Abstract
Letters to the Editor
Artificial Intelligence (AI) systems have the potential to augment our assessment and management of patients at home. Limited only by our imagination, potential applications could address a full spectrum of needs from companionship in the form of pet avatars or robots for socially isolated patients to daily medication and activities of daily living (ADL) reminders for dementia patients. (page 1174)
Brief Reports
Pilot study assesses the feasibility of mouthpiece ventilation in relieving dyspnea among patients with acute chronic obstructive pulmonary disease exacerbation. (page 1261)
Fast Facts and Concepts
Perimortem Gamete Procurement and Posthumous Reproduction #463 (page 1285)
Psilocybin Use in Palliative Care #464 (page 1287)
Personal Reflection
“What did that mean?” I asked. Were her snakes the nightmares of being tied to the bed? The thoughts about stopping treatment? This unique choice we give to patients sustained on dialysis, who live so close to the thin film between life and death. Perhaps killing the snakes for Mercy meant facing the sometimes more frightening choice to continue on. (page 1292)
Case Discussions in Palliative Medicine
Cancer-related neuropathic pain often requires treatment with multiple modalities involving multidisciplinary teams. In select refractory cases, cingulum bundle ablation may be an effective alternative treatment modality. (page 1297)
Book and Media Reviews
(page 1307)
Consumer Assessment of Health Care Providers and Systems Regarding Serious Illness
A major development in organized health care is quality evaluation by consumers (patients and family members). In the United States, such evaluations have serious “teeth.” The evaluation of the quality of physician–patient communication in the setting of serious illness among primary care patients at 3 University of California Health Systems was performed. The reliability of the scale was higher among patients with negative experiences than positive experiences. (page 1234)
Neurologist Communication Curriculum
Historically, neurologists were consultants—they communicated with the referring physician. Now, due to broad changes in the practice of neurology, communication skills with patients and families are needed. This two-part communication curriculum uses a pre–post study design that included direct observations of resident–patient interactions (which improved, p < 0.001) and patient perception surveys (which did not change). (page 1180)
Interprofessional Outpatient Primary Care Team Communication Training
Most communication skills training related to serious illness focuses on physicians. Yet, outpatient primary care in the United States has moved to team model, including advance practice providers, nurses, social workers, and others. In this prospective trail of 156 participants, there were significant increases among all professions to use the Serious Illness Conversation Guide. (page 1198)
End-of-Life Care Education for Pediatric Palliative Care Specialists
When the specialty of palliative medicine emerged, adult critical care specialists lagged in incorporating such training into their specialty. Pediatrics as a whole has lagged adult medicine, but pediatric palliative medicine has emerged. In this survey of physicians training in subspecialty pediatric critical care, most physicians and program directors reported a need for additional education within their training programs. Interestingly, the emotional, moral, and legal issues were identified as needs only by the trainees rather than their program directors. (page 1217)
Change in Resuscitation Status of COVID-19 Patients Over Time
One might expect that decisions regarding attempts at cardiopulmonary resuscitation might be independent of historical periods in time. Yet, in this retrospective study of 3615 patients hospitalized in a single academic medical center in the United States between March 1, 2020 and December 31, 2021 when there were four surges in COVID-19 hospitalizations, medical orders to limit resuscitation decreased. Race (Black vs. White), time spent in the ICU, age, and Charlson comorbidity index were correlated with the occurrence of such medical orders. (page 1188)
Palliative Care Units in Hospitals
Acute palliative care units in general hospitals are devoted to intensive management of symptoms and other palliative care needs. In retrospective pre–post study at a single academic medical center, 16,611 patients in the prepalliative care unit and 18,305 patients in the postpalliative care unit period were studied. The opening of the unit was associated with an increase in orders not to resuscitate and orders for comfort measures only in seriously ill patients. (page 1240)