathlessness or suffocation. None of the patients' had discussed these fears with a health care professional. Improved patient education is needed in order to improve patients understanding of their condition and prognosis. Open commu...

Eye Donation in Sydney Metropolitan Palliative Care Units

Journal of Palliative Medicine — Mon, 12 Oct 2009 15:56:05 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Feasibility and Effectiveness of the NEST13+ as a Screening Tool for Advanced Illness Care Needs

Journal of Palliative Medicine — Mon, 12 Oct 2009 15:55:49 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy Volunteers

Journal of Pain and Symptom Management — Mon, 12 Oct 2009 00:00:00 +0100

Abstract: Morphine is usually given intravenously (IV) for the treatment of moderate-to-severe pain, but subcutaneous (SC) administration is a viable alternative for parenteral delivery. The pharmacokinetics of SC morphine may be enhanced by coadministration with a hyaluronidase product. In this Phase IV, double-blind, randomized, crossover study, 18 healthy adults received a single dose of 2mg morphine SC with 150U of recombinant human hyaluronidase (rHuPH20), SC with 0.9% normal saline, or IV on three consecutive days. The primary endpoint was time to maximum plasma morphine concentration (Tmax) for SC injection with rHuPH20 vs. SC injection without rHuPH20. Safety and tolerability were assessed each study day, the day after the last injection, and 28 days after the last injection. After...

The INFUSE-Morphine Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneously Administered Morphine in Patients with Advanced Illness

Journal of Pain and Symptom Management — Mon, 12 Oct 2009 00:00:00 +0100

Abstract: Morphine is often administered by the subcutaneous (SC) route when venous access is difficult to achieve. Hyaluronidase temporarily increases the permeability of SC connective tissues by degrading hyaluronan and has been shown to increase the dispersion and absorption of coadministered molecules. Therefore, hyaluronidase could enhance the pharmacokinetics of subcutaneous morphine. This Phase IIIB, double-blind, randomized, placebo-controlled crossover study compared the pharmacokinetics, safety, and tolerability of morphine administered SC with and without 150U of recombinant human hyaluronidase (rHuPH20) with those of intravenous (IV) morphine administration in 13 patients in a hospice or palliative care setting. Each patient received morphine 5mg parenterally daily for three da...

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In this issue

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:44:02 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 861-861. (Source: Journal of Palliative Medicine)

News and Views

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:44:01 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 863-863. (Source: Journal of Palliative Medicine)

Moral Distress in Palliative Care

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:59 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 865-866. (Source: Journal of Palliative Medicine)

Billing for Palliative Consultations a Prerequisite for the Field's Maturation

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:57 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 871-874. (Source: Journal of Palliative Medicine)

Medical Trainee Perceptions of Medical School Education about Suffering: A Pilot Study

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:16 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 929-935. (Source: Journal of Palliative Medicine)

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The Power of Presence and Listening: A Fellow's Narrative

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:07 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 961-962. (Source: Journal of Palliative Medicine)

Natural Death

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:05 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 959-959. (Source: Journal of Palliative Medicine)

“South Dakota's Dying to Know”: Personal Experiences with End-of-Life Care

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:43:01 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 905-913. (Source: Journal of Palliative Medicine)

Racial Differences in Self-Reported Exposure to Information about Hospice Care

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:42:23 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 921-927. (Source: Journal of Palliative Medicine)

Communication as Comfort: Multiple Voices in Palliative Care

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:42:22 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 969-970. (Source: Journal of Palliative Medicine)

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Treatment of Malignant Enterovesical Fistula with Octreotide

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:42:21 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 965-967. (Source: Journal of Palliative Medicine)

Systematic Reviews and Meta-Analyses

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:42:17 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 937-946. (Source: Journal of Palliative Medicine)

Managing One's Emotions as a Clinician #203

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:42:13 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 955-956. (Source: Journal of Palliative Medicine)

Patients Who Are Near Death Are Frequently Unable To Self-Report Dyspnea

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:54 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 881-884. (Source: Journal of Palliative Medicine)

The Cautious Use of Cyclizine in a Patient with Myasthenia Gravis

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:53 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 879-880. (Source: Journal of Palliative Medicine)

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Introduction

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:52 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 969-969. (Source: Journal of Palliative Medicine)

Destination Ventricular Assist Devices for Heart Failure #205

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:52 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 956-957. (Source: Journal of Palliative Medicine)

Improving the Quality of Spiritual Care as a Dimension of Palliative Care: The Report of the Consensus Conference

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:32 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 885-904. (Source: Journal of Palliative Medicine)

Emergency Department Research in Palliative Care: Challenges in Recruitment

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:29 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 867-868. (Source: Journal of Palliative Medicine)

Three Days

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:28 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 963-964. (Source: Journal of Palliative Medicine)

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Announcements

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:26 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 977-978. (Source: Journal of Palliative Medicine)

The Role of Fentanyl in Cancer-Related Pain

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:24 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 947-954. (Source: Journal of Palliative Medicine)

Meetings and Events

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:41:23 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 975-976. (Source: Journal of Palliative Medicine)

Humeral Metastasis in Patients with Stage IV Non-Small–Cell Lung Cancer Portends a Short Life Expectancy

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:40:33 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 869-870. (Source: Journal of Palliative Medicine)

Recent Literature

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:40:31 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 973-974. (Source: Journal of Palliative Medicine)

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Mastering Communication with Seriously III Patients: Balancing Honesty with Empathy and Hope

