Healing Touch

I especially love the distinction between the e-patient and the actual patient.
Although our current health care reimbursement system measures mostly our e-patient care, we must take good care of both.
Nancy


Abraham Verghese : A Doctor's Touch on TED

Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

Tools for Documenting Capcity

These are great tools for documenting capacity.
--Nancy

Does this patient have medical decision-making capacity?

Sessums LL, Zembrzuska H, Jackson JL.

JAMA. 2011 Jul 27;306(4):420-7. Review.   PMID:  21791691.

     Link to this Article. 

Aid to Capacity Evaluation (ACE)
     Link to PDF
     Disclaimer to use the ACE Tool.

Terminal Velocity

This article offers a nice discussion of the dying process.
Nancy

Terminal Velocity on Journal of Palliative Medicine : a Multi-disciplinary Blog to Advance Palliative Care by Author VJ Periyakoil, MD, Senior Associate Editor, JPM

Article of Interest : The Quagmire

The Quagmire : How American Medicine is Destroying Itself.   CALLAHAN D, NULAND S.   New Republic [serial online]. June 9, 2011;242(8):16-18. Available from: Academic Search Premier, Ipswich, MA.  Accessed August 30, 2011.

Link to Full-text Article.  

Summary :   The article discusses what the authors consider to be an unsustainable trajectory in American medicine. In their view too many resources are being committed to the pursuit of cures for chronic illnesses not likely to be remedied for many years to come. They believe that medicine should adopt new priorities, starting with the goal of bringing everybody's life expectancy up to the age of 80. They maintain that geriatric care should focus less on postponing death and more on increasing the quality of life during one's final years.

Pain Resource Team Topics

Affinity Health System’s Pain Resource Nurse Team consists of RNs from the hospitals and clinics working to promote pain education for all staff at all sites and improve patient care. Dr. Nancy Homburg co-chairs this team and provides valuable input for us.

The Team has developed several topics to address some of the common side effects of opioids, treatment of pain in the older adult, and the Fentanyl patch. These evidence-based practice topics are for your reference and will also be available at each Nursing station and in the Clinics.

The Current Pain Topics are linked below on the "Pain Resource Team"  Webpage (35708)

Treating Pain in the Older Adult    (35702)

Opioid-Induced Nausea and Vomiting  (35705)

Opioid-Induced Constipation  (35706)

Transdermal Fentanyl   (35707)

If you have any questions or suggestions for other topics, please contact:

Caroline Alterman, MSN, RN, CNL - AHS Pain Management

Office phone: 223-1229 - Mercy Medical Center

738-2089 - St. Elizabeth Hospital

calterma@affinityhealth.org

Concurrent Care for Children Implementation Tool Kit by the NHPCO

On March 23, 2010, President Obama signed the Patient Protection and Affordable Care Act (PPACA) into law enacting a new provision, Section 2302, termed the “Concurrent Care for Children” Requirement, the CCCR.  This means all children with a life threatening illness can receive full treatment and still have the support of hospice care. See links below for the tool kit.

Nancy

The National Hospice and Palliative Care Organization has a wonderful resource on concurrent care for children. You can find their toolkit on their website, or use this direct link.  

This can be a wonderful resource for developing guidelines, policies or procedures for implementing concurrent care for children.  

EOL Coalitions - Training Materials for Caring for Veterans at the End of Life

Hello all,

Thought I would send out a small introduction to a training tool that we have developed under a grant that is available free of charge to address the unique needs of veterans at end of life.     The finishing touches are being put on the DVD and audio CD so it will be a month or so before we will be mailing out the Tookit.

If you are interested, or know of anyone else that would have a use for these materials be send me your mailing address.    We will put one in the mail to you when the DVD and audio CD is complete.   

There will also be a presentation at the HOPE (the state hospice association) Annual conference that is scheduled for Oct 26 & 27 in Appleton where hospice providers will receive the completed toolkit.   For a review of some of the materials, you can also look at the HOPE of Wisconsin web site at https://hopeofwisconsin.org/ProgramsToolkits.aspx  and select Veteran Partnership.

