Skip to main content

Top 25 Studies in Hospice and Palliative Care (#HPMtop25)



by: Kara Bishoff (@kara_bischoff )

Back in 2015 we wrote a post asking for input on what articles should belong on a list of the top 25 articles in hospice and palliative care.   We decided to focus on hospice palliative care studies and trials - as opposed to review articles, consensus statements and opinion pieces.

Here’s what we came up with. It was hard to pick just 25! We highly prioritized clinical utility and tried to achieve diversity & balance. Many others are worthy of inclusion. Take a look and let us know if you have suggested changes for next year.

Module 1: Symptom Management
  1. Randomized, Double-Blind, Placebo-Controlled Trial of Oral Docusate in the Management of Constipation in Hospice Patients. Tarumi Y et al. JPSM, 2013.
  2. Once-Daily Opioids for Chronic Dyspnea: A Dose Increment and Pharmacovigilance Study. Currow DC et al. JPSM, 2011.
  3. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Abernethy AP et al. Lancet, 2010.
  4. Does Feeding Tube Insertion and Its Timing Improve Survival? Teno JM et al. JAGS, 2012.
  5. Parenteral Hydration in Patients With Advanced Cancer: A Multicenter, Double-Blind, Placebo-Controlled Randomized Trial. Bruera E et al. JCO, 2013.
  6. Effect of Duloxetine on Pain, Function, and Quality of Life Among Patients With Chemotherapy-Induced Painful Peripheral Neuropathy: A Randomized Clinical Trial. Lavoie Smith EM et al. JAMA, 2013.
  7. Randomized Double-Blind Trial of Sublingual Atropine vs. Placebo for the Management of Death Rattle. Heisler M. JPSM, 2013.
Module 2: Advance Care Planning
  1. Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers. Steinhauser KE et al. JAMA, 2000
  2. 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
  3. Advance Directives and Outcomes
of Surrogate Decision Making before Death. Silveira MJ et al. NEJM, 2010
  4. A Communication Strategy and Brochure for Relatives of Patients Dying in the ICU. Lautrette A et al. NEJM, 2007
  5. Family Satisfaction with Family Conferences about End-of-life Care in the Intensive Care Unit: Increased Proportion of Family Speech is Associated with Increased Satisfaction. McDonagh JR et al. Crit Care Med, 2004
  6. Provision of Spiritual Support to Patients
With Advanced Cancer by Religious Communities and Associations With Medical Care
at the End of Life. Balboni TA et al.  JAMA Intern Med, 2013. 
  7. Family Perspectives on End-of-life Care at Last Place of Care. Teno JM et al. JAMA, 2004.
Module 3: Prognostication
  1. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. Christakis NA et al. BMJ, 2000
  2. Trends in Survival after In-Hospital Cardiac Arrest. Girotra S et al. NEJM, 2012
  3. Functional Status of Elderly Adults before and after Initiation of Dialysis. Tamura MK et al. NEJM, 2009
  4. Patients’ Expectations about Effects of Chemotherapy for Advanced Cancer. Weeks JC et al. NEJM, 2012
  5. “It’s not just what the doctor tells me:” Factors that influence surrogate decision-makers’ perceptions of prognosis. Boyd EA et al. Crit Care Med, 2010.
Module 4: Health Systems & Policy
  1. Cost Savings Associated With US Hospital Palliative Care Consultation Programs. Morrison RS et al. Arch Intern Med, 2008
  2. Hospice Enrollment Saves Money For Medicare And Improves Care Quality Across A Number Of Different Lengths-Of-Stay. Kelley AS et al. Health Affairs, 2013
  3. Do Palliative Consultations Improve Patient Outcomes? Cassarett D et al. J Am Geriatr Soc, 2008. 
  4. Change in End-of-Life Care for Medicare Beneficiaries: Site of Death, Place of Care, and Health Care Transitions in 2000, 2005, and 2009. Teno JM et al. JAMA, 2013
  5. Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer. Temel JS et al. NEJM, 2010
  6. Early Palliative Care in Advanced Lung Cancer: A Qualitative Study. Yoong J. JAMA Intern Med, 2013.

So what do you think we forgot? What studies do you most commonly think about, mention, and cite during your clinical work that's not on this list?



Comments

Anonymous said…
I would suggest the following for ACP: Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345. and:

Hammes BJ, Rooney BL. Death and end-of-life planning in one midwestern community. Arch Intern Med. 1998;158(4):383-90.
Eric Widera said…
Two other articles that were sent to me that we should consider for next year:

1) Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, Mitchell SL, Jackson VA, Block SD, Maciejewski PK, Prigerson HG. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA 2008; 300:1665-73.

2) Wright AA, Keating NL, Ayanian JZ, Chrischilles EA, Kahn KL, Ritchie CS, Weeks JC, **Earle CC, **Landrum ME. Family perspectives on aggressive cancer care near the end of life. JAMA. 2016;315(3)284-92.

I use #1 all the time in my teaching. The hard part will be to figure out what to take out!

Eric
Heathercita said…
Thank you, this is a great resource!
Dan Matlock said…
I love this! You could do it like the bill of rights and just keep adding amendments!
Chris Ralph said…
Anyone else disappointed with "real life" results of duloxetine in CIPN? I work in outpatient palliative oncology and the "successes" seem to be few and far betweeen.
Ross Albert said…
The list is great-

I find these two additional articles to be helpful in prognostication and in teaching. (Especially the Neuman article).

Neuman MD; et al. Survival and Functional Outcomes After Hip Fracture
Among Nursing Home Residents. JAMA Intern Med. 2014;174(8):1273-1280.

Stapleton, RD. Long-term Outcomes After In-Hospital CPR in
Older Adults With Chronic Illness. CHEST.2014;146(5):1214-1225.

(Twitter: @RossAlbertMD )

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Survival from severe sepsis: The infection is cured but all is not well

Severe sepsis is a syndrome marked by a severe infection that results in the failure of at least one major organ system: For example, pneumonia complicated by kidney failure. It is the most common non-cardiac cause of critical illness and is associated with a high mortality rate.

But what happens to those who survive their hospitalization for severe sepsis? An important study published in JAMA from Iwashyna and colleagues provides answers and tells us all is not well. When the patient leaves the hospital, the infection may be cured, but the patient and family will need to contend with a host of major new functional and cognitive deficits.

Iwashyna examined disability and cognitive outcomes among 516 survivors of severe sepsis. These subjects were Medicare enrollees who were participants in the Health and Retirement Study. The average age of patients was 77 years.

When interviewed after discharge, most survivors were left with major new deficits in their ability to live independently. …