Report by Dr. Emese Somogyi – April 2013:
- Should you consider a feeding tube in your patients with advanced dementia? A new study confirms that there is no difference in survival when compared to assisted oral feedings.
- For the next time someone talks about using feeding tubes for pressure ulcers, you might like to let them know that there is interesting new research data. There is no benefit in healing existing ulcers. The risk for developing new pressure ulcers in patients with feeding tubes is double. Why? Possible mechanisms include immobility due to restraints, skin irritation from diarrhea , and sacral edema from fluid overload.
- Should you offer parental hydration in patients with advanced cancer? They found no advantage in terms of survival and subjective well-being. However if this is one of those situations when the family and patient associate hydration with hope and comfort (even after an attempt to educate them), you could make a case for using it.
- Gabapentin is a promising new treatment for chronic cough.
- So is acupuncture for dyspnea in COPD patients.
- Giving your patient an SSRI for depression and an NSAID for pain? There is new data indicating a greatly increased risk of bleeding due to a drug-drug interaction.
- Octreotide to reduce secretions in patients with malignant bowel obstruction is falling out of favor.
- Do you have a cachectic patient on fentanyl patches? The actual dose achieved might be 50% less due to absorption issues.
- Is your patient on opioid medication also driving? There is a 20 – 40% increased risk of road trauma.
- Are you considering subcutaneous ketamine for chronic cancer pain? Don’t do it, too much toxicity and too little effect.
- Frustrated with families and caregiver who just “would not get it”? Research tells us that the worse the prognosis, the greater the gap between what we are saying and what families are predicting.
- Talking to patients about numeric pain scores:
- What is the number now?
- What is the worse you experienced in the x time period?
- What is the best you experienced in the x time period?
- What is your goal?
- Two pearls for treating heroin-dependent patients:
- “How much do you need to take to keep from getting sick?
- Some experts use the following estimate: $1/day heroin=1 mg/day methadone
- Words that work: “What would you need to have happen to be at peace when John dies?”
Life’s tough choices – By Vicki Viotti.
With more facing difficult end-of-life decisions, awareness and enhancements in palliative and hospice care have grown tremendously. By Vicki Viotti. Star Advertiser, Oct 30, 2011, Section F1&F4
2011 Public Opinion Research on Palliative Care
- Language makes a difference. Palliative care is about improving quality of life, providing an extra layer of support, and having a team focus to patient care.
- Palliative care is a relative unknown among consumers.
- Once informed, consumers say they would be very likely to consider using palliative care if they or a loved one had a serious illness.
- 95% of respondents agree that it is important that patients with serious illness and their families be educated about palliative care.
- 92% of respondents say it is important that palliative care services be made available at all hospitals for patients with serious illness and their families.
You may want to have and in-depth look and download the 15-page pdf of the survey.
Care of the whole person
We hare happy to share with you this article from The American Cancer Society talking about the importance of palliative care. “Care of the whole person” by Jnnifer L.W.Fink, RN was published in Triumph Summer 2011 edition of ACS.
Click here for a PDF of the article
Twelve Breaths’: Lessons From The End Of Life
In case you missed the show “Twelve Breaths’: Lessons From The End Of Life” on NPR on July 25, you can listen to it on-line. (As long as this link by NPR is ‘hot’)
“When life draws to an end, family, caregivers and medical professionals face a flurry of often heartbreaking decisions. Are there any last treatments to try? How much longer can a patient hold on? When is it time to turn off the ventilator – and who gets to decide?”
Background materials of interest
For a number of important articles please check Pivotal Palliative Care Articles from The Center to Advance Palliative Care (CAPC).