Fast Facts

# 211 Guided Imagery for Anxiety

Anxiety occurs in hospitalized patients for many reasons including fear of specific procedures, worry about the future, and lack of control. This Fast Fact will discuss guided imagery as an anxiety reduction technique.

# 213 Prognosis in HIV and AIDS

This Fast Fact discusses prognostication in patients who are suffering life-threatening complications related to HIV infection using data where cART was available.

# 215 Opioid Poorly Responsive Cancer Pain

Relief of cancer pain from opioids is rarely all or nothing; most patients experience some degree of analgesia alongside opioid toxicities. While opioid poorly-responsive pain is not a discreet syndrome, it is a commonly encountered clinical scenario. This Fast Fact reviews key points in its assessment and management.

# 217 Restless Leg Syndrome

Restless Leg Syndrome (RLS) is a neurologic disorder characterized by unpleasant sensations in the legs causing an uncontrollable urge to move when at rest in an effort to relieve those feelings. RLS disrupts sleep, can lead to excessive daytime sleepiness, depression, and a decreased quality of life. This Fast Fact will review its evaluation and management.

# 219 Responding to Requests for Non-Disclosure of Medical Information

This Fast Fact will introduce readers to a practical approach to responding to families who request non-disclosure to the patient.

# 221 Treatment of Pain in Patients Taking Buprenorphine for Opioid Addiction

Buprenorphine, a mixed opioid agonist/antagonist, available in the United States, is approved for treatment of opioid addiction in the US; such use is restricted to qualified physicians who have received training and a waiver to practice medication-assisted opioid addiction therapy.

# 223 The Family Meeting: Starting the Conversation

This Fast Fact reviews the early steps of the actual meeting.

# 225 The Family Meeting: Causes of Conflict

This Fast Fact explores understanding the causes of conflict and how to plan an effective strategy to move beyond the conflict to meet the needs of the patient and surrogates.

# 227 The Family Meeting: End of Life Goal Setting and Future Planning

This Fast Fact discusses an approach to goal setting when the expected length of life is short.

# 229 Seizure Management in the Dying Patient

The actual incidence of seizures in dying patients is unknown, and while likely uncommon, they can cause tremendous distress to patients and families. This Fast Fact reviews management strategies for seizures near the end of life.

# 231 Practical Aspects of Using NPPV at the End of Life

This Fast Fact discusses practical aspects of how using Non-Invasive Positive Pressure Ventilation (NPPV) can be used to palliate dyspnea in dying patients.

# 233 Implementation of a Family Presence During Resuscitation Protocol

The key components of a successful Family Presence During Resuscitation Protocol policy

# 235 Prognostic Models in Critically Ill Adults

Common ICU prognostic models and their role in guiding patient care and communication

# 237 Evaluation of Spinal Cord Compression

The clinical features and diagnosis of Spinal Cord Compression in adults

# 239 Prognostication in Severe Traumatic Brain Injury in Adults

Discusses prognostication in severe Traumatic Brain Injury in adults

# 241 Improving Communication When Hearing Loss is Present

Hearing loss can lead to misunderstandings, which in the health care setting can literally have life-or-death implications.

# 243 Palliative Care for Patients with Down Syndrome

# 245 Addressing Medical-Legal Suffering for Patients with Advanced Illness

# 247 Initiating a Hospice Referral from the Emergency Department

Patients with an end-stage illness often present to the Emergency Department (ED) with a crisis event (1). This Fast Fact provides information for ED providers on how to refer a patient to hospice care directly from the ED (2). Fast Fact #246 suggests strategies for caring for patients receiving hospice care who present to the ED.

# 249 Topical Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the treatment of musculoskeletal pain. This Fast Fact reviews the pharmacology, clinical efficacy and adverse effects of topical NSAIDs for the treatment of musculoskeletal pain.

# 251 Carotid Blowout Management

Carotid blowout is the rupture of the extracranial carotid arteries or their major branches. It is an uncommon but devastating complication of head and neck cancer. This Fast Fact will discuss the approach to patients with carotid blowout, including patients near the end of life whose care goals are focused on safety and comfort.

# 253 Palliative Care Consultation in the ICU

The Intensive Care Unit (ICU) is the setting for high-intensity health care designed to resolve life-threatening illnesses and extend life. However, risks of mortality and severe morbidity remain high and virtually all ICU patients have palliative care needs. This Fast Fact reviews the role of palliative care consultations in the ICU along with options for more generalist palliative care services provided by ICU clinicians

# 255 Topical Capsaicin for Neuropathic Pain

Capsaicin 0.075% cream demonstrated statistically significant benefit in post-herpetic neuralgia, post-surgical neuropathies, and diabetic neuropathy, compared to placebo.

# 257 Use of Rectal Meds for Palliative Care Patients

This Fast Fact introduces the use of rectal medications for patients in palliative care settings. The rectal route is an efficient and practical alternative in administering a broad array of palliative care medications to patients with a compromised oral route.

# 259 Modafinil

Modafinil is a non-amphetamine psychostimulant approved for the treatment of excessive daytime somnolence associated with obstructive sleep apnea, narcolepsy, and shift work sleep disorder. This Fast Fact reviews use of modafinil for symptom management in the seriously ill.

# 261 Hot Flashes in Palliative Care – Part 1

Hot flashes are a common symptom which can negatively impact quality of life. Failure to assess and offer treatment for hot flashes is common. This Fast Fact is the first in a three part series reviewing hot flash assessment and treatment.

