Hospice Patients Research Articles

Risk factors for opioid-related adverse drug events among older adults after hospital discharge.

Although opioids are initiated on hospital discharge in millions of older adults each year, there are no studies examining patient- and prescribing-related risk factors for opioid-related adverse drug events (ADEs) after hospital discharge among medical patients. A retrospective cohort study of a national sample of Medicare beneficiaries aged 65 years and older, hospitalized for a medical reason, with at least one claim for an opioid within 2 days of hospital discharge. We excluded patients receiving hospice care and patients admitted from or discharged to a facility. We used administrative billing codes and medication claims to define potential opioid-related ADEs within 30 days of hospital discharge, and competing risks regression to identify risk factors for these events. Among 22,879 medical hospitalizations (median age 74, 36.9% female) with an opioid claim within 2 days of hospital discharge, a potential opioid-related ADE occurred in 1604 (7.0%). Independent risk factors included age of 80 years and older (HR 1.18, 95% CI 1.05-1.33); clinical conditions, including kidney disease (HR 1.22, 95% CI 1.08-1.37), dementia/delirium (HR 1.38, 95% CI 1.22-1.56), anxiety disorder (HR 1.20, 95% CI 1.06-1.36), opioid use disorder (HR 1.20, 95% CI 1.03-1.39), intestinal disorders (HR 1.31, 95% CI 1.15-1.49), pancreaticobiliary disorders (HR 1.32, 95% CI 1.09-1.61), and musculoskeletal and nervous system injuries (HR 1.35, 95% CI 1.17-1.54); red flags for opioid misuse (HR 1.37, 95% CI 1.04-1.80); opioid use in the 30 days before hospitalization (HR 1.20, 95% CI 1.08-1.34); and prescription of long-acting opioids (HR 1.34, 95% CI 1.06-1.70). Potential opioid-related ADEs occurred within 30 days of hospital discharge in 7.0% of older adults discharged from a medical hospitalization with an opioid prescription. Identified risk factors can be used to inform physician decision-making, conversations with older adults about risk, and development and targeting of harm reduction strategies.

Prohibit, Protect, or Adapt? The Changing Role of Volunteers in Palliative and Hospice Care Services During the COVID-19 Pandemic. A Multinational Survey (Covpall).

Volunteers are common within palliative care services, and provide support that enhances care quality. The support they provided, and any role changes, during the coronavirus disease 2019 (COVID-19) pandemic are unknown. The aim of this study is to understand volunteer deployment and activities within palliative care services, and to identify what may affect any changes in volunteer service provision, during the COVID-19 pandemic. Multi-national online survey disseminated via key stakeholders to specialist palliative care services, completed by lead clinicians. Data collected on volunteer roles, deployment, and changes in volunteer engagement. Analysis included descriptive statistics, a multivariable logistic regression, and analysis of free-text comments using a content analysis approach. 458 respondents: 277 UK, 85 rest of Europe, and 95 rest of the world. 68.5% indicated volunteer use pre-COVID-19 across a number of roles (from 458): direct patient facing support (58.7%), indirect support (52.0%), back office (48.5%) and fundraising (45.6%). 11% had volunteers with COVID-19. Of those responding to a question on change in volunteer deployment (328 of 458) most (256/328, 78%) indicated less or much less use of volunteers. Less use of volunteers was associated with being an in-patient hospice, (odds ratio [OR]=0.15, 95% CI=0.07-0.3, P<.001). This reduction in volunteers was felt to protect potentially vulnerable volunteers, with policy changes preventing volunteer support. However, adapting was also seen where new roles were created, or existing roles pivoted to provide virtual support. Volunteers were mostly prevented from supporting many forms of palliative care which may have quality and safety implications given their previously central roles. Volunteer re-deployment plans are needed that take a more considered approach, using volunteers more flexibly to enhance care while ensuring safe working practices. Consideration needs to be given to widening the volunteer base away from those who may be considered to be most vulnerable to COVID-19.

