Updates in hospice and palliative care

Provision of spiritual care to patients with advanced cancer: Associations with medical care and quality of life near death

Spiritual care
Spiritual needs -> use of hospice & life sustaining treatments at last week of life

Clinical bottom line:

Patients with advanced cancer who receive pastoral care are more likely to feel their spiritual needs are supported by the medical team Supporting patients spiritual needs may change their utilization of health care and increase their quality of life near death.

Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer

Multicomponent educational intervention

Nurse led telephone support -> enhancement of quality of life of rural cancer patients

Clinical bottom line:

Providing rural patients with advanced cancer with nurse led telephone support and education to encourage patient activation, selfmanagement, and empowerment improves quality of life and decreases rates of depression.

Looking beyond where children die: Determinants and effects of planning a childs location of death.

Clinical bottom line:

Communication about end-of-life treatment options and home care may help parents to plan their childs location of death. Planning may increase home death, decrease use of life sustaining treatments, and improve parents experience of the death.

Trying to be a good parent as defined by interviews with parents who made phase I, terminal care, and resuscitation decisions for their children

Good parent
Doing right things for my child Being there for my child Conveying love Being an advocate Being good life example

Clinical bottom line:

Clinicians can help parents to cope with the very difficult experience of making decisions for their seriously ill children by learning what it means to them to be a good parent and helping them to achieve that.

The clinical course of advanced dementia

Proxy understanding of prognosis-> type of care received at the end of life

 Nursing home patients with advanced dementia have high morbidity, mortality, and symptom burden. Proxy knowledge and understanding of the clinical course of dementia is associated with decreased interventions near the end of life.

Clinical bottom line:

Functional status of elderly adults before and after initiation of dialysis

Clinical bottom line:

The initiation of dialysis in nursing home patients is associated with a rapid decline in functional status and high rates of mortality at 1 year. Presenting this prognostic information may help older nursing home residents and their families to make decisions about the initiation of dialysis that are consistent with their goals and values.

Atropine, hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care

Death rattle
>Sign of impending death

Clinical bottom line:

In the first 48 hours of treatment subcutaneous or intravenous atropine, scopolamine, and hyoscine are equally effective at treating terminal death rattle.

Association of an educational program in mindful communication with burnout, empathy, and attitudes among primary care physicians

Mindfulness > A quality of awareness that includes the ability to pay attention in a particular way: on purpose and in the present moment dec. Burnout Inc. Empathy for patients Improved mood Inc. Emotional stability

Clinical bottom line:

Mindfulness communication training may be an effective means to improve both patient and provider outcomes in hospice and palliative care.