Wednesday, August 31, 2016

August 2016 Palliative Care Review

by Christian Sinclair

Some August highlights from non-core HPC journals focusing on palliative care and hospice topics. Anyone who would like to explore any article in depth for a future Pallimed post is welcome to contact us.

Nondisclosure by Dr. Abby Rosenberg, published in JAMA, is a wonderful opportunity to examine if we are doing the right thing for a patient. Having reconnected with the mother of a teenage patient who died 6 years ago, the doctor and the mother were able to talk about the struggle to disclose to Sam, the patient, that he was dying. 

Dr. Paul Rousseau offers a great analysis of the faulty-thinking and potential lack of shared decision-making when someone chooses a partial code (i.e. CPR without intubation, or CPR without cardioversion, etc.) Partial codes - When "Less" may not be "More," is a one to bring to your next meeting for discussion.

The rates for tube feeding placement for people in nursing homes with advanced dementia are going down. We know this thanks to research from Dr. Susan Mitchell and colleagues, published in JAMA earlier this month.

Holy cow! It is hard to believe anyone would start a fentanyl patch on an opioid-naive patient, especially an older adult in a nursing home. But 1 in 10 nursing home residents are getting them, sometimes even 50mcg or more! Check out GeriPal for more breakdown.

When looking at overuse of non-beneficial treatments, how do physicians make decisions? Is the decision-making process evidence-based, based on habitual tendency, or patient-centered? If you guessed B, then you might be interested in this study looking at Choosing Wisely recommendations from ASTRO and ASCO, which showed that the physician you see is going to guide the therapy you get. Very similar to the recent hospice study which showed significant variation between physician hospice referral practices.

Have you recently been operated on? Are you concerned about chronic pain and being on opioids after your surgery? Then this study by Dr. Neilesh Soneji and colleagues from JAMA Surgery may provide some relief, since it showed that only 0.4% of older adults (older than 65y) are on chronic opioids 1 year out from surgery, if they were opioid-naive before surgery.

More surgeons talking about palliative care but this time in the setting of malignant bowel obstruction (MBO). Dr. Elizabeth Lilley and her peers look at shared-decision making, disease experience and health care priorities in the setting of MBO. Seems like surgeons really get this palliative care thing...Atul Gawande, Sherwin Nuland, Paul Kalanithi, amiright?

Christian Sinclair, MD, FAAHPM is editor of Pallimed, and a palliative care doctor at the University of Kansas. When he is not tossing out unread journals, you can usually find him playing a board game with his son.

Pallimed | Blogger Template adapted from Mash2 by Bloggermint