PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PCFACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at [email protected].
Table of Contents
From PC-FACS Issue 226—August 7, 2020
Sympathectomy Effects on Allodynia
Concerns of Decision Makers
Culturally Based Telepalliative Care
Psychological Measures and Mortality
Early Integration of Pediatric Palliative Care
Nonopioid Treatment Regimens
Adults with NSCLC Receiving ICIs
Summaries With Commentaries
Local Sympathectomy Promotes Anti-Inflammatory Responses and Relief of Paclitaxel-Induced Mechanical and Cold Allodynia in Mice
Chemotherapy-induced neuropathic pain (NP) is a disabling condition affecting up to 80% of patients during treatment with antineoplastic drugs.1,2 Can local sympathetic blockage treat chemotherapy-induced NP?
Design and Participants
This study investigated whether and how localized sympathectomy influences the development and progression of chemotherapy-induced NP. In 8- to 10-week-old male and female mice receiving intraperitoneal injections of the chemotherapeutic drug paclitaxel every other day, the ipsilateral gray rami entering the spinal nerves near the L3 and L4 dorsal root ganglia (DRG) were cut on one side. Sympathectomy effects were then assessed in chemotherapy-induced pain-like behaviors and neuroimmune and electrophysiologic responses. Analyses included two-way repeated-measures ANOVA with Bonferroni correction, one-way ANOVA with Tukey's test, and Mann-Whitney and t-tests.
Microsympathectomy produced a fast and sustained recovery from mechanical allodynia (via withdrawal response to von Frey hair stimulation) in the ipsilateral hindpaw (mean±SD: sympathectomy vs. sham at day 5, 1.07±0.34g hair vs. 0.51±0.17g; n=5; P=0.030 in males, and 1.08±0.28g vs. 0.62±0.16g; n=5; P=0.036 in females) (whereas no contralateral-paw effect was observed in these same mice) and prevented cold allodynia development in the ipsilateral hindpaw of males and females after paclitaxel. Mechanistically, microsympathectomy induced transcriptional increases in DRG of macrophage markers and anti-inflammatory cytokines (eg, transforming growth factor-β [TGF-β]). Accordingly, monocyte/macrophage depletion and TGF-β signaling blockage reversed the relief of mechanical allodynia by microsympathectomy. In particular, exogenous TGF-β was sufficient to relieve mechanical allodynia after paclitaxel (TGF-β 100ng/site vs. vehicle at 3h, 1.21±0.34g vs. 0.53±0.14g, n=5, P=0.001 in males), and TGF-β signaling regulated DRG neuronal activity.
Paclitaxel is a commonly used chemotherapy for several solid tumors. Unfortunately, it is associated with disabling neuropathic pain, generally involving distal extremities, that can persist for months or years after treatment. Currently, no effective, US Food and Drug Administration–approved treatment exists for neuropathy caused by paclitaxel or other antineoplastic drugs. The prevalence of neuropathy is very high, up to 80%, and often requires clinicians to decrease the dose or shorten the duration of a potentially lifesaving chemotherapy.2 Local sympathetic blocks are an established treatment for complex regional syndrome, phantom limb pain, postherpetic neuralgia, and cancer pain.3 This study highlights the analgesic effect of a local sympathectomy in mouse models of paclitaxel-induced peripheral neuropathy, mediated by transforming growth factor beta in the DRG, resulting in faster resolution of mechanical and prevention of cold allodynia.
Local surgical sympathectomy in a mouse model of paclitaxel-induced neuropathy relieved nociceptive pain by decreasing the inflammatory response in the DRG.
Regina M. Mackey, MD, Center for Palliative Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
Tonello R, Xie W, Lee SH, et al. Local sympathectomy promotes anti-inflammatory responses and relief of paclitaxel-induced mechanical and cold allodynia in mice. Anesthesiology. 2020 Jun;132(6):1540–1553. https://doi.org/10.1097/ALN.0000000000003241.
- 1.Sisignano M, Baron R, Scholich K, Geisslinger G. Mechanism-based treatment for chemotherapy-induced peripheral neuropathic pain. Nat Rev Neurol. 2014;10(12):694–707.
