Delirium is a syndrome associated with a sudden change in a person’s mental function that interferes with their thinking and awareness. It is a common problem that confronts many patients, families and clinicians in the palliative care setting. Delirium usually develops as a result of a serious medical condition, which can often be found and treated. However, the symptoms of delirium – such as fluctuating confusion, reduced attention, disturbed sleep-wake cycle, and/or hallucinations – can be very distressing for everyone involved, and may persist for many days to weeks.
Medications – including antipsychotics such as haloperidol and risperidone – are often used to manage the symptoms of delirium. But do they actually work?
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What? We will be discussing the following topics during the journal club
Topic 1: Why was the study conducted? Are the study questions / aims relevant to you and/or your work?
Topic 2: How was the study conducted? What did you like about the study methodology? Would you have done anything differently?
Topic 3: What were the main findings from the study? Were you surprised by any of the study results?
Topic 4: Has this study changed the way you think about delirium in the palliative care setting? Why and why not? What’s next?
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Kasia’s research aims to improve sustainable acute care health delivery for an ageing population, while her clinical experience includes general medical and acute palliative care. In her PhD, Kasia developed an approach to measure nurse-sensitive outcomes, which is currently being used to evaluate a Government-funded implementation of a cognitive identifier. Kasia has a passion for identifying and researching the structures and processes which impede or enable quality patient care, and sharing her learning and inquiry with nursing students, industry and professional groups. Here, Palliverse asks her about her latest research project and dipping her toe into the world of social media.
Tell us about yourself . What are you doing in Australia?
Hello, my name is Giovanni Galvis. I was born in Caracas-Venezuela. I studied Medicine in Bogota-Colombia. After my graduation I decided to go to Europe. I have always been fascinated with the history and architecture and of course the good level in research and clinical medicine there. I spent some time in Germany but in 2007 I moved to Sweden where I did research in the beginning and then started my specialty in Clinical Oncology. I am doing a placement at Peter MacCallum Cancer Centre attending the department of Pain and Palliative Care, the breast clinic and the melanoma clinic.
What is your impression of palliative care and cancer care in Australia? Is it different from that in Sweden? How?Continue reading →
A thoughtful article regarding our modern attitudes to dying by Dr Craig Bowron, an internist (i.e. physician in internal medicine for us Down Under, or general medicine consultant)
Opting to try all forms of medical treatment and procedures to assuage this guilt is also emotional life insurance: When their loved one does die, family members can tell themselves, “We did everything we could for Mom.”
In my experience, this is a stronger inclination than the equally valid (and perhaps more honest) admission that “we sure put Dad through the wringer those last few months.”
I agree with Dr Bowron, that sometimes we may not consider the cost to the person (not the financial cost, other costs) of being able to say, “We did everything we could.”
What do you think? Does this apply where you are?
PS Thanks to Tegan, a social worker I work with, for pointing me to this article.
Not the traditional festive season article perhaps, but this review article by Dr Blinderman and the late Dr Billings provides a good summary in a very reputable and widely read journal concerning end of life care in hospitals in the United States.
Is end of life care in hospital in the US different?
The article reports that 29% of deaths take place in hospitals in America, a bit lower than I would have expected. In Australia, 54% die in hospital but this includes inpatient palliative care deaths which are excluded from the US figure of 29%.
According to AIHW, 42% of the Australians who died in hospital had some involvement from palliative care (42% of 54% in hospital deaths is 23%) About a third of patients who died as an admitted patient in hospital (a third of 54% is about 15%) died in inpatient palliative care. That still leaves us behind the US, with around 36% dying in a non palliative inpatient Australian hospital bed compared to 29% in the USA.
Interestingly the NEJM article does not refer to subcutaneous medications which are the mainstay of terminal care medication administration in Australia, New Zealand and the UK. Do US practitioners use less SC medication?
Personally I don’t find that cough and nausea are so troubling at the end of life, and we would promote meticulous mouth care for dry mouth ahead of pharmacological management.
The article also advises us to avoid benzodiazepines for delirium including at the end of life, which I found surprising.
Dear reader, do you have any thoughts? What is end of life care like in hospitals in your neck of the woods?
Sadly, I am not actually AT ASCO, the annual meeting of the American Society for Clinical Oncology which is taking place in Chicago this year.
However thanks to the modern day marvels of social media I was able to watch this lecture by Dr Riedel and a team at Duke University Medical Centre.
Dr Riedel introduced a model where palliative physicians ( “palliatricians”. What do you think? I love a neologism, myself….) co-rounded with the oncologists in the inpatient oncology unit.
Statistically significant reductions in length of stay (LOS), 7 and 30 day readmissions, and ICU admissions were demonstrated. Nurse and doctor satisfaction was increased. Nurses felt the quality of care was improved.
All the medical oncologists surveyed felt that the palliatricians added to the care of the patient and that they learned some stuff about symptom management. I know I learn heaps when I round with medical oncologists! Communication and collaboration was improved.
It was a shame they didn’t look at patient satisfaction, but hopefully that might happen in future.
Seen anything interesting coming out of ASCO this year?