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  • The Greatest Gift: How a Patient’s Death Taught Me to Be a Physician

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    JAMA. 2017; 318(18):1761-1762. doi: 10.1001/jama.2017.15158
  • Effect of Lorazepam With Haloperidol vs Haloperidol Alone on Agitated Delirium in Patients With Advanced Cancer Receiving Palliative Care: A Randomized Clinical Trial

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    JAMA. 2017; 318(11):1047-1056. doi: 10.1001/jama.2017.11468

    This randomized clinical trial compares the effect of lorazepam vs placebo added to haloperidol for persistent agitation in patients with advanced cancer and delirium.

  • The United Kingdom Sets Limits on Experimental Treatments: The Case of Charlie Gard

    Abstract Full Text
    JAMA. 2017; 318(11):1001-1002. doi: 10.1001/jama.2017.10410

    This Viewpoint discusses the case of Charlie Gard, a young boy with severe mitochondrial disease on life support in the United Kingdom, and the issues at stake in the conflict between his parents’ wishes to pursue expensive, unproven treatment and the UK National Health Service’s insistence on a palliative approach.

  • Finding Joy in Practice: Cocreation in Palliative Care

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    JAMA. 2017; 317(20):2065-2066. doi: 10.1001/jama.2017.1109
  • Extremis : A Documentary Look at End-of-Life Decisions in the ICU

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    JAMA. 2017; 317(3):240-241. doi: 10.1001/jama.2016.20009

    This Arts and Medicine essay reviews Extremis, a 2016 short documentary streaming on Netflix, which addresses the challenges of end-of-life communication and decision-making in the ICU by following the work and patients of a critical and palliative care physician at Highland Hospital in Oakland, California.

  • Little White Lies

    Abstract Full Text
    JAMA. 2017; 317(1):27-28. doi: 10.1001/jama.2016.11872
  • JAMA November 22, 2016

    Figure 1: Participant Flow in a Randomized Clinical Trial of Inpatient Palliative Care Compared With Standard Transplant Care Among Patients Hospitalized for Hematopoietic Stem Cell Transplantation (HCT)

    aReasons for ineligibility included language barrier (n = 10), benign disease (n = 6), previous HCT (n=15), clinician refusal (n = 2), enrollment in another supportive care trial (n = 8), transplantation aborted within 24 hours of admission (n = 6), combined solid organ transplantation and HCT (n = 3), and primarily outpatient transplantation (n = 6).
  • JAMA November 22, 2016

    Figure 1: Results of Literature Searches to Identify Randomized Clinical Trials of Palliative Care Interventions

    The specific reasons for exclusion of 5958 records at the title and abstract screening stage were not recorded.
  • JAMA November 22, 2016

    Figure 2: Random-Effects Meta-analysis of Randomized Clinical Trials on the Association Between Palliative Care and Patient Quality of Life at 1- to 3-Month Follow-up

    For all trials, the P value for the pooled standardized mean difference (SMD) was .02; τ2, 0.52; and Q, 268.18. For trials at low risk of bias, the P value for the pooled the SMD was .01; τ2, <0.0001; and Q, 3.36. For trials at high risk of bias, the P value for the pooled SMD was .05; τ2, 1.52; and Q, 233.84. For trials at unclear risk of bias, the P value for the pooled SMD was .31; τ2, 0.01; and Q, 3.00. Sample sizes in the figure are the number of patients analyzed at the specific time points. Error bars represent 95% CIs. The size of the shaded squares indicates study weight. Diamonds represent pooled SMDs and 95% CIs. The vertical dashed line indicates the pooled effect estimate, and the solid vertical line depicts a null effect. SF-36 indicates Short Form-36; EQ5D, EuroQol 5 Dimensions Questionnaire; FACIT-Pal, Functional Assessment of Chronic Illness Therapy–Palliative; FACT-L TOI, Functional Assessment of Cancer Therapy–Lung Treatment Outcome Index; FACT-G, Functional Assessment of Cancer Therapy- General; FACIT-Sp, Functional Assessment of Chronic Illness Therapy-Spirituality; KCCQ, Kansas City Cardiomyopathy Questionnaire; MLHFQ, Minnesota Living With Heart Failure Questionnaire; and MQOL-HK, McGill Quality of Life Questionnaire–Hong Kong adaptation.aSolid or hematological cancers. bBrain, gastrointestinal, head-neck, lung, and other cancers. cBreast, colon, lung, and gynecological cancers, and lymphoma. dNot further specified. eBreast cancer.fGastrointestinal, lung, genitourinary, and breast cancers. gCancer, chronic obstructive pulmonary disease, interstitial lung disease, and motor neuron disease. hNon–small cell lung cancer. iLung, gastrointestinal, genitourinary, breast, and gynecological cancers. jBreast, colon, lung, and other cancers. kBreast, colon, lung, and prostate cancers.
  • JAMA November 22, 2016