[Offerings include some of the following documents : ]

Honoring Veteran Preferences in End-of-Life Care (pdf)

Intake / Admission - Identify Veterans upon Admission

          The Military History Pocket Card 

Quick Tips for PTSD/Anxiety (pdf)

Thank you for caring for our veterans

Teri Rostberg, Exec Director

Hope Hospice and Palliative Care

Medford WI

715-748-3434

[Posted with Teri's permission and encouragement.]

We are finding agencies that may use some of the materials useful as well beyond Veteran clients and their families.

Twin Cities Program Helps Patients Discuss End-of-Life Planning

Listen here :


Or read about it here.

Dr. Homburg says :   "This is a wonderful link. Exactly what we're hoping to do with the Fox Cities Foundation Grant." 

Treat the Pain

From their website :  "The disparities in access to pain treatment worldwide are staggering. Cancer deaths are expected to double by 2030 and many of those deaths will be in developing countries with little to no access to adequate pain treatment. Through the Treat the Pain campaign, we are advocating for effective pain control measures to be available to all cancer patients in pain. We invite you to join us in helping stop unnecessary suffering worldwide."

The initiative includes short videos from the LIFE Before Death Documentary Series that are meant to be shared in effort to spread the word and "treat the pain" of this global problem.

LIFE before Death : Free Training Films

These 50 powerful short films are freely available to any pain, palliative care, hospice and end of life health professionals around the world to download here and use for training and advocacy.

LIFE Before Death is a documentary project supported by the Lien Foundation, the IASP, the Mayday Fund, the UICC and the Institute for Palliative Medicine at San Diego Hospice.

These Short Films feature leaders from the field including Dr Kathleen Foley, Dr Balfour Mount, Dr Betty Ferrell RN, Dr Jim Cleary, Professor Michael Cousins, Dr Henry Ddungu and Dr Charles Von Gunten.

The Short Films will be releasing at a rate of one per week from May 2011.

Article of Interest : Treatment of Cancer Pain

Treatment of cancer pain  Russell K Portenoy MD
The Lancet, Volume 377, Issue 9784, Pages 2236 - 2247, 25 June 2011
Link to Full Text Article
SummaryIn patients with active cancer, the management of chronic pain is an essential element in a comprehensive strategy for palliative care. This strategy emphasises multidimensional assessment and the coordinated use of treatments that together mitigate suffering and provide support to the patient and family. This review describes this framework, an approach to pain assessment, and widely accepted techniques to optimise the safety and effectiveness of opioid drugs and other treatments. The advances of recent decades suggest a future that includes increased evidence-based targeting of specific analgesic interventions within an individualised plan of care that is appropriate throughout the course of illness.

Full-text Article available at : at :  http://www.sciencedirect.com/science/article/pii/S0140673611602365    

A Patient's Journey with Palliative Care Services

Affinity Palliative Care Nurse, Sally Marohn discovered this YouTube video that elegantly and eloquently explains what Palliative Care means to this patient. She  goes through all the emotions as she explains ...  Enjoy!

Basic Symptom Control in Pediatric Palliative Care

Below is a link to a great resource on Pediatric Palliative Care.

Fortunately pediatric end-of-life care is rare, but we all want to have the best information when the need arises.

Nancy

Basic Symptom Control in Paediatric Palliative Care is available free to download at www.act.org.uk/symptomcontrol

UK children’s palliative care charity ACT has launched a newly revised and extended key resource for all doctors and nurses providing care and support to terminally ill or life-threatened children. The resource, Basic Symptom Control in Paediatric Palliative Care aims to provide doctors and nursing staff with an ‘all in one’ reference tool for symptom management and children’s palliative care medicines.

Basic Symptom Control in Paediatric Palliative Care contains information about how to appropriately treat a wide range of symptoms and contains 28 chapters on the most common symptoms and issues within children’s palliative care.  It also includes a comprehensive prescribing formulary to support those prescribing in children’s palliative medicine, covering over 90 medicines. The formulary has been adapted from the Association of Paediatric Palliative Medicine’s master formulary for children’s palliative medicine.

Caring for babies, children and young people who have a terminal or life-threatening health condition can be very daunting for GPs and paediatricians. Many GPs may only care for one or two children with life-limiting conditions in their entire working life. Basic Symptom Control in Paediatric Palliative Care has been designed to address some of the fears and challenges that these professionals may face. 