Journal of Palliative Medicine — Tue, 06 Oct 2009 14:40:27 +0100

Journal of Palliative Medicine Oct 2009, Vol. 12, No. 10: 970-971. (Source: Journal of Palliative Medicine)

Surges of Electroencephalogram Activity at the Time of Death: A Case Series

Journal of Palliative Medicine — Mon, 05 Oct 2009 15:29:37 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

A Comparative Study of 2 Sustained-Release Morphine Preparations for Pain in Advanced Cancer

Palliative Care JournalClub - Selected Articles — Mon, 05 Oct 2009 05:07:11 +0100

Am J Hosp Palliat Care (new issue) (Source: Palliative Care JournalClub - Selected Articles)

Phase II Trial of Mirtazapine for Cancer-Related Cachexia and Anorexia

Palliative Care JournalClub - Selected Articles — Sun, 04 Oct 2009 23:15:50 +0100

Am J Hosp Palliat Care (new issue) (Source: Palliative Care JournalClub - Selected Articles)

A comparison of intranasal fentanyl spray with oral transmucosal fentanyl citrate for the treatment of breakthrough cancer pain: an open-label, randomised, crossover trial

Palliative Care JournalClub - Selected Articles — Sun, 04 Oct 2009 23:11:13 +0100

Curr Med Res Opin (new issue) (Source: Palliative Care JournalClub - Selected Articles)

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Personal growth after a suicide loss: cross-sectional findings suggest growth after loss may be associated with better mental health among survivors.

Omega — Sat, 03 Oct 2009 02:56:03 +0100

Authors: Feigelman W, Jordan JR, Gorman BS With a diverse sample of 462 parent survivors of their child's suicide we explored the association of the personal growth subscale of the Hogan Grief Reaction Checklist (HGRC) with mental health problems among longer-term survivors. In this article we offer additional validation for this scale's association with longer-term survivorship and reduced grief difficulties. We also demonstrate its negative relationship with mental health problems. In addition, we explore the demographic correlates of personal growth, which are likely to enable some survivors to experience personal growth sooner than others. Overall, the findings suggest that personal growth represents an important part in the process of healing after suicide loss. PMID: 19791516...

Prolonged grief disorder and depression in widows due to the Rwandan genocide.

Omega — Sat, 03 Oct 2009 02:56:03 +0100

Authors: Schaal S, Elbert T, Neuner F Should pathological grief be viewed as a nosological category, separate from other forms of mental diseases? Diagnostic criteria for "Prolonged Grief Disorder" (PGD) have recently been specified by Prigerson and her coworkers. We interviewed a total of 40 widows who had lost their husbands during the Rwandan genocide in 1994. We assessed Major Depression using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and prolonged grief reactions with the PG-13. In order to examine the distinctiveness of the two syndromes we performed a multitrait correlational matrix analysis using modified versions of Generalized Proximity Functions (GPFs). 12.5% (n = 5) of the sample fulfilled the criteria for a diagnosis of PGD; 40% (n = 16) met criteria for...

How do the young suicide survivors wish to be met by psychologists? A user study.

Omega — Sat, 03 Oct 2009 02:56:03 +0100

Authors: Dyregrov K Little user-knowledge has been documented on the experiences of young suicide bereaved with psychosocial assistance and therapy. Thirty-two adolescents who had lost a close family member or friend by suicide participated in a research project by filling in questionnaires and participating in focus group interviews. The article explores the young people's experiences with and wishes for help from psychologists, and shows that the young bereaved do not receive the psychological assistance they wish for and need. The shortcomings are discussed in relation to the organization, form, and contents of the help. In order to reach youth with adequate assistance in an extreme life situation, it is worth listening to their opinions about how they want to be approached in the w...

Spiritual beliefs among Israeli nurses and social workers: a comparison based on their involvement with the dying.

Omega — Sat, 03 Oct 2009 02:56:03 +0100

Authors: Pelleg G, Leichtentritt RD The purpose of the study was to compare spiritual beliefs and practices between nurses and health care social workers based on their involvement with dying patients. Exposure to the dying was identified by two indicators: the percentage of terminally ill patients in the provider's care and the work environment. On the basis of the literature, differences were expected between the two types of professionals and the three degrees of involvement with the dying. Nurses were expected to have a higher spiritual perspective than social workers; and health care providers with high involvement in care for the dying were expected to hold the highest levels of spiritual beliefs. Contrary to expectations, no differences in spirituality were found between nurses ...

Embodied grief: bereaved parents' narratives of their suffering body.

Omega — Sat, 03 Oct 2009 02:56:03 +0100

Authors: Gudmundsdottir M Experiences and symptoms emanating from the bereaved person's body are commonly considered to be psychosomatic reactions to loss. The lingering of such experiences is thought to reflect a maladaptive coping style that needs to be addressed to access the psychological pain underlying the symptoms. In this interpretive, phenomenological study of 15 family members in seven families who lost a child to sudden, unexpected death, stories of embodied grief are explored to further understand the grieving body. The findings of this study illuminate the many ways parents experience their grieving body and they underscore the importance of witnessing and acknowledging stories of the body in clinical work with bereaved parents who are learning to live in a world without t...