The Effects of a Death Preparation Education Program on Death Anxiety, Death Attitudes, and Attitudes toward End-of-Life Care among Nurses in Convalescent Hospitals.

The purpose of this study was to examine the effects of a death preparation education program for nurses working in convalescent hospitals on death anxiety, death attitudes, and attitudes toward end-of-life care. This was a quasi-experimental study with a non-equivalent control group, pre-test and post-test design. Among 53 participants, 26 were assigned to the non-equivalent experimental group and 27 to the control group. The program was performed in the formats of lectures, video-watching, group discussions, and sharing, and consisted of 10 sessions held twice a week, for 5 weeks (90 minutes per session). Data were analyzed using descriptive statistics, the t-test, and the chi-square test in SPSS version 21.0. Significant differences between the experimental and control groups were observed in death anxiety (t=7.62, P<0.001), death attitudes (t=-7.58, P<0.001), and attitudes to end-of-life care (t=-10.30, P<0.001). It was confirmed that the death preparation education program reduced death anxiety and had a positive effect on death attitudes and attitudes toward end-of-life care. Based on the results of this study, it is expected that specialized and systematic education that can increase the implementation and stability of death preparation education in various fields, including nursing, will have a positive effect on both hospice patients and members of society more broadly.

Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective.

The COVID-19 pandemic has exposed the inadequacies of the current healthcare system and needs a paradigm change to one that is holistic and community based, illustrated by the healing wheel. The present paper proposes that existential positive psychology (PP 2.0) represents a promising approach to meet the rising needs in palliative care. This framework has a twofold emphasis on (a) how to transcend and transform suffering as the foundation for wellbeing and (b) how to cultivate our spiritual and existential capabilities to achieve personal growth and flourishing. We propose that these objectives can be achieved simultaneously through dialectical palliative counselling, as illustrated by Wong’s integrative meaning therapy and the Conceptual Model of CALM Therapy in palliative care. We then outline the treatment objectives and the intervention strategies of IMT in providing palliative counselling for palliative care and hospice patients. Based on our review of recent literature, as well as our own research and practice, we discover that existential suffering in general and at the last stage of life in particular is indeed the foundation for healing and wellbeing as hypothesized by PP 2.0. We can also conclude that best palliative care is holistic—in addition to cultivating the inner spiritual resources of patients, it needs to be supported by the family, staff, and community, as symbolized by the healing wheel.

Hospice Saves Costs for Families: Evidence from 16 Years of Medicare Survey Data

Research ObjectiveUse of hospice is an indicator of high quality end‐of‐life care. As of 2019, more than half of all deaths in the US occurred under the care of hospice. Economic evaluations of hospice have primarily focused on cost savings to the Medicare program or managed care programs without consideration of costs to families. Families of people near end of life are vulnerable to adverse financial experiences, which may compound their physical, mental and emotional burden through bereavement. Our objective was to estimate the impact of hospice use on family out‐of‐pocket (OOP) and total healthcare expenditures.Study DesignWe conducted a pooled, cross‐sectional analysis of healthcare spending in the last 6 months of life using data from the nationally representative Medicare Current Beneficiary Survey (MCBS), 2002–2018. We measured total healthcare expenditures across all payers (Medicare, Medicaid, private insurance, HMO, family OOP, other) and by expenditure type (inpatient care, outpatient care, skilled nursing, home health, hospice, and prescription drugs). We used propensity‐score based Inverse Probability Treatment Weighting to match participants who used hospice and those who did not, stratifying the exposure group by duration of hospice use.Population StudiedMCBS participants who died between 2002 and 2018.Principal FindingsOf 8568 decedents, average total healthcare expenditures in the last six months of life were $42,343 (SD $44,427) and family OOP expenditures were $4827 (SD $9550). OOP spending for families was driven by nursing home care, averaging $538 in the last month of life, followed by spending for medical provider visits ($229 in the last month of life). Total healthcare expenditures were lower for those who used hospice compared to matched non‐hospice controls for the following hospice care durations: 7 days prior to death ($1417 lower expenditures for hospice users, P &lt; 0.001); 2 weeks prior to death ($5221 lower, P &lt; 0.001); 1 month prior to death ($6426, P &lt; 0.001); and 3 months prior to death ($3351, P &lt; 0.010). Family OOP expenditures were lower for those who used hospice 2 weeks prior to death ($275, P &lt; 0.001), 1 month prior to death ($402, P &lt; 0.001), and 3 months prior to death ($464, P = 0.072) compared with matched controls who did not use hospice. Families enrolled with hospice spent significantly less OOP on medical provider visits and inpatient care than families who did not enroll with hospice.ConclusionsHospice enrollment was associated with lower costs for families in the month prior to death, as well as savings for payers. The magnitude of OOP savings of hospice enrollment to families are meaningful to many Americans, particularly those with lower socioeconomic status. Savings in healthcare expenditures in total and for families were driven by inpatient care and medical provider visits.Implications for Policy or PracticeAs healthcare continues to shift from institutions to the community settings and use of home‐based care such as hospice increases, it is important to assess cost shifting to families. Our findings that hospice does not shift economic burden from Medicare to families underscores the need to promote timely access to hospice care as even those with short hospice durations experienced cost savings.Primary Funding SourceNational Institutes of Health.