- 2.Flatters SJL, Dougherty PM, Colvin LA. Clinical and preclinical perspectives on chemotherapy-induced peripheral neuropathy (CIPN): a narrative review. Br J Anaesth. 2017;119(4):737–749.
- 3.Sekhadia MP, Nader A, Benzon HT. Peripheral sympathetic blocks. In: Benzon H, Raja SN, Fishman S, Liu S, Cohen SP, eds. Essentials of Pain Medicine. Amsterdam, Netherlands: Elsevier, 2011:621–628.
Concerns of Surrogate Decision Makers for Patients with Acute Brain Injury
Many intubated patients with severe acute brain injury (SABI) require goals-of-care (GOC) discussions regarding life-sustaining therapy vs. comfort measures only.1 Are there identifiable patterns in how surrogates for patients with SABI prioritize GOC concerns?
Design and Participants
This study tested whether surrogate decision makers for patients with SABI and poor prognosis are categorizable by their prioritization of different GOC. An online survey of adults age ≥30 years recruited via a probability-based panel representative of the US population (GfK KnowledgePanel) was conducted. Respondents were asked to consider a hypothetical older adult family member with SABI and imagine being the surrogate decision maker for a possible tracheostomy and gastrostomy placement. Participants were randomized to one of two prognostic scenarios: the patient likely being left with a range of severe functional disability (SFD) or remaining in a vegetative state (VS). Prioritization of 12 decision-making concerns (eg, respecting patient wishes, minimizing suffering) was assessed, and latent class analysis (LCA) discovered decisional groups. Multinomial logistic regression was used.
There were no between-survey (SFD vs. VS) participant demographic differences. The completion rate was 45%; data weighting mitigated nonresponse bias. For SFD (n=792), LCA revealed four groups, all sharing concerns regarding respecting patient wishes and minimizing suffering. The four groups were otherwise distinguished by unique concerns that their members highlighted: an older adult remaining severely disabled (34%), family consensus (26%), doubt regarding prognostic accuracy (21%), and long-term care costs (19%). For VS (n=796), LCA revealed five groups, four of five having similar concern profiles to the SFD groups. The largest group (29%) expressed the most prognostic doubt. An additional (16%) prioritized religious concerns.
This study focused more specifically on certain patients than typical research on surrogate decision making for serious illness. It was useful that the authors were clear about how they defined two variants of “poor prognosis” from the SABI population because they were not surveying people who had personal experience with these medical issues. Tracheostomy and gastrostomy placement, among the most critical decisions that must be made for a patient with SABI, typically occur about 2 weeks after the injury, when the decision maker has had some time to assimilate information about the patient's condition and see how the patient is progressing. Future development of educational tools and interventions specifically focused on the concerns highlighted by the survey responders is planned.
Understanding the concerns of surrogate decision makers allows clinicians to anticipate and address those concerns when designing shared decision-making aids and communication and support interventions.
Beth Popp, MD FACP HMDC FAAHPM, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Hwang DY, Knies AK, Mampre D, et al. Concerns of surrogate decision makers for patients with acute brain injury. Neurology. 2020 May 12;94(19):e2054–e2068. https://doi.org/10.1212/WNL.0000000000009406
- 1.Cai X, Robinson J, Muehlschlegel S, et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocrit Care. 2015;23(1):131–141.
Developing and Testing the Feasibility of a Culturally Based Telepalliative Care Consult Based on the Cultural Values and Preferences of Southern, Rural African American and White Community Members: A Program by and for the Community
Cultural insensitivity may compromise end-of-life care for patients from diverse racial and ethnic groups.1 Can a culturally based palliative care (PC) program be effectively implemented?
Design and Participants
This qualitative study (2013–2016) developed a culturally based PC teleconsult program for African American (AA) and white elders with serious illness in rural South Carolina and their families. Community-based participatory research methods were used, including a Community Advisory Group with equal numbers of AA and white people. Study aims were to determine values/preferences of each ethnic group and ascertain group commonalities/differences; develop a culturally based PC consult protocol; and determine the feasibility of program delivery and acceptability to patients/caregivers and clinicians.