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Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

(Source: Journal of Pain and Symptom Management)

Editorial Board

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

(Source: Journal of Pain and Symptom Management)

Pc-facs

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

(Source: Journal of Pain and Symptom Management)

Outpatient Continuous Interscalene Brachial Plexus Block in Cancer-Related Pain

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

Abstract: This case outlines the use of a continuous interscalene brachial plexus block to treat cancer-related pain. Using an elastomeric device, the patient's previously intractable pain was controlled and he was able to return home. Furthermore, the patient developed a pragmatic and effective method of balancing loss of power and sensation against pain control using the flow restrictor. This case illustrates the potential of an integrated approach to cancer pain management to obtain rapid pain relief in the acute hospital setting. (Source: Journal of Pain and Symptom Management)

Bereaved Parents' Perceptions About When Their Child's Cancer-Related Death Would Occur

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

Abstract: Parents of terminally ill children with cancer frequently ask clinicians when their child will die. Such information helps parents prepare for the child's death. To identify how parents perceived when their child's cancer-related death would occur, we conducted a secondary analysis of telephone interviews with 49 bereaved parents 6–10 months after their child's death to extract their descriptions of this occurrence. The parents knew in advance that their child was going to die, but they described when their child's death would occur in three different ways: anticipated (parents observed changes that alerted them that death was imminent; n=22, 52.4%), surprising (parents were surprised that their child died on that particular day; n=13, 31.0%), and overdue (parents had been wait...

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A Community Population Survey of Prevalence and Severity of Dyspnea in Adults

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

Abstract: Given the progress in the symptomatic treatment of breathlessness, and the physical and psychological morbidity associated with chronic breathlessness, estimates of the size of the population that may benefit from better support become imperative. Prevalence estimates have varied widely (0.9% of clinical encounters to 32%) and have largely relied only on respondents who used clinical services. Whole-of-population approaches may be able to define better the “true” prevalence of chronic breathlessness and quantify exertion limited by breathlessness. The aim of this study was to estimate population levels of chronic breathlessness, severity of limits to exercise, and demographic predictors of the presence of breathlessness. A whole-of-population face-to-face survey method (n=8,3...

Evaluating Cognitive, Emotional, and Physical Fatigue Domains in Daily Practice by Single-Item Questions in Patients With Advanced Cancer: A Cross-Sectional Pragmatic Study

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

Abstract: To assess cancer-related fatigue (CRF), multidimensional questionnaires are required. The aim of this study was to evaluate single-item fatigue (SIF) screening questions—one for global fatigue and three for the fatigue domains (cognitive, emotional, and physical)—for their immediate use in daily oncology practice. Sixty-one fatigued patients with advanced cancer completed SIF assessments (visual analog scales for global fatigue and for fatigue in the cognitive, emotional, and physical domains, respectively), and the Brief Fatigue Inventory (BFI), the Fatigue Assessment Questionnaire (FAQ), the Hospital Anxiety and Depression Scale (HADS), and the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life-C30 (QLQ-C30). SIF-global correlated with BFI (r...

Development of a Standard for Hospital-Based Palliative Care Consultation Teams Using a Modified Delphi Method

Journal of Pain and Symptom Management — Wed, 30 Sep 2009 23:00:00 +0100

Abstract: Although palliative care consultation teams are rapidly being disseminated throughout Japan as a result of government policy, the role of these teams has not been standardized. The aim of this study was to develop a hospital-based palliative care consultation team standard. We adopted a modified Delphi method to develop a standard. Twenty-seven multiprofessional panelists were selected according to two criteria: adequate experience as part of a palliative care consultation team and representative of 16 palliative care-related organizations. Panelists rated the appropriateness of 33 statements in a provisional standard, which was generated by the authors, using a nine-point Likert-type scale in a first-round survey. We set two criteria for agreement: the median value was 8 or mor...

Room for improvement? A quality of life assessment in patients with malignant bowel obstruction.

Palliative Medicine — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Selby D, Wright F, Stilos K, Daines P, Moravan V, Gill A, Chakraborty A This prospective study followed 35 patients admitted to hospital with malignant bowel obstruction (MBO) to evaluate quality of life (QOL). Subjects completed the Edmonton Symptom Assessment Scale (ESAS) and Rotterdam Symptom Checklist (RSCL) at recruitment, and at one week, one month and three months.The highest ranked ESAS scores at recruitment (which was generally 18-36 hours post admission to hospital) included loss of appetite (median=7.5), fatigue (6.5) and overall well-being (6.0). The total ESAS score improved by 7.5, 11.5 and 11.0 points respectively at one week, one month and three months (p<0.05, p<0.01, NS).RSCL median scores for physical and psychological subscales were high at baseline (...

Quantifying the impact of standardized assessment and symptom management tools on symptoms associated with cancer-induced anorexia cachexia syndrome.

Palliative Medicine — Wed, 30 Sep 2009 23:00:00 +0100

The objective of this study was to quantify the impact of standardized assessment and management tools on patient symptom scores in cancer-induced anorexia cachexia syndrome (ACS) using a within-group study design. Baseline assessments included the Patient Generated Subjective Global Assessment (PG-SGA) tool and an amended Symptoms and Concerns Checklist (SCC). Symptom management strategies, written for this project, were instigated. Follow-up SCC scores were collected at 2 and 4 weeks. Forty out of 79 patients referred were recruited; 29/79 (36.7%) were too unwell or had died prior to consent. At baseline, the PG-SGA tool revealed 250 active symptoms associated with ACS. Total PG-SGA score was above 9 for all patients. Predominant interventions involved simple dietary advice and prescript...

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French general practitioners vary in their attitudes toward treating terminally ill patients.

