The last day of the Annual Assembly is bittersweet as things come to a close, but it also means it is time for one of the highlights of the meeting year after year,the State of the Science. If you missed it, make a point to see the next one! Drs. Nathan Goldstein and Wendy Anderson reviewed articles from 2010 with a systematic format and highlight the key articles from the year. They critique the methodologies and analyze the results to help decide how the articles should be applied to every day practice.
This last year has been an amazing year. The number of high quality studies is higher each year, and they are showing up not only in high quality journals, but also in the media where they may impact the public. The research is demonstrating the value of the work we do and directing the care of the future.
Not surprisingly, things began with Temel’s trial of early palliative care for non-small cell lung cancer NSCLC (N Engl J Med 2010 363:733-42) The clinical bottom-line is that early palliative care integrated with standard oncologic care for patients with metastatic NSCLC is associated with improved QOL, mood, less use of aggressive therapies at the end-of-life, and longer survival, but they caution that we don’t know precisely why, and that this study was done in a mature program and limited to NSCLC.
Next, they reviewed Dr. Amy Abernathy’s RCT of oxygen vs. compressed air in patients with a prognosis >1 mo who have normal oxygen saturations (Lancet 2010 376: 784-93) As compared to compressed room air, oxygen therapy delivered by nasal cannula provides no additional symptomatic benefit for relief of refractory dyspnoea in patients with life limiting illness. Questions remain though about whether room air will be acceptable to patients and family, and whether a fan is a preferable alternative.
Dr. Unroe’s analysis of 1 year outcomes after prolonged ventilation at Duke may be useful to help patients and families with decision-making. Ann Intern Med 2010 153:167-75 Patients who received prolonged mechanical ventilation had high rates of mortality and functional dependence at hospital discharge. Between hospital discharge, 3-months, and 1-year, improvement in functional status was rare, high mortality persisted, and quality of life was poor.
The factors that influence surrogates understandings of prognosis was analyzed by Dr. EA Boyde in Crit Care Med 2010 38:1270-5 and can help us with a conceptual model of communication. Surrogates integrate information from a number or sources when estimating a patient’s prognosis, including providers, their knowledge and observations of the patient, intuition, and faith, and support of loved ones.
Curious what other articles were reviewed????
Stay tuned for Part II after the plane lands.