Hospice and Comfort Care Patient Utilization of Emergency Medical Services

Introduction: Emergency medical services (EMS) were designed to prevent death and disability. When hospice patients call 9-1-1, it can create challenging scenarios for EMS providers, patients, and families. The objective of this investigation is to understand the characteristics of hospice and comfort care patient EMS utilization in Alameda County, California. Methods: This is a 15-month (7/1/2019-10/1/2020) retrospective observational study in Alameda County using electronic patient care reports (PCRs). The search terms "hospice" and "comfort measures only" were applied to PCR narratives. Results: Of the 237,493 EMS provider response calls, 534 (0.2%) were for hospice and comfort care patients. One hundred seventy-four (32.6%) calls were from skilled nursing facilities versus 343 (64.2%) from private residences. Among the most common primary impressions were respiratory complaints (96; 18.0%), altered mental status (96; 18.0%), weakness (58; 10.9%), and cardiac arrest (45; 8.4%). The most common interventions included blood glucose (244; 45.7%), electrocardiogram (181; 33.9%), and intravenous placement (170; 31.8%). Of note, eight (1.5%) patients received cardiopulmonary resuscitation, and an additional eight (1.5%) patients were intubated endotracheally or received a supraglottic airway device for intubation. Sixty-eight (12.7%) patients received medications, the most common of which were fentanyl (17; 3.2%) and albuterol (16; 3.0%). Of note, five (0.9%) patients received naloxone. Ultimately, 468 (87.6%) patients were transported by EMS. Of the 33 (6.1%) patients who died on the scene, three received resuscitation attempts. Conclusion: Although EMS providers encounter hospice and comfort care patients infrequently, awareness of hospice services and comprehensive end-of-life care communication skills with patients and family should be an important part of EMS.

Inpatient Hospice Palliative Care Unit and Palliative Consultation Service Enhance Comprehensive Quality of Life Outcomes in Terminally Ill Cancer Patients: A Prospective Longitudinal Study.

This study aimed to explore the effectiveness of an inpatient hospice palliative care unit (PCU) and palliative consultation service (PCS) on comprehensive quality of life outcome (CoQoLo) among terminally ill cancer patients. This was a prospective longitudinal study. Terminally ill cancer patients who met the inclusion criteria and received PCU or PCS in a northern Taiwanese medical center were recruited. The CoQoLo Inventory was used to measure CoQoLo level pre- and seven days following hospice care between August 2018 and October 2019. A total of 90 patients completed the study. No significant differences were found in CoQoLo levels between the PCU and PCS groups pre- and seven days following care. However, the CoQoLo level of patients significantly improved seven days following care in both PCU and PCS groups, compared with pre-hospice care. Patients’ age, religious belief, marital status, closeness with family, palliative prognostic index (PPI), and symptom severity were significant concerning CoQoLo levels after adjusting for patients’ baseline characteristics. PCU and PCS showed no difference in CoQoLo levels, but both of them can improve CoQoLo among terminally ill cancer patients. These patients could receive PCU or PCS to achieve a good CoQoLo at the end-of-life stage.