Palliative Medicine — Wed, 30 Sep 2009 23:00:00 +0100

Authors: Mas C, Albaret MC, Sorum P, Mullet E The purpose of this study is to analyze French general practitioners' attitudes toward prescribing opiate painkillers for dying patients and compare them with their attitudes toward making frequent home visits. One hundred and fifteen general practitioners indicated the acceptability of prescribing opiates in 48 scenarios of terminal cancer patients with different levels of age, gender, stated pain, request for painkillers, and signs of depression; 103 of them also indicated the acceptability of making frequent home visits in the same 48 scenarios. The responses were analyzed using analysis of variance and cluster analysis. For prescribing opiates, four clusters of physicians were found: 13 prescribed primarily in response to stated pain; 4...

Advancing Palliative Care as a Human Right

Journal of Pain and Symptom Management — Fri, 25 Sep 2009 00:00:00 +0100

This article describes recent advocacy activities and explores practical strategies for the palliative care community to use within a human rights framework to advance palliative care development worldwide. (Source: Journal of Pain and Symptom Management)

Improving Availability of and Access to Opioids in Colombia: Description and Preliminary Results of an Action Plan for the Country

Journal of Pain and Symptom Management — Fri, 25 Sep 2009 00:00:00 +0100

This article describes the preparation and implementation of an action plan in Colombia as a part of an international fellowship program on opioid policy developed by the PPSG and funded by the Open Society Institute. The action plan for Colombia included three steps: 1) a survey of regulators and health care providers to identify the current situation and their perceptions of opioid availability in the regions of the country; 2) a workshop with representatives of the Ministry of Health, the national and state competent authorities, pain and palliative care physicians, and international leaders; and 3) implementation workshops at the local level throughout the country. For the survey, response rates of 47% and 96% were registered among physicians and competent authorities, respectively. Th...

Morphine Inhalation by Cancer Patients: A Comparison of Different Nebulization Techniques Using Pharmacokinetic, Spirometric, and Gasometric Parameters

Journal of Pain and Symptom Management — Fri, 25 Sep 2009 00:00:00 +0100

Abstract: Despite numerous case reports suggesting the value of morphine (M) nebulization in the treatment of breathlessness, only a few clinical trials have been able to support this. The reason for this could lie in the lack of understanding of the localization of opioid receptors in the airways and the biopharmaceutics and pharmacokinetics of nebulized morphine. In the present study, we compared two different methods of pneumodosimetric nebulization: the Bronchial Control Treatment System-Sidestream (BCTS-S) and the Bronchial Control Treatment System-Micro Cirrus (BCTS-MC). The first method delivers relatively large aerosol particles (2–5μm) preferentially to the bronchial tree and trachea. In the BCTS-MC method, small aerosol particles (0.5–2μm) mostly reach the alveoli. Ten pati...

Associations Between Physical Activity and Quality of Life in Cancer Patients Receiving Palliative Care: A Pilot Survey

Journal of Pain and Symptom Management — Thu, 24 Sep 2009 00:00:00 +0100

Abstract: The primary aim of this study was to examine the association between physical activity and quality of life (QoL) in cancer patients receiving palliative care. Fifty advanced cancer patients aged 18 years or older with clinician-estimated life expectancy of 3–12 months and Palliative Performance Status Scale scores greater than 30% were recruited from an outpatient palliative care clinic and palliative home care. Participants completed a cross-sectional survey by means of face-to-face interview assessing self-reported QoL (McGill Quality of Life Questionnaire [MQOL]), self-reported physical function (Late-Life Function and Disability Instrument), symptoms (Edmonton Symptom Assessment System), and physical activity behavior. Seventy-six percent (38 of 50) of the participants wer...

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A Meta-Analysis of the Relationship Between Response Expectancies and Cancer Treatment-Related Side Effects

Journal of Pain and Symptom Management — Thu, 24 Sep 2009 00:00:00 +0100

Abstract: Response expectancies, defined as expectations for nonvolitional responses, have been proposed to contribute to the experience of side effects of cancer and its treatment. To statistically evaluate this association, a systematic search of the published literature was conducted, resulting in 14 studies appropriate for meta-analysis. Results revealed a significant (Z=6.58, P (Source: Journal of Pain and Symptom Management)

Differences in the Use of Pain Coping Strategies Between Oncology Inpatients with Mild vs. Moderate to Severe Pain

Journal of Pain and Symptom Management — Thu, 24 Sep 2009 00:00:00 +0100

Abstract: The purposes of this study were to determine a clinically significant cutpoint for worst pain and to evaluate for differences in the use of pain coping strategies between oncology inpatients with mild (i.e., worst pain intensity scores of ≤4) compared with moderate to severe (i.e., worst pain intensity scores of >4) pain based on results of the cutpoint analysis. Oncology inpatients in pain (n=224) completed the Coping Strategies Questionnaire (CSQ), the Brief Pain Inventory, and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Fifty-six percent had moderate to severe pain. Patients in the moderate to severe pain group had significantly poorer Karnofsky Performance Status scores (P=0.04) and significantly lower rating...

State of Consciousness During the Last Days of Life in Patients Receiving Palliative Care

Journal of Pain and Symptom Management — Thu, 24 Sep 2009 00:00:00 +0100

Most patients want to interact with proxies and nursing staff to be able to make clear decisions until death. In addition, to address and treat symptoms efficiently, communication is crucial. But communication can be altered because of disease progression or metabolic abnormalities, and side effects from drugs are frequently implicated in the occurrence of delirium or impaired consciousness. Common drugs that cause this effect include anxiolytic and antipsychotic agents and even opioids. Previous studies have reported that about 30% of patients were conscious until death, meaning that 70% were not. In recent years, great improvements have been made in the management of pain with the availability of various new agents and the introduction of opioid rotation. We thus wanted to determine whet...

