Palliative Care

Clinical review far outperforms PMPs for detecting opioid misuse in cancer palliative care

Among 906 cancer patients in a safety-net palliative clinic, 93% had at least one prescription monitoring program (PMP) review. Only 4% of patients with PMP review had documented PMP concerns, versus 20% identified with non-medical opioid use via structured clinical review. History of illicit drug use, opioid prescribing for non-malignant pain, and family illicit drug use strongly predicted PMP irregularities. Clinical review missed few patients flagged by the PMP, whereas PMP alone missed most patients with concerning opioid behaviors. PMPs should be used as a supplement to, not a substitute for, detailed bedside risk assessment in cancer pain management. 1

“PalliPulm” defines core primary palliative skills for pulmonary and critical care clinicians

An American Thoracic Society workshop developed the scalable “PalliPulm” framework to integrate palliative care into pulmonary-critical care medicine. Key ambulatory competencies include symptom management, serious illness communication, and caregiver support for patients with serious respiratory illness. In inpatient settings, prioritized skills include serious illness communication, symptom management, palliative care fundamentals, and end-of-life care. The report offers pragmatic strategies and educational resources to embed these skills into PCCM training and daily practice. It also addresses culturally appropriate framing of palliative care for patients and caregivers within respiratory care pathways. 2

Serious events markedly reduce days at home for older community-dwelling adults

This prospective cohort of 754 community-living adults aged 70 or older quantified days at home after serious health events. In the 6 months after critical illness or non-elective major surgery, mean days at home fell to 70% of expected time. Elective major surgery and other hospitalizations also reduced days at home, though less than critical illness and urgent major surgery. Much of the time away from home was spent in nursing facilities; hospice facility days were uncommon across groups. These estimates can anchor prognostic and discharge conversations about expected function and location of care after hospitalization. 3

One in three cognitively impaired surgical patients develop delirium despite perioperative best practices

In 1255 surgical patients with preoperative cognitive impairment, 33.9% developed postoperative delirium by 4 A’s Test assessment. Maintaining glucose under 200 mg/dL, using a temperature probe, and keeping temperature above 36 °C each reduced delirium odds in separate models. When all practices were modeled together, only postoperative glucose monitoring remained significantly associated, and delirium incidence stayed high. Findings indicate current perioperative best-practice bundles alone are insufficient to prevent delirium in this vulnerable group. Palliative teams should anticipate substantial delirium risk, counsel families, and plan proactive support and goals-of-care discussions perioperatively. 4