# 263 Hot Flashes in Palliative Care – Part 3

Assessment and drug treatments of hot flashes (‘flushes’) were discussed in Fast Facts # 261-2; this Fast Fact reviews non-drug and complementary/alternative medicine (CAM) therapies.

# 200 Non-Opioid Anti-Tussives

This Fast Fact will address peripherally-acting agents.

# 202 Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures, 2nd Edition

Vertebral compression fractures (VCFs) occur in up to 20% of patients above the age of 50, mostly due to osteoporosis.

# 204 African Americans and End-of Life Care

This Fast Fact outlines research findings on differences in end-of-life care and values between African Americans and the population as a whole.

# 206 Genetic Screening and DNA Banking at the End-of-Life

Once patients die, however, their DNA is no longer readily available for this future testing. On the other hand, decisions about genetic testing are complex and can have profound emotional, familial, and financial impacts on those affected and should not be pursued hastily.

# 208 Clinical Care Following Withdrawal of Dialysis

This Fast Fact addresses care of the patient around the time of dialysis discontinuation.

# 264 Prostacyclin Withdrawal in Pulmonary Hypertension

Pulmonary artery hypertension (PAH) is a disease of the pulmonary vascular system characterized by elevated pulmonary vascular resistance. Patients with advanced PAH are often treated with prostacyclins. This Fast Fact reviews suggested guidelines for withdrawal of prostacyclin therapy in dying patients with PAH.

# 012 Myths About Advance Directives, 2nd ed

There are two general types of advance directives:

# 003 Syndrome of Imminent Death, 2nd ed

This trajectory is often referred to as “actively dying” or “imminent death”. Prompt recognition of this trajectory is key for clinicians to provide the most appropriate interventions for both the patient and family.

# 002 Converting to/from Transdermal Fentanyl, 2nd ed

Quick—what dose of the transdermal fentanyl patch (DuragesicTM) is equianalgesic to a 3 mg/hr morphine continuous infusion? Conversions to and from fentanyl transdermal are notoriously tricky, requiring knowledge of the published conversion data, general opioid pharmacology, and a generous dose of common sense. See also Fast Fact #36 on opioid dose conversions.

# 006 Delivering Bad News-Part 1, 2nd ed

Case Scenario: You are caring for a previously healthy 52 year old man with a new problem of abdominal pain. After conservative treatments fail, a diagnostic abdominal CT scan is done showing a focal mass with ulceration in the body of the stomach and numerous (more than 10) densities in the liver compatible with liver metastases. The radiologist feels that the findings are absolutely typical of metastatic stomach cancer. How do you prepare to discuss these test results with the patient?

# 008 Morphine and Hastened Death, 2nd ed

Question: What is the distinction between the use of morphine at the end of life to control symptoms and euthanasia/assisted suicide?

# 010 Tube Feed or Not Tube Feed?, 2nd ed

The Fast Fact reviews data on the use of tube feeding in advanced illness.

# 014 Palliative Chemotherapy, 2nd ed

One often hears the term palliative chemotherapy, but what exactly does it mean and how can a non-oncologist decide if it has potential value?

# 016 Moderating an End-of-Life Family Conference, 2nd ed

Learning the process steps of a Family Conference are an important skill for physicians, nurses and others who are in a position to help patients and families reach consensus on end-of-life planning.

# 019 Taking A Spiritual History, 2nd ed

Taking a spiritual history is one way to support the patient in this exploration.

# 033 Ventilator Withdrawal Protocol, 2nd ed

This is the first part of a three-part series on withdrawing ventilators in patients expected to die

# 021 Hope and Truth Telling, 2nd ed

This Fast Fact discusses the difficult balance between maintaining hope and truth telling, especially as it applies to giving bad news.

# 023 Discussing DNR Orders-Part 1, 2nd ed

`Code status’ discussions with seriously ill patients should always take place in the context of the larger goals of care, using a step-wise approach. This Fast Fact introduces an approach to having these discussions.

# 025 Opioids and Nausea, 2nd ed

Why do patients get nauseated and vomit after receiving an opioid?

# 027 Dyspnea at End of Life, 2nd ed

This Fast Fact reviews key elements in the assessment and treatment of dyspnea near the end-of-life.

# 029 Responding to Patient Emotion, 2nd ed

Here are eight tasks that guide you in responding to patient emotion:

# 031 Confronting Personal Mortality, 2nd ed

Confronting our own mortality

# 034 Symptom Control for Ventilator Withdrawal in the Dying Patient, 2nd ed

This is the second of a three-part series: Symptom Control for Ventilator Withdrawal in the Dying Patient

# 036 Calculating Opioid Dose Conversions, 2nd ed

Listed below are methods for common conversions using standard published conversion ratios.

# 038 Discussing Hospice, 2nd ed

Hospice discussions with seriously ill patients should always take place in the context of the larger goals of care, using a step-wise approach.

# 047 What Do I Tell The Children, 2nd ed

A common question asked by dying adults or their family members is What do I tell the children?

# 042 Broaching the Topic of a Palliative Care Consultation with Patients and Families, 2nd ed

This Fast Fact provides tips for beginning a discussion leading to a visit by a palliative care consultation team.

# 044 Changing the Status Quo-Quality Improvement, 2nd ed

How do you change the status quo? What can you do when the system of care does not support best practice?

# 046 Malignant Wounds, 2nd ed

Few things can worsen a patient’s quality of life greater than an oozing, odorous, painful, and bleeding malignant skin wound.

# 049 Gabapentin for Neuropathic Pain, 2nd ed

Gabapentin (Neurontin) is widely used for neuropathic pain.

# 051 Choosing an Oral Opioid Combination Product, 2nd ed

This Fast Fact will review information for rationally choosing among the various products.

