“Despite the evidence that more people will die of frailty and multiple long-term conditions than of cancer, our services for those moving towards the end of their life remain focussed on the needs of the latter group”
Commentaries: Study: Palliative Care Reduces Hospital Stay, Cost of Sickest Patients – U.S. News (free) AND Prompt Palliative Care Saves Money, Especially in Sickest Patients – MedPage Today (free registration required)
Related Guidelines: American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement (free) AND ESPEN guideline on ethical aspects of artificial nutrition and hydration (free)
Related Reviews: Artificial nutrition and hydration in advanced dementia – Canadian Family Physician (free) AND End-of-life issues in advanced dementia: Part 1: goals of care, decision-making process, and family education – Canadian Family Physician (free) AND End-of-life issues in advanced dementia: Part 2: management of poor nutritional intake, dehydration, and pneumonia – Canadian Family Physician (free) AND Advanced Dementia – New England Journal of Medicine (free)
Commentaries: Updated ASTRO guideline for palliative lung radiation now recommends concurrent chemotherapy for some stage III patients – eCancer News (free) AND ASTRO updates lung radiation guideline for non-small cell lung cancer patients – Health Imaging (free)
See website: End of Life Choices
Related initiatives: This Startup Makes End-Of-Life Planning A Piece Of Cake (free) AND New Document for Patients: Advanced Health Directive for Dementia (free document and commentaries)
Clinical Updates: Palliative radiotherapy – The BMJ (free)
Clinical Update for non-specialists on the benefits, practicalities, and side effects of palliative radiotherapy
““Palliative care” had connotations of treatment withdrawal and imminent death… practicing the principles of palliative care is needed, but the term “palliative care” should be avoided or reframed”.
See related articles on this subject: Palliative care: renaming as supportive care and integration into comprehensive cancer care – CMAJ (free) AND Perceptions of palliative care among patients with advanced cancer and their caregivers (free)
Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial – The Lancet Oncology (link to abstract – $ for full-text)
Related Guideline: Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update (free) AND Commentary: Concurrent Palliative Care: Recommendations From the ASCO Clinical Practice Guideline – The ASCO Post (free)
One Day Your Mind May Fade. At Least You’ll Have a Plan – The New York Times (10 articles per month are free)
Source: New document allows advance planning for dementia – Univadis (free registration required)
“A Simple Way to Document the Medical Care You Would Want If You Had Dementia”
“…majority of people with cancer would like their physicians to ask them where they would prefer to receive end-of-life care” (from NewsWise).
Related: Early palliative care for adults with advanced cancer – Cochrane Library (free summary and original article) AND How Early Palliative Care May Benefit Patients With Incurable Cancer – ASCO Post (free)
Advance care planning for patients with chronic respiratory diseases: a systematic review of preferences and practices – Thorax (link to abstract – $ for full-text)
Palliative Care Eligibility, Symptom Burden, and Quality-of-Life Ratings in Nursing Home Residents – JAMA Internal Medicine (link to abstract – $ for full-text)
Commentaries: Nursing home residents eligible for palliative care often don’t get it – Reuters (free) AND Most nursing home residents eligible for palliative care but lack access – MedicalXpress (free)
Commentaries: Palliative Care Associated With Decreased Costs For Patients With Advanced Cancer – Oncology Nurse Advisor (free) AND Early Palliative Care Is Key Driver in Reducing Costs – Medscape (free registration required)
Related study: Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer – Journal of Oncology Practice (link to abstract – $ for full-text) AND Commentaries: Palliative Care May Substantially Decrease Health-Care Utilization in Patients With Advanced Cancer – ASCO Post (free) AND End-of-Life Palliative Care Lowered Utilization for Patients With Cancer – AJMC (free)
Commentaries: A milestone for palliative care and pain relief – The Lancet (free registration required) AND Millions die suffering amid global opioid gap, report says – STAT (free) AND More than 25 million people dying in agony without morphine every year – The Guardian (free)
Editorial: Identifying frailty in primary care (free)
“the tool can reliably estimate risk of dying within 12 months and risk of unplanned admissions among patients aged between 65 and 100 years old” (from MyScience).
Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial – JAMA (link to abstract – $ for full-text)
Commentaries: Lorazepam, Haloperidol, and Delirium – Pallimed (free) AND Drug Combo Found Helpful in End-of-Life Delirium – MedPage Today (free registration required) AND Lorazepam Plus Haloperidol Improves Agitation in Cancer-Related Delirium – OncologyNurse Advisor (free)
Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial – Journal of The American College of Cardiology (link to abstract – $ for full-text)
Commentaries: Palliative Care Intervention Improves Quality of Life in Advanced Heart Failure Patients – American College of Cardiology, Latest in Cardiology (free) AND Palliative Care & CHF: PAL-HF trial – Pallimed (free)
Effect of Palliative Care on Aggressiveness of End-of-Life Care Among Patients With Advanced Cancer – Journal of Oncology Practice (link to abstract – $ for full-text)
Commentaries: Palliative Care May Substantially Decrease Health-Care Utilization in Patients With Advanced Cancer – ASCO Post (free) AND End-of-Life Palliative Care Lowered Utilization for Patients With Cancer – AJMC (free) AND Palliative Care Cut Healthcare Use in Advanced Cancer – MedPage Today (free registration required)
Original article: Are Hospital/ED Transfers Less Likely Among Nursing Home Residents With Do-Not-Hospitalize Orders? – Journal of Post-Acute and Long-Term Care Medicine (link to abstract – $ for full-text)
Narrative review: Palliative and end-of-life care in nephrology: moving from observations to interventions – Current Opinion in Nephrology & Hypertension, via Medscape (free registration required)
Should Doctors Decide When It’s Futile to Keep Charlie Gard Alive? – Medscape (free registration required)
Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial (link to abstract – $ for full-text)
Commentaries: Palliative Care Intervention Improves Quality of Life in Advanced Heart Failure Patients – American College of Cardiology, Latest in Cardiology (free) AND Palliative Care Improves Heart Failure Quality-of-Life – MedPage Today (free registration required)
Effect of specialist palliative care services on quality of life in adults with advanced incurable illness in hospital, hospice, or community settings: systematic review and meta-analysis – The BMJ (free)
The meta-analysis showed a small effect on quality of life with specialist palliative care. The effect was most pronounced for patients with cancer and for those who received specialized care early.
See more on Standardized Criteria for Palliative Care Consultation in our April 24 issue, see #8
A better way to care for the dying – The Economist (a few articles per month are free) (RT @EricTopol see Tweet)
“How the medical profession is starting to move beyond fighting death to easing it”.
Prospective, before-after cohort study: Standardized Criteria for Palliative Care Consultation on a Solid Tumor Oncology Service Reduces Downstream Health Care Use – Journal of Oncology Practice (free)
Commentaries on the study: Standardized Palliative Care Consults Cut Cancer Readmissions – Also, less chemotherapy after discharge – MedPage Today (free registration required) AND Standardized Cancer Palliative Care Consults Linked to Stronger Home-Based Support – AJMC (free)
Patients with at least one of the following 4 criteria: 1) advanced solid tumor; 2) prior hospitalization within 30 days; 3) hospitalization > 7 days; or 4) active symptoms – received automatic palliative care consultation. The rates of 30-day readmissions dropped from 35% to 18% and chemotherapy after discharge dropped from 44% to 18%.
See also: Use of Medications of Questionable Benefit at the End of Life in Nursing Home Residents with Advanced Dementia – CBCNews (free) AND Many With Advanced Dementia Receiving Drugs of Uncertain Benefit – Medscape (free registration required)
“Historically, the practice has been “if in doubt, err on the side of aggressive, life-sustaining treatment,””. That might be changing.