American Journal of Hospice and Palliative Medicine current issue

Hospice--Palliative Medicine: A Look Back and Into the Future

Enck, R. E. — Wed, 18 Nov 2009 17:18:50 PST

Making Explicit the Contention in Hospice Care

Moon, P. J. — Wed, 18 Nov 2009 17:18:50 PST

At the core of hospice remains the defining nature of mortals tending to other mortals facing diagnosed terminality. Such situations are pregnant with meanings. As mortals are subjective beings, social engagements become inundated with meaning differences. This alludes to the inescapable occurrence of collisions and conflicts in meaning. It would behoove us to make explicit the contention that exists in hospice care, given that death is the nonnegotiable outcome to be diversely faced by all involved persons whose lived approaches related to death issues may characteristically lack unanimity. Toward elucidating the inherently contentious nature of hospice care, the dynamical influence of external forces that overlie thanatological matters in society and the complex human dynamic in hospice care situations are discussed. Practice suggestions for hospice staff are offered.

How to Attract More Males to Community-Based Hospice Palliative Care Volunteer Programs

Claxton-Oldfield, S., Guigne, S., Claxton-Oldfield, J. — Wed, 18 Nov 2009 17:18:50 PST

Two separate studies were conducted to better understand why so few middle-aged and older men volunteer in hospice palliative care; only about 10% of the patient/family care volunteers in New Brunswick’s community-based hospice palliative care volunteer programs are men. In study 1, 15 (22%) of the 68 men who read a brief description about the kinds of things that hospice palliative care volunteers do expressed an interest in this type of volunteerism. The main reasons given for their lack of interest included ‘‘being too busy’’ and ‘‘not being able to handle it emotionally.’’ At least one third of the men who said ‘‘No’’ to becoming a hospice palliative care volunteer expressed an interest in 10 of 13 other common volunteer activities (eg, driving). In study 2, 59 men were presented with a list of 25 tasks that hospice palliative care volunteers might perform when providing emotional, social, practical, and administrative support. The men were asked to indicate which tasks they would be willing to perform if they were a hospice palliative care volunteer. The men were least willing to serve on the board of directors (28%), provide hands on patient care (38%), and work in the volunteer program’s office (42%); they were most willing to talk to the patient (97%), share hobbies and interests with the patient (92%), listen to the patient’s memories and life stories (90%), and provide friendship and companionship (88%). The results of these studies may have implications for the recruitment of male volunteers to work with dying patients and their families.

Music Therapy in an Integrated Pediatric Palliative Care Program

Knapp, C., Madden, V., Wang, H., Curtis, C., Sloyer, P., Shenkman, E. — Wed, 18 Nov 2009 17:18:50 PST

National experts have recommended that children with life-limiting illnesses receive integrated palliative and medical care. These programs offer a variety of services, including music therapy. Using survey data from parents whose were enrolled in Florida’s Partners in Care: Together for Kids (PIC:TFK) program, this study investigates parents’ experiences with music therapy. About 44% of children with life-limiting illnesses and 17% of their siblings used music therapy. For children who used music therapy, multivariate results suggest that their parents were 23 times as likely to report satisfaction with the overall PIC:TFK program (P < .05) versus parents whose children did not use music therapy. Pediatric palliative care programs should include music therapy, although recruiting licensed music therapists may be challenging.

Advance Care Planning in the Primary Care Setting: A Comparison of Attending Staff and Resident Barriers

Tung, E. E., North, F. — Wed, 18 Nov 2009 17:18:50 PST

Advance directive completion rates remain poor in the ambulatory setting. The purpose of this study was to explore and contrast staff provider and resident physicians’ experiences with advance care planning (ACP) and to identify barriers to this process in the primary care setting. A 17-item survey was administered to staff primary care providers and categorical internal medicine residents. Staff providers were more likely to discuss ACP after prompting from patients’ family members (P < .02) or after a change in health status (P < .02) and were more likely to believe that non-physician members of the care team should counsel patients about ACP. The majority of respondents cited system-based barriers as major obstacles to ACP. Strategies aimed at systematizing the ACP process for both patients and providers are needed.

