Welcome to VistaCare's VIA Archive. Here you will find all the articles we have presented in past issues. Click on a headline to read the full summary and access a print-friendly version. Click here for a printable version of the latest issue of VIA.

The following is a summary of the article, “Letting Go of the Rope — Aggressive Treatment, Hospice Care and Open Access,” by Alexi A. Wright, MD, and Ingrid T. Katz, MD, MHS, that appeared in The New England Journal of Medicine, July 26, 2007.

Many patients who meet the criteria for hospice care still opt for palliation from such treatments as chemotherapy, radiation, IV antibiotics and tube feedings. In many communities, this creates a... »

The following is a summary of the article, "Where Do Prevention and Palliative Care Meet? A Systematic Literature Study on the Interfaces of Two Different Health Care Sectors," by Nils Schneider, MD, MPH, and Ulla Walter, PhD, that appeared in the American Journal of Hospice and Palliative Medicine, April/May 2007.

While preventive care and palliative care appear to juxtapose, as palliative care continues to evolve and gain recognition in the medical world, the need for a connection between the two is becoming... »

The following is a summary of the article, "Using Methadone to Control Pain in Patients During Final Stages of Life," by John F. Manfredonia, DO, FACOFP, FAAHPM, VistaCare Regional Medical Director, that appeared in the Journal of the American Osteopathic Association, June 2007.

This article explores the use of methadone hydrochloride as an effective, low-cost and safe method of chronic pain management for patients during end-of-life stages. Methadone — the only... »

The following is a summary of the article, “The Effect of Underlying Health Status on Patient or Surrogate Preferences for End-of-Life Care: A Pilot Study,” by Kara Zivin Bambauer, PhD, and Muriel R. Gillick, MD, that appeared in the American Journal of Hospice and Palliative Medicine, June/July 2007.

This article seeks to reinforce previous studies on the importance of patients’ understanding of their prognosis in end-of-life planning. Patients who underestimate their survival are more... »

The following is a summary of the article “Improving End-of-Life Outcomes in Nursing Homes by Targeting Residents at High Risk of Mortality for Palliative Care: Program Description and Evaluation” by Cari Levy, MD, Monica Morris, BS, and Andrew Kramer, MD, that appeared in the March 1, 2008, Journal of Palliative Medicine.

A retrospective chart review compared end-of-life care outcomes to assess use of a program titled Making Advance Planning a Priority (MAPP). This initiative first identified individuals at high... »

The following is a summary of the article “Opioids and the Management of Chronic Severe Pain in the Elderly: Consensus Statement of an International Expert Panel with Focus on the Six Clinically Most Often Used World Health Organization Step III Opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone)” by Joseph Pergolizzi, MD, Rainer H. Böger, MD, Keith Budd, MD, Albert Dahan, MD, Serdar Erdine, MD, Guy Hans, MD, Hans-Georg Kress, MD, Ph.D., Richard Langford, MD, Ph.D., Rudolf Likar, MD, FRCA, Robert B. Raffa, Ph.D., and Paola Sacerdote, Ph.D., featured in May 23, 2008, (online version of Vol. 8, Issue 4) of Pain Practice.

Seven categories of opoid use for managing chronic pain in the elderly are addressed in this consensus report drawn from evidence-based literature analyzed by an international panel. Criteria for... »

The following is a summary of the article “Depression and Quality of Life in Cancer Patients With and Without Pain: the Role of Pain Beliefs” by Azadeh Tavoli, Ali Montazeri, Rasool Roshan, Zahra Tavoli and Mahdiyeh Melyani, featured in BMC Cancer 2008, 8:177.

