Media Watch 549

Attached is the current issue of Media Watch (#549).

Of particular interest in this week's issue
 
 

When paediatricians and families can’t agree

Archives of Disease in Childhood | Online – 30 January 2018 – Recent high-profile cases have highlighted the difficulties that professionals caring for terminally ill or technology dependent children face. Occasionally there is science and evidence behind the decisions we make, but not always. Medicine does have its black and white disciplines – it is either cancer or it isn’t; or you either need to have an operation or you don’t. But paediatrics is often a discipline of uncertainty dealing with many shades of grey. Paediatricians learn to live with uncertainty and similarly have to support parents and young people to accept this uncertainty. Sometimes we have to wait for nature to reveal itself or for the future to unfold as it should. Herein lies the art of paediatrics: the ability to watch and wait, intervening in a timely fashion when required to do so and recognising the sad eventuality of having to let go of life at times. This is our craft: to do what is in the child’s best interests and use therapies that will help with life’s quality but not unnecessarily prolong inevitable death. However there are competing interests in this delicate balance in doing what is right for the child. 

 

Surveying care teams after in-hospital deaths to identify preventable harm and opportunities to improve advance care planning

The Joint Commission Journal on Quality & Patient Safety, 2018;44(2):84-93. As part of a quality improvement initiative, a post-death care team survey was developed to explore how it might augment the existing process for learning from deaths. A survey was sent to the care team for all inpatient deaths on the hospital medicine and medical ICU services at one institution. Survey responses were reviewed to identify cases that required further investigation. During the distribution period ... 82 patients died, and 191 care team members were surveyed. Based on the survey responses, 5 patients (6.1%) not identified by other review processes were investigated further, resulting in the identification of several important opportunities for improvement. The free-text comment analysis revealed themes around the importance of advance care planning in seriously ill patients, as well as evidence of the emotional and psychological strain on clinicians who care for patients who die. 

 

The growing demand for hospice and palliative medicine physicians: Will the supply keep up?

Journal of Pain & Symptom Management | Online – 2 February 2018 – The need for hospice and palliative care is growing rapidly as the population increases and ages and as both hospice and palliative care become more accepted. Hospice and palliative medicine (HPM) is a relatively new physician specialty, currently training 325 new fellows annually. Given the time needed to increase the supply of specialty trained physicians, it is important to assess future needs to guide planning for future training capacity. The current U.S. supply of HPM specialists is 13.35 per 100,000 adults 65 and over. This ratio varies greatly across the country. Using alternate assumptions for future supply and demand, the authors project need in 2040 will range from 10,640 to almost 24,000 HPM specialist physicians. Supply will range from 8,100 to 19,000. Current training capacity is insufficient to keep up with population growth and demand for services. HPM fellowships would need to grow from the current 325 graduates annually to between 500 to 600 per year by 2030 to assure sufficient physician workforce for hospice and palliative care services given current service provision patterns.