Hospital Palliative Care Study Reveals Nine Major Findings
February 22, 2018Categories: Loyola Medicine
MAYWOOD, IL – Caregivers of patients surviving a prolonged critical illness experience high and persistent rates of depression.
Losing a partner can be especially stressful for lesbian, gay, bisexual and transgender (LGBT) people.
Resident physicians experience moral distress when they administer futile treatments to patients at the end of life.
These are among nine major findings from the latest research on hospital palliative care, according to a study published in the Journal of Hospital Medicine, an official publication of the Society of Hospital Medicine. Loyola Medicine hospitalist Aziz Ansari, DO, SFHM, FACP, is corresponding author (a hospitalist is an inpatient physician who works exclusively in the hospital).
Dr. Ansari was part of a nationwide panel of leading palliative care experts who reviewed and ranked 55 studies about hospital palliative care published in 2016. Palliative care treats pain and other symptoms of serious illness, with the goal of improving quality of life for the patient and family.
From the list, the panel selected the nine most significant studies, based on scientific rigor, relevance to hospital medicine and impact on clinical practice. Here are the studies’ findings:
Caregiver Depression
More than half of patients with prolonged critical illnesses need support from a caregiver a year after hospitalization. A study that followed 280 caregivers for a year found that many experienced high and persistent rates of depression.
“Hospitalists should be attentive to factors associated with caregiver vulnerability and offer support,” Dr. Ansari and colleagues wrote. “Improving caregivers’ sense of control and social support may be targets for intervention."
LGBT Partner Loss
A study found that grieving LGBT people face additional barriers and stressors, including homophobia, failure by healthcare workers to acknowledge the relationship, additional legal and financial issues and the shadow of HIV/AIDS.
Moral Distress Among Doctors
Moral distress occurs when a clinician feels powerless to take what he or she believes to be the ethically correct action. A study of resident physicians found they experience significant moral distress with futile treatments, such as feeding tubes for patients with advanced dementia. Many said they felt obligated to provide end-of-life care that was not in the patient's best interest and caused the patient to suffer.
Treating Delirium
Antipsychotics are widely used to treat symptoms of delirium. But a study found that patients receiving the antipsychotics risperidone and haloperidol had higher delirium scores than patients who received non-drug treatments for delirium.
Treating Cancer Pain
One study found that low-dose morphine was superior to weak opioids such as codeine and tramadol for treating moderate cancer pain. Another study found that methadone used as an adjunct pain medication can improve moderate cancer pain.
Inappropriate Use of Antimicrobials
When a patient is nearing the end of life, a physician may write a comfort care order, which is meant to ensure that the final hours or days are tranquil and pain-free, without prolonging life. But a study found that among 711 patients still alive 24 hours after a comfort care order was written, 15.6 percent still were receiving antimicrobials (antibiotics or antifungals).
Educational Videos Are Effective
Advance care planning is making decisions about the care you would wish to receive if you became incapacitated. A study found that using educational videos increased the percentage of hospital patients who did advance care planning.
Palliative Care Consultations
A study examined the effectiveness of an intervention program for family members of patients with prolonged critical illnesses. The intervention included supportive conversations and information about the illness and prognosis. The team met with family members seven days after the patient went on a ventilator and again 10 days later. The study found that family members who received the interventions had similar rates of anxiety and depression and higher rates of post-traumatic stress disorder than family members who did not receive the interventions. The study did not evaluate routine specialty palliative care consultation in the ICU. Also, the palliative intervention used in the study was more informational, rather than driven by clinical considerations as in standard consultations.
The study by Dr. Ansari and colleagues is titled “Update in Hospital Palliative Care: Symptom Management, Communication, Caregiver Outcomes and Moral Distress.”
In addition to Dr. Ansari, other co-authors are Rachel Havyer, MD, (first author) of the Mayo Clinic, Daniel Pomerantz, MD, of Albert Einstein College of Medicine, Robert Jayes, MD, of George Washington University, Patricia Harris, MD, of the University of California, Los Angeles and Stephanie Harman, MD, of Stanford University.
About Loyola Medicine
Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. The three-hospital system includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital, as well as convenient locations offering primary care, specialty care and immediate care services from nearly 2,000 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, the John L. Keeley, MD, Emergency Department, a Level 1 trauma center, Illinois's largest burn center, the Nancy W. Knowles Orthopaedic Institute, a certified comprehensive stroke center, transplant center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing.
Established in 1961, Gottlieb Memorial Hospital is a 247-licensed-bed community hospital in Melrose Park that includes the Judd A. Weinberg Emergency Department, the Loyola Center for Metabolic Surgery and Bariatric Care, Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center, acute rehabilitation, a transitional care center, childcare center and fitness center. Founded in 1919, MacNeal Hospital is a 374-licensed-bed teaching hospital in Berwyn with advanced medical, surgical and psychiatric services and a 68-bed behavioral health program.
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About Trinity Health
Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 127,000 colleagues and more than 38,300 physicians and clinicians caring for diverse communities across 26 states. Nationally recognized for care and experience, the Trinity Health system includes 93 hospitals, 107 continuing care locations, the second largest PACE program in the country, 142 urgent care locations and many other health and well-being services. In fiscal year 2024, the Livonia, Michigan-based health system invested $1.3 billion in its communities in the form of charity care and other community benefit programs. For more information, visit us at www.trinity-health.org, or follow us on LinkedIn, Facebook, and X (formerly known as Twitter).