Treatment of cancer-related anorexia with olanzapine and megestrol acetate: a randomized trial

Palliative Care JournalClub - Selected Articles — Mon, 21 Sep 2009 05:06:57 +0100

Support Care Cancer (new issue) (Source: Palliative Care JournalClub - Selected Articles)

Associations between home death and GP involvement in palliative cancer care

Palliative Care JournalClub - Selected Articles — Sun, 20 Sep 2009 22:01:06 +0100

Br J Gen Pract 2009;59(6):671-7 (Source: Palliative Care JournalClub - Selected Articles)

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Are we there yet? The state of the evidence base for guidelines on breaking bad news to cancer patients

Palliative Care JournalClub - Selected Articles — Sun, 20 Sep 2009 21:49:48 +0100

Eur J Cancer (new issue) (Source: Palliative Care JournalClub - Selected Articles)

Support Needs of Informal Hospice Caregivers: A Qualitative Study

Journal of Palliative Medicine — Fri, 18 Sep 2009 13:37:01 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Bereavement needs assessment in specialist palliative care: a review of the literature.

Palliative Medicine — Wed, 16 Sep 2009 23:00:00 +0100

Authors: Agnew A, Manktelow R, Taylor BJ, Jones L Bereavement needs assessment for specialist palliative care services has been highlighted as important by NICE guidance on palliative care for adults with cancer. Identifying and implementing appropriate bereavement measurement tools has remained a challenge. This paper identifies and reviews bereavement measurement tools to determine their suitability for use within bereavement services and hospice settings. Cochrane, MEDLINE, PsycINFO and CINAHL, electronic databases were searched, yielding 486 papers. From fifty-nine full text papers appraised, 10 measurement tools were analysed in detail. Some tools had been tested on specific populations which limited transferability to specialist palliative care settings; some lacked adequate theo...

Governance in changing times: the experiences of hospice trustees in the United Kingdom.

Palliative Medicine — Wed, 16 Sep 2009 23:00:00 +0100

Authors: Turner M, Payne S Hospice trustees are volunteers who are vital to the governance and management of independent, charitable hospices, yet little is known about their roles and concerns. This paper presents some findings from a qualitative study which explored the views and perspectives of hospice trustees in the UK. Twenty hospice trustees took part in semi-structured telephone interviews, which were analysed using an iterative thematic approach. Nine themes emerged from the analysis, and were grouped into two major categories. One theme, 'becoming a trustee', is presented in this paper to illustrate trustees' concerns about the challenges they face in adapting to change. The pace of change currently facing hospices in the UK is an issue of particular concern to trustees, pres...

An open-label, 1-year extension study of the long-term safety and efficacy of once-daily OROS(R) hydromorphone in patients with chronic cancer pain

BMC Palliative Care - Latest articles — Mon, 14 Sep 2009 23:00:00 +0100

Conclusions: The results of this extension study suggest that long-term repeated dosing with once-daily OROS(R) hydromorphone can be beneficial in the continuing management of persistent, moderate-to-severe cancer pain. (Source: BMC Palliative Care - Latest articles)

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Assessment of Symptoms Reported by 10- to 18-Year-Old Cancer Patients in Taiwan

Journal of Pain and Symptom Management — Mon, 14 Sep 2009 00:00:00 +0100

Abstract: The purposes of this study were 1) to assess and describe the occurrence, frequency, severity, and distress of symptoms reported by Taiwanese pediatric cancer patients who were between 10 and 18 years of age, and 2) to use statistical analysis to determine whether the multiple dimensions (i.e., frequency, severity, or distress) of the Memorial Symptom Assessment Scale (MSAS) 10–18 alone can provide sufficient useful information for the assessment of symptoms that patients report as distressing. A total of 144 Taiwanese pediatric cancer patients and their mothers participated in this cross-sectional study. The frequency of symptoms for all patients ranged from 52% for “lack of energy” to 10% for “feeling nervous.” The most common symptoms (occurrence >40%) were “lack o...

GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study

BMC Palliative Care - Latest articles — Sun, 13 Sep 2009 23:00:00 +0100

Conclusions: While some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research (Source: BMC Palliative Care - Latest articles)

Screening for Constipation in Palliative Care Patients

Journal of Palliative Medicine — Fri, 11 Sep 2009 13:09:55 +0100

Journal of Palliative Medicine , Vol. 0, No. 0. (Source: Journal of Palliative Medicine)

Balloon kyphoplasty in malignant spinal fractures: a systematic review and meta-analysis.

BMC Palliative Care - Latest articles — Tue, 08 Sep 2009 23:00:00 +0100

Conclusions: It appears that there is level III evidence showing BKP is a well-tolerated, relatively safe and effective technique that provides early pain relief and improved functional outcomes in patients with painful neoplastic spinal fractures. BKP also provided long-term benefits in terms of pain and disability. However, the methodological quality of the original studies prevents definitive conclusions being drawn. Further investigation into the use of BKP for spinal fractures in cancer patients is warranted. (Source: BMC Palliative Care - Latest articles)

Formulation selection and pharmacokinetic comparison of fentanyl buccal soluble film with oral transmucosal fentanyl citrate: a randomized, open-label, single-dose, crossover study

Palliative Care JournalClub - Selected Articles — Sun, 06 Sep 2009 05:07:13 +0100

Clin Drug Investig 2009;29:647-54 (Source: Palliative Care JournalClub - Selected Articles)

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Heart Failure: The Hidden Problem of Pain

Journal of Pain and Symptom Management — Fri, 04 Sep 2009 00:00:00 +0100

This study assessed pain in HF and identified contributing factors. As part of a multicenter study, 96 veterans with HF (96% male, 67±11 years) completed measures of symptoms, pain (Brief Pain Inventory [BPI]), functional status (Functional Morbidity Index), and psychological state (Patient Health Questionnaire-2 and Generalized Anxiety Disorder-2). Single items from the BPI interference and the quality of life-end of life measured social and spiritual well-being. Demographic and clinical variables were obtained by chart audit. Correlation and linear regression models evaluated physical, emotional, social, and spiritual factors associated with pain. Fifty-three (55.2%) HF patients reported pain, with a majority (36 [37.5%]) rating their pain as moderate to severe (pain≥4/10). The presen...