    Figure 3: Random-Effects Meta-analysis of Randomized Clinical Trials on the Association Between Palliative Care and Patient Quality of Life at 4- to 6-Month Follow-Up

    For all trials, the P value for the pooled standardized mean difference (SMD) was .12; τ2, 0.04; and Q, 28.51. For trials at high risk of bias, the P value for the pooled the SMD was .07; τ2, <0.06; and Q, 9.15. For trials at low risk of bias, the P value for the pooled SMD was .01; τ2 <0.0001; Q, 3.20. For trials at unclear risk of bias, the P value for the pooled SMD was .41; τ2, 0.05; and Q, 4.86. Sample sizes in the figure are the number of patients analyzed at the specific time points.Error bars represent 95% CIs. The size of the shaded squares indicates study weight. Diamonds represent pooled SMDs and 95% CIs. The vertical dashed line indicates the pooled effect estimate, and the solid vertical line depicts a null effect. EQ-5D indicates EuroQol 5 Dimensions Questionnaire; FACT-G, Functional Assessment of Cancer Therapy-General; FACIT-Pal, Functional Assessment of Chronic Illness Therapy-Palliative; FACIT-Sp, Functional Assessment of Chronic Illness Therapy-Spirituality; HIV, human immunodeficiency virus; MOS-HIV, Medical Outcomes Study-HIV scale; KCCQ, Kansas City Cardiomyopathy Questionnaire; and SF-36, Short Form-36. aBrain, gastrointestinal, head-neck, lung, and other cancers. bBreast, colon, lung, and gynecological cancers, and lymphoma. cBreast cancer. dUpper gastrointestinal cancers.eGastrointestinal, lung, genitourinary, and breast cancers. fProstate cancer. gNot further specified. hLung, gastrointestinal, genitourinary, breast, and gynecological cancers. iBreast, colon, lung, and prostate cancers.
  • JAMA November 22, 2016

    Figure 4: Meta-analysis of Randomized Clinical Trials on the Association Between Palliative Care and Symptom Burden at 1- to 3-Month Follow-up

    For all trials, the P value for the pooled standardized mean difference (SMD) was .03; τ2, 0.86; and Q, 230.90. For trials at high risk of bias, the P value for the pooled the SMD was .14; τ2, 2.34; and Q, 215.72. For trials at unclear risk of bias, the P value for the pooled SMD was .01; τ2, <0.0001; and Q, 230.90. Sample sizes in the figure are the number of patients analyzed at the specific time points.Error bars represent 95% CIs. The size of the shaded squares indicates study weight. Diamonds represent pooled SMDs and 95% CIs. The vertical dashed line indicates the pooled effect estimate, and the solid vertical line depicts a null effect. CHFQ indicates Chronic Heart Failure Questionnaire; COPD, chronic obstructive pulmonary disease; ESAS, Edmonton Symptom Assessment Scale; FACT-L LCS, Functional Assessment of Cancer Therapy-Lung Lung Cancer Scale; NRS SOB, Numerical Rating Scale Shortness of Breath; POS, Palliative Outcomes Scale; QUAL-E, Quality of Life at the End of Life; and SES, Symptom Experience Scale.aSolid or hematological cancers. bCOPD or other source of dyspnea. cBreast, colon, lung, and gynecological cancers, and lymphoma. dGastrointestinal, lung, genitourinary, and breast cancers. eCancer, COPD, heart failure, interstitial lung disease, motor neuron disease. fNon–small cell lung cancer. gLung, gastrointestinal, genitourinary, breast, and gynecological cancers.
  • JAMA November 22, 2016

    Figure 5: Meta-analysis of Randomized Clinical Trials on the Association Between Palliative Care and Symptom Burden at 4- to 6-Month Follow-up