# 053 Sublingual Morphine, 2nd ed

The advantage of using SL morphine over intermittent IV boluses is a longer duration of action.

# 055 Decision Making Capacity, 2nd ed

In contrast, decision making capacity (‘decisionality’) refers to a physician’s determination, based on clinical examination, that a patient is able to make medical decisions for him- or herself.

# 057 Neuroexcitatory Effects of Opioids: Patient Assessment, 2nd ed

This Fast Fact will discuss risk factors and patient assessment of the neuroexcitatory opioid side effects, particularly myoclonus

# 059 Dealing with Anger, 2nd ed

A guide to managing these situations is presented below.

# 101 Insomnia: Patient Assessment 2nd Edition

This Fast Fact focuses on the assessment of insomnia; it is the first of a series of three Fast Facts about insomnia .

# 103 Oral Transmucosal Fentanyl Citrate, 2nd ed

This Fast Fact only discusses OTFC (Actiq).

# 105 Insomnia: Pharmacological Therapies 2nd Edition

This Fast Fact focuses on the pharmacological treatment of insomnia.

# 107 Controlled Sedation for Refractory Suffering - Part II

This Fast Fact will review sedation techniques.

# 109 Death Rattle and Oral Secretions, 2nd ed

As the level of consciousness decreases in the dying process, patients lose their ability to swallow and clear oral secretions.

# 111 Cardiac Pacemakers at End-of-Life

This Fast Fact discusses management of cardiac pacemakers at life’s end.

# 113 Bisphosponates for Bone Pain

Bisphosphonates are used for the treatment or prophylaxis of cancer-related bone complications, including pain.

# 115 Declaring Brain Death: The Neurologic Criteria

This Fast Fact reviews the details of declaring death based on neurological criteria.

# 117 Pediatric Pain Assessment Scales

Research has shown that neonates may experience as much pain as older children and long-term consequences from exposure to repeated painful stimuli.

# 119 Invasive Treatment Options for Malignant Bowel Obstruction

Invasive treatment options should be considered for all patients except those who are actively dying.

# 121 Oral Mucositis: Diagnosis and Assessment

This Fast Fact discusses the diagnosis and assessment of mucositis.

# 123 Palliative Care and ICU Care: Daily ICU Care Plan Checklist

An ICU daily care plan checklist can be used to promote palliative care, simultaneously with curative or life-prolonging therapies.

# 125 The Palliative Performance Scale (PPS)

This Fast Fact reviews the Palliative Performance Scale.

# 127 Substance Use Disorders in the Palliative Care Patient, 2nd ed

The spectrum of substance use disorders (SUDs) are characterized by increasing degrees of craving, compulsive use, loss of control, and continued use despite harm.

# 129 Steroids in the Treatment of Bone Pain

This Fast Fact discusses the use of corticosteroids for painful bone metastases.

# 061 Use of Psycho-Stimulants in Palliative Care, 2nd ed

More than 95% of patients experience fatigue near the end of life

# 063 The Legal Liability of Under-Treatment of Pain, 2nd ed

It is well recognized that physician’s fear of regulatory scrutiny (DEA, state medical boards), is a major contributor to the problem of under treatment of pain.

# 065 Establishing End-of-Life Goals: The Living Will Interview, 2nd ed

Doctor-patient discussions about end-of-life treatment are often framed as a choice between “medical treatment vs. treatment withdrawal.”

# 067 Radiation for Palliation - Part 2, 2nd ed

This Fast Fact reviews the common indications for and outcomes of palliative XRT.

# 069 Pseudoaddiction, 2nd ed

Put simply, pseudoaddiction is something that we do to patients, through our fears and mis-understanding of pain, pain treatment, and addiction.

# 071 Meperidine for Pain: What's all the fuss?, 2nd ed

This Fast Fact discusses the pharmacology of MP and concerns about its use as an analgesic.

# 073 Amyotrophic Lateral Sclerosist (ALS) Management of Respiratory Failure, 2nd ed

Respiratory failure is the most common cause of death from amyotrophic lateral sclerosis (ALS).

# 075 Methadone for the Treatment of Pain, 2nd ed

This Fast Fact will introduce methadone’s pharmacology and clinical use as an analgesic.

# 077 Telephone Notification of Death - Part 2, 2nd ed

This Fast Fact discusses the dilemma of whether to provide telephone information versus asking family members to first come to hospital before telling them that death has occurred.

# 079 Discussing Organ Donation with Families, 2nd ed

The purpose of this Fast Fact is to review the issues surrounding organ, tissue, and cornea donation.

# 081 Management of Hiccups, 2nd ed

Hiccups (singultus) are distressing to patients and families; when chronic, they diminish quality of life.

# 083 Why Patients Do Not Take Their Opioids, 2nd ed

his Fast Fact discusses common reasons that patients do not take prescribed opioids, thus resulting in unnecessary pain and suffering.

# 085 Epidural Analgesia, 2nd ed

In palliative care, epidural analgesia may be appropriate for patients with regional pain (e.g. pelvic pain from cervical cancer) and/or patients who do not tolerate or obtain relief from oral/parenteral drugs and non-drug therapies.

# 087 Medicare Hospice Benefit Part II: Places of Care and Funding, 2nd ed

This Fast Fact will review where services are provided and the reimbursement system for hospice care.

# 089 Pain Management in Nursing Homes: Analgesic Prescribing Tips, 2nd ed

This Fast Fact will review simple strategies for improving pain management outcomes.