Basic Symptom Control in Paediatric Palliative Care has been developed and edited by Dr Satbir Singh Jassal, GP and Medical Director at Rainbows Children’s Hospice, with contributions and peer reviews from 30 leading paediatric and palliative care specialists. The resource has been published by ACT and is funded by the Department of Health.  Basic Symptom Control in Paediatric Palliative Care is available free to download at www.act.org.uk/symptomcontrol

The Last 6 Years : One Man's Experience with Palliative Care Captured on Film

The last six years: one man's experience with palliative care captured on film
This short film (13 minutes) tells the real life story of Jim Ray Cooper and his experiences during the last six years of his life with advanced lung disease. Mr. Cooper was a Navy Frogman in the Korean War. The frogmen were predecessors for the modern day Navy Seals. Frogman training requires much higher levels of fitness, and during the course there is often a high elimination rate of trainees who do not make the grade. Mr. Cooper held a record for holding his breath for five minutes! It was indeed ironic that he developed severe lung disease and was chronically breathless and oxygen dependent. In 2005, Mr. Cooper was told that he was dying of advanced lung disease and that he had less than six months to live. At that time, he was suffering with severe breathlessness and pain and was terrified that he was going to suffocate to death as his lung disease worsened. Mr. Cooper was referred to Dr. Periyakoil's Palliative Care Clinic for pain and symptom management. Dr. Periyakoil and her team began providing intensive palliative care and were able to control his pain, depression, breathlessness, PTSD and other distressing symptoms. Once his symptoms were under control, Mr. Cooper regained his desire to live and spent the last six years of his life with his family. As palliative care experts had helped him live longer and feel better, Mr. Cooper became passionately committed to increasing public awareness of this new and important medical sub-specialty. To this end, he asked Dr. Periyakoil to film his final years and use his story to teach patients, their families and health care personnel about the process of serious illness and the benefits of palliative care.   Further Information

ACP Decisions Patient Education Videos

Advanced Care Planning Decisions Video Library
http://www.acpdecisions.org/videolibrary.html
     *  Free registration is required to preview the videos.

**********************************************************************************
Additional info from an email sent to Dr. Homburg :

ACP Decisions Patient Education Videos Featured on CBS Evening News

BOSTON, Massachusetts (June 1, 2011) – The ACP Decisions Patient Education Videos were featured on Wednesday, June 1, 2011 at 6:30 pm Eastern Standard Time on the CBS Evening News.  The news segment chronicled the experience of a patient diagnosed with advanced cancer as she and her family watched an ACP video that provided information about advance care planning and end-of-life care options.

The videos were an eye-opener for the patient and allowed her to make an informed decision consistent with her values.  She credited the videos for helping her better understand what occurs in the final days of an illness: “When I saw that gentleman laying there on that ventilator – that was difficult. I wouldn’t want that for me or anyone else.”  The segment concluded with a comment by Dr. Jonathan LaPook, CBS Evening News Medical Correspondent:

“When a patient comes to you and says ‘Doc I’m going to beat this’ and

part of you agrees with them or wants to agree with them, it’s hard to

start [an end-of-life] conversation and I have made the mistake in my very

own practice of delaying that conversation too long and watching

one of my patients needlessly suffer at the end of their life because I

was not able to properly coordinate end-of-life care. Yes it is a tough

conversation, but we owe it to our patients to have it.”

To view the segment, click here: http://www.cbsnews.com/stories/2011/06/01/eveningnews/main20068123.shtml

About Nous Foundation, Inc.

Nous Foundation, Inc. is a non-profit organization consisting of clinicians and researchers who want to empower patients with patient-centered, culturally appropriate, and easy to use video decision aids. Our carefully crafted video support tools undergo rigorous review by leading experts in medicine, geriatrics, oncology, palliative care, ethics, and decision-making.  All of our videos are first studied in the research arena and include participants who represent geographic, racial, age, and religious diversity. Our video decision aids are filmed and produced by Drs. Angelo Volandes and Aretha Delight Davis along with colleagues from Harvard Medical School, Massachusetts General Hospital, Memorial Sloan-Kettering Cancer Center, Boston Medical Center, and the University of Chicago.

