Abstract
Letters to the Editor
The surprise question was initially intended to consider palliative care referral and not as a predictor of mortality. Nevertheless, the vast majority of articles in the literature have used the surprise question in multiple timeframes as a predictor of mortality. There are at least 28 studies that have used the surprise questions as a single predictor for mortality. (page 292)
Brief Reports
Multicenter prospective longitudinal study to document the opioid conversion factor postswitch in cancer, and whether pain and adverse effect outcomes differ between switched opioid groups. (page 388)
Fast Facts and Concepts
Debriefing Challenging Clinical Encounters: The Pause Framework #474 (page 421)
Serious Illness Care Considerations for Hindu Patients #475 (page 423)
Personal Reflection
He wanted to know what could have caused (his wife's) cardiac arrest, her prognosis, and how we were going to care for the patient.
“I am so scared right now.”
“I understand,” one of the members of the health care team replied. “No, you don't understand. Not unless you have ever seen your family member like this.” (page 429)
Case Discussions in Palliative Medicine
Authors present a case of difficult-to-control cancer-related rectal and pelvic pain in a patient who responded well in her last days of life to a low-dose bupivacaine epidural. (page 434)
Book and Media Reviews
(page 438)
Original Article Key Points
Many people living with advanced cancer may experience unique symptoms and unmet needs that would benefit from palliative care. This study examined palliative care delivery among a population-based sample of people diagnosed with advanced nonsmall cell lung cancer or advanced melanoma and characteristics associated with receipt of palliative care. (page 316)
This study highlights the importance of paying attention to opioid-induced nausea and vomiting (OINV) not only during opioid introduction, but also during opioid dose escalation. A history of OINV and Eastern Cooperative Oncology Group performance status (ECOG PS) (≥2) was detected as significant risk factors, and special attention should be paid to patients with these risk factors. (page 301)
NECPAL found that 65% of noncancer hospitalized older adults aged 75+ years were eligible for palliative care, predicting one-year mortality with a performance similar to a validated geriatric prognostic tool. NECPAL could help clinicians, detecting those patients in whom palliative care should be integrated with active care simultaneously also in this multimorbid population. (page 367)
Palliative care utilization in patients with end-stage liver disease was associated with decreased use of invasive procedures and shorter lengths of stay, based on the National Inpatient Sample database study. Minorities and patients in lower income brackets were less likely to receive palliative care, highlighting significant health care disparities. (page 335)
This multidisciplinary quality improvement (QI) project addressed existing gaps in the timely reassessment of breathlessness in a community palliative care service. A new process to optimize how clinicians assess and review moderate breathlessness scores increased the proportion of patients reassessed within seven days of an initial nursing assessment by 58% in six months. (page 324)