Efficacy and tolerability of intranasal fentanyl spray 50 to 200 microg for breakthrough pain in patients with cancer: a phase III, multinational, randomized, double-blind, placebo-controlled, crossover trial with a 10-month, open-label extension treatment period

Palliative Care JournalClub - Selected Articles — Tue, 01 Sep 2009 05:06:11 +0100

Clin Ther 2009;31(6):1177-91 (Source: Palliative Care JournalClub - Selected Articles)

The Congress of Vienna.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Breitbart W PMID: 19788767 [PubMed - in process] (Source: Palliative and Supportive Care)

Reappraisal in the eighth life cycle stage: a theoretical psychoeducational intervention in elderly patients with cancer.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Holland J, Poppito S, Nelson C, Weiss T, Greenstein M, Martin A, Thirakul P, Roth A Elderly patients with cancer face unique physical and psychiatric challenges in coping with their illness. Optimal psychosocial therapy for older cancer patients requires recognizing certain enhanced psychological capacities such as coping better with illness, which is associated with older age. This strength can be combined with the most appropriate cognitive coping strategies to develop a model intervention. This paper describes such a model, which integrates Erik Erikson's eighth and final psychosocial developmental life stage, in which the task is to achieve ego integrity (equanimity) or to experience despair (sadness, regrets), with Susan Folkman's cognitive coping paradigm, which utilizes...

Adjusting to pancreatic cancer: perspectives from first-degree relatives.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Petrin K, Bowen DJ, Alfano CM, Bennett R OBJECTIVE: The combination of a difficult early diagnosis, few treatment options, and high mortality rate could make the experience of pancreatic cancer different from the experience of other cancers, both for patients and families. To design effective interventions for families with a diagnosis of pancreatic cancer, there is need for a model of family members' adjustment to cancer that is specific to these unique aspects of pancreatic cancer. METHOD: Trained clinical interviewers and a genetic counselor conducted phone interviews with 22 first-degree relatives-parents, siblings, and offspring-from a pool of participating family members. The interview transcripts were analyzed using qualitative coding methods. RESULTS: Participants expr...

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Quality of life measures (EORTC QLQ-C30 and SF-36) as predictors of survival in palliative colorectal and lung cancer patients.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

This study assessed whether better prediction is achieved using generic (SF-36) HRQoL measures or cancer-specific (EORTC QLQ-C30) measures that include symptoms. METHOD: Fifty-four lung and 46 colorectal patients comprised the sample. Ninety-four died before study conclusion. EORTC QLQ-C30 and SF-36 scores and demographic and clinical information were collected at baseline. Follow-up was 5 years. Deaths were flagged by the Office of National Statistics. Cox regression survival analyses were conducted. Surviving cases were censored in the analysis. RESULTS: Univariate analyses showed that survival was significantly associated with better EORTC QLQ-C30 physical functioning, role functioning, and global health and less dyspnea and appetite loss. For the SF-36, survival was significantly assoc...

Associations with worry about dying and hopelessness in ambulatory ovarian cancer patients.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Shinn EH, Taylor CL, Kilgore K, Valentine A, Bodurka DC, Kavanagh J, Sood A, Li Y, Basen-Engquist K OBJECTIVE: Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design. METHOD: Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were ent...

The psychological responses of outpatient breast cancer patients before and during first medical consultation.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

This study used a content analysis of interviews to chronologically examine psychological response of cancer patients seeking medical consultation at three points in time. RESULTS: Patients at the time of their first outpatient breast cancer consultation experience negative feelings before the examination, directly influenced by the suspicion of cancer. These include anxiety and worries, fear, evasion, depression, and impatience. These tendencies do not change at the time of consultation. However, in addition to negative feelings, some people also possess positive feelings, either simultaneously or at a different point in time. Further, many patients tend to talk at length about psychological responses before seeking treatment, understanding the process they went through to come to seek tr...

Development and validation of the Family Decision-Making Self-Efficacy Scale.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Nolan MT, Hughes MT, Kub J, Terry PB, Astrow A, Thompson RE, Clawson L, Texeira K, Sulmasy DP OBJECTIVE: Several studies have reported high levels of distress in family members who have made health care decisions for loved ones at the end of life. A method is needed to assess the readiness of family members to take on this important role. Therefore, the purpose of this study was to develop and validate a scale to measure family member confidence in making decisions with (conscious patient scenario) and for (unconscious patient scenario) a terminally ill loved one. METHODS: On the basis of a survey of family members of patients with amyotrophic lateral sclerosis (ALS) enriched by in-depth interviews guided by Self-Efficacy Theory, we developed six themes within family decision ...

