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Update in hospital palliative care.
Wendy G Anderson1, Lynn A Flint, Jay R Horton
1Division of Hospital Medicine, University of California, San Francisco, San Francisco, California; Palliative Care Program, University of California, San Francisco, San Francisco, California.
Journal of Hospital Medicine
|November 12, 2013
Summary
Recent hospital palliative care research shows symptom relief options like catheters for breathing issues and improved constipation treatment. Cardiopulmonary resuscitation (CPR) outcomes for patients and families also offer new insights.
Area of Science:
- Palliative Care
- Hospital Medicine
- Clinical Practice Research
Background:
- Palliative care is essential for hospitalists treating seriously ill patients.
- Recent research offers potential impacts on hospital-based palliative care practices.
Purpose of the Study:
- To summarize and critique recent research relevant to hospital palliative care.
- To provide recommendations for clinical practice based on scientific evidence.
Main Methods:
- A hand-search of leading journals and PubMed was conducted for articles published between January 2012 and May 2013.
- Nine articles were selected based on scientific rigor and relevance to hospital practice.
- Findings, strengths, and limitations of selected articles were reviewed.
Main Results:
- Indwelling pleural catheters and talc pleurodesis offer comparable dyspnea relief for malignant pleural effusions.
- Oxygen may not be necessary for dyspnea in many dying patients; docusate may be redundant for opioid-induced constipation.
- Atropine showed no benefit for respiratory rattles; older adults can survive in-hospital cardiopulmonary resuscitation (CPR) up to one year post-discharge.
- Observing CPR may reduce family post-traumatic stress; surrogate decision-makers often exhibit optimistic prognostic interpretation.
- Patients with metastatic cancer may believe chemotherapy offers a cure; goals-of-care videos may reduce CPR preference in skilled nursing facility admissions.
Conclusions:
- Recent studies offer crucial insights into symptom management interventions.
- Research highlights important findings regarding cardiopulmonary resuscitation (CPR) outcomes for both patients and their families.
- Evidence supports updated clinical practices in hospital palliative care.
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