# 091 Interventional Options for Malignant Upper GI Obstruction, 2nd ed

This Fact Fact reviews interventional approaches for upper GI obstructions, especially when further radiation, chemotherapy, medical management, or curative surgical options are longer helpful.

# 093 Cannabinoids in the Treatment of Symptoms in Cancer and AIDS, 2nd ed

Recent scientific studies of cannabinoids for symptom management have focused on nausea/vomiting and appetite stimulation.

# 095 Opioid Withdrawal, 2nd ed

Physical dependence is a normal and predictable neurophysiological response to regular treatment with opioids for more than 1-2 weeks duration.

# 097 Blocks of the Sympathetic Axis for Visceral Pain, 2nd ed

In the palliative care setting, the most common indication for interrupting the sympathetic axis is to control pain arising from malignancies of the abdominal and pelvic viscera.

# 099 Chemotherapy: Response and Survival Data, 2nd ed

The table below synthesizes data for several common cancers.

# 130 Oral Mucositis: Prevention and Treatment

This Fast Fact focuses on prevention and general treatment of radiation (XRT) and chemotherapy-induced oral mucositis.

# 132 Ketamine Use in Palliative Care

This Fast Fact reviews the use of ketamine in palliative care as an analgesic.

# 134 Non-Oral Hydration Techniques in Palliative Care

This Fast Fact reviews the technical aspects of providing non-oral hydration.

# 136 Medical Futility

This Fast Fact will discuss the current understanding of the term futility.

# 138 Grief in Children and Developmental Concepts of Death

This Fast Fact reviews key developmental concepts and describes strategies for addressing children’s grief.

# 140 Medicare Hospice Benefit: Levels of Hospice Care

Because more than 95% of hospice care is in the form of routine home care, clinicians may not be aware that the MHB specifies four different levels of hospice services to meet the diverse needs of dying patients and their family.

# 142 Opioid-Induced Hyperalgesia

This Fast Fact reviews the clinical findings and treatment options

# 144 Palliative Care Issues in Heart Failure

This Fast Fact reviews domains of medical management common to most end-stage HF patients.

# 146 Screening for Depression in Palliative Care

This Fast Fact reviews that literature on depression screening tools.

# 148 The Lidocaine Patch

This Fast Fact reviews its mechanism of action, research data, and dosage information.

# 150 Prognostication in Dementia

This Fast Fact reviews issues of prognostication in dementia.

# 152 The Military History as a Vehicle for Exploring End-of-Life Care with Veterans

Knowing the components of a military history can be a useful tool in bridging the silence that often surrounds the war experience and can act as a catalyst for discussions about end of life preferences.

# 154 Use of Interpreters in Palliative Care

This Fast Fact reviews key issues when using interpreters in the palliative care setting.

# 156 Evaluating Requests for Hastened Death

This Fast Fact provides guidance on how to evaluate and initially respond to a patient who raises the topic of a hastened death.

# 158 Respiratory Secretion Management

This Fast Fact reviews treatment options for managing distressing secretions.

# 160 Screening ICU Delirium

Delirium can be hypoactive or hyperactive. Patients with hypoactive delirium are calm, but inattentive and manifest decreased mobility. Patients with hyperactive delirium are agitated and combative, and also lack the ability to maintain attention to complete tasks.

# 162 Advance Care Planning in Chronic Illness

This Fast Fact reviews key concepts of the Advance Care Planning (ACP) process.

# 164 Informed Consent in Palliative Care - Part I

This Fast Fact reviews the legal basis for informed consent.

# 166 Once Daily Oral Morphine Formulations

To prevent confusion due to similar generic names, this Fast Fact will use trade-names for Kadian and Avinza, and “ER-morphine” to describe extended-release formulations which are usually dosed q12 hours.

# 168 Health Professional Burnout - Part II

This Fast Fact will explore symptoms of burnout and its personal and professional consequences.

# 170 Health Professional Burnout - Part IV

This Fast Fact will briefly describe assessment tools used in health professional research.

# 172 Professional Patient Boundries in Palliative Care

This Fast Fact reviews issues in health professional-patient boundaries in palliative care.

# 174 Dementia Medications in Palliative Care

This Fast Fact will suggest guidelines for continued use or discontinuation in the hospice/palliative care setting.

# 176 Evaluation of Malignant Ascites

This Fast Fact reviews the causes and diagnosis of malignant ascites.

# 178 The National Polst Paradigm Initiative, 2nd Edition

This Fast Fact will review key elements of the POLST project.

# 180 Parenteral Lidocaine for Neuropathic Pain

This Fast Fact reviews the use of parenteral lidocaine for neuropathic pain.

# 182 Xerstomia, 2nd ed

This Fast Fact will review the causes and treatments of xerostomia.

# 184 Conflict Resolution II: Principled Negotiation

Principled negotiation is an approach to resolving conflict that avoids power struggles and unwanted compromises.

# 186 Anxiety in Palliative Care - Causes and Diagnosis

This Fast Fact will discuss the causes and evaluation of anxiety.

# 188 Hepatic Encephalopathy in ESLD

Hepatic encephalopathy (HE) is a neuropsychiatric syndrome with a fluctuating course associated with end stage liver disease (ESLD).

# 190 Parenteral Nutrition in Advanced Cancer Patients

This Fast Fact reviews the role of PN in advanced cancer patients.

# 192 Palliative Care for Adults with Developmental Disabilities

This Fast Fact will review special issues in the care of developmentally disabled people with life-limiting diseases.

# 194 Disclosing Medical Error

This Fast Fact will address how to disclose error with a patient/family.

