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Exploring Suffering:  Why the Reluctance? Quill

 

Five Things Physicians and Patients Should Question in Palliative Care (more)     

Geripal, February 20, 2013


AAHPM’s Choosing Wisely list of 5 Five Things Physicians and Patients Should Question are the following:

Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead, offer oral assisted feeding.

  1. Don’t delay palliative care for a patient with serious illness who has physical, psychological, social or spiritual distress because they are pursuing disease-directed treatment.
  2. Don’t leave an implantable cardioverter-defibrillator (ICD) activated when it is inconsistent with the patient/family goals of care.
  3. Don’t recommend more than a single fraction of palliative radiation for an uncomplicated painful bone metastasis.
  4. Don’t use topical lorazepam (Ativan), diphenhydramine (Benadryl), haloperidol (Haldol) (“ABH”) gel for nausea.

Interestingly, AGS’s list of Five Things Physicians and Patients Should Question starts off on a very similar note as AAHPM's list:
  1. Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.
  2. Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia.
  3. Avoid using medications to achieve hemoglobin A1c less than 7.5 in most adults age 65 and older; moderate control is generally better.
  4. Don’t use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium.
  5. Don’t use antimicrobials to treat bacteriuria in older adults unless specific urinary tract symptoms are present.

What if the patient is your mother?  (more)

Hastings Center Bioethics Forum
Susan Gilbert, 04/01/2013

The problems with end-of-life care are clear enough. Patients and their families/significant others still have trouble talking with one another and their doctors about how they would and would not want to spend their final days. All too often, for many reasons, patients’ wishes are not honored. 


Words Matter: How “EOL” Rhetoric Undermines Good Palliative Care

Robert Martensen, 01/21/2011

Key words can be powerful in shaping cultural norms that flourish in hospitals and training programs. (more)