Examining the Association of Billed Advance Care Planning With End-of-Life Hospital Admissions Among Advanced Cancer Patients in Hospice.

Advance care planning (ACP), or the consideration and communication of care preferences for the end-of-life (EOL), is a critical process for improving quality of care for patients with advanced cancer. The incorporation of billed service codes for ACP allows for new inquiries on the association between systematic ACP and improved EOL outcomes. Using the IBM MarketScan® Database, we conducted a retrospective medical claims analysis for patients with an advanced cancer diagnosis and referral to hospice between January 2016 and December 2017. We evaluated the association between billed ACP services and EOL hospital admissions in the final 30 days of life. This is a cross-sectional retrospective cohort study. A total of 3,705 patients met the study criteria. ACP was measured via the presence of a billed ACP encounter (codes 99497 and 99498) prior to the last 30 days of life; hospital admissions included a dichotomous indicator for inpatient admission in the final 30 days of life. Controlling for key covariates, patients who received billed ACP were less likely to experience inpatient hospital admissions in the final 30 days of life compared to those not receiving billed ACP (OR: 0.34; p < 0.001). The receipt of a billed ACP encounter is associated with reduced EOL hospital admissions in a population of patients with advanced cancer on hospice care. Strategies for consistent, anticipatory delivery of billable ACP services prior to hospice referral may prevent potentially undesired late-life hospital admissions.

A known unknown? Pharmacological prevention of venous thromboembolism in nursing home residents.

A known unknown? Pharmacological prevention of venous thromboembolism in nursing home residents.

Serious Illness Communication Practices in Glioblastoma: An Institutional Perspective.

Background: Early, high-quality advance care planning discussions are essential for supporting goal-concordant care among glioblastoma (GBM) patients. Objective: Using mixed methods, we sought to characterize current serious illness (SI) communication practices at our institution. Methods: The electronic medical records of 240 deceased GBM patients cared for at the Abramson Cancer Center in Philadelphia, PA between 2017 and 2019 were systematically reviewed for documented SI conversations about four domains: prognosis, goals, end-of-life planning, and code status. Patient outcomes and SI conversation characteristics were analyzed using descriptive statistics. Standardized interviews about GBM care were held with five clinicians. Interview transcripts were analyzed using grounded-theory coding to identify emergent themes. Results: Nearly all patients (96%) had at least one documented SI conversation (median: 4, interquartile range [IQR] 2-7), mostly outpatient with medical oncology physicians. Median timing of first SI conversation was 360 days before death. SI conversations were not significantly associated with patient outcomes, including inpatient death and hospice enrollment. Seven themes emerged from clinician interviews: balancing hope and reality, anticipatory guidance, neglect of the "big picture," need for earlier conversations, care coordination, the role of clinical expertise, and communication training. Conclusion: SI conversations were documented early and often in our sample, but their quality was difficult to assess. Contrary to our quantitative findings, interviewees reported that SI conversations were late, infrequent, inadequate, and fragmented across specialties, failing to explore critical issues such as prognosis and functional decline.