Validation of the Demoralization Scale in an Irish advanced cancer sample.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

This article presents a validation study of the Demoralization Scale, a 24-item, 5-point response questionnaire developed by Kissane et al. in 2004 to assess demoralization in advanced cancer patients. METHOD: One hundred Irish inpatients with advanced palliative cancer completed the Demoralization Scale and measures of depression, hopelessness, quality of life, and personal hopefulness. RESULTS: Principal component analysis of the Demoralization Scale yielded four similar factors found by Kissane et al. (2004), namely, loss of meaning, dysphoria, disheartenment, and sense of failure. A new factor, the hopelessness factor, was also found in the current study. The reliability of the five factors was good, ranging from .72 to .93. Contrary to the findings of Kissane et al.'s (2004) study, di...

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Attitudes of Quebec doctors toward sedation at the end of life: an exploratory study.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Blondeau D, Dumont S, Roy L, Martineau I OBJECTIVE: The induction of sedation at the end of life is a much debated practice and not very documented. The goal of this study was to explore the practice from both a clinical and ethical point of view. METHODS: Data were collected through semistructured interviews with 19 Quebec physicians working in palliative care. RESULTS: Doctors' first priority was their patients, not patients' families. Clinically, the therapeutic aim of sedation was strictly to relieve suffering on the part of the patient. Ethically, getting the patient's consent was imperative. The family's consent was only required in cases of incapacity. Generally, sedation and euthanasia were seen as two distinct practices. SIGNIFICANCE OF THE RESEARCH: There are still v...

Perspectives on palliative care in Lebanon: knowledge, attitudes, and practices of medical and nursing specialties.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Abu-Saad Huijer H, Dimassi H, Abboud S OBJECTIVE: Our objective was to determine the knowledge, attitudes, and practices of physicians and nurses on Palliative Care (PC) in Lebanon, across specialties. METHOD: We performed a cross-sectional descriptive survey using a self-administered questionnaire; the total number of completed and returned questionnaires was 868, giving a 23% response rate, including 74.31% nurses (645) and 25.69% physicians (223). RESULTS: Significant differences were found between medical and surgical nurses and physicians concerning their perceptions of patients' and families' outbursts, concerns, and questions. Knowledge scores were statistically associated with practice scores and degree. Practice scores were positively associated with continuing educat...

International comparison study on the primary concerns of terminally ill cancer patients in short-term life review interviews among Japanese, Koreans, and Americans.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Ando M, Morita T, Ahn SH, Marquez-Wong F, Ide S OBJECTIVE: The aim of this study was to investigate the primary concerns of terminally ill cancer patients in a Short-Term Life Review among Japanese, Koreans, and Americans to develop intervention programs to be tailored to patients in other countries. METHOD: Twenty Japanese, 16 Korean, and 7 American terminally ill cancer patients who were in the hospice wards of general Christian hospitals in each country participated in this study. Medical staff members (nurses, social workers, clinical psychologists) performed Short-Term Life Review Interviews with each patient. Patients reviewed their lives in the first session, the interviewers made simple albums for each patient in the week following the first session, and patients and i...

Providing care and sharing expertise: reflections of nurse-specialists in palliative home care.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

This study explored the experiences, perspectives, and reflections of five nurse-specialists in palliative home care, whose dual role includes caring for patients in their daily practice as well as sharing their knowledge, skills, expertise, and experiences with other home care nurses in the community. METHODS: A qualitative research design, incorporating face-to-face semistructured interviews, was used. Interviews were based on open-ended questions such as: "What is your experience in providing palliative home care to patients and their families? How do you feel about sharing your expertise and experiences with home care nurses?" Data were content analyzed using the constant comparative method. RESULTS: Three major themes and a number of subthemes emerged: (1) acknowledging one's own limi...

Hope in palliative care: an integrative review.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

The objective of this review is to describe the current status of research on hope in palliative care. METHODS: Integrative review was conducted to determine current knowledge on the topic. CINAHL and PubMed MEDLINE databases were used to find the articles relevant to this review. The data consisted of 34 articles on hope and palliative care published in peer-reviewed journals. A qualitative approach utilizing content analysis was used in this review. RESULTS: There are at least two overarching themes of patients' hope in the palliative context: "living with hope" and "hoping for something" which however are not separate contents. Several instruments for measuring hope in a palliative context have been produced. However, future research is needed to gather further validity evidence for the...

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Complications.

Palliative and Supportive Care — Mon, 31 Aug 2009 23:00:00 +0100

Authors: Rousseau P PMID: 19788780 [PubMed - in process] (Source: Palliative and Supportive Care)

Pc-facs

Journal of Pain and Symptom Management — Mon, 31 Aug 2009 23:00:00 +0100

(Source: Journal of Pain and Symptom Management)

The Defined Trial Period in Ethical Decision Making

Journal of Pain and Symptom Management — Mon, 31 Aug 2009 23:00:00 +0100

Abstract: In the face of acute life-threatening illness, especially when superimposed upon chronic illness, patients and their families often face great difficulty in establishing treatment preferences and goals of care. This is especially true early in treatment when prognostication is difficult. The “defined trial period” is discussed and emphasized as a useful strategy in resolving some of these dilemmas. This strategy depends on acceptance of the moral and legal equivalency of withholding and withdrawing treatment. An unusual case is presented in which the use of a defined trial period enabled the entire care team to form a consensus on a treatment plan. Society faces a great challenge in how it balances competing interests in the allocation of scarce resources. (Source: Journal of...

Novel Use of Amantadine: To Treat Hiccups

Journal of Pain and Symptom Management — Mon, 31 Aug 2009 23:00:00 +0100

We report a complex clinical case of intractable hiccups in a patient with cancer of the pancreas and Parkinson's disease and some of the problems encountered when attempting symptom control. We also discuss a potential therapeutic response to a novel agent, amantadine, unlicensed in the treatment of hiccups. (Source: Journal of Pain and Symptom Management)

MedWorm: Palliative Care

Center to Advance Palliative Care Palliative Care Clinical Care and Customer Satisfaction Metrics Consensus Recommendations

Can Metaphors and Analogies Improve Communication with Seriously Ill Patients?

