Monday, October 4, 2010

"We're All Going to Die. Deal With It"

So says the editorial  associated with a recent BMJ "Spotlight" series of review articles on palliative care in patients with diagnoses other than cancer.  The series was financially supported by the British Heart Foundation.

The reviews are rather cursory but give a sense of the perspective on the other side of the pond.  The major highlight is the announcement from the BMJ Group that they will begin publication of a new journal next April entitled BMJ Supportive and Palliative Care.   Great to see!  (Any comments on the journal name?)

Articles include:

"Spiritual dimensions of dying in pluralistic cultures"

"Despite the decline of formal religion many people still regard the idea of spirituality as essential to their sense of self, especially at times of inner turbulence. We explore how the spiritual needs of dying patients can be understood and met in pluralist and secular societies"
"Dying matters: let's talk about it": About changing societal attitudes regarding death.  (Christian, it includes only a brief mention of social marketing and no mention of social media!)  It does laud the Project on Death in America for recognizing the need to raise public awareness surrounding death and dying.

"Achieving a good death for all": With mentions of the Liverpool care pathway and a national care of the dying audit. 


"Having the difficult conversations about the end of life":  Actually only includes two paragraphs about conducting conversations near the end of life.  Most of the review discusses barriers to having the conversations and the fact that there are no direct financial incentives in the National Health Service to initiate these conversations.  One of the barriers mentioned is doctors reluctance to initiate conversations regarding prognosis due to a desire to "keep in the frame of 'curative change agent.'" (Is that in the shape of a "Bond" or "Bourne" agent?)   They make the debatable assertion that:
"Patients view the option of supportive care without continued disease modifying treatment as the clinical team “giving up”: they value their doctors’ expertise in up to date active interventions and prefer them to remain in the role of curative agent."
"Recognizing and managing key transitions in the end of life":  The article has a table which describes potential indicators for palliative care involvement.  The indicators look like they are taken verbatim from the NHPCO hospice criteria guidelines. 

The same issue includes a study describing how supervision of methadone consumption (for treatment of opioid addiction) may have played a role in reducing methadone related deaths.  It also includes another editorial with a blunt title that at first I thought was part of the palliative care series, but then I realized that it's an editorial prioritizing the eradication of diarrhea due to poor sanitation, especially in children.  I think we could all agree on that. 

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