Contact:  Angelo Volandes, MD, MPH,

Tel:  1-866-440-5969

Email: Angelo@acpdecisions.org

Engage with Grace : The One Slide Project

Engage with Grace and The One Slide Project have one goal :
To help ensure that all of us--and the ones we love--can end our lives in the same purposeful way we lived them. 


The project encourages readers to download the slide, and share it where ever we can. 
Be able to answer the questions for yourself, and for your loved ones.
            Get the Conversation started.


They also encourage people to come back and share your story about how you used the slide.
**********

This link was shared by Dr. Jim Deming at Franciscan Health care in Tomah.  Thank you!

We've had only limited success working within healthcare to get these conversations going.

It's encouraging for the general public to raise these issues also. Another example is the new PBS broadcast "Consider the Conversation". To check out a 5" clip of this show: http://www.netaonline.org/5minutes.htm#CONSIDER. This film also encourages everyone to discuss these issues.

-- Nancy

Article of Interest

J Clin Oncol. 2011 May 9. [Epub ahead of print]         Link to full-text article.

Longitudinal Perceptions of Prognosis and Goals of Therapy in Patients With Metastatic Non-Small-Cell Lung Cancer: Results of a Randomized Study of Early Palliative Care.

Temel JS, Greer JA, Admane S, Gallagher ER, Jackson VA, Lynch TJ, Lennes IT, Dahlin CM, Pirl WF.

Source

Massachusetts General Hospital Cancer Center, Boston, MA; State University of New York, Buffalo, NY; and Yale Cancer Center, New Haven, CT.

Abstract

PURPOSE Understanding of prognosis among terminally ill patients impacts medical decision making. The aims of this study were to explore perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer (NSCLC) and to examine the effect of early palliative care on these views over time. PATIENTS AND METHODS Patients with newly diagnosed metastatic NSCLC were randomly assigned to receive either early palliative care integrated with standard oncology care or standard oncology care alone. Participants completed baseline and longitudinal assessments of their perceptions of prognosis and the goals of cancer therapy over a 6-month period. Results We enrolled 151 participants on the study. Despite having terminal cancer, one third of patients (46 of 145 patients) reported that their cancer was curable at baseline, and a majority (86 of 124 patients) endorsed getting rid of all of the cancer as a goal of therapy. Baseline perceptions of prognosis (ie, curability) and goals of therapy did not differ significantly between study arms. A greater percentage of patients assigned to early palliative care retained or developed an accurate assessment of their prognosis over time (82.5% v 59.6%; P = .02) compared with those receiving standard care. Patients receiving early palliative care who reported an accurate perception of their prognosis were less likely to receive intravenous chemotherapy near the end of life (9.4% v 50%; P = .02). CONCLUSION Many patients with newly diagnosed metastatic NSCLC hold inaccurate perceptions of their prognoses. Early palliative care significantly improves patient understanding of prognosis over time, which may impact decision making about care near the end of life.

PMID:   21555700     [PubMed - as supplied by publisher]

Full-text available at :  http://jco.ascopubs.org/content/29/17/2319.long   Accessed 9 June 2011. 

Pediatric Palliative Care Online Courses Available

The National Hospice and Palliative Care Organization (NHPCO)'s Pediatric Palliative Care Online Training Series provides instant access to educational resources for pediatric care providers.  The series offers 10 online educational modules written by leading pediatric palliative/hospice care experts across the country and will be available through NHPCO's E-Online in 2011. 

Two of the ten modules are now available :

Pediatric Palliative Care Principles and Standards

and
Pediatric Palliative Care delivery Models

Each module offers valuable content, case studies and practical examples to help your organization deliver quality care for children with life-threatening conditions and their families.

Article of Interest

Impact of death and dying on the personal lives and practices of palliative and hospice care professionals.

Sinclair S.     CMAJ. 2011 Feb 8;183(2):180-7. Epub 2010 Dec 6.    PMID:   21135081.  FREE full-text vailable at :  http://www.cmaj.ca/cgi/content/full/183/2/180   Accessed 24 May 2011. 