This study conducted by researchers at the Cancer Institute, the Iranian Institute for Health Sciences Research and the Department of Psychology at Shahed University, all in Tehran, Iran,... »

The following is a summary of the article “Prevalence of Cognitive Impairment without Dementia in the United States” by Brenda L. Plassman, Ph.D.; Kenneth M. Langa, MD, Ph.D.; Gwenith G. Fisher, Ph.D.; Steven G. Heeringa, Ph.D.; David R. Weir, Ph.D.; Mary Beth Ofstedal, Ph.D.; James R. Burke, MD, Ph.D.; Michael D. Hurd, Ph.D.; Guy G. Potter, Ph.D.; Willard L. Rodgers, Ph.D.; David C. Steffens, MD, MHS; John J. McArdle, Ph.D.; Robert J. Willis, Ph.D.; and Robert B. Wallace, MD, that appeared in Annals of Internal Medicine, March 18, 2008.

According to this study funded by the National Institute on Aging, large numbers of the senior population in America demonstrate measurable cognitive impairment that does not reach the threshold for... »

The following is a summary of the article, “Understanding Hospice — An Underutilized Option for Life’s Final Chapter,” by Gail Gazelle, MD, that appeared in The New England Journal of Medicine, July 26, 2007.

The overwhelming perception of hospice care is that it is utilized primarily for terminal cancer, yet 40 percent of hospice admissions are the result of entirely different conditions, including... »

The following is a summary of the article, “Level of Symptom Relief and the Need for Palliative Care in the Hemodialysis Population," by Anita Jablonski, PhD, RN, that appeared in the Journal of Hospice and Palliative Nursing, February 2007.

A recent study examined the potential of palliative care to provide greater symptom relief for patients with end-stage renal disease (ESRD). The study posits that ESRD patients make apt recipients... »

The following is a summary of the article, “The Power of Interdisciplinary Collaboration in Hospice,” by Elaine M. Wittenberg-Lyles, PhD, and Debra Parker, MSW, PhD, featured in Progress in Palliative Care, 2007.

Grounded in the concept of holistic health care, the success of a hospice program hinges on attending to a patient’s biological, psychological and social needs. In order to accomplish this,... »

The following is a summary of the article, “Update in Cancer Pain Syndromes,” by Victor T. Chang, MD, et al., that appeared in the Journal of Palliative Medicine, November 2006.

In the article, the authors study a wide array of reviews regarding cancer pain management and point out that research is still in its earliest stages. Very few strong, randomized blinded studies... »

The following is a summary of the article “Optimizing Quality of Life Through Palliative Care”* by Mehul J. Desai, MD, MPH; Ann Kim, MD; Patrick C. Fall, DO; and Dajie Wang, MD, that appeared in the JAOA—Journal of the American Osteopathic Association, December 2007 (Supplement 7, Vol. 107).

Of patients currently diagnosed with cancer, 70 percent experience pain ranging from moderate to very severe as a result of treatment or the disease itself. However, studies of pain control in this... »

Recommendations for Assessing and Managing Symptoms to Provide Psychological and Social Support

The following is a summary of the article “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” by Amir Qaseem, MD, PhD, HMA; Vincenza Snow, MD; Paul Shekelle, MD, PhD; Donald E. Casey Jr., MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians, that appeared in the Annals of Internal Medicine, Jan. 15, 2008.

The authors detail five recommendations to improve palliative care of patients nearing end of life based in part on an evidence report/technology assessment from the Agency for Healthcare Research... »

Complications of Age-Associated Syndromes

The following is a summary of the article “Heart Failure: Old Disease, Older Adults, Fresh Perspective” by George A. Heckman, MD, MSc, FRCPC; Catherine Demers, MD, MSc, FRCPC; David B. Hogan, MD, FCRPC; and Robert S. McKelvie, MD, PhD, FRCPC, that appeared in Geriatrics & Aging, January/February 2008.

The incidence of cardiovascular disease increases significantly after age 65 and, in the United States, accounts for almost 60 percent of mortality at age 85 and older. In this review of the... »

Thank you to everyone who participated in our recent VistaCare VIA Readership Survey! You provided us with valuable information about who you are, why you signed up to receive our bi-monthly e-newsletter, what you like about our free service and what you’d like to see in coming issues.