    For all trials, the P value for the pooled standardized mean difference (SMD) was .01; τ2, <0.0001; and Q, 3.97. For trials at low risk of bias, the P value for the pooled the SMD was .06; τ2, <0.0001; and Q, 0.62. For trials at high risk of bias, the P value for the pooled SMD was .01; τ2, <0.0001; and Q, 0.31. Sample sizes in the figure are the number of patients analyzed at the specific time points.Error bars represent 95% CIs. The size of the shaded squares indicates study weight. Diamonds represent pooled SMDs and 95% CIs. The vertical dashed line indicates the pooled effect estimate, and the solid vertical line depicts a null effect. APOS indicates African Palliative Outcomes Scale; BPI, Brief Pain Inventory; ESAS, Edmonton Symptom Assessment Scale; HF, heart failure; HIV, human immunodeficiency virus; MS, multiple sclerosis; OSQ, Omega Symptom Questionnaire; and SES, Symptom Experience Scale.aBreast, colon, lung, and gynecological cancers and lymphoma. bUpper gastrointestinal cancers. cGastrointestinal, lung, genitourinary, and breast cancers. dProstate cancer. eLung, gastrointestinal, genitourinary, breast, and gynecological cancers.
  • JAMA November 22, 2016

    Figure 6: Meta-analysis of Randomized Clinical Trials on the Association Between Palliative Care and Survival

    For all trials, the P value for the pooled hazard ratio (HR) was .44; τ2, 0.08; and Q, 24.29. For trials at low risk of bias, the P value for the pooled the HR was .14; τ2, <0.0001; and for Q, <0.0001. For high risk of bias, the P value for the pooled HR was .99; τ2, <0.59; and Q, 7.03. For unclear risk of risk of bias the P value for the pooled HR was .74; τ2, 0.06; and Q, 10.98. Sample sizes in the figure are the number of patients analyzed at the specific time points.Error bars represent 95% CIs. The size of the shaded squares indicates study weight. Diamonds represent pooled HRs and 95% CIs. The vertical dashed line indicates the pooled effect estimate, and the solid vertical line depicts a null effect (ie, HR, 1).aNon–small cell lung cancer. bGastrointestinal, lung, genitourinary, and breast cancers. cCancer, heart failure, chronic obstructive pulmonary disease, end-stage renal disease, stroke, and dementia. dBreast, colon, lung, and other cancers. eGastrointestinal, lung, breast, gynecological, genitourinary, kidney, lymphoma, skin, and other cancers.
  • The Promise of Palliative Care: Translating Clinical Trials to Clinical Care

    Abstract Full Text
    JAMA. 2016; 316(20):2090-2091. doi: 10.1001/jama.2016.17163
  • Association Between Palliative Care and Patient and Caregiver Outcomes: A Systematic Review and Meta-analysis

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    JAMA. 2016; 316(20):2104-2114. doi: 10.1001/jama.2016.16840

    This meta-analysis of clinical trials article assesses the effects of palliative care interventions on patient quality of life, symptom burden, and survival and on caregiver burden and satisfaction.

  • Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial

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    JAMA. 2016; 316(20):2094-2103. doi: 10.1001/jama.2016.16786

    This randomized trial assesses the effect of an inpatient palliative care intervention vs standard transplant care on quality of life during hospitalization for patients undergoing hematopoietic stem cell transplantation (HCT).

  • Nondisclosure

    Abstract Full Text
    JAMA. 2016; 316(8):821-821. doi: 10.1001/jama.2016.5348
  • Senate Committee Holds Hearing on Palliative and Hospice Care

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    JAMA. 2016; 316(6):575-575. doi: 10.1001/jama.2016.10619
  • Why Population Health and Palliative Care Need Each Other

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    JAMA. 2016; 316(1):27-28. doi: 10.1001/jama.2016.5961

    This Viewpoint discusses the characteristics of palliative care and population health and describes how synergies between these disciplines might improve quality of care, especially for older persons with life-limiting illnesses.

  • Better Palliative Care for All: Improving the Lived Experience With Cancer

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    JAMA. 2016; 316(1):29-30. doi: 10.1001/jama.2016.6491

    This Viewpoint calls for increased research funding and focus on palliative care as a twin approach when initiating cancer-directed treatment as soon as patients receive their diagnosis.