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MOST CHILDREN RECEIVING PALLIATIVE CARE LIVE FOR MORE THAN A YEAR

Palliative care for adults, mostly cancer patients over age 60, is usually thought of as short-term care to ease the patient's dying. In contrast, most children receiving palliative care—with the exception of infants—are alive for more than a year after beginning care, a new multicenter study shows. Only in the past decade have children's hospitals begun offering palliative care services to address the needs of children with advanced, life-threatening conditions and their families.

Chris Feudtner, MD, PhD, MPH, of Children's Hospital of Philadelphia, and colleagues followed 515 children, who received palliative care at six children's hospitals during a 3-month enrollment period, for 12 months or until death.¹ Of these, 36% were new to the pediatric palliative care programs, whereas 64% were established patients. Ages ranged from less than 1 month (5%) to 19 years or older (16%). Genetic/congenital problems accounted for 41% of the group, followed by neuromuscular disorders (39%), cancer (20%), respiratory problems (13%), and gastrointestinal disorders (11%). More than half of the children had more than one condition, resulting in problems totaling more than 100% of patients. Nearly half of the patients (47%) were cognitively impaired and 31% suffered chronic pain.

Thirty percent of the children died within 12 months of their palliative care consult, with a median time-to-death of 107 days. The children who died within 30 days of the consult were more likely to be infants, and their consultation goals were more likely to be decision-making support, near-death recommendations, or parental and sibling bereavement.

NEWER ANTIDEPRESSANTS EQUALLY EFFECTIVE IN TREATING MAJOR DEPRESSIVE DISORDER

The Agency for Healthcare Research and Quality (AHIRQ) reinforces previous findings that second-generation antidepressants are equally effective in treating major depressive disorder and its symptoms. There is no evidence to support choosing one antidepressant over another based on either greater efficacy or effectiveness. Although second-generation antidepressants are similar in efficacy, they cannot be considered identical drugs. Evidence supports some differences among individual drugs with respect to onset of action, side effects, and some measures of health-related quality of life. The updated evidence review from AHRQ's Effective Health Care Program, Comparative Effectiveness of Second Generation Antidepressants in the Pharmacologic Treatment of Adult Depression—An Update to a 2007 Report, reviews the evidence on 13 second-generation antidepressants—bupropion, cilalopram, desvenlafaxine, duloxetine, escitalopram, fluoxetine, fluvoxamine, mirtazapine, nefazodone, paroxetine, sertraline, trazodone, and venlafaxine. The report updates current evidence on the comparative efficacy, benefits, and harms of second-generation therapies in treating patients with major depressive disorder, dysthymia, and subsyndromal depression. It also highlights areas for future research, including the need for research on the efficacy of second-generation antidepressants in subpopulations and in patients who have not responded to initial treatments. This and other publications are accessible on AHRQ's Effective Health Care Program Web site. www.effectivehealthcare.ahrq.gov.

THE JOINT COMMISSION AWARDS FIRST ADVANCED CERTIFICATIONS FOR PALLIATIVE CARE

Regions Hospital in St. Paul, Minnesota; Strong Memorial Hospital in Rochester, New York; Mt. Sinai Medical Center, New York City; St. Joseph Mercy Oakland, Pontiac, Michigan; and The Connecticut Hospice, Inc. in Branford, Connecticut, became the first hospitals across the country to receive Advanced Certification for Palliative Care from The Joint Commission, as announced in a Joint Commission press release dated February 27. The Joint Commission certification program was developed under the guidance of a national task force of experts on palliative care.

“Seriously ill patients will benefit from the decision by these five leading hospitals to follow national standards and evidence-based guidelines that emphasize the need for expert caregivers to work together as teams with patients and their families,” says Michele Sacco, executive director, Advanced Certification for Palliative Care, The Joint Commission. “Certification signifies that these hospitals are committed to patient and family-centered care to optimize the quality of life for patients with serious illnesses. It is the best signal to the community that the quality of care these organizations provide is effectively managed to meet the unique and specialized needs of patients.”

The Joint Commission Advanced Palliative Care Certification standards emphasize:

• A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite expertise in palliative care;

• Leadership endorsement and support of the program's goals for providing care, treatment, and services;

• A special focus on patient and family engagement;

• Processes that support the coordination of care and communication among all care settings and providers; and

• The use of evidence-based national guidelines or expert consensus to guide patient care.

For more information about the Advanced Certification for Palliative Care program, call [phone], or e-mail [email protected].