In this survey, we learned that 26.2 percent of you are physicians or their associates, that 22.2 percent of you work in nursing homes or long-term care facilities and that 15.1 percent of you are... »

The following is a summary of the article “Use of Thromboprophylaxis in Palliative Care Patients: A Survey Among Experts in Palliative Care, Oncology, Intensive Care, and Anticoagulation” by Katharina A. Kierner, MD; Verena Gartner, MD; Maria Schwarz, MD; and Herbert H. Watzke, MD, that appeared in the American Journal of Palliative Medicine, April/May 2008.

Although palliative care patients are generally bedridden and have more than one other risk factor for venous thromboembolism (VTE), such as cancer or a history of VTE, the topic of... »

The following is a summary of the article “Current Concepts in Diastolic Heart Failure” by Sunil Dhar, MD; Deepak Koul, MD; and Gilbert E. D’Alonzo, Jr, DO, that appeared in The Journal of the American Osteopathic Association, April 2008.

Heart failure is one of the leading causes of hospitalization for patients over the age of 65, and mortality rates remain high despite advances in medical treatment. Diastolic heart failure, which is ... »

The following is a summary of the article “The Silent Geriatric Giant: Anxiety Disorders in Late Life” by Keri-Leigh Cassidy, MD; and Neil A. Rector, Ph.D., that appeared in Geriatrics & Aging, April 2008.

Older patients tend to present anxiety with different symptoms than younger patients, which can lead to misdiagnosis in this population. Because these patients typically have other medical and/or... »

The following is a summary of the article “The Role of the Family Physician in the Referral and Management of Hospice Patients” by Weckmann MT, that appeared in American Family Physician, March 15, 2008.

Primary care physicians can and should be integral in their patients' hospice care, both in recognizing the appropriate time for referral and in continuing treatment as the primary attending... »

The following is a summary of the article, “A Prospective Randomized Study of Corticosteroids as Adjuvant Drugs to Opioids in Advanced Cancer Patients,” by Sebastiano L. Mercadante, et al, that appeared in the American Journal of Hospice and Palliative Medicine, February/March 2007.

The use of corticosteroids has much potential in a palliative setting, but the benefits for pain management up to this point have been anecdotal. A recent study aimed to evaluate the safety and... »

The following is a summary of the article, “Comparing Hospice and Nonhospice Patient Survival Among Patients Who Die Within a Three-Year Window,” by Stephen R. Connor, Ph.D., et al, that appeared in the Journal of Pain and Symptom Management, March 2007.

A widespread belief exists that hospice hastens death through the use of opioids and sedatives. One recent study aimed to dispel that myth by evaluating the difference of survival periods for... »

The following is a summary of the article “'I'm Not Ready for Hospice': Strategies for Timely and Effective Hospice Discussions” by David J. Casarett, MD, MA, and Timothy E. Quill, MD, featured in the Annals of Internal Medicine, March 2007.

Hospice experts and physicians widely agree that earlier enrollment in a hospice program is beneficial for patients with terminal illnesses. However, several barriers often delay referral. While poor ... »

The following is a summary of the article, “Identification of Inpatient DNR Status: a Safety Hazard Begging for Standardization,” by Niraj L. Sehgal, MD, MPH, and Robert M. Wachter, MD, that appeared in the Journal of Hospital Medicine, December 13, 2007.

Although hospitals must provide proper documentation of a patient’s wishes for end-of-life care, including do-not-resuscitate (DNR) status, in order to obtain and keep accreditation, hospitals... »

The following is a summary of the article, “Opioid Analgesics for Cancer Pain: Symptom Control for the Living or Comfort for the Dying? A Qualitative Study to Investigate the Factors Influencing the Decision to Accept Morphine for Pain Caused by Cancer,” by C.M. Reid, R. Gooberman-Hill and G.W. Hanks that appeared in the Annals of Oncology, August 2007.

A significant portion of cancer treatment involves pain management. While opioid analgesics tend to be the primary substances used to control pain, many patients express concern and refusal of these... »

The following is a summary of the article, “’I’m Not Ready for Hospice’: Strategies for Timely and Effective Hospice Discussions,” by David J. Casarett, MD, MA, and Timothy E. Quill, MD, that appeared in the Annals of Internal Medicine, March 20, 2007.