# 196 Bisphosphonates and Osteonecrosis of the Jaw

Osteonecrosis of the jaw (ONJ) is a potentially devastating complication associated with bisphosphonate therapy.

# 198 Regulatory Issues for Prescribing Schedule II Opioids at the End-of-Life

This Fast Fact will review US federal regulations regarding prescribing Schedule II drugs.

# 001 Diagnosis and Treatment of Terminal Delirium, 2nd ed

This Fast Fact reviews assessment and management issues in terminal delirium.

# 003 Syndrome of Imminent Death, 2nd ed

This trajectory is often referred to as “actively dying” or “imminent death”. Prompt recognition of this trajectory is key for clinicians to provide the most appropriate interventions for both the patient and family.

# 005 The Causes of Nausea and Vomiting (V.O.M.I.T.), 2nd ed

An easy way to remember the causes of vomiting is the VOMIT acronym. In the table below receptors involved in different types of nausea are highlighted using this acronym. Blockade of these receptors allows rational, focused therapy.

# 007 Depression in Advanced Cancer, 2nd ed

Endicott has proposed substituting somatic criteria with affective criteria when evaluating depression in advanced cancer patients:

# 009 Hospice & Palliative Medicine Recertification Exam, 2nd ed

# 011 Delivering Bad News-Part 2, 2nd ed

Residents often feel strong emotions when they have to give bad news to a patient. As a preceptor, you will want to support the resident. Key teaching points:

# 013 Determining Prognosis in Advanced Cancer, 2nd ed

How long do I have, Doc?

# 015 Constipation, 2nd ed

Four major components affect the production of a normal BM: solid waste, water, motility and lubrication.

# 017 Patient-Centered Interviewing, 2nd ed

Patient-centered Interviewing - You can assess a patient’s illness experience by asking about 4 dimensions—Feelings, Ideas, Function and Expectations. The acronym FIFE can be a helpful reminder.

# 019 Taking A Spiritual History, 2nd ed

Taking a spiritual history is one way to support the patient in this exploration.

# 021 Hope and Truth Telling, 2nd ed

This Fast Fact discusses the difficult balance between maintaining hope and truth telling, especially as it applies to giving bad news.

# 023 Discussing DNR Orders-Part 1, 2nd ed

`Code status’ discussions with seriously ill patients should always take place in the context of the larger goals of care, using a step-wise approach. This Fast Fact introduces an approach to having these discussions.

# 025 Opioids and Nausea, 2nd ed

Why do patients get nauseated and vomit after receiving an opioid?

# 027 Dyspnea at End of Life, 2nd ed

This Fast Fact reviews key elements in the assessment and treatment of dyspnea near the end-of-life.

# 029 Responding to Patient Emotion, 2nd ed

Here are eight tasks that guide you in responding to patient emotion:

# 031 Confronting Personal Mortality, 2nd ed

Confronting our own mortality

# 033 Ventilator Withdrawal Protocol, 2nd ed

This is the first part of a three-part series on withdrawing ventilators in patients expected to die

# 035 Information for Patients and Families About Ventilator Withdrawal, 2nd ed

This is Part 3 of a three-part series on withdrawing ventilator withdrawal.

# 037 Pruritus, 2nd ed

Pruritus (itching) is a common and often distressing symptom near the end of life.

# 039 Using Naloxone, 2nd ed

Naloxone (Narcan®), a semisynthetic opioid antagonist, is indicated for the complete or partial reversal of life-threatening CNS/respiratory depression induced by opioids.

# 041 Pressure Ulcer Management: Debridement & Dressings (Part 2), 2nd ed

This Fast Fact discusses the management, staging and prevention of pressure ulcers.

# 043 Is It Grief of Depression?, 2nd ed

This Fast Fact will review the definitions and clinical features that distinguish these conditions

# 045 Medical Management of Bowel Obstruction, 2nd ed

Malignant bowel obstruction is a common oncologic complication; most common in ovarian and colon cancer.

# 047 What Do I Tell The Children, 2nd ed

A common question asked by dying adults or their family members is What do I tell the children?

# 049 Gabapentin for Neuropathic Pain, 2nd ed

Gabapentin (Neurontin) is widely used for neuropathic pain.

# 051 Choosing an Oral Opioid Combination Product, 2nd ed

This Fast Fact will review information for rationally choosing among the various products.

# 053 Sublingual Morphine, 2nd ed

The advantage of using SL morphine over intermittent IV boluses is a longer duration of action.

# 055 Decision Making Capacity, 2nd ed

In contrast, decision making capacity (‘decisionality’) refers to a physician’s determination, based on clinical examination, that a patient is able to make medical decisions for him- or herself.

# 057 Neuroexcitatory Effects of Opioids: Patient Assessment, 2nd ed

This Fast Fact will discuss risk factors and patient assessment of the neuroexcitatory opioid side effects, particularly myoclonus

# 059 Dealing with Anger, 2nd ed

A guide to managing these situations is presented below.

# 061 Use of Psycho-Stimulants in Palliative Care, 2nd ed

More than 95% of patients experience fatigue near the end of life

# 063 The Legal Liability of Under-Treatment of Pain, 2nd ed

It is well recognized that physician’s fear of regulatory scrutiny (DEA, state medical boards), is a major contributor to the problem of under treatment of pain.

# 065 Establishing End-of-Life Goals: The Living Will Interview, 2nd ed

Doctor-patient discussions about end-of-life treatment are often framed as a choice between “medical treatment vs. treatment withdrawal.”

# 067 Radiation for Palliation - Part 2, 2nd ed

This Fast Fact reviews the common indications for and outcomes of palliative XRT.