Influence of Malignancy on the Decision to Withhold or Withdraw Life-Sustaining Therapy in Critically Ill Patients

Cavallazzi, R., Hirani, A., Vasu, T. S., Pachinburavan, M., Kane, G. C. — Wed, 18 Nov 2009 17:18:50 PST

Purpose: To evaluate the influence of malignancy on the decision to limit life-sustaining therapy in the intensive care unit (ICU). Methods: At the day of patients’ admission to the ICU, we prospectively collected information on demographics, acute physiology and chronic health evaluation (APACHE) II score, and features related to malignancy. We retrospectively collected information on in-hospital survival and decision to withhold or withdraw life-sustaining treatment. Results: This study included 122 adult critically ill patients. After adjusting for age and APACHE II score, patients with malignancy had 3.02 (95% CI 1.19 to 7.62) higher odds of having life-sustaining therapy withdrawn or withheld as compared to patients without active malignancy. Conclusion: Our study showed that critically ill patients with malignancy are more likely to have their life-sustaining therapy withheld or withdrawn than those without malignancy after adjusting for severity of disease. This finding may be related to a perception that critically ill patients with malignancy have worse prognosis as compared with those without malignancy.

Buprenorphine for Neuropathic Pain--Targeting Hyperalgesia

Induru, R. R., Davis, M. P. — Wed, 18 Nov 2009 17:18:50 PST

Opioids are well known to relieve severe, acute, and chronic nociceptive pain, but neuropathic pain shows a relatively poor response to opioids. Buprenorphine, a partial mu and ORL-1-receptor agonist, kappa-delta receptor antagonist, interacts with different G proteins than potent mu agonists and hence is not cross-tolerant to standard opioids. Buprenorphine blocks central sensitization (hyperalgesia) that is commonly found with neuropathic pain. We present a patient with neuropathic pain and tactile allodynia in which buprenorphine alleviated the hyperalgesia to a greater extent than pain severity. We found buprenorphine to be effective in reducing hypersensitivity in neuropathic pain when pure mu agonists fail to produce a response or in individuals who are intolerant to pure mu agonists.

Diphenhydramine May Be Useful as a Palliative Treatment for Patients Dying With Parkinson's Disease and Tremors: A Case Report and Discussion

Gonzalez, F. — Wed, 18 Nov 2009 17:18:50 PST

Diphenhydramine is an antihistamine with anticholinergic properties, which has been used for the treatment of Parkinson disease (PD) prior to the development of newer agents with better side-effect profiles. However, most of these agents are given orally. Unfortunately, at the time of death, patients with paralysis agitans are no longer able to swallow and they can experience worsening of their tremors. We report the case of 1 patient with congestive heart failure (CHF) and PD who was unable to swallow and developed uncontrollable tremors 24 hours prior to death and whose tremors were successfully treated with diphenhydramine. We feel that in preimminent patients who cannot swallow or may not have perioral endoscopic gastrostomy (PEG)s or feeding tubes, parenteral diphenhydramine may be an appropriate palliative intervention to reduce tremors.

Family Support Services in Pediatric Palliative Care

Knapp, C. A., Contro, N. — Wed, 18 Nov 2009 17:18:50 PST

A fundamental premise of pediatric palliative care is that support is provided not only to the ill child but to the family as well. In doing so, a number of services may be offered to family members throughout the child’s illness, at the time of death and into bereavement, such as respite, counseling, expressive therapies, and bereavement support. Support may also be needed for the child’s peers at school, church, or on sporting teams. Evidence on family supportive care in pediatric palliative care research is scarce. The majority of existing studies are undertaken with bereaved parents. Although these studies are insightful, further information is needed to understand families’ needs along the illness trajectory and to determine whether unmet needs exist.

New Clinical End Points in Rehabilitation Medicine: Tools for Measuring Quality of Life

Abresch, R. T., Carter, G. T., Han, J. J., McDonald, C. M. — Wed, 18 Nov 2009 17:18:50 PST

Traditional clinical end points in rehabilitation medicine have centered on objective measures of human performance, including quantitative muscle strength testing, functional independence measurements (FIM), and timed motor performance (TMP). However, it is now increasingly recognized that health-related quality of life (HRQoL) is a valid clinical end point. Health-related quality of life is a broad concept involving an individual’s physical health, psychological state, personal beliefs, and interpersonal and social support relationships. The goals for this article are to show the value of performing HRQoL measurements and briefly describe methods used to assess quality of life (QoL).

Providing Care in an Unacceptable Environment

Wed, 18 Nov 2009 17:18:50 PST

A Son's Remembrance

Baxter, J. D. — Wed, 18 Nov 2009 17:18:50 PST

For a Peaceful Cancer Death in Egypt: Palliative Care IS NOT

Alsirafy, S. A. — Wed, 18 Nov 2009 17:18:50 PST