Palliative Care
Authors: Keith M. Swetz, Arif H. Kamal
Journal: Annals of Internal Medicine (2012)

In the Clinic7 February 2012Palliative CareKeith M. Swetz, MD, Arif H. Kamal, MD, Deborah Cotton, MD, MPH, Darren Taichman, MD, PhD, and Sankey Williams, MDKeith M. Swetz, MD, Arif H. Kamal, MD, Deborah Cotton, MD, MPH, Darren Taichman, MD, PhD, and Sankey Williams, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-3-201202070-01002 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Palliative medicine focuses on quality of life and the alleviation of symptoms in patients with serious illness. It aims to consider the physical, mental, spiritual, and social well-being of patients and their families in order to maintain hope while ensuring patient dignity and respecting autonomy. Palliative care medicine encompasses both consultative palliative care for patients with serious illnesses, and hospice care for patients at the end-of-life (EOL). Palliative care is appropriate at any stage of a serious illness whether the goal is cure or maximizing quality of life. It is a fundamental component of the practice of medicine in all ...References1. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995;274:1591-8. [PMID: 7474243] Google Scholar2. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011;14:17-23. [PMID: 21133809] Google Scholar3. Fox E, Landrum-McNiff K, Zhong Z, Dawson NV, Wu AW, Lynn J. Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments. JAMA. 1999;282:1638-45. [PMID: 10553790] Google Scholar4. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327:523-8. [PMID: 12958109] Google Scholar5. Currow DC, McDonald C, Oaten S, Kenny B, Allcroft P, Frith P, et al. Once-daily opioids for chronic dyspnea: a dose increment and pharmacovigilance study. J Pain Symptom Manage. 2011;42:388-99. [PMID: 21458217] Google Scholar6. Mahler DA, Selecky PA, Harrod CG. Management of dyspnea in patients with advanced lung or heart disease: practical guidance from the American college of chest physicians consensus statement. Pol Arch Med Wewn. 2010;120:160-6. [PMID: 20502400] Google Scholar7. Abernethy AP, McDonald CF, Frith PA, Clark K, Herndon JE 2nd, Marcello J, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376:784-93. [PMID: 20816546] Google Scholar8. Bausewein C, Booth S, Gysels M, Higginson I. Nonpharmacological interventions for breathlessness in advanced stages of malignant and nonmalignant diseases. Cochrane Database Syst Rev. 2008:CD005623. [PMID: 18425927] Google Scholar9. Wood GJ, Shega JW, Lynch B, Von Roenn JH. Management of intractable nausea and vomiting in patients at the end of life: "I was feeling nauseous all of the time . . . nothing was working". JAMA. 2007;298:1196-207. [PMID: 17848654] Google Scholar10. Witlox J, Eurelings LS, de Jonghe JF, Kalisvaart KJ, Eikelenboom P, van Gool WA. Delirium in elderly patients and the risk of postdischarge mortality, institutionalization, and dementia: a meta-analysis. JAMA. 2010;304:443-51. [PMID: 20664045] Google Scholar11. Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000;160:786-94. [PMID: 10737278] Google Scholar12. Breitbart W, Marotta R, Platt MM, Weisman H, Derevenco M, Grau C, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:231-7. [PMID: 8561204] Google Scholar13. Block SD. Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians - American Society of Internal Medicine. Ann Intern Med. 2000;132:209-18. [PMID: 10651602] Google Scholar14. Yavuzsen T, Davis MP, Walsh D, LeGrand S, Lagman R. Systematic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol. 2005;23:8500-11. [PMID: 16293879] Google Scholar15. Loprinzi CL, Kugler JW, Sloan JA, Mailliard JA, Krook JE, Wilwerding MB, et al. Randomized comparison of megestrol acetate versus dexamethasone versus fluoxymesterone for the treatment of cancer anorexia/cachexia. J Clin Oncol. 1999;17:3299-306. [PMID: 10506633] Google Scholar16. McMahon MM, Hurley DL, Kamath PS, Mueller PS. Medical and ethical aspects of long-term enteral tube feeding. Mayo Clin Proc. 2005;80:1461-76. [PMID: 16295026] Google Scholar17. Hanson LC, Ersek M, Gilliam R, Carey TS. Oral feeding options for people with dementia: a systematic review. J Am Geriatr Soc. 2011;59:463-72. [PMID: 21391936] Google Scholar18. Candy B, Sampson EL, Jones L. Enteral tube feeding in older people with advanced dementia: findings from a Cochrane systematic review. Int J Palliat Nurs. 2009;15:396-404. [PMID: 19773704] Google Scholar19. Smith TJ, Dow LA, Virago E, Khatcheressian J, Lyckholm LJ, Matsuyama R. Giving honest information to patients with advanced cancer maintains hope. Oncology (Williston Park). 2010;24:521-5. [PMID: 20568593] Google Scholar20. Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665-73. [PMID: 18840840] Google Scholar21. Wendler D, Rid A. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med. 2011;154:336-46. [PMID: 21357911] Google Scholar22. Olsen ML, Swetz KM, Mueller PS. Ethical decision making with end-of-life care: palliative sedation and withholding or withdrawing life-sustaining treatments. Mayo Clin Proc. 2010;85:949-54. [PMID: 20805544] Google Scholar23. Schenck AP, Rokoske FS, Durham DD, Cagle JG, Hanson LC. The PEACE Project: identification of quality measures for hospice and palliative care. J Palliat Med. 2010;13: 1451-9. [PMID: 21155640] Google Scholar24. Dy SM, Asch SM, Lorenz KA, Weeks K, Sharma RK, Wolff AC, et al. Quality of end-of-life care for patients with advanced cancer in an academic medical center. J Palliat Med. 2011;14:451-7. [PMID: 21391819] Google Scholar25. Reuben DB. Quality indicators for the care of undernutrition in vulnerable elders. J Am Geriatr Soc. 2007;55 Suppl 2:S438-42. [PMID: 17910568] Google Scholar26. Qaseem A, Snow V, Shekelle P, Casey DE Jr, Cross JT Jr, Owens DK, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Evidence-based interventions to improve the palliative care of pain, dyspnea, and depression at the end of life: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;148:141-6. [PMID: 18195338] Google Scholar Author, Article, and Disclosure InformationAuthors: Keith M. Swetz, MD; Arif H. Kamal, MD; Deborah Cotton, MD, MPH; Darren Taichman, MD, PhD; Sankey Williams, MD PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTrends in Restricting Symptoms at the End of Life from 1998 to 2019: A Cohort Study of Older PersonsPalliative Care and End-of-Life IssuesBurden of Restricted Activity and Associated Symptoms and Problems in Late Life and at the End of LifeClinical Excellence in Palliative Care: Examples From the Published LiteraturePalliative Care and End-of-Life IssuesImproving the Quality of Palliative Care through National and Regional Collaboration EffortsEfficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: Systematic review and meta-analysisOverview of palliative care and hospice servicesPhysician Attitudes toward Palliative Care for Patients with Pulmonary Arterial Hypertension: Results of a Cross‐Sectional SurveyThe sentinel hospitalization and the role of palliative careThe Role of Palliative Care in Medical EducationRichard J. Lin, MD, PhD 7 February 2012Volume 156, Issue 3Page: ITC2-1KeywordsCaregiversDeliriumDyspneaMorphineNauseaOpioidsOxycodonePalliative carePatientsQuality of life ePublished: 7 February 2012 Issue Published: 7 February 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...