# 069 Pseudoaddiction, 2nd ed

Put simply, pseudoaddiction is something that we do to patients, through our fears and mis-understanding of pain, pain treatment, and addiction.

# 071 Meperidine for Pain: What's all the fuss?, 2nd ed

This Fast Fact discusses the pharmacology of MP and concerns about its use as an analgesic.

# 073 Amyotrophic Lateral Sclerosist (ALS) Management of Respiratory Failure, 2nd ed

Respiratory failure is the most common cause of death from amyotrophic lateral sclerosis (ALS).

# 075 Methadone for the Treatment of Pain, 2nd ed

This Fast Fact will introduce methadone’s pharmacology and clinical use as an analgesic.

# 077 Telephone Notification of Death - Part 2, 2nd ed

This Fast Fact discusses the dilemma of whether to provide telephone information versus asking family members to first come to hospital before telling them that death has occurred.

# 079 Discussing Organ Donation with Families, 2nd ed

The purpose of this Fast Fact is to review the issues surrounding organ, tissue, and cornea donation.

# 081 Management of Hiccups, 2nd ed

Hiccups (singultus) are distressing to patients and families; when chronic, they diminish quality of life.

# 083 Why Patients Do Not Take Their Opioids, 2nd ed

his Fast Fact discusses common reasons that patients do not take prescribed opioids, thus resulting in unnecessary pain and suffering.

# 085 Epidural Analgesia, 2nd ed

In palliative care, epidural analgesia may be appropriate for patients with regional pain (e.g. pelvic pain from cervical cancer) and/or patients who do not tolerate or obtain relief from oral/parenteral drugs and non-drug therapies.

# 087 Medicare Hospice Benefit Part II: Places of Care and Funding, 2nd ed

This Fast Fact will review where services are provided and the reimbursement system for hospice care.

# 089 Pain Management in Nursing Homes: Analgesic Prescribing Tips, 2nd ed

This Fast Fact will review simple strategies for improving pain management outcomes.

# 091 Interventional Options for Malignant Upper GI Obstruction, 2nd ed

This Fact Fact reviews interventional approaches for upper GI obstructions, especially when further radiation, chemotherapy, medical management, or curative surgical options are longer helpful.

# 093 Cannabinoids in the Treatment of Symptoms in Cancer and AIDS, 2nd ed

Recent scientific studies of cannabinoids for symptom management have focused on nausea/vomiting and appetite stimulation.

# 095 Opioid Withdrawal, 2nd ed

Physical dependence is a normal and predictable neurophysiological response to regular treatment with opioids for more than 1-2 weeks duration.

# 097 Blocks of the Sympathetic Axis for Visceral Pain, 2nd ed

In the palliative care setting, the most common indication for interrupting the sympathetic axis is to control pain arising from malignancies of the abdominal and pelvic viscera.

# 099 Chemotherapy: Response and Survival Data, 2nd ed

The table below synthesizes data for several common cancers.

# 101 Insomnia: Patient Assessment 2nd Edition

This Fast Fact focuses on the assessment of insomnia; it is the first of a series of three Fast Facts about insomnia .

# 103 Oral Transmucosal Fentanyl Citrate, 2nd ed

This Fast Fact only discusses OTFC (Actiq).

# 105 Insomnia: Pharmacological Therapies 2nd Edition

This Fast Fact focuses on the pharmacological treatment of insomnia.

# 107 Controlled Sedation for Refractory Suffering - Part II

This Fast Fact will review sedation techniques.

# 109 Death Rattle and Oral Secretions, 2nd ed

As the level of consciousness decreases in the dying process, patients lose their ability to swallow and clear oral secretions.

# 111 Cardiac Pacemakers at End-of-Life

This Fast Fact discusses management of cardiac pacemakers at life’s end.

# 113 Bisphosponates for Bone Pain

Bisphosphonates are used for the treatment or prophylaxis of cancer-related bone complications, including pain.

# 115 Declaring Brain Death: The Neurologic Criteria

This Fast Fact reviews the details of declaring death based on neurological criteria.

# 117 Pediatric Pain Assessment Scales

Research has shown that neonates may experience as much pain as older children and long-term consequences from exposure to repeated painful stimuli.

# 119 Invasive Treatment Options for Malignant Bowel Obstruction

Invasive treatment options should be considered for all patients except those who are actively dying.

# 121 Oral Mucositis: Diagnosis and Assessment

This Fast Fact discusses the diagnosis and assessment of mucositis.

# 123 Palliative Care and ICU Care: Daily ICU Care Plan Checklist

An ICU daily care plan checklist can be used to promote palliative care, simultaneously with curative or life-prolonging therapies.

# 125 The Palliative Performance Scale (PPS)

This Fast Fact reviews the Palliative Performance Scale.

# 127 Substance Use Disorders in the Palliative Care Patient, 2nd ed

The spectrum of substance use disorders (SUDs) are characterized by increasing degrees of craving, compulsive use, loss of control, and continued use despite harm.

# 129 Steroids in the Treatment of Bone Pain

This Fast Fact discusses the use of corticosteroids for painful bone metastases.

# 131 The Physician as Family Member

Caring for a dying patient who has a physician-family member provides challenges and opportunities.

# 133 Non-Oral Hydration in Palliative Care

This Fast Fact discusses medical decision-making about non-oral hydration in palliative care settings.

# 135 Neoplastic Meningitis

Neoplastic meningitis (NM) – also known as leptomeningeal metastases, meningeal carcinomatosis, or leukemic meningitis, is a common oncologic complication representing spread of tumor cells to the subarachnoid space (SAS).