My Lucky Experience with Cats

News and Views

Physician Self-Disclosure at the End of Life: Is it Beneficial?

Meetings and Events

Recent Literature

A Tale of Two Deaths: A Palliative Care Chaplain Reflects

Introduction

Toxicity of Bisphosphonates

In this issue

Malignant Pericardial Effusions #209

In Defiance of Death: Exposing the Real Costs of End-of-Life Care

Malignant Pleural Effusions: Interventional Management #157

Critical

Legal Issues in the Care of Pressure Ulcer Patients: Key Concepts for Health Care Providers: A Consensus Paper from the International Expert Wound Care Advisory Panel

Decision-Making Capacity

Announcements

The Psychological Well-Being Scale for Family Caregivers in Palliative Care

Even in death …

“Desensitization” of Opioids: A Case Study

Makin' A Doctor

Cultural conceptualizations of hospice palliative care: More similarities than differences.

Can you hear me now? The experience of a deaf family member surrounding the death of loved ones.

The intravenous to oral relative milligram potency ratio of morphine during chronic dosing in cancer pain.

Oncologist patient-centered communication with patients with advanced cancer: Exploring whether race or socioeconomic status matter.

European Association for Palliative Care (EAPC) recommended framework for the use of sedation in palliative care

RCGP launches 'ante-mortal' End of Life Care Strategy

Unbearability of suffering at the end of life: the development of a new measuring device, the SOS-V

Table of Contents

Editorial Board

Pc-facs

Responding to Suffering: Providing Options and Respecting Choice

Validation of a Simplified Anorexia Questionnaire

Efficacy of Dexmethylphenidate for the Treatment of Fatigue After Cancer Chemotherapy: A Randomized Clinical Trial

Attitudes of Patients with Advanced Cancer Toward Research

Axonal Common Peroneal Nerve Palsy and Delayed Proximal Motor Radial Conduction Block Following Infliximab Treatment

Transdermal fentanyl as a front-line approach to moderate-severe pain: a meta-analysis of randomized clinical trials

Treatment of Malignant Pleural Effusion: PleuRx® Catheter or Talc Pleurodesis? A Cost-Effectiveness Analysis

Evaluation of quality-of-life measures for use in palliative care: A systematic review.

Creating social work competencies for practice in hospice palliative care.

The pragmatic use of apomorphine at the end of life.

Costs associated with resource utilization during the palliative phase of care: a Canadian perspective.

What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices.

Impact of Writing “Comfort Measures Only” Orders in a Community Teaching Hospital

Propofol for Terminal Sedation in Palliative Care: A Systematic Review

Care for the Bodies of Deceased Cancer Inpatients in Japanese Palliative Care Units

A Study into the Children's Palliative Care Educational Needs of Health Professionals in Uganda

“Love Your Neighbor Like Yourself”: A Jewish Ethical Approach to the Use of Pain Medication with Potentially Dangerous Side Effects

Effect of Topical Morphine (Mouthwash) on Oral Pain Due to Chemotherapy- and/or Radiotherapy-Induced Mucositis: A Randomized Double-Blinded Study

A Medical–Legal Partnership as a Component of a Palliative Care Model

A Chemical Hemostatic Technique for Bleeding from Malignant Wounds

Benefits and Challenges in Use of a Standardized Symptom Assessment Instrument in Hospice

Palliative Care Provision by Rural General Practitioners in New Zealand

The Effect of Oral Methadone on the QTc Interval in Advanced Cancer Patients: A Prospective Pilot Study

Discharge Outcomes and Survival of Patients with Advanced Cancer Admitted to an Acute Palliative Care Unit at a Comprehensive Cancer Center

Descriptive Analysis of the In-Hospital Course of Patients who Initially Survive Out-of-Hospital Cardiac Arrest but Die In-Hospital

Preliminary report of the integration of a palliative care team into an intensive care unit.

Depression assessment and classification in palliative cancer patients: a systematic literature review.

Collaborating or co-existing: a survey of attitudes of medical oncologists toward specialist palliative care.

Intranasal alfentanil for severe intractable angina in inoperable coronary artery disease.

Living with advanced chronic obstructive pulmonary disease: patients concerns regarding death and dying.

Eye Donation in Sydney Metropolitan Palliative Care Units

Feasibility and Effectiveness of the NEST13+ as a Screening Tool for Advanced Illness Care Needs

The INFUSE-Morphine IIB Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneous Morphine in Healthy Volunteers

The INFUSE-Morphine Study: Use of Recombinant Human Hyaluronidase (rHuPH20) to Enhance the Absorption of Subcutaneously Administered Morphine in Patients with Advanced Illness

In this issue

News and Views

Moral Distress in Palliative Care

Billing for Palliative Consultations a Prerequisite for the Field's Maturation

Medical Trainee Perceptions of Medical School Education about Suffering: A Pilot Study

The Power of Presence and Listening: A Fellow's Narrative

Natural Death

“South Dakota's Dying to Know”: Personal Experiences with End-of-Life Care

Racial Differences in Self-Reported Exposure to Information about Hospice Care

Communication as Comfort: Multiple Voices in Palliative Care

Treatment of Malignant Enterovesical Fistula with Octreotide

Systematic Reviews and Meta-Analyses

Managing One's Emotions as a Clinician #203