Between-group themes were equivalent (eg, disrespectful treatment of patients/family by hospital physicians); similar but with variation (eg, in both groups, religion/church was important and pastors helped family face the end of life, but AAs herein considered the church central to everything); and divergent (eg, AAs herein believed that hope and miracles were always possible and that God was decider, a theme absent with whites herein). Group-specific recommendations for the culturally based consult were incorporated into the standard consult. Hospital leadership support was high, but the main implementation challenge was the lower-than-expected referral by hospitalists (18/28 eligible patients). Feasibility and acceptability were tested on 18/32 patients. PC MD implementation fidelity was 98% (via checklist of protocol-determined items). PC physicians made recommendations in four instances; 3/4 were followed by hospitalists. All 16 eligible patients approached were too ill/noncommunicative and unable to provide consent. Six AA and three white caregivers consented; three and four declined. In all applicable questions, caregivers were satisfied/very satisfied.
Culturally appropriate models of care that consider diverse cultural preferences are lacking and thus are a source of disparity in palliative care. Attention to the various aspects of the patient experience is inherent in end-of-life care, and more attention to varied frames of reference, value systems, and life experiences based on patients' cultures is vital. Though further and broader studies are needed, this thoughtfully developed and executed study helps providers gain a cultural perspective on individual patients. This is the first study to create a program utilizing rural, southern AA and white community members to understand their specific, culturally based experiences. Thus, by aligning ourselves with the race, culture, and ethnicity of diverse populations, we can work in partnerships with patients, their families, and their communities to identify and provide culturally meaningful care and promote quality of life.
Involving your community and engaging administrators to develop care programs based on the local communities' cultural values and preferences are keys for success in developing mutual respect and inclusion of all cultures.
Parneeta H. Bhatia, MD, St. Louis VAMC and St. Louis University School of Medicine, St. Louis, MO, and Jane E Loitman, MD MBA FAAHPM, Washington University School of Medicine, St. Louis, MO
Elk R, Emanuel L, Hauser J, Bakitas M, Levkoff S. Developing and testing the feasibility of a culturally based telepalliative care consult based on the cultural values and preferences of southern, rural African American and white community members: a program by and for the community. Health Equity. 2020 Mar 26;4(1):52–83. https://doi.org/10.1089/heq.2019.0120
- 1.Krakauer EL, Crenner C, Fox K. Barriers to optimum end-of-life care for minority patients. J Am Geriatr Soc. 2002;50(1):182–190.
Association of Functional, Cognitive, and Psychological Measures with 1-Year Mortality in Patients Undergoing Major Surgery
More than 4 million operations are performed annually on Americans age 65 years and older.1 Are functional, cognitive, and psychological measures associated with 1-year mortality in older adults after major surgery?
Design and Participants
This study determined the association between physical, cognitive, and psychological function measures and 1-year mortality in older adults after major surgery. Retrospective analysis of a prospective cohort study of participants age ≥66 years who were enrolled in the nationally representative Health and Retirement Study and underwent one of three major surgery types was performed. Associated factors included: dependence in activities of daily living (ADLs), dependence in performing instrumental ADLs, inability to walk several blocks, cognitive status, and depression. Cox regression was used.
Participants (n=1,341) were age mean=76 (SD=6) years, 55% female, 85% white, 63% married/partnered, and 98% community dwelling. Sixty percent had social support other than their spouse, 6% had dementia, 23% had cognitive impairment without dementia, and 25% had depression presurgery (66% had >2 comorbidities). Seven percent underwent abdominal aortic aneurysm repair, 51% coronary artery bypass graft, and 42% colectomy; 17% died ≤1 year postoperation. After adjusting for age, comorbidity burden, surgical type, sex, race/ethnicity, wealth, income, and education, these measures were associated with 1-year mortality: >1 ADL dependence (29% vs. 13%; aHR=2.76; P=.001), >1 instrumental ADL dependence (21% vs. 14%; aHR=1.32; P=.05), the inability to walk several blocks (17% vs. 11%; aHR=1.64; P=.01), dementia (21% vs. 12%; aHR=1.91; P=.03), and depression (19% vs. 12%; aHR=1.72; P=.01). The risk of 1-year mortality increased within the increasing risk factors present (0 factors: 10%; 1 factor: 16%; 2 factors: 28%).