# 137 Carcinoid Syndrome: Symptom Management

This Fast Fact will focus on managing the symptoms of CS.

# 139 Hospice Referral: Moving from Hospital to Home

This Fast Fact reviews key steps in the transition from the acute care hospital setting to home hospice care.

# 141 Prognosis in End-Stage COPD

This Fast Fact will review prognostication in patients with advanced COP

# 143 Prognostication in Heart Failure

This Fast Fact reviews prognostication data in Heart Failure (HF).

# 145 Panic Disorder at the End-of-Life

Separating “normal” death-related anxiety from pathological panic is an important palliative care skill.

# 147 Oropharyngeal Candidasis

Oropharyngeal candidiasis (thrush) occurs commonly in seriously ill and dying patients.

# 149 Teaching the Family What To Expect When the Patient Is Dying

Family members look to the physician and nurse to help them know what to expect when a loved one is dying.

# 151 Hypercalcemia of Malignancy

Up to 30 percent of patients with cancer develop hypercalcemia.

# 153 Health Literacy in Palliative Medicine

This Fast Fact reviews assessment and management strategies for poor health literacy.

# 155 Completing a Death Certificate

This Fast Fact reviews key steps in the completion of a death certificate.

# 157 Malignant Pleural Effusions Interventional Management

This Fast Fact reviews key facts regarding effusion management.

# 159 Responding to a Request for Hastening Death

This Fast Fact focuses on possible ways of responding to patients who continue to want a hastened death despite every effort to find appropriate palliative care alternatives.

# 161 Opioid Use in Renal Failure

This Fast Fact reviews recommendations for opioid use in the setting of renal failure and in patients receiving chronic dialysis.

# 163 Decision Making in Chronic Kidney Disease

This Fast Fact reviews key concepts of the ACP process for CKD patients.

# 165 Informed Consent in Palliative Care - Part II

This Fast Fact discusses common myths about informed consent that arise in palliative care.

# 167 Health Professional Burnout - Part I

This Fast Fact will describe burnout and its risk factors, and review essential research regarding health professionals and burnout.

# 169 Health Professional Burnout - Part III

This Fast Fact will address strategies to avoid burnout while sustaining personal and professional health, integrity, and growth.

# 171 Methadone for Neuropathic Pain

This Fast Fact examines the research base regarding methadone and neuropathic pain and reviews the rise in methadone-related deaths.

# 173 Cancer Related Fatigue

This Fast Fact reviews diagnostic and treatment approaches in the palliative care setting.

# 175 Opioid Allergic Reactions

This Fast Fact will review signs, symptoms, and management options of opioid allergies and pseudo-allergies.

# 177 Palliative Treatment of Malignant Ascites

This Fast Fact will review treatment approaches and the important role of determining the Serum Ascites-Albumin Gradient as a diagnostic and treatment aid.

# 179 CPR Survival in the Hospital Setting

This Fast Fact will review data on CPR outcomes in hospitalized patients.

# 181 Oral Oxymorphone

This Fast Fact will review oral oxymorphone and its place in pain management.

# 183 Conflict Resolution I: Careful Communication

This Fast Fact provides an alternative approach to conflict resolution based on understanding a patient’s or family’s story, attending to their emotions, and establishing shared goals.

# 185 Topical Opioids for Pain

This Fast Fact reviews the mechanism of action, research data, and dosing information on topically applied opioids.

# 187 Non-Tricyclic Antidepressants for Neuropathic Pain

This Fast Fact reviews the use of non-tricyclic antidepressants for neuropathic pain.

# 189 Prognosis in Decompensated Chronic Liver Failure

This Fast Fact reviews prognosis in chronic liver failure, focusing on two validated prognostic indices.

# 191 Prognostication in Patients Receiving Dialysis

This Fast Fact reviews the current data regarding prognostication in patients receiving chronic hemo- and peritoneal dialysis.

# 193 Decision Making for Adults with Developmental Disabilities Near the End-of-Life

This Fast Fact will address medical decision making for adults with developmental disabilities (DD) who are facing terminal or life-limiting diseases such as cancer, end-stage organ failure, or progressive debility.

# 195 Responding to a Colleague's Error

This Fast Fact will discuss responding to a colleague’s error.

# 197 Chemotherapy Associated Peripheral Neuropathy

This Fast Fact will review the clinical features and treatment of CAPN.

# 199 Opioids for Cough

This Fast Fact will focus on the use of opioids for the symptomatic treatment of cough.

# 201 Palliative Care for Patients with Huntington's Disease

This Fast Fact will focus on supportive and terminal care for patients with HD and their families.

# 203 Managing One's Emotions as a Clinician

This Fast Fact focuses on clinicians’ emotional responses to patient care.

# 205 Destination Ventricular Assist Devices for Heart Failure

In 2002, the FDA approved the LVAD not only as “bridge therapy”, but also as an alternative to transplantation, or “destination therapy.”

# 207 Withdrawl of Dialysis: Decision Making

This Fast Fact reviews key issues pertaining to the decision to stop chronic dialysis; Fast Fact #208 will discuss the care of patients after it is stopped.

# 209 Malignant Pericardial Effusions

Malignant pericardial effusions (MPEs) are a rare complication of advanced cancer, but are associated with high morbidity and mortality. This Fast Fact discusses the diagnosis and management of MPEs.

# 211 Guided Imagery for Anxiety

Anxiety occurs in hospitalized patients for many reasons including fear of specific procedures, worry about the future, and lack of control. This Fast Fact will discuss guided imagery as an anxiety reduction technique.

