Media Watch 545

Attached is the current issue of Media Watch (#545).

Of particular interest in this week's issue:

Acceptance in the end of life

JAMA ONCOLOGY | Online – 4 January 2018 – Why are terminally ill patients so often over-treated? One major reason is that cancer diagnosis and treatment decisions have been made more difficult by the field’s complexities. While it is acceptable for an aggressive patient to pursue treatment against our recommendation, people tend to simplify situations and settle for sub-optimal solutions. I trust experts to tell me what to do when I am lost in a maze that they can get out of. Likewise, we are called to help patients see through the misinformation, denial, overconfidence, distrust, and confusion that clouds their reasoning. When patients have metastatic cancer, they frequently do not know their prognosis, nor do they always understand the palliative intent of our treatment. This misconception holds for oncologists as well, who tend to overestimate survival time. Another major cause of over-treatment is that both physicians and patients tend to overvalue the end of life (EoL) and make irrational decisions. A life’s ending is weighted especially heavily when quality of life (QoL) is judged. If you ask people to judge how desirable their life was, they overweight their life’s quality at the end and ignore the duration. Physicians grasp this fact, preferring to avoid high-intensity EoL care more than non-physicians. However, we do not effectively communicate this skepticism to patients. Supportive care often yields a better QoL than active treatment, but it is underused and undervalued. Extending a poor QoL is considered a success due to biased thinking shaped by having extended lives of good quality. This misconception holds for oncologists, who tend to overestimate survival time... 

We’re the eyes and the ears, but we don’t have a voice: Perspectives of hospice aides

JOURNAL OF HOSPICE & PALLIATIVE NURSING, 2018;20(1):47-54. Hospice aides (HA) are integral to the delivery of home hospice care and play an essential role in the effective communication and collaboration of the hospice interdisciplinary team. Despite their critical role, little is known about their perceptions of their role in providing hospice services. This qualitative study explores HA’s perspectives of their work; their relationships with patients, families, and interdisciplinary team members; and, their contributions to end-of-life care. Two focus groups of HAs and 16 hours of observation of in-home caregiving were conducted. Three themes were identified: 1) “We’re the eyes and ears”; 2) “We’re kept out of the loop”; and, 3) “We have no voice.” HAs described themselves as frontline providers based on the close relationships they formed with patients and family members yet felt under recognized by members of the hospice team. Better understanding of their role could enhance the integration of HA into patient- and family-centered team interactions, leading to both improved patient and family outcomes and retention and support of this critical component of the hospice workforce. 

I’d recommend ...” How to incorporate your recommendation into shared decision making for patients with serious illness

JOURNAL OF PAIN & SYMPTOM MANAGEMENT | Online – 2 January 2018 –Patients and families facing serious illness often want and need their clinicians to help guide medical decision making by offering a recommendation. Yet clinicians worry that recommendations are not compatible with shared decision-making, and feel reluctant to offer them. The authors describe an expert approach to formulating a recommendation using a shared decision-making framework. They offer three steps: 1) Valuate the prognosis and treatment options; (2) Understand the range of priorities that are important to your patient given the prognosis; and, 3) Base your recommendation on the patient’s priorities most compatible with the likely prognosis and available treatment options.