Reviews

Update in hospital palliative care

Abstract

BACKGROUND

Seriously ill patients frequently receive care in hospitals, and palliative care is a core competency for hospitalists. We aimed to summarize and critique recent research that has the potential to impact the clinical practice of palliative care in the hospital.

METHODS

We reviewed articles published between January 2012 and May 2013, identified through a hand‐search of leading journals and PubMed. The authors collectively selected 9 articles based on their scientific rigor and relevance to hospital practice. We review their findings, strengths, and limitations and make recommendations for practice.

RESULTS

Key findings include: indwelling pleural catheters and talc pleurodesis provide similar relief of dyspnea in patients with malignant pleural effusions; oxygen many not be needed to prevent dyspnea in many dying patients; docusate may not be needed in addition to sennosides to treat opioid‐induced constipation; atropine is no more effective than placebo in treating respiratory rattles in dying patients; many older adult survivors of in‐hospital cardiopulmonary resuscitation (CPR) are alive up to 1 year after discharge; observing CPR may decrease family post‐traumatic stress; surrogates of intensive care unit patients often interpret prognostic information optimistically; many patients with metastatic cancer feel that chemotherapy may cure their disease; viewing a goals‐of‐care video may decrease preference for CPR in patients being admitted to skilled nursing facilities.

CONCLUSIONS

Recent research provides important insights into the effectiveness of medications and interventions for symptom management, outcomes of CPR for patients and families, and communication and advance care planning in the hospital. Journal of Hospital Medicine 2013;8:715–720. © 2013 Society of Hospital Medicine

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