# 213 Prognosis in HIV and AIDS

This Fast Fact discusses prognostication in patients who are suffering life-threatening complications related to HIV infection using data where cART was available.

# 215 Opioid Poorly Responsive Cancer Pain

Relief of cancer pain from opioids is rarely all or nothing; most patients experience some degree of analgesia alongside opioid toxicities. While opioid poorly-responsive pain is not a discreet syndrome, it is a commonly encountered clinical scenario. This Fast Fact reviews key points in its assessment and management.

# 217 Restless Leg Syndrome

Restless Leg Syndrome (RLS) is a neurologic disorder characterized by unpleasant sensations in the legs causing an uncontrollable urge to move when at rest in an effort to relieve those feelings. RLS disrupts sleep, can lead to excessive daytime sleepiness, depression, and a decreased quality of life. This Fast Fact will review its evaluation and management.

# 219 Responding to Requests for Non-Disclosure of Medical Information

This Fast Fact will introduce readers to a practical approach to responding to families who request non-disclosure to the patient.

# 221 Treatment of Pain in Patients Taking Buprenorphine for Opioid Addiction

Buprenorphine, a mixed opioid agonist/antagonist, available in the United States, is approved for treatment of opioid addiction in the US; such use is restricted to qualified physicians who have received training and a waiver to practice medication-assisted opioid addiction therapy.

# 223 The Family Meeting: Starting the Conversation

This Fast Fact reviews the early steps of the actual meeting.

# 225 The Family Meeting: Causes of Conflict

This Fast Fact explores understanding the causes of conflict and how to plan an effective strategy to move beyond the conflict to meet the needs of the patient and surrogates.

# 227 The Family Meeting: End of Life Goal Setting and Future Planning

This Fast Fact discusses an approach to goal setting when the expected length of life is short.

# 229 Seizure Management in the Dying Patient

The actual incidence of seizures in dying patients is unknown, and while likely uncommon, they can cause tremendous distress to patients and families. This Fast Fact reviews management strategies for seizures near the end of life.

# 231 Practical Aspects of Using NPPV at the End of Life

This Fast Fact discusses practical aspects of how using Non-Invasive Positive Pressure Ventilation (NPPV) can be used to palliate dyspnea in dying patients.

# 233 Implementation of a Family Presence During Resuscitation Protocol

The key components of a successful Family Presence During Resuscitation Protocol policy

# 235 Prognostic Models in Critically Ill Adults

Common ICU prognostic models and their role in guiding patient care and communication

# 237 Evaluation of Spinal Cord Compression

The clinical features and diagnosis of Spinal Cord Compression in adults

# 239 Prognostication in Severe Traumatic Brain Injury in Adults

Discusses prognostication in severe Traumatic Brain Injury in adults

# 241 Improving Communication When Hearing Loss is Present

Hearing loss can lead to misunderstandings, which in the health care setting can literally have life-or-death implications.

# 243 Palliative Care for Patients with Down Syndrome

# 245 Addressing Medical-Legal Suffering for Patients with Advanced Illness

# 247 Initiating a Hospice Referral from the Emergency Department

Patients with an end-stage illness often present to the Emergency Department (ED) with a crisis event (1). This Fast Fact provides information for ED providers on how to refer a patient to hospice care directly from the ED (2). Fast Fact #246 suggests strategies for caring for patients receiving hospice care who present to the ED.

# 249 Topical Nonsteroidal Anti-Inflammatory Drugs

Nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly prescribed drugs in the treatment of musculoskeletal pain. This Fast Fact reviews the pharmacology, clinical efficacy and adverse effects of topical NSAIDs for the treatment of musculoskeletal pain.

# 251 Carotid Blowout Management

Carotid blowout is the rupture of the extracranial carotid arteries or their major branches. It is an uncommon but devastating complication of head and neck cancer. This Fast Fact will discuss the approach to patients with carotid blowout, including patients near the end of life whose care goals are focused on safety and comfort.

# 253 Palliative Care Consultation in the ICU

The Intensive Care Unit (ICU) is the setting for high-intensity health care designed to resolve life-threatening illnesses and extend life. However, risks of mortality and severe morbidity remain high and virtually all ICU patients have palliative care needs. This Fast Fact reviews the role of palliative care consultations in the ICU along with options for more generalist palliative care services provided by ICU clinicians

# 255 Topical Capsaicin for Neuropathic Pain

Capsaicin 0.075% cream demonstrated statistically significant benefit in post-herpetic neuralgia, post-surgical neuropathies, and diabetic neuropathy, compared to placebo.

# 257 Use of Rectal Meds for Palliative Care Patients

This Fast Fact introduces the use of rectal medications for patients in palliative care settings. The rectal route is an efficient and practical alternative in administering a broad array of palliative care medications to patients with a compromised oral route.

# 259 Modafinil

Modafinil is a non-amphetamine psychostimulant approved for the treatment of excessive daytime somnolence associated with obstructive sleep apnea, narcolepsy, and shift work sleep disorder. This Fast Fact reviews use of modafinil for symptom management in the seriously ill.

# 261 Hot Flashes in Palliative Care – Part 1

Hot flashes are a common symptom which can negatively impact quality of life. Failure to assess and offer treatment for hot flashes is common. This Fast Fact is the first in a three part series reviewing hot flash assessment and treatment.

# 263 Hot Flashes in Palliative Care – Part 3

Assessment and drug treatments of hot flashes (‘flushes’) were discussed in Fast Facts # 261-2; this Fast Fact reviews non-drug and complementary/alternative medicine (CAM) therapies.