This study highlights the importance of preoperative evaluation of functional, cognitive, and psychological assessment, along with medical comorbidities, when considering an older patient for major surgery. Impairment in ADLs and instrumental ADLs, mobility impairment, dementia, and depression were strongly associated with 1-year mortality. This supports the conclusion that perioperative assessment needs to consider geriatric risk factors. “Frailty, for example, is a geriatric syndrome that is a major independent risk factor for 1-year mortality after surgery.”2 The use of frailty assessments, such as modified versions of the Frailty Index and other scales based on comprehensive geriatrics assessments, predicts clinical outcomes. Palliative care providers and surgeons should use these assessment tools to provide support and help with prognostication and goals of care conversations.
Functional, cognitive, and psychological risk factor evaluation should be included in preoperative assessment for older adults undergoing major surgery.
Dashima Carthen, MD FACP, Visiting Nurse Services of New York, New York, NY
Tang VL, Jing B, Boscardin J, et al. Association of functional, cognitive, and psychological measures with 1-Year mortality in patients undergoing major surgery. JAMA Surg. 2020 Mar 11;155(5):412–418. https://doi.org/10.1001/jamasurg.2020.0091
- 1.Schwarze ML, Barnato AE, Rathouz PJ, et al. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg. 2015;150(4):325–331. https://doi.org/10.1001/jamasurg.2014.1819
- 2.Kim SW, Han HS, Jung HW, et al. Multidimensional frailty score for the prediction of postoperative mortality risk. JAMA Surg. 2014 Jul;149(7):633–640.
Pediatric Oncology Providers' Perspectives on Early Integration of Pediatric Palliative Care
Most children with cancer diagnosed yearly (80% globally) live in low- and middle-income countries where therapy is suboptimal because of limited access to curative treatment and pediatric palliative care (PPC).1–3 What are Lebanese healthcare providers' perceptions about early PPC in pediatric oncology?
Design and Participants
This study explored the perceptions of pediatric oncology providers at the Children's Cancer Institute in Lebanon regarding the integration of early PPC in the management of children with cancer. Pediatric oncology nurses and pediatric oncologists were invited to participate in focus group interviews (semistructured) to assess their perceptions about early PPC integration. A qualitative descriptive approach was followed. The principal investigator read the audio-recorded interview transcripts to identify keywords and phrases, generated data-driven codes, and then clustered them into categories from which themes emerged.
Nurses (n=10; 25% of nurses) were 90% female, age mean=38 years, and had mean=11 (SD=8.3) years pediatric oncology experience; all held ≥bachelor's of science in nursing degrees. Physicians (n=7; 50%) were 57% female, age mean=29 (SD=3.9) years, and had mean=2.8 (SD=1.8) years pediatric oncology experience. Two 45- to 60-minute interviews were held with the seven physicians and two with the 10 nurses. Analysis yielded four themes: (1) providers understood PPC as pain relief and psychological support, mainly at the end of life; (2) the timing of integrating PPC is linked to the end of life, advanced disease, or treatment failure; (3) interdisciplinary collaboration is important for addressing patients' and families' needs effectively; and (4) communication with the child and family is one of the most difficult aspects of integrating PPC.
In nearly every study describing the challenges of PPC delivery, investigators cite issues of scope (PPC is associated with the end of life), and communication (discussing difficult news is daunting). This novel study of Lebanese pediatric oncology providers also underscores foundational values of PPC, namely relief of pain and suffering, the importance of interdisciplinary collaboration, and the value of effective communication. It also reminds us that many challenges transcend cultures, including an aversion to discussing childhood death and a sense among physicians of death as failure. This study was unique in that it described a community where access to health care may be limited, and where religion plays a key role in medical decision making. Also, participants were relatively young; more senior physicians may have even greater resistance to early integration of PPC.
Although some PPC challenges span cultures, the most effective solutions may be specific to the context and culture at hand.
