Updates in Hospital Palliative Care

Background: This review critiques recent palliative care (PC) literature with likelihood of impacting general hospital practice in order to help address the PC needs of patients. Methods: Articles published between January and December 2018 were identified through hand-search of leading PC journals and MEDLINE search. The final ten selected articles were determined by consensus based on scientific rigor, relevance to general hospital medicine, and impact to practice. Results: Key findings include: Early PC interventions reduced healthcare costs; Prognostic awareness of surrogates of patients with advanced dementia was associated with reduced burdensome interventions; Care transitions, especially in the last 3 days of life, can be detrimental to caregivers' well-being and perceptions of care; Haloperidol was effective for treatment of nausea and vomiting without untoward effects; Antipsychotics did not improve delirium symptoms in hospitalized patients; A fan directed to the face improved dyspnea; Disparities in advance directive completion disappeared when equal opportunities were given; Improving communication with families of critically ill patients improved perceptions of patient-centered care; Communication-priming tools improved the quality and documentation of goals of care conversations; Discussing prognosis did not harm the patient-provider relationship. Conclusion: Recent PC research affirmed the importance of PC delivery to patients with life-limiting illness and provided important guidance to hospitalists on symptom management, advance care planning, and communication.Rachel D. Havyer (1*), Nauzley Abedini (2), Robert L. Jayes (3), Brenda Matti-Orozco (4), Daniel H. Pomerantz (5), Aziz A. Ansari (6); 1. Division of Community Internal Medicine, Mayo Clinic. 2. Division of Palliative Medicine, University of California San Francisco. 3. Division of Geriatrics and Palliative Medicine, George Washington University Medical Faculty Associates. 4. Division of General Internal Medicine and Palliative Medicine, Morristown Medical Center, Atlantic Health System. 5. Department of Medicine, Montefiore New Rochelle Hospital. 6. Division of Hospital Medicine, Loyola University Medical CenterIncludes bibliographical reference

Update in palliative care - 2011

INTRODUCTION: The aim of this update is to summarize scientifically rigorous articles published in 2010 that serve to advance the field of palliative medicine and have an impact on clinical practice. METHOD: We conducted two separate literature searches for articles published between January 1, 2010 and December 31, 2010. We reviewed title pages from the Annals of Internal Medicine, British Medical Journal, Journal of the American Geriatrics Society, JAMA, Journal of Clinical Oncology, JGIM, Journal of Pain and Symptom Management, Journal of Palliative Medicine, Lancet, New England Journal of Medicine, PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care). We also conducted a Medline search with the key words "palliative," "hospice," and "terminal" care. Each author presented approximately 20 abstracts to the group. All authors reviewed these abstracts, and when needed, full text publications. We focused on articles relevant to general internists. We rated the articles individually, eliminating by consensus those that were not deemed of highest priority, and discussed the final choices as a group. RESULTS: We first identified 126 articles with potential relevance. We presented 20 at the annual SGIM update session, and discuss 11 in this paper

Palliative care: An update for internists

All clinicians should maintain basic skills in general palliative care to help address the needs of patients and families. Because keeping up with the information provided by the growing palliative care literature can be challenging, we conducted a detailed search via Medline for palliative care articles published in 2020 in top peer-reviewed medical journals. Using a consensus-driven process of selection, we reviewed and summarized 11 articles to enhance knowledge of the practice-changing palliative care literature for general internists

To stent or not to stent: An evidence-based approach to palliative procedures at the end of life

Patients near the end of life often undergo invasive procedures, such as biliary stenting for obstructive jaundice, with the intent of relieving symptoms. We describe a case in which the medical team and a patient and family are considering a second palliative biliary stent despite the patient's limited life expectancy. We review available evidence to inform the decision, focusing on the specific question of whether the benefits of palliative biliary stents in patients with advanced cancer outweigh the risks. We then apply the evidence to the issue of how the primary and/or palliative care team and the interventionist communicate with patients and their families about the risks and benefits of palliative procedures. Review of the evidence found several prospective case series without control groups that measured patient-centered outcomes. Studies had high attrition rates, results for improvements in symptoms and quality of life were mixed, and rates of complications and short-term mortality were high. In conclusion, the limited evidence does not support that the benefits of palliative biliary stents in this population outweigh the risks. We propose that primary care teams consider and discuss the larger picture of the goals of care with patients and families when considering offering these procedures, as well as benefits and potential harms, and consider involving palliative care services early, before consultation with an interventionist