Establishing an evidence-based infection surveillance program for home care and hospice: A large Midwest health system's experience

Home care and hospice are unique and rapidly growing healthcare settings. However, there is a lack of published findings related to evidence-based infection surveillance programs among these settings. Our health system hired a Home Care and Hospice Infection Preventionist to implement an infection surveillance program using evidence-based infection surveillance criteria appropriate for these settings, the Association for Professionals in Infection Control and Epidemiology (APIC) and Healthcare Infection Control Practices Advisory Committee (HICPAC) definitions for home health care and home hospice infections, National Healthcare Safety Network long-term care facility (LTCF) criteria, and McGeer criteria for LTCFs. These surveillance criteria were built into new surveillance databases for Home Care, Home Hospice, and inpatient Hospice House. Infection Prevention reported infections and trends to respective departments monthly and as needed in the event of any significant infections. For most infection types, there were less infections identified during January-April 2021 than for the same period in 2019-2020. Having Infection Prevention coordinate the Home Care and Hospice infection surveillance program will help establish reliable healthcare-associated infection baseline data and help identify the population at risk. Future enhancements to automatically identify infections among this patient population are planned once Home Care and Hospice begin using the health system's electronic medical record.

Deaths in critical care and hospice—prevalence, trends, influences: a national decedent cohort study

ObjectivesEnd-of-life and bereavement care support services differ in critical care and inpatient hospice settings. There are limited population-level data comparing deaths in these two locations. We aimed to compare the...

Healthy days at home: A population-based quality measure for cancer patients at the end of life.

Healthy Days at Home (HDAH) is a novel population-based outcome measure. In this study, its use as a potential measure for cancer patients at the end of life (EOL) was explored. Patient demographics and health care use among Medicare beneficiaries with cancer who died over the years 2014 to 2017 were identified. The HDAH was calculated by subtracting the following components from 180 days: number of days spent in inpatient and outpatient hospital observation, the emergency room, skilled nursing facilities (SNF), inpatient psychiatry, inpatient rehabilitation, long-term hospitals, and inpatient hospice. How HDAH and its components varied by beneficiary demographics and health care market were evaluated. A patient-level linear regression model with HDAH as the outcome, hospital referral region (HRR) random effects, and market fixed effects were specified, as well as beneficiary age, sex, and comorbidities as covariates. The 294,751 beneficiaries at the EOL showed a mean number of 154.0 HDAH (out of 180 days). Inpatient (10.7 days) and SNF (9.7 days) resulted in the most substantial reductions in HDAH. Males had fewer adjusted HDAH (153.1 vs 155.7, P < .001) than females; Medicaid-eligible patients had fewer HDAH compared with non-Medicaid-eligible patients (152.0 vs 154.9; P < .001). Those with hematologic malignancies had the fewest number of HDAH (148.9). Across HRRs, HDAH ranged from 10.8 fewer to 10.9 more days than the national mean. At the HRR-level, home hospice was associated with greater HDAH, whereas home health was associated with fewer HDAH. HDAH may be a useful measure to understand, quantify, and improve patient-centered outcomes for cancer patients at EOL.

H.O.P.E. & Healing: a randomized pilot study of structured palliative care referrals in recurrent ovarian cancer