Megan J. Thorvilson, MD MDiv, Mayo Clinic Children's Center, Rochester, MN
Saad R, Kurdahi LB, Yazbick-Dumit N, Irani C, Muwakkit S. Paediatric oncology providers' perspectives on early integration of paediatric palliative care. Int J Palliat Nurs. 2020 Mar 2;26(3):100–109. https://doi.org/10.12968/ijpn.2020.26.3.100
- 1.Rodriguez-Galindo C, Friedrich P, Alcasabas P, et al. Toward the cure of all children with cancer through collaborative efforts: pediatric oncology as a global challenge. J Clin Oncol. 2015;33(27):3065–3073.
- 2.Delgado E, Barfield RC, Baker JN, et al. Availability of palliative care services for children with cancer in economically diverse regions of the world. Eur J Cancer. 2010;46(12):2260–2266.
- 3.Rodriguez-Galindo C, Friedrich P, Morrissey L, Frazier L. Global challenges in pediatric oncology. Curr Opin Pediatr. 2013;25(1):3–15.
Effectiveness of Nonopioid Treatment Regimens for Pain
Uncontrolled pain in patients involves complex interactions between physiological, psychological, sociocultural, sensory, cognitive, and behavioral dimensions.1,2 How effective are nonopioid pain treatment interventions?
Factors Associated with Improvement in Uncontrolled Cancer Pain Without Increasing the Opioid Daily Dose Among Patients Seen by an Inpatient Palliative Care Team
Design and Participants
This retrospective study at a university cancer center determined the proportion of patients referred to an inpatient palliative care team who achieved clinically improved pain (CIP) without opioid dose increase. Eligibility criteria included: taking opioid medication; having ≥2 consecutive visits; and an Edmonton Symptom Assessment Scale (ESAS) pain score ≥4 at consultation.
Of 300 patients, CIP was achieved in 65% (of whom 43% achieved CIP without an increase in oral morphine equivalent daily dose [MEDD]). CIP without MEDD increase was associated with more adjuvant medication changes (P=.003), less opioid rotation (P=.005), and lower symptom distress scale of ESAS (P=.04).
Comparative Effectiveness of Embedded Mental Health Services in Pain Management Clinics vs. Standard Care
Design and Participants
This retrospective, matched, two-cohort study investigated whether embedded behavioral medicine (BM) programs, common psychiatric care services and/or psychological services within multidisciplinary pain management programs, are associated with improved outcomes. Patient-reported outcomes (PROs) were examined, including PROs Measurement Information System pain, mental health, and physical function measures collected for every patient at every clinic visit. Baseline to 1-year changes were compared in those receiving BM plus usual care vs. a propensity score–weighted standard care (SC) group seen in the same practice.
At baseline, BM patients had worse scores on most pain, mental health, and physical health measures and were likelier to be female, from a diverse racial or ethnic group, and have lower socioeconomic status. At follow-up, both BM (n=451) and SC patients (n=8,383) showed significant and comparable improvements in pain intensity, physical function, depression, and sleep disturbance. BM (vs. SC) patients showed significantly greater improvements in their global impressions of change (all P<.05).
Both studies retrospectively identify nonopioid interventions that are significantly associated with improved pain outcomes. Nearly one-half of the improvement in pain outcomes for palliative care inpatients occurred without increased opioid dosing; this improvement was associated with increased use of adjuvant medications, less opioid rotation, and lower reported symptom distress. Likewise, clinical outcomes for an at-risk population of pain management clinic outpatients were significantly improved after embedding mental health services within the pain management clinic. The retrospective cohort designs of these studies provide unique opportunity to identify the nature and strength of these associations but cannot provide any causative links.
Severe and chronic pain are complex in nature, and these studies retrospectively identify nonopioid interventions and services associated with improved clinical outcomes.
Dan Handel, MD, University of Colorado School of Medicine, Denver, CO
Qian Y, Haider A, Lu Z, et al. Factors associated with improvement in uncontrolled cancer pain without increasing the opioid daily dose among patients seen by an inpatient palliative care team. J Palliat Med. 2020 Apr;23(4):483–488. https://doi.org/10.1089/jpm.2019.0243.
Gillman A, Zhang D, Jarquin S, Karp JF, Jeong J-H, Wasan AD. Comparative effectiveness of embedded mental health services in pain management clinics vs. standard care. Pain Med. 2020 May 1;21(5):978–991. https://doi.org/10.1093/pm/pnz294
- 1.Strasser F, Walker P, Bruera E. Palliative pain management: when both pain and suffering hurt. J Palliat Care. 2005;21(2):69–79.
