Journal of palliative medicine
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Comparative Study
Health literacy not race predicts end-of-life care preferences.
Several studies have reported that African Americans are more likely than whites to prefer aggressive treatments at the end of life. ⋯ Health literacy and not race was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. In addition, after viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to race and health literacy. These findings suggest that clinical practice and research relating to end-of-life preferences may need to focus on a patient education model incorporating the use of decision aids such as video to ensure informed decision-making.
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To describe acetylcholinesterase inhibitor (AChEI) and memantine use among persons over the age of 65 admitted to hospice with a primary diagnosis of dementia and identify patient and hospice program characteristics associated with the use of these agents. ⋯ A notable number of hospice enrollees with a primary diagnosis of dementia were prescribed AChEI and/or NMDA receptor antagonist therapy. Studies are needed to better define the role of these agents as well as the impact of medication discontinuation in persons with end-stage dementia.
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Studies of end-of-life care have shown that Latino patients want more aggressive care compared to white patients. While this has been attributed to aspects of ethnicity, national origin, and religion, it is possible that limited education might obscure the true relationship between Latino patients and their end-of-life care preferences. ⋯ Educational level was an independent predictor of end-of-life preferences after hearing a verbal description of advanced dementia. After viewing a video of a patient with advanced dementia there were no longer any differences in the distribution of preferences according to educational level. These findings suggest that educational level is an important variable to consider in research and in patient care when communicating about end-of-life care preferences. While attention to patients' culture is important, it is also important to avoid ascribing choices to culture that may actually reflect inadequate comprehension. Attention to communication barriers with techniques like the video used in the current study may help ensure optimal end-of-life care for Latino patients irrespective of educational level.
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To determine if physician prediction of survival duration (PSD) is accurate for patients with metastatic breast or prostate cancer. ⋯ KPS, FACT scores, and PSD all are correlated with actual survival. Physicians on this study were able to predict which patients would have longer survival times, although prediction of survival was optimistic compared to actual survival by an average of 3 months.
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ABSTRACT Carotid blowout is a devastating complication in patients with head and neck malignancy. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. Recently, endovascular therapy has been proposed for head and neck surgical patients. ⋯ The use of such techniques in cases of impending or acute carotid blowout syndrome has been previously described to be beneficial for palliative head and neck cancer patients as well. We introduce a case of a head and neck cancer patient receiving palliative care, presenting with threatened carotid blowout, who was managed with endovascular placement of a covered stent under elective conditions in order to prevent an inevitable carotid rupture. In the present case endovascular carotid stenting allowed preservation of the vessel, prevented the dramatic situation of carotid rupture, and facilitated a rapid hospital discharge without any neurologic or stenting sequelae.