Abstract

Background Working within the landscape of death and dying, professionals in palliative and hospice care provide insight into the nature of mortality that may be of benefit to individuals facing the end of life. Much less is known about how these professionals incorporate these experiences into their personal lives and clinical practices. Methods This ethnographic inquiry used semi-structured interviews and participant observation to elicit an in-depth understanding of the impact of death and dying on the personal lives of national key leaders (n = 6) and frontline clinicians (n = 24) involved in end-of-life care in Canada. Analysis of findings occurred in the field through constant comparative method and member checking, with more formal levels of analysis occurring after the data-collection phase. Results Eleven specific themes, organized under three overarching categories (past, present and future), were discovered. Early life experiences with death were a common and prominent feature, serving as a major motivator in participants' career path of end-of-life care. Clinical exposure to death and dying taught participants to live in the present, cultivate a spiritual life, reflect on their own mortality and reflect deeply on the continuity of life. Interpretation Participants reported that their work provided a unique opportunity for them to discover meaning in life through the lessons of their patients, and an opportunity to incorporate these teachings in their own lives. Although Western society has been described as a "death-denying" culture, the participants felt that their frequent exposure to death and dying was largely positive, fostering meaning in the present and curiosity about the continuity of life. 

Consider the Conversation

There's a link below to a clip of Consider the Conversation. Check it out!

It's the film we were hoping to share for National Healthcare Decisions Day, April 16  ...better later than never. We can share it for NHDD next year.

Let's call to request it be shown by PBS here.

Nancy

 

Consider the Conversation Documentary Film    Website

---

From: Michael Bernhagen [mailto:mike.bernhagen@rainbowhospicecare.org]
Sent: Thursday, May 19, 2011 2:19 PM

I thought all of you might appreciate hearing that Consider the Conversation: A Documentary on a Taboo Subject, the film I co-produced with Wisconsin’s Teacher of the Year, Terry Kaldhusdal, will be released to PBS stations nationwide via the National Educational Telecommunications Association on June 18th.  Without question, this represents a unique opportunity for healthcare organizations throughout America to educate their communities and potentially partner with their local PBS station in the effort.

If you'd like to see Consider the Conversation broadcast in your city, please call or e-mail your local PBS affiliate today.  And, to view the first five minutes of the film, please click here.

Achievement of this goal would not have been possible without the support of so many caring people including the Rainbow Hospice Foundation, our families, interviewees, donors and the countless folks who provided access for filming, watched us present over the past year or purchased the DVD on Amazon.com.

All the best,

Mike Bernhagen

"Dad...this film is all the things I need you to hear."

This short film is a perfect fit for today's world filled with distractions and...hey what's that shiny object over there.  Sorry.

This 4 minute film titled "THE UNSPOKEN" from Jason van Genderen was the runner up at Tropfest Australia 2011  and is more powerful than even a Hallmark commercial, more heartfelt then a torch song, and evidence that we are capable of appreciating people before they are dead and gone. 

Enjoy!

Article of Interest : Identifying Patients in Need of Palliative Care Assessment ...

J Palliat Med. 2011 Jan;14(1):17-23. Epub 2010 Dec 6.         

Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care.

Weissman DE, Meier DE.             Link to this Article (Affinity or Paid Access Only)

Source

Medical College of Wisconsin/Froedtert Hospital , Milwaukee, Wisconsin, USA. dweissma@mcu.edu

Abstract

Workforce shortages, late referrals, and palliative care program resource constraints present significant barriers to meeting the needs of hospitalized patients facing serious illnesses. The Center to Advance Palliative Care convened a consensus panel to select criteria by which patients at high risk for unmet palliative care needs can be identified in advance for a palliative care screening assessment. The consensus panel developed primary and secondary criteria for two checklists-one to use for screening at the time of admission and one for daily patient rounds. The consensus panel believes that by implementing a checklist approach to screening patients for unmet palliative care needs, combined with educational initiatives and other system-change work, hospital staff engaged in day-to-day patient care can identify a majority of such needs, reserving specialty palliative care services for more complex problems.

