As David Currow said when he received his Excellence in Research award, hospice and palliative medicine researchers need to meticulously measure toxicity in addition to benefits of palliative interventions. How do you think the State of the Science studies did with this goal? What do you think about the conclusions of each of the studies? Any changes in your practice? Thanks to the presenters Jay Horton, Kimberly Johnson,Nick Dionne-Odom, and Cardinale Smith for reviewing and presenting. Always a fun presentation.

Neurolytic sympathectomy in management of cancer pain-time effect: a prospective, randomized multicenter study http://t.co/fdqI1A2meB #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Comparative effectiveness-senna to prevent problematic constipation in peds onc patients receiving opioids:http://t.co/rYyx3xY7jI #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Randomized Controlled Trial of Expressive Writing for Patients With Renal Cell Carcinoma http://t.co/2reY7q5CM0 #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study http://t.co/CsbkLEa0jF #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

An integrated palliative and respiratory care service for patients with advanced disease: An RCT http://t.co/awhOMOKRAy #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Inpatient palliative care for patients with acute heart failure: outcomes from a randomized trial. http://t.co/HCRVaXRIw4 #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Intervention to improve care at life's end in inpatient settings: the BEACON trial. http://t.co/Ht7MwhzIYF #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

Association of experience with illness and end-of-life care with advance care planning in older adults http://t.co/S04ifi57iM #hpm15

— Lyle Fettig (@lfettig) February 28, 2015

The State of the Science plenary is one of my favorite traditions at the AAHPM Annual Assembly.   This year, Jay Horton and Kim Johnson took the lead in presenting analyses of some of the previous year's most important hospice and palliative medicine research.  For those attendees interested in seeing their slides again, you can find them here.

Some of the research below further confirms our previous understanding of the state of the science (for instance, the studies on the low utility of feeding tubes in many circumstances).  Other studies provide quality randomized controlled trial data on questions which have nagged our field but where previous RCT data are minimal or completely lacking (e.g. parenteral fluids near end of life and ketamine for cancer pain).

We'd love to hear what you think about each study.  Feel free to comment on the blog.  If you like a study, you can further disseminate it by Retweeting it directly from this post! 

Associations between end-of-life discussion characteristics and care received near death: a prospective #hpm13 ncbi.nlm.nih.gov/m/pubmed/23150…
— Lyle Fettig, MD (@lfettig) March 16, 2013

A randomized, placebo-controlled trial of acupuncture in patients with COPD #hpm13 state of science ncbi.nlm.nih.gov/m/pubmed/22905…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Barriers to conducting advance care discussions for children w/ life-threatening conditions. #hpm13 state of science ncbi.nlm.nih.gov/m/pubmed/22392…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Surrogate decision makers' interpretation of prognostic information: a mixed-methods study. #hpm13 State of Science ncbi.nlm.nih.gov/m/pubmed/22393…
— Lyle Fettig, MD (@lfettig) March 16, 2013

RCT to assess the efficacy/ toxicity of subcutaneous ketamine in management of cancer pain. #hpm13 State of Science ncbi.nlm.nih.gov/m/pubmed/22965…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Feeding tubes and the prevention or healing of pressure ulcers.#hpm13 State of science ncbi.nlm.nih.gov/m/pubmed/22782…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Does feeding tube insertion and its timing improve survival?#hpm13 state of science ncbi.nlm.nih.gov/m/pubmed/23002…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Parenteral hydration in patients with advanced cancer: a multicenter, double-blind, RCT #hpm13 state of science ncbi.nlm.nih.gov/m/pubmed/23169…
— Lyle Fettig, MD (@lfettig) March 16, 2013

meaning of IV/sq hydration 2 family caregivers & pts with advanced ca receiving hospice care.#hpm13 state of science ncbi.nlm.nih.gov/m/pubmed/22459…
— Lyle Fettig, MD (@lfettig) March 16, 2013

Influence of hospice on NH residents with advanced dementia who received Medicare-SNF near the end of life. #hpm13 ncbi.nlm.nih.gov/m/pubmed/23110…
— Lyle Fettig, MD (@lfettig) March 16, 2013

In the current issue of Archives of Internal Medicine, under the category, "Health Care Reform" is a Research Letter entitled, Hospital-Based Palliative Medicine Consultation: A Randomized Controlled Trial. It is brought to you by the good folks at UCSF. It was a 2-year, randomized, prospective, clinical trial of patients 65 years or older with heart failure, cancer, chronic obstructive pulmonary disease, or cirrhosis, who were able to give informed consent, and who spoke English.