- 2.Syrjala KL, Chapko ME. Evidence for a biopsychosocial model of cancer treatment-related pain. Pain. 1995;61(1):69–79.
Performance Status and End-of-Life Care Among Adults with Non–Small Cell Lung Cancer Receiving Immune Checkpoint Inhibitors
Immune checkpoint inhibitors (ICIs) targeting the programmed cell death-1 (PD-1) axis may represent an appealing option for adults with non-small cell lung cancer (NSCLC).1–3 What benefit can patients with NSCLC and impaired performance status (PS≥2) derive from ICIs?
Design and Participants
This retrospective, single-site study (2015–2017) examined ICI use in a nontrial population of patients with advanced NSCLC that included those who had PS≥2. Cox regression compared overall survival (OS) of patients who had PS≥2 at ICI treatment beginning with those who had PS=0–1. Logistic regression analyzed the association between ICI use in the last 30 days of life and end-of-life healthcare utilization.
Patients' (N=237; 55% male, 87% white) age at ICI initiation was 67 years (mean; range=37–91), and 35% had PS≥2. Eighty-one percent received ICI as second-line or later therapy. Comparing patients with PS=0–1, patients with PS≥2 were older (70±9.2 vs. 66±11; P<.001) and had lower albumin levels (P<.0001); the groups did not otherwise differ. OS was median=4.5 months (95% CI=2.3–6.9) in patients with PS≥2 and 14 months (11–19) in those with PS=0–1 (hazard ratio=2.5; P<.0001). Among the patients who died (n=184), 29% who had PS≥2 received ICIs in their last 30 days of life, vs. 11% of those who had PS=0–1 (P=.002). OS after first-line ICI treatment was median=8.8 months. ICI receipt in the last 30 days of life was associated with decreased hospice referral (odds ratio [OR]=0.29; P=.008), decreased receipt of hospice for >7 days (OR=0.17; P<.001), increased hospitalization in the last 30 days of life (OR=3.46; P=.008), and increased in-hospital (or skilled nursing facility) deaths (OR=5.27; P=.001), independent of PS.
This study emphasizes the impact of an impaired PS on outcomes for patients with advanced NSCLC treated with ICIs. However, its retrospective design and the recent advances in clinical practice limit its contribution to the counseling of this patient population. Some of the findings may suggest that patients starting ICIs, particularly in the last 30 days of life, could have goals of care consistent with more aggressive treatments even when facing worsening PS and disease progression. The 25% 1-year survival for patients with PS>2 may support hopes for life prolongation in this patient population. ICIs have recently become a standard first-line treatment for patients with advanced lung cancer, regardless of PD-L1 expression and PS, but it is not clear yet if there is a subgroup of patients who may respond more favorably to this treatment.
Patients with advanced NSCLC and impaired PS should be counseled about the possible adverse impacts of their condition on the outcome of treatment with ICIs.
Giovanni Elia, MD FAAPM, University of California, San Francisco, San Francisco, CA
Petrillo LA, El-Jawahri A, Nipp RD, et al. Performance status and end-of-life care among adults with non–small cell lung cancer receiving immune checkpoint inhibitors. Cancer. 2020 May 15;126(10):2288–2295. https://doi.org/10.1002/cncr.32782
- 1.O'Connor JM, Fessele KL, Steiner J, et al. Speed of adoption of immune checkpoint inhibitors of programmed cell death 1 protein and comparison of patient ages in clinical practice vs. pivotal clinical trials. JAMA Oncol. 2018 Aug;4(8):e180798–e180798. https://doi.org/10.1001/jamaoncol.2018.0798
- 2.Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–1550. https://doi.org/10.1016/S0140-6736(1501281-7)
- 3.Garon EB, Hellmann MD, Rizvi NA, et al. Five-year overall survival for patients with advanced non–small-cell lung cancer treated with pembrolizumab: results from the phase I KEYNOTE-001 study. J Clin Oncol. 2019;37(28):2518–2527. https://doi.org/10.1200/JCO.19.00934
Farah PD, El Hachem P. The current role of medical simulation in palliative care. StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2020.