PMID:  21133809

Dr. Homburg's commentary :
A recent article about Palliative Care needs in the hospital setting discusses this issue of palliative sedation.
It explains primary palliative care that everyone should be able to do (simple advance care planning, establishing goals of care, discussing DNR status, pain and symptom management, support of caregivers) & specialty level Palliative Care that only those certified should do. Specialty Palliative care Consultation is necessary in my opinion, for the initiation of Palliative Sedation. Specialty privileges should be available to AHS Medical Staff with this certification. Currently Dr Haine and I have passed our certification exam.
The article suggests a consult with a Palliative Care specialist might also be considered for prolonged ICU stays (> 7-10 days?), disagreements about plan of care, pre LVAT, pre AICD, pre feeding tube, pre trach and of course difficult issues with advance care planning, establishing goals of care, discussing DNR status, pain and symptom management, support of caregivers. As the AHS Palliative Care program grows, we'll need to establish better screening to provide appropriate Palliative Care to all the AHS patients in and out of the hospital setting who would benefit from our service.

Improving Advanced Illness Care : The Evolution of State POLST Programs

The link below has a 2-page exec summary and a 64-page full report by the AARP on the POLST paradigm.

As we work to bring POLST to "standard of care" in the Fox Cities/Oshkosh area, endorsements by national organizations will make introduction and implementation smoother.
Thanks for sharing with us, Sara [Buscher]!
Nancy
Improving Advanced Ilnness Care : The Evolution of State POLST Programshttp://www.aarp.org/health/doctors-hospitals/info-04-2011/polst-04-11.html

"Physician Orders for Life-Sustaining Treatment (POLST) is a promising program to elicit and honor the treatment goals of people with advanced progressive illness or frailty. Research shows that POLST effectively communicates patient treatment choices, whatever they may be, without sacrificing comfort care. This report documents the evolution of POLST in 12 states and highlights lessons learned for states developing and implementing new programs." -- AARP Public Policy Report

Articles of Note

1.   Metoclopramide versus hydromorphone for the emergency department treatment of migraine headache.

Griffith JD, Mycyk MB, Kyriacou DN.

J Pain. 2008 Jan;9(1):88-94. Epub 2007 Nov 5.   PMID:  17981511.

         Link to Article.  (Affinity or paid access only)

2.   Impact of death and dying on the personal lives and practices of palliative and hospice care professionals.

Sinclair S.

CMAJ. 2011 Feb 8;183(2):180-7. Epub 2010 Dec 6.    PMID:  21135081.

         Link to Article.  (Free access)

3.   Palliative care in amyotrophic lateral sclerosis: a review of current international guidelines and initiatives.

Bede P, Oliver D, Stodart J, van den Berg L, Simmons Z, O Brannagáin D, Borasio GD, Hardiman O.

J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):413-8. Epub 2011 Feb 5.   PMID:   21297150.

         Link to Article.  (Affinity or paid access only)

Surgical Clinics of North America (April 2011 issue) Focuses on Pallitive Care

The April 2011 issue of Surgical Clinics of North America (Vol. 91, Issue 2) focuses on Pallitive Care.
Dr. Homburg says it is wonderful!!

Affinity users have online access to Surgical Clinics of North America through MDConsult. 
              Use this link to go directly to the April 2011 issue. 

As long as you are using an Affinity computer, or sign in with your MDConsult login, you should be able to access any of these articles.  Let me know if you have any trouble with it.

SPARK at Milwaukee Public Museum

The Milwaukee Public Museum is currently holding a cultural programming exhibit for people with memory loss.

SPARK! programs feature interactive exhibit experiences in a welcoming environment. Specially trained Museum educators engage participants in lively discussions, object handling and other multi-sensory activities.

If you are interested in passing more information on about the exhibit, you can find it at:

http://www.mpm.edu/events/spark

Found by  

Kristyna Williams

Article of Interest : Systematic Review - The Effect on Surrogates of Making Treatment Decisions for Others

The most recent issue of Annals of Internal Medicine reportedly has an interesting article on the trauma of surrogacy and the heart wrenching effects on decision makers who don't know their loved ones wishes.    This is in striking contrast to the honor felt by the surrogates who know they're fulfilling their loved ones wishes.     This will be a good article for the blog - and in time for National Healthcare Decision Day. 
-- Nancy

 Systematic review: the effect on surrogates of making treatment decisions for others. Wendler D, Rid A. Ann Intern Med. 2011 Mar 1;154(5):336-46. PMID: 21357911. Available at : http://www.annals.org/content/154/5/336.full.pdf+html    Accessed 14 March 2011.