<h3>Objectives:</h3> The inclusion of palliative care (PC) across the cancer continuum has been identified as a marker of high-quality cancer care. With limited PC specialists, integrated approaches may be necessary with the primary oncologist providing this care. However, recurrent ovarian cancer patients often have significant physical and/or emotional needs that may be best addressed by PC specialists. Our primary objective was to test the effect of a structured PC intervention on quality of life (QOL) for patients with recurrent ovarian cancer. Secondary objective was to assess the effect of the structured PC approach on overall survival. <h3>Methods:</h3> This was an IRB approved prospective randomized controlled trial at 2 academic institutions and was registered with clinicaltrials.gov (NCT02090582). Eligible patients included those with platinum resistant ovarian cancer or platinum sensitive cancer with a sentinel clinical event (recent bowel obstruction, liver metastases, pleural effusion or ascites). Subjects were randomized 1:1 to usual care versus a structured palliative care intervention (see Figure 1). Quality of life was assessed using the Functional Assessment of Cancer Therapy-Ovarian (FACT-O) and Functional Assessment of Chronic Illness Therapy-Palliative Care (FACIT-PAL) at baseline and 12-week intervals. Wilcoxon tests were used to detect differences between arms. Overall survival was analyzed using Kaplan-Meyer curves. <h3>Results:</h3> A total of 54 subjects were enrolled from 5/2014-4/2016; 26 in the intervention arm and 28 in the control arm. Median follow up was 6.5 months (Range: 2-12months). Median age of subjects was 63 with an ECOG performance status of 1. The majority of patients were Caucasian (44; 81.5%) and had platinum resistant disease (37; 68.5%). Most patients had received between 1-3 prior lines of chemotherapy (34/54; 63%); 5 patients (9.2%) had received ≥6 lines of therapy. There was no difference in overall or subset QOL in patients receiving usual care compared to those in the structured PC arm (p=0.14). There were no differences in hospital admissions (p=0.96), days from last chemo to hospice admission (p=1.0), days from hospice admission to death (p=0.41), place of death (p=0.68) or number of PC appointments (p=0.30) between the two arms. Patients enrolled in the 2nd half of the cohort were more likely to die at home rather than in the hospital or inpatient hospice (p=0.01) compared to subjects enrolled early in the study period. 81% of subjects randomized to the intervention arm completed at least 1 QDACT assessment (range 1-17). Similarly, there was no overall survival difference between the 2 arms (9.3m vs 10.1m; p=0.21). <h3>Conclusions:</h3> Structured integrated approaches between gynecologic oncology providers and PC specialists are feasible. The QDACT tool may be an effective, standardized measure to assess cancer symptom burden over time in this population. Further study is needed to identify interventions and collaborations that may have the greatest impact on QOL for recurrent ovarian cancer patients.

Is Neuropathic Pain a Good Marker of Peripheral Neuropathy in Hospice Patients with Advanced Cancer? The Single Center Pilot Study.

Neuropathic pain (NP) affects approximately 30% of patients with advanced cancer. The prevalence of neuropathic pain related to peripheral neuropathy (NP-RPN) in these patients is not known. The aim of the study was to evaluate NP-RPN prevalence in hospice patients and to find out whether the absence of this pain is sufficient to rule out peripheral neuropathy. The study included a total of 76 patients with advanced cancer who were cared for at inpatient hospices. All patients were asked about shooting or burning pain (of the feet and hands), were examined systematically for sensory deficits and had a nerve conduction study performed. NP-RPN was found in 29% of the patients. Electrophysiologically-diagnosed peripheral neuropathy was found in 79% of patients, and the diagnostic electrophysiological criteria for neuropathy were met by one half of the patients without NP-RPN. The severity of NP-RPN was correlated with the clinically assessed severity of sensory neuropathy and the Karnofsky score, but was not correlated with the intensity of the clinical signs of motor neuropathy. The presence of NP-RPN did not reflect greater prevalence of motor and sensory abnormalities in neurological and electrophysiological examinations. The absence of NP-RPN did not rule out polyneuropathy in hospice patients.

Palliative Care Needs in Breast Cancer Patients Entering Inpatient Hospice in Western Kenya

ContextBreast cancer in Kenya is associated with a high mortality due to late stage disease at presentation and limited access to specialty care. ObjectivesTo understand the symptom burden in breast cancer patients entering hospice in Western Kenya and utilize the data to meet the growing need for palliative care and hospice services. MethodsWe conducted a quality improvement exercise to assess the needs of Kenyan women admitted to inpatient hospice with the diagnosis of breast cancer. A retrospective chart review was undertaken to collect and collate demographic, physical and symptom data from a standardized admission form and the medical record. ResultsBetween 2011–2019, 62 women with breast cancer were admitted for care. The median age was 50.0 years (range 23–86) and the median time from diagnosis to admission one year (range 0–4). Only 20% had received surgical treatment for breast cancer. Pain was the predominant symptom on admission (98%) and breast wounds were the most common physical finding. Approximately 50% voiced worry, depression, and stress with <10% voicing spiritual distress. The mean length of stay was 42.6 days (median 10, range 1–1185). While over 70% died in hospice, 27% were discharged home. ConclusionsThe low rate of surgical intervention leads to painful breast wounds that were a major factor for many women seeking hospice admission. The findings challenge our team to maintain expertise in pain and wound management but to also include breast cancer awareness in our rural outreach services.

