Points and Pearls Excerpt
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In patients with life-limiting illnesses, effective communication techniques should be used to determine what the patient and family know about the condition and to clarify their goals of care.
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The patient’s goals of care and previously expressed wishes, not the prognosis, should always guide treatment focus.
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An advance directive is a general term for any documentation provided by a patient that lays out future medical decisions and preferences to be used in the event a patient is unable to communicate.
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The POLST (physician orders for life-sustaining treatment) and MOLST (medical orders for life-sustaining treatment) are specific medical orders signed by a physician after a conversation with a patient or his surrogate. www.oregonpolst.org
Most Important References
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Reuben DB, Mor V. Dyspnea in terminally ill cancer patients. Chest. 1986;89(2):234-236. (Prospective; 1754 patients) DOI: https://doi.org/10.1378/chest.89.2.234
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Lunney JR, Lynn J, Foley DJ, et al. Patterns of functional decline at the end of life. JAMA. 2003;289(18):2387-2392. (Prospective cohort; 4190 patients) DOI: http://doi.org/10.1001/jama.289.18.2387
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Steinhauser KE, Christakis NA, Clipp EC, et al. Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA. 2000;284(19):2476- 2482. (Cross-sectional survey; 1122 patients/families/providers) DOI: http://doi.org/10.1001/jama.284.19.2476
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Quill TE, Arnold R, Back AL. Discussing treatment preferences with patients who want “everything.” Ann Intern Med. 2009;151(5):345-349. (Review) DOI: http://doi.org/10.7326/0003-4819-151-5-200909010-00010
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Clemens KE, Quednau I, Klaschik E. Use of oxygen and opioids in the palliation of dyspnoea in hypoxic and non-hypoxic palliative care patients: a prospective study. Support Care Cancer. 2009;17(4):367-377. (Nonrandomized trial; 46 patients) DOI: http://doi.org/10.1007/s00520-008-0479-0
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Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376(9743):784-793. (Double-blind randomized controlled trial; 239 patients) DOI: http://doi.org/10.1016/S0140-6736(10)61115-4
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Galbraith S, Fagan P, Perkins P, et al. Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage. 2010;39(5):831-838. (Randomized controlled crossover trial; 50 patients) DOI: http://doi.org/10.1016/j.jpainsymman.2009.09.024
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