State of the Science Part II

Wow! A day and a half to get home. Who knew there would be snow in Minnesota in the winter? I hope you find yourself as reinvigorated by the Assembly as I have been.

So what were the other key articles? Well, perhaps you’ve seen Lyle Fettig’s excellent post at PalliMed complete with hyperlinks. If not, here’s Part II:

What is the experience that children undergo when treated with Stem cell transplant (SCT) for malignancy? Parents and Physician’s perspectives are presented in Ullrich CK, Dussel V, Hilden JM, Sheaffer JW, Lehmann L, Wolfe J Blood 2010 115: 3879-85. While success rates are improving, 5-year survival for children undergoing SCT is 50-60%. Physicians and parents of children who underwent SCT as the last mode of cancer-directed therapy reported knowing that the treatment will not result in cure less often and later than those of children who do not undergo SCT. This was associated with more use of life-sustaining treatments, less planning, and increased symptom burden for the children.

And for those with Dementia, the impact of pneumonia is described in Givens JL, Jones RN, Shaffer ML, Kiely DK, Mitchell SL Archives of Internal Medicine 2010 170: 1102-7. This study can be used to help surrogates decide whether or not to initiate antibiotics in severely demented patients in LTC. Residents in 22 Boston area nursing homes were studied.

—Treatment with antimicrobial agents is associated with longer survival (273 mean increase in days)
—No differences were noted between survival based on route of antimicrobial delivery
—Patients who lived and received antimicrobial agents had more discomfort
—For patients who died, there was no difference in comfort for those who did or did not receive antimicrobial agents or in other words, withholding antibiotics did not appear to increase suffering.
Finally, our State of the Science closes with two articles about surrogacy and advanced care planning.

The first study presents a randomized trial of disease specific discussions from the Respecting Choices program of LaCrosse Wi. Patients and their surrogates were randomized to either a facilitated interview or usual care. For patients with CHF or ESRD, a facilitated, structured patient-surrogate interview improved surrogate understanding of patient preferences for care at the end of life.

The final study used a randomized trial of video to facilitate end-of-life conversations with cancer patients. El-Jawahri A, Podgurski LM, Eichler AF, Plotkin SR, Temel JS, Mitchell SL, Chang Y, Barry MJ, Volandes AE J Clin Oncol 2010 28:305-10 Viewing a video depicting end-of-life care options increased patients’ preference for comfort care, and decreased their desire to receive CPR and other life-prolonging therapies.
So in conclusion, it’s been a great year for Hospice and Palliative Medicine. To all of you HPM researchers, keep up the great research!
And Finally, Happy Anniversary to HPNA on reaching such a great milestone!

1 thought on “State of the Science Part II”

  1. And a Huge Thanks to Nate and Wendy for the tremendous amount of work they put into this presentation. As one attendee said, ” This is the one talk that I make it a point to never miss!”

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