Access should work at any Affinity computer.

Article of Interest : Patients who make "wrong" choices

J Palliat Med. 2011 Jan;14(1):13-6.   

Patients who make "wrong" choices.   

Macauley R.   PMID:  21244250.   Available at :  http://tinyurl.com/44qlqxd  Accessed 15 June 2011.

Loved this article.  Intro quote says it all.
           --- Nancy

"You're Sick. It's Serious."

From the American Academy of Hospice and Palliative Medicine who want us to share these videos far and wide.  

Four slightly modified versions of this video have been created, focusing on more specific types of illness :

Cancer   http://www.youtube.com/watch?v=sBvcHZUSszE  

COPD    http://www.youtube.com/watch?v=nJL_oi3yMIY

Dementia      http://www.youtube.com/watch?v=blAHFRSBdNA

Heart Failure    http://www.youtube.com/watch?v=W4mOi_rhdKo

Articles of Interest

The following articles came from Pallimed.     We've added links so you can easily access the full-text as long as you're at an Affinity computer.    Enjoy! 

• Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ.   Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19;363(8):733-42. PubMed PMID: 20818875.    Available at : http://www.nejm.org/doi/full/10.1056/NEJMoa1000678   Accessed 21 February 2011.   

• Abernethy AP, McDonald CF, Frith PA, Clark K, Herndon JE 2nd, Marcello J, Young IH, Bull J, Wilcock A, Booth S, Wheeler JL, Tulsky JA, Crockett AJ, Currow DC. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010 Sep 4;376(9743):784-93. PubMed PMID: 20816546; PubMed Central PMCID: PMC2962424.     Available at :  http://tinyurl.com/4flb3nn    (Lancet)   Accessed 21 February 2011.  

 

• Unroe M, Kahn JM, Carson SS, Govert JA, Martinu T, Sathy SJ, Clay AS, Chia J, Gray A, Tulsky JA, Cox CE. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study. Ann Intern Med. 2010 Aug 3;153(3):167-75. PubMed PMID: 20679561; PubMed Central PMCID: PMC2941154.     Available at :   http://search.ebscohost.com/login.aspx?direct=true&db=c9h&AN=52706586&site=ehost-live     Accessed 21 February 2011.   

• Boyd EA, Lo B, Evans LR, Malvar G, Apatira L, Luce JM, White DB. "It's not just what the doctor tells me:" factors that influence surrogate decision-makers' perceptions of prognosis. Crit Care Med. 2010 May;38(5):1270-5. PubMed PMID: 20228686.      Available at : http://tinyurl.com/4oc2pt4 (Ovid)     Accessed 21 February 2011.   

• Ullrich CK, Dussel V, Hilden JM, Sheaffer JW, Lehmann L, Wolfe J. End-of-life experience of children undergoing stem cell transplantation for malignancy: parent and provider perspectives and patterns of care. Blood. 2010 May 13;115(19):3879-85. Epub 2010 Mar 12. PubMed PMID: 20228275.      Available at :  http://bloodjournal.hematologylibrary.org/cgi/content/full/115/19/3879       Accessed 21 February 2011.   

• Givens JL, Jones RN, Shaffer ML, Kiely DK, Mitchell SL. Survival and comfort after treatment of pneumonia in advanced dementia. Arch Intern Med. 2010 Jul 12;170(13):1102-7. PubMed PMID: 20625013; PubMed Central PMCID: PMC2914628.     Available at :  http://archinte.ama-assn.org/cgi/reprint/170/13/1102   Accessed 21 February 2011.   

• Kirchhoff KT, Hammes BJ, Kehl KA, Briggs LA, Brown RL. Effect of a disease-specific planning intervention on surrogate understanding of patient goals for future medical treatment. J Am Geriatr Soc. 2010 Jul;58(7):1233-40. PubMed PMID: 20649686; PubMed Central PMCID: PMC2964863.     Available at :  http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02760.x/pdf   Accessed 21 February 2011.   

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