http://archinte.jamanetwork.com/ en-us Mon, 25 Feb 2013 00:00:00 GMT Mon, 25 Feb 2013 15:50:39 GMT Silverchair editor@archinte.jamanetwork.com webmaster@archinte.jamanetwork.com http://archinte.jamanetwork.com/article.aspx?articleID=1566605 Mon, 25 Feb 2013 00:00:00 GMT Yoong J, Park ER, Greer JA, et al. <span class="paragraphSection"><div class="boxTitle">Background</div>Early ambulatory palliative care (PC) is an emerging practice, and its key elements have not been defined. We conducted a qualitative analysis of data from a randomized controlled trial that demonstrated improved quality of life, mood, and survival in patients with newly diagnosed metastatic non–small cell lung cancer who received early PC integrated with standard oncologic care vs standard oncologic care alone. Our objectives were to (1) identify key elements of early PC clinic visits, (2) explore the timing of key elements, and (3) compare the content of PC and oncologic visit notes at the critical time points of clinical deterioration and radiographic disease progression.<div class="boxTitle">Methods</div>We randomly selected 20 patients who received early PC and survived within 4 periods: less than 3 months (n = 5), 3 to 6 months (n = 5), 6 to 12 months (n = 5), and 12 to 24 months (n = 5). We performed content analysis on PC and oncologic visit notes from the electronic health records of these patients.<div class="boxTitle">Results</div>Addressing symptoms and coping were the most prevalent components of the PC clinic visits. Initial visits focused on building relationships and rapport with patients and their families and on illness understanding, including prognostic awareness. Discussions about resuscitation preferences and hospice predominantly occurred during later visits. Comparing PC and oncologic care visits around critical time points, both included discussions about symptoms and illness status; however, PC visits emphasized psychosocial elements, such as coping, whereas oncologic care visits focused on cancer treatment and management of medical complications.<div class="boxTitle">Conclusions</div>Early PC clinic visits emphasize managing symptoms, strengthening coping, and cultivating illness understanding and prognostic awareness in a responsive and time-sensitive model. During critical clinical time points, PC and oncologic care visits have distinct features that suggest a key role for PC involvement and enable oncologists to focus on cancer treatment and managing medical complications.</span> 173 4 283 290 10.1001/jamainternmed.2013.1874 http://archinte.jamanetwork.com/article.aspx?articleID=1566605 http://archinte.jamanetwork.com/article.aspx?articleID=1567628 Mon, 25 Feb 2013 00:00:00 GMT Smith AK. <span class="paragraphSection">In 2010, Temel and colleagues published what many believe is the most influential article in palliative care (PC) since the 1995 publication of the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment (SUPPORT). Temel and colleagues randomized 151 patients at the Massachusetts General Hospital with metastatic non–small cell lung cancer to receive early outpatient PC or standard care. Patients randomized to PC had significant improvement in quality of life and lower rates of depressive symptoms compared with those who received standard care. These findings confirmed the benefits that many clinicians suspected from anecdotal experience. What shocked many was the finding that despite receiving less aggressive end-of-life care, patients randomized to PC had a longer median survival than patients in the standard care group.</span> 173 4 291 292 10.1001/jamainternmed.2013.1888 http://archinte.jamanetwork.com/article.aspx?articleID=1567628