Although hospice programs offer many benefits for patients, providing them with a high quality of care in addition to spiritual and emotional support for their families, only one-third of all... »

The following is a summary of the article, “Spirituality and Medicine: Prevalence of Spirituality-in-Medicine Instruction at Osteopathic Medical Schools,” by Elizabeth K. McClain, EDS; Rance L. McClain, DO; Gautam J. Desai, DO; and Sara A. Pyle, Ph.D., that appeared in the Journal of the American Osteopathic Association, April, 2008.

Patients’ religious beliefs and spirituality affect their decisions about how they approach their medical care and which treatments to pursue, according to some studies. Decisions about... »

The following is a summary of the article “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” by Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Paul Shekelle, MD, PhD; Donald E. Casey, Jr., MD, MPH, MBA; J. Thomas Cross, Jr., MD, MPH; and Douglas K. Owens, MD, MS, that appeared in the Annals of Internal Medicine, January 2008.

The American College of Physicians (ACP) released updated guidelines for palliative care of pain, dyspnea and depression, including five specific recommendations. Researchers looked at evidence-based ... »

The following is a summary of the article “Mini-Suffering State Examination Scale: Possible Key Criterion for 6-Month Survival and Mortality of Critically Ill Dementia Patients” by Bechor Zvi Aminoff, MD, PhD, that appeared in the American Journal of Hospice and Palliative Medicine, January 2008.

Estimating life expectancy of end-stage dementia patients continues to challenge clinicians for determining when hospice care is appropriate. Several attempts have been made to refine eligibility... »

The following is a summary of the article, “Novel Drug Combinations for Advanced Breast Cancer,” by William J. Gradishar, MD, based on presentations from the San Antonio Breast Cancer Symposium in December 2007.

Jill W. Chamberlain, editorial director of Hematology-Oncology at Medscape, spoke with Dr. Gradishar about current drug combinations under investigation for patients with metastatic breast cancer.... »

The following is a summary of the article “Nurse Views of the Adequacy of Decision Making and Nurse Distress Regarding Artificial Hydration for Terminally Ill Cancer Patients: A Nationwide Survey” by Mitsunori Miyashita, RN, PhD; Tatsuya Morita, MD; Yasuo Shima, MD; Rieko Kimura, RN, MHlthSci; Mikako Takahashi, RN, CNS; and Isamu Adachi, MD, that appeared in the American Journal of Hospice and Palliative Medicine, Vol. 24, No. 6.

The majority of nurses surveyed believe current discussion among nurses and physicians of artificial hydration for terminally ill patients is insufficient. Of the 3,328 responses, 39 percent of... »

The following is a summary of the article “Physician-Assisted Death — From Oregon to Washington State” by Robert Steinbrook, MD, that appeared in New England Journal of Medicine, December 11, 2008, 359; 24.

In this Perspective article, national correspondent for the New England Journal of Medicine Robert Steinbrook, MD, describes November 2008 election results in the state of Washington of special... »

The following is a summary of the article “False Hopes, Unwarranted Fears: The Trouble with Medical News Stories” by Public Library of Science Editors, featured in Public Library of Science (PLoS) Medicine, May 2008, Volume 5, Issue 5; e118.

This report describes a focus-group study conducted by North Carolina researchers who identified and explored culture-influenced issues affecting care for African-American patients with cancer.... »

The following is a summary of the article “Communication, Decision Making, and Cancer: What African Americans Want Physicians to Know” by Sharon W. Williams, Ph.D., Laura C. Hanson, MD, MPH, Carlton Boyd, MPH, Melissa Green, MPH, Moses Goldmon, Ed.D., Gratia Wright, BS, and Giselle Corbie-Smith, MD, M.Sc., featured in Vol. 11, No. 9, 2008, of the Journal of Palliative Medicine.

This report describes a focus-group study conducted by North Carolina researchers who identified and explored culture-influenced issues affecting care for African-American patients with cancer.... »

The following is a summary of the article “Ischemic heart disease and primary care: identifying gender-related differences. An observational study” by Inés Cruz, Catalina Serna, Jordi Real, Gisela Galindo, Eduardo Gascó and Leonardo Galván, featured in BMC Family Practice, 2008, 9:60 doi:10.1186/1471-2296-9-60.