Deprescribing in Hospice Patients: Discontinuing Aspirin, Multivitamins, and Statins

ObjectiveTo facilitate deprescribing of aspirin, multivitamins, and statins in hospice patients enrolled in Mayo Clinic Hospice, Rochester, Minnesota.Patients and MethodsDuring the fall of 2019, we conducted a quality improvement project to improve care of Mayo Clinic Hospice patients by decreasing the percentage of patients taking aspirin, multivitamins, or statins. Project interventions included the addition of a palliative medicine fellow to the hospice interdisciplinary team, nurse education, and implementation of an evidence-based deprescribing resource tool. The resource tool included a communication framework to guide deprescribing conversations and a literature summary supporting deprescribing. The project team recorded the number of patients taking 1 of these medications by intermittently surveying the hospice census. Process and counterbalance measures were tracked with online surveys of hospice nursing staff.ResultsAt the start of the project, 22 of 69 patients (32%) were taking aspirin, a multivitamin, or a statin. After introduction of the deprescribing resource tool and the addition of a palliative medicine fellow to the interdisciplinary team, this was reduced to 20 of 83 patients (24%), a 24% decrease. Results appeared to be driven primarily by a reduction in multivitamin use (33% decrease). Self-reported comfort and knowledge about deprescribing improved among the hospice nursing staff, as did satisfaction in their workflow from 5.4 to 6.0 (maximum, 7).ConclusionThe addition of a dedicated team member to address medication issues and provision of an evidence-based deprescribing resource tool appear to reduce the use of unnecessary and potentially harmful medications in ambulatory hospice patients.

Parenteral Lidocaine for Complex Cancer Pain in the Home or Inpatient Hospice Setting: A Review and Synthesis of the Evidence.

Background: Cancer pain can remain refractory despite escalating opioids and adjuvants. Systemic Lidocaine is an option, but current approaches are hospital centered. While advantageous in advanced cancer, evidence is lacking for parenteral Lidocaine use in community-based care.Objectives: Review evidence for parenteral lidocaine in complex cancer pain outside the hospital setting.Design: Systematic review of peer-reviewed articles of any study design, including reviews. Search in four databases used keyword variations of “cancer,” “pain,” “Lidocaine,” and “parenteral.” Search was extended through reference lists of full texts assessed. ed data from articles screened and selected were synthesized narratively by a palliative care clinician in Singapore.Results: Eight hundred eighty-three articles identified were screened by title and abstract. Twenty-eight full texts were assessed. Seven articles fulfilled criteria for synthesis of findings. A total of 73 patients received parenteral Lidocaine for mixed pains, reported collectively in 1 retrospective chart review, 3 practice guidelines, 2 case series, and 1 case study. Intravenous or subcutaneous Lidocaine was commenced in hospital or hospice and continued at home. Dosages and administration schedules varied, involving slow bolus with continuous infusion or the latter alone, for up to 240 days. All produced positive outcomes, with no severe adverse events. Monitoring included routine vital signs and conscious levels; electrocardiogram, liver, and renal function tests were uncommon. Lidocaine levels were not consistently assessed.Conclusion: Parenteral Lidocaine can be effective and safe in the community setting. More empirical studies are needed to inform patient selection and treatment protocol, and to validate expected outcomes.

Virtual reality in hospice: improved patient well-being

BackgroundVirtual reality (VR) technology as a therapeutic intervention has been gaining attention in healthcare settings in recent years. Studies suggest that using the technology can help alleviate symptoms such as...

Pharmacists find purpose in end-of-life care

Pharmacists find purpose in end-of-life care