Journal of palliative medicine
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Background: Palliative care is expanding as part of treatment, but remains underutilized in trauma settings. Palliative care consultations (PCC) have shown to reduce nonbeneficial, potentially inappropriate interventions (PII), as decision for their use should always be made in the context of both the patient's prognosis and the patient's goals of care. Objective: To characterize trauma patients who received PCC and to analyze the effect of PCC and do-not-resuscitate (DNR) orders on PII in severely injured patients. ⋯ Conclusions: PCC reduced PII in severely injured trauma patients by factor of two. Since the majority of PII in PCC patients occurred before PCC, a more timely administration of PCC is recommended. To streamline goals of care, PCC should supplement or precede a DNR discussion.
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Background: There are substantial disparities in distribution of palliative care (PC) services within Latin America, with Bolivia historically lagging behind neighboring countries in PC metrics. Comprehensive data on PC in Bolivia were last collected in 2012 through the Latin American Association for Palliative Care (ALCP) Atlas of PC. Objective: To update the 2012 data and describe the current state of PC in Bolivia to aid in their ongoing efforts to expand PC services. ⋯ Teams report significant barriers for their patients to obtain opioid pain medications. Conclusions: Bolivian PC teams utilize multidisciplinary teams and have the capability to treat many of the essential PC symptoms with guideline-recommended treatments. However, it is unclear whether availability of services translates to accessibility for most patients, especially given their geographic distribution and cost of services.
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Case Reports
Palliative Spine Surgery in a Patient with Advanced Cancer: A Case Report and Decision-Making Guide.
The spine is a frequent site of cancer metastasis leading to intractable pain, functional impairment, and poor quality of life. When analgesic regimens and nonpharmacological interventions fail, spine surgery may be indicated. For patients with advanced disease, the decision to operate can become a dilemma. ⋯ Shortly after surgery, he settled on a regimen merely equivalent to 45 mg of morphine per day. The article explores the role of palliative spine surgery in managing intractable cancer-related back pain. The authors offer a guide when considering surgical procedures for patients with limited prognosis.
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Background: In 2017, the American College of Surgeons' Trauma Quality Improvement Program adopted a Palliative Care Best Practices Guidelines that calls for early palliative care for hospitalized injured patients. Objective: To develop an educational intervention to address the palliative needs of injured patients. Design: Palliative faculty presented a three-part monthly lecture series focused on core primary palliative skills, including the components of palliative care; conducting family conferences; communication skills for complex medical decision making; pain management; and, end-of-life planning. ⋯ The overall rate of palliative specialist consultation also increased (8.4% vs. 16.1%, p < 0.001). Conclusion: Embedding primary palliative education into usual didactic and rounding time for an inpatient trauma team is an effective way to help residents develop palliative skills and foster culture change. Educational partnerships such as this may serve as an example to other trauma programs.