This review looks at medical simulation in PalCare. As we move into Zoom-based learning, having an understanding of what sorts of virtual or simulation-based learning have been tried will be helpful for those of us in MedEd.
Skoch BM, Sinclair CT. Management of urgent medical conditions at the end of life. Med Clin North Am. 2020 May;104(3):525–538. https://doi.org/10.1016/j.mcna.2019.12.006.
This is a perfect article to share in summer, as a whole crop of new trainees bring energy and enthusiasm to our medical centers. This article offers an overview of end-of-life emergencies when comfort and dignity are at risk, with a focus on treatment outside of the hospital.
Zabrocka E, Sierko E. Thromboprophylaxis in the end-of-life cancer care: the update. Cancers (Basel). 2020 Mar 5;12(3):600. https://doi.org/10.3390/cancers12030600.
Something that stymies even the most experienced clinicians, managing anticoagulants at end-of-life is complicated. This review focuses less on treatment of known thrombosis and aims to review the data and recommendations around prophylaxis of clotting near the end of life.
Chow R, Bruera E, Temel JS, Krishnan M, Im J, Lock M. Interrater reliability in performance status assessment among healthcare professionals: an updated systematic review and meta-analysis. Support Care Cancer. 2020 May;28(5):2071–2078. https://doi.org/10.1007/s00520-019-05261-7
This article reviews the reliability between healthcare professionals for measures of performance status. For anyone who has struggled at a hospice interdisciplinary team meeting to understand a patient's function, this article will shed light on the “best” scale to use. Unfortunately, the scale that performed best, the Karnofsky Performance Status Scale, doesn't always fit well with hospice care because it says things like “urgently requiring admission” and “hospitalization necessary.”
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PC-FACS was created in 2005 by Founding Editor-in-Chief Amy P. Abernethy, MD, PhD, FACP, FAAHPM. The Academy is deeply grateful to Dr. Abernethy for creating this important publication and for her many contributions to the field of hospice and palliative medicine. PC-FACS is edited by Editor-in-Chief, Mellar P. Davis, MD, FCCP, FAAHPM, of the Geisinger Health System, and Associate Editor-in-Chief, Abby R. Rosenberg, MD, MS, FAAP, of the Seattle Children's Research Institute. All critical summaries are written by Jeff Fortin, MD. AAHPM thanks the following PCFACS Editorial Board members for their review of the critical summaries and preparation of the commentaries:
Robert M. Arnold, MD FAAHPM, Editor in Chief
Abby R. Rosenberg, MD MS FAAP, Associate Editor in Chief
Rony Dev, DO MS, Senior Section Editor
Kenneth Cornetta, MD
Rachel Hadler, MD
Ashima Lal, MD
Bioethics, Humanities, and Spirituality
Jessica A. Moore, DHCE MA, Senior Section Editor
Craig Blinderman, MD MA FAAHPM
Timothy Mark Corbett, MD MA HMCD FAAHPM
Gregory Phelps, MD MPH MAHCM
Beth Popp, MD HMDC FAAHPM FACP
Diversity and Inclusion
Ronit Elk, PhD, Senior Section Editor
Elizabeth Chuang, MD MPH
Jane Loitman, MD
Mona Patel, DO
Mei-Ean Yeow, MN
Geriatrics and Care Transitions
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Ahsan Azhar, MBBS MD FACP
Dashima Carthen, MD
Catherine Bree Johnston, MD MPH
Laura Patel, MD
Hospice, Hospice and Palliative Medicine Interface, and Regulatory Issues
Christopher Jones,MD FAAHPM, Senior Section Editor
Ambereen Mehta, MD MPH
Kyle Neale, DO
Alan Roth, DO FAAFP FAAHPM
Renato Samala, MD FACP
Robert C. Macauley, MD FAAP FAAHPM, Senior Section Editor
Regina Okhuysen-Cawley, MD
Charles Paine, MD
Megan Thorvilson, MD, MDiv
Erin Zahradnik, MD, Senior Section Editor
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Dan Handel, MD
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Symptom Assessment and Management
Giovanni Elia, MD FAAHPM, Senior Section Editor
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Published online: August 12, 2020
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