Documentation of gender inequalities in the diagnosis and treatment of patients with ischemic heart disease (IHD) has emerged in recent years. This retrospective observational study utilizes clinical ... »

The following is a summary of the article “Managing Pain in Geriatric Patients” by Thomas A. Cavalieri, DO, that appeared in JAOA, Journal of the American Osteopathic Association, Supplement 4, Vol. 107, No. 6, June 2007.

This continuing education publication provides an overview of pain management in older adults that covers the following: challenges to accurate assessment of pain; observations and cautions regarding ... »

The following is a summary of the article “Can Physicians Accurately Predict Survival Time in Patients with Metastatic Cancer? Analysis of RTOG 97-14” by William F. Hartsell, MD, Michelle Desilvio, Ph.D., Deborah Watkins Bruner, Ph.D., Charles Scarantino, MD, Ph.D., Robert Ivker, DO, Mack Roach, III, MD, John Suh, MD, William F. Demas, MD, Benjamin Movsas, MD, Ivy A. Petersen, MD, and Andre A. Konski, MD, MBA, featured in Vol. 11, No. 5, 2008, of the Journal of Palliative Medicine.

Upon delivering a diagnosis of metastatic cancer, physicians generally are asked by patients and their family members to predict life expectancy. Although such information helps those affected by the ... »

The following is a summary of the article “Measuring Decision-Making Capacity in Cognitively Impaired Individuals” by J. Karlawish, featured in Neurosignals, 2008; 16(1): 91–8. Epub 2007 Dec 5.

Patients with Alzheimer’s disease and other forms of dementia experience multiple disabilities, among them the loss of the four decision-making capacities identified in this study as... »

The following is a summary of the article “Self-perceived Symptoms and Care Needs of Patients With Severe to Very Severe Chronic Obstructive Pulmonary Disease, Congestive Heart Failure or Chronic Renal Failure and Its Consequences for Their Closest Relatives: The Research Protocol” by Daisy JA Janssen, Emiel FM Wouters, Jos MGA Schols, and Martijn A. Spruit. BMC Palliative Care 2008 7:5.

This protocol was designed to obtain information from patients with severe to very severe chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF) and chronic renal failure (CRF)... »

The following is a summary of the article “Randomized, Double-Blind, Placebo-Controlled Trial of Erythropoietin in Non-Small-Cell Lung Cancer With Disease-Related Anemia” by James R. Wright, et al., that appeared in The Journal of Clinical Oncology, February 20, 2007.

Because previous trials have suggested improved quality of life (QOL) in anemic cancer patients treated with erythropoietin but have not used QOL as the primary outcome, this study was designed... »

The following is a summary of the article, “Discussing End-of-Life Care with Older Patients: What Are You Waiting For?” by Laura Brooks, BScN, MScN, ACNP, and Mary Anne Huggins, MD, CCFP, DABHPC, that appeared in Geriatics & Aging, July 2007.

While discussing end-of-life care with patients might not be the easiest conversation, the importance of such discussions is paramount, ensuring that patients can make personal wishes known before... »

The following is a summary of the article, “Palliative Care and Appropriate Medication Use in End-Stage Heart Failure,” by Mary Lynn McPherson, PharmD, BCPS, that appeared in Medscape Nurses, May 2007.

With heart failure rates rising across the nation, it is imperative that physicians begin to consider the ramifications of medication usage in end-of-life care.The author suggests that physicians... »

The following is a summary of the article, “The Palliative Power of Storytelling: Using Published Narratives as a Teaching Tool in End-of-Life Care” by Elaine M. Wittenberg-Lyles, PhD, et al, that appeared in the Journal of Hospice and Palliative Nursing, July/August 2007.

Many healthcare providers struggle between extending length of life for their patients while preserving quality of life. This tension between the scientific and the humanistic side of palliative care ... »

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