Surrogate decision-makers, physicians may differ on patient's outlook | Study examines pain management in end-of-life ICU patients | Researchers: Talk to ESRD patients about supportive care options
May 20, 2016
Hospice and Palliative Medicine SmartBrief
News for physicians caring for the seriously ill
Top Story
Surrogate decision-makers, physicians may differ on patient's outlook
Surveys from 229 surrogate decision-makers for ICU patients found that in 53% of cases they expressed at least a 20% difference from a physician's view in rating a patient's prognosis, researchers reported in the Journal of the American Medical Association. Data showed surrogates tended to be more optimistic about the prognosis, while physicians expressed more accurate views.
HealthDay News (5/17) 
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Palliative & Hospice Care Update
Study examines pain management in end-of-life ICU patients
Researchers who reviewed records from 48 ICU patients who transitioned to end-of-life palliative care found that pain management provided did not meet institutional guidelines and documentation was lacking for 40% of days patients were in pain. A survey of nurses found many reported they were comfortable managing end-of-life pain, and greater knowledge and awareness of guidelines about pain management did not necessarily correlate with increased comfort, researchers told an American Association of Critical-Care Nurses conference.
Medscape (free registration) (5/18) 
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Researchers: Talk to ESRD patients about supportive care options
Nephrologists can find it difficult to talk with patients who have end-stage renal disease about supportive care that does not include dialysis, even as medicine is moving toward aligning treatments with patient goals and values, researchers said. “There are social, cultural, and religions norms confounding these discussions and an unfounded fear that discussing the end of life issues with patients will cause our field to regress back to a time of restricted access to care for patients," said Dr. Frank Maddux of Fresenius Medical Care, author of a paper in the journal Seminars in Dialysis.
Nephrology News & Issues (5/18) 
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Patient & Family Perspective
Caregivers may benefit from patients' early palliative care, study says
A study linked providing cancer patients palliative care soon after a terminal diagnosis with better quality of life and fewer symptoms of depression among caregivers. The study, prepared for presentation at the American Society of Clinical Oncology's annual meeting, suggests palliative care "creates a powerful positive feedback loop in families facing cancer," said researcher Dr. Areej El-Jawahri.
HealthDay News (5/18) 
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Medical Research
Skin autofluorescence may be marker for cognitive impairment
Researchers said assessing skin autofluorescence may help screen for mild cognitive impairment in adults with prehypertension. The study, presented at the American Society of Hypertension's annual meeting, found that after adjusting for multiple variables, patients who had the highest SAF were more than four times as likely to have mild impairment, compared with patients who had the lowest SAF.
Medscape (free registration) (5/17) 
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Study shows need for cognitive screening in patients with DFU
Patients with diabetic foot ulcers had lower scores on cognition tests than their peers with diabetes but no foot ulcers, highlighting a need to screen DFU patients for cognitive impairment, researchers reported in Diabetes Care. The case-control study showed that DFU patients had lower scores on memory, executive function, reaction time, attention and psychomotor tests; and cognitive abilities had declined among cases while remaining stable in controls.
Healio (free registration)/Endocrine Today (5/17) 
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Health Policy & Practice
MACRA may not fully address needs of elderly, experts say
The Medicare Access and CHIP Reauthorization Act, created to replace the sustainable growth rate payment system for physicians, may not fully address the needs of patients receiving long-term or end-of-life care, experts said at a Physician-Focused Payment Model Technical Advisory Committee meeting. Joanne Lynn of Altarum's Center for Eldercare and Advanced Illness said alternative payment models being created for MACRA must consider the care needs of elderly patients and those with chronic diseases.
Modern Healthcare (tiered subscription model) (5/13) 
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HHS issues final anti-discrimination rules
Medicaid, Medicare, insurers that offer plans through, and any other program or health care provider that accepts federal funds must comply with recently finalized anti-discrimination rules that clarify the agency's policy on gender identity, among other provisions. Coverage of gender transition surgery is not explicitly required, but regulators might question denial of coverage for medically necessary services related to gender transition.
Modern Healthcare (tiered subscription model) (5/13),  The Washington Post (tiered subscription model) (5/13) 
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Trends & Technology
Survey looks at telehealth use across provider categories
Seventy-two percent of hospitals use telehealth, compared with 52% of physician groups and clinics and 36% of other providers, finds a survey from Avizia. Researchers also found that 38% of health care executives want telehealth options that could be integrated into their existing EHR systems. Barriers to telehealth adoption include clinician resistance, infrastructure investment, reimbursement concerns, credentialing and workflow design. (5/17) 
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Prepare for the Fall HPM Exam
This year, the Intensive Board Review Course will be held as part of the 2016 Summer Institute in Pittsburgh. This course has been completely redesigned to provide you with a learning experience that reviews content for the ABMS HPM certification exam. Learn more about this opportunity and more.
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Best of 2016 Annual Assembly Recordings
We've made it easy for you to hear some of the best sessions from the 2016 Annual Assembly. Learn about burnout, methadone safety, the pharmacy ladies, steroids for pain and nausea, opioid dependency and more. These and other topics are now available in the AAHPM bookstore.
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