Media Watch 530

Attached is the current edition of Media Watch (#530).

Of special interest:
 

Continuation of non-essential medications in actively dying hospitalised patients

BMJ SUPPORTIVE & PALLIATIVE CARE | Online – 13 September 2017 – Non-essential medications continue to be administered to actively dying patients. Discontinuation of these medications may be facilitated by interventions that enhance recognition and consideration of patients’ actively dying status. In this study, five non-essential medications, clopidogrel, donepezil, glyburide, metformin and propoxyphene, were ordered in less than 5% of cases. More common were orders for simvastatin, calcium tablets, multivitamins, ferrous sulfate, diphenhydramine and subcutaneous heparin. Significant decreases were found for donepezil, propoxyphene, metformin and multivitamins. Orders for one or more non-essential medications were less likely to occur in association with palliative care consultation, do-not-resuscitate orders and orders for death rattle medication. Patients who died in an intensive care unit were more likely to receive a non-essential medication, as were older patients.

 

Gaps in patients’ understanding of palliative chemotherapy. Can we better communicate that treatment is not curative?

EXPERT REVIEW OF QUALITY OF LIFE IN CANCER CARE | Online – 11 September 2017 – Misunderstanding in cancer patients receiving chemotherapy is common; 50% of cancer chemotherapy is given with palliative intent. Many patients receiving chemotherapy for incurable cancer may not understand that chemotherapy is unlikely to be curative. Cancer patients expect to share treatment decisions with their oncologist. Provision of a question prompt list and endorsement by physicians enhances patient participation in consultations and promotes patient questions about prognosis. Audio-recordings of oncologist consultations with newly detected incurable cancer patients document that most patients were informed about the aim of cancer treatment and that their disease was incurable. Oncologists checked patient understanding in only 10% of consultations.