JOURNAL OF PALLIATIVE MEDICINE Volume 19, Number 5, 2016 ª Mary Ann Liebert, Inc. DOI: 10.1089/jpm.2016.0087
Recent Literature Feature Editor: Paul C. Rousseau
Wordingham SE, McIlvennan CK, Dionne-Odom JN, Swetz KM. Complex care options for patients with advanced heart failure approaching end of life. Curr Heart Fail Rep 2016;13:20–29. Care for patients with advanced cardiac disease continues to evolve in a complex milieu of therapeutic options, advanced technological interventions, and efforts at improving patientcentered care and shared decision making. Despite improvements in quality of life and survival with these interventions, optimal supportive care across the advanced illness trajectory remains diverse and heterogeneous. In this article, the authors outline challenges in prognostication, communication, and caregiving in advanced heart failure and review the unique needs of patients who experience frequent hospitalizations, require chronic home inotropic support, and who have implantable cardioverter-defibrillators and mechanical circulatory support in situ, to name a few. This is a very good review and recommended for all palliative care clinicians. Saeed O, Shah A, Kargoli E, et al. Antiplatelet therapy and adverse hematologic events during Heart Mate II support. Circ Heart Fail 2016;9:e002296. Hematologic adverse events are common during continuous flow left ventricular assist device support; yet, their relation to antiplatelet therapy, including aspirin (ASA) dosing, is uncertain. In this single-center retrospective review of all patients supported by a continuous flow left ventricular assist device (Heart Mate II) from June 2006 to November 2014, the authors attempted to determine adverse hematologic events while patients were on antiplatelet therapy during Heart Mate II support. Patients were categorized into three groups: (1) ASA 81 mg plus dipyridamole 75 mg daily (n = 26) from June 2006 to August 2009 with a target international normalized ratio (INR) of 2.0–3.0; (2) ASA 81 mg daily (n = 18) from September 2009 to August 2011 with a target INR of 1.5–2.0; and (3) ASA 325 mg daily (n = 70) from September 2011 to November 2014 with a target INR of 2.0–3.0. Hemorrhagic and thrombotic outcomes were retrieved £365 days after implantation. Cumulative survival free from adverse events was calculated using Kaplan–Meier curves, and Cox proportional hazard ratios were generated. Results demonstrated that hemorrhagic events occurred in 6 patients on ASA 81 mg plus dipyridamole (26%; 0.42 events per patient year; mean INR at event, 2.2); in 4 patients on ASA 81 mg (22%; 0.38 events per patient year; mean INR at event, 2.0); and in 38 patients on ASA 325 mg (54%; 1.4 events per patient year; mean INR at event, 2.2). Patients on ASA 325 mg had a higher adjusted hazard ratio of 2.9 (95% confidence interval, 1.2–7.0) versus ASA 81 mg plus dipyridamole ( p = 0.02)—and for hemorrhagic events, an adjusted hazard ratio of 3.4 (95% confidence interval, 1.2–9.5) versus ASA 81 mg ( p = 0.02). Thrombotic events rates were not different between groups. The authors conclude that highdose ASA in Heart Mate II patients treated concomitantly with warfarin is associated with an increased hazard of bleeding but does not reduce thrombotic events.
Shore JC, Gelber MW, Koch LM, Sower E. Anticipatory grief: An evidence-based approach. J Hospice Palliat Nurs 2016;18:15–19. Anticipatory grief is a symptom that can be experienced by caregivers and patients, especially those coping with advanced disease. Frequently, symptoms of anticipatory grief are disguised as depression, anxiety, or pain. This article reviews the concept of anticipatory grief, explores various assessment tools, and offers communication-based management strategies. O’Mahony S, Gerhart JI, Grosse J, et al. Posttraumatic stress symptoms in palliative care professionals seeking mindfulness training: Prevalence and vulnerability. Palliat Med 2016;30:189–192. Exposure to trauma is ubiquitous in palliative medicine. Repeated exposure to trauma may contribute to compassion fatigue and posttraumatic stress disorder symptoms in medical and supportive care professionals such as physicians, nurses, and social workers. These symptoms may be intensified among medical and supportive care professionals who use avoidant or rigid coping strategies. The aim of this study was to provide an estimate of posttraumatic stress disorder symptoms in a sample of professionals who work in palliative care settings and have already been enrolled in mindfulness-based communication training. The design of the study involved palliative care providers providing self-reported ratings of posttraumatic stress disorder symptoms, depression, and coping strategies using validated measures including the Acceptance and Action Questionnaire, Cognitive Fusion Questionnaire, and the Posttraumatic Stress Disorder Checklist– Civilian Version. A total of 21 professionals working with palliative care patients completed assessments prior to beginning mindfulness-based communication training. Results demonstrated that posttraumatic stress disorder symptoms were prevalent in this sample of professionals; 42% indicated positive screens for significant posttraumatic stress disorder symptoms, and 33% indicated probable posttraumatic stress disorder diagnosis. The authors conclude that posttraumatic stress disorder symptoms may be common among professionals working in palliative medicine, and that professionals prone to avoidant coping and those with more rigid negative thought processes may be at higher risk for posttraumatic stress disorder symptoms. Flickingera TE, Sahab S, Roterd D, et al. Respecting patients is associated with more patient-centered communication behaviors in clinical encounters. Patient Educ Couns 2016; 99:250–255. Attitudes towards patients may influence how clinicians interact. In this study the authors investigated whether respect for patients was associated with communication behaviors during HIV care encounters. They analyzed audiorecordings of visits between 413 adult HIV-infected patients and 45
primary HIV care providers. The independent variable was clinician-reported respect for the patient, and outcomes were clinician and patient communication behaviors assessed by the Roter Interaction Analysis System (RIAS). Results demonstrated that when clinicians had higher respect for a patient they engaged in more rapport building, social chitchat, and positive talk. Patients of clinicians with higher respect for them engaged in more rapport building, social chitchat, positive talk, and gave more psychosocial information. Encounters between patients and clinicians with higher respect for them had more positive clinician emotional tone, more positive patient emotional tone, less clinician verbal dominance, and more patient-centeredness. The authors conclude that respect is associated with positive and patient-centered communication behaviors during encounters, and that clinicians should be mindful of their respectful attitudes and work to foster positive regard for patients. They also suggested that educators should also consider methods to enhance trainees’ respect in communication skills training. Lynes C, Phillips J, Keane C, et al. An evaluation of a bereavement program in a US research hospital. Am J Hospice Palliat Med 2016;33:150–153. The Bereavement Program at the National Institutes of Health (NIH) Clinical Center was established in 2005. The
program makes contact with the next of kin on four occasions postnotification of death. The objective of this analysis was to evaluate program effectiveness for those individuals who the authors successfully made contact with on all four occasions (n = 39). At 12 months postnotification, the majority viewed the NIH as a source of support (56%), and the frequency of positive emotional ratings increased (59%). However, there are limitations to this analysis, and biases may be present. In sum, this analysis serves as an example of a successful hospital-based bereavement program that enrolls patients who have been treated at the institution in any capacity who are also patients enrolled in institutional review board approved research protocols. Address correspondence to: Paul C. Rousseau, MD Wake Forest University School of Medicine Section of Gerontology and Geriatric Medicine Palliative and Supportive Care Watlington Hall Medical Center Boulevard Winston-Salem, NC 27106 E-mail: [email protected]