NATIONAL QUALITY FORUM ENDORSES PALLIATIVE AND END-OF-LIFE CARE MEASURES

The National Quality Forum (NQF) Board of Directors approved for endorsement 14 quality measures on palliative and end-of-life care on February 14. The measures address a wide range of care concerns, including pain management, psychosocial needs, care transitions, and experiences of care.

“As the number of older adults in this country continues to grow, palliative and end-of-life care services are needed more than ever,” said Janet Corrigan, PhD, MBA, president and CEO of NQF. “This set of measures will help promote the type of high-quality care older people and acutely ill patients deserve.”

For this project, NQF sought measures focused on care concerns such as managing pain, weight loss, and depression. It also sought measures that would directly assess—and improve over time—the experience of patients undergoing palliative and end-of- life care, as well as the experience of their families. In all, 22 measures were evaluated against NQF's endorsement criteria by a panel of providers, measurement experts, and consumer representatives; 14 measures were endorsed.

“These palliative and end-of-life care measures are a welcome addition to the NQF portfolio,” said June Lunney, PhD, RN, director of research at the Hospice and Palliative Nurses Association and co-chair of the Palliative Care and End-of-Life Care Endorsement Maintenance Steering Committee. “As the number of palliative and end-of-life care programs continue to grow across the country, it's critical that providers have the right measurement tools to help ensure patients receive safe, high-quality, and compassionate care.”

The endorsed measures include those previously endorsed by NQF and newly submitted measures for initial endorsement. Twelve measures are new. The ongoing evaluation and updating of endorsed measures ensures the currency and relevance of NQF's palliative and end-of-life care portfolio.

“Palliative care teams have been shown to help improve patient care quality throughout the course of treatment,” said R. Sean Morrison, MD, director of the National Palliative Care Research Center and co-chair of the Palliative Care and End-of-Life Care Endorsement Maintenance Steering Committee. “This measure set will help support such efforts, such as enhanced treatment of pain and other symptoms, improved communication between providers and patients, fewer admissions to emergency departments, and increased patient satisfaction.”

NQF is a voluntary consensus standards-setting organization. Any party may request reconsideration of any of the 14 endorsed quality measures listed below by submitting an appeal no later than March 14 (to submit an appeal, go to the NQF Measure Database accessible at:http://www.qualityforum.org/Measures_List.aspx). For an appeal to be considered, the notification must include information clearly demonstrating that the appellant has interests directly and materially affected by the NQF-endorsed recommendations and that the NQF decision has had (or will have) an adverse effect on those interests.

The endorsed measures are:

• 1634: Hospice and Palliative Care—Pain Screening (UNC) (paired with measure 1637)

• 1637: Hospice and Palliative Care—Pain Assessment (UNC) (paired with measure 1634)

• 1617: Patients treated with an Opioid who are given a bowel regimen (RAND)

• 1628: Patients with advanced cancer assessed for pain at outpatient visits (RAND)

• 1638: Hospice and Palliative Care—Dyspnea Treatment (UNC) (paired with measure 1639)

• 1639: Hospice and Palliative Care—Dyspnea Screening (UNC) (paired with measure 1638)

• 1626: Patients admitted to the ICU who have care preferences documented (RAND)

• 1641: Hospice and Palliative Care—Treatment Preferences (UNC)

• 1647: Percentage of hospice patients with documentation in the clinical record of a discussion of spiritual/religious concerns or documentation that the patient/caregiver did not want to discuss (Deyta)

• 0209: Comfortable dying (NHPCO) (maintenance)

• 1625: Hospitalized patients who die an expected death with an ICD that has been deactivated (RAND)

• 0208: Family Evaluation of Hospice Care (NHPCO) (maintenance)

• 1632: CARE—Consumer Assessments and Reports of End of Life (Center for Gerontology and Health Care Research)

• 1623: Bereaved Family Survey (PROMISE Center)

ACTTION PLANS 2ND ANNUAL SCIENTIFIC WORKSHOP

The Analgesic Clinical Trial Translations, Innovations, Opportunities, and Networks (ACTTION) is a public-private partnership with the United States Food and Drug Administration (FDA) is to identify, prioritize, sponsor, coordinate, and promote innovative activities—with a special interest in optimizing clinical trials—that will expedite the discovery and development of improved analgesic treatments for the benefit of the public health. ACTTION is a multiyear, multiphase initiative that is closely aligned with the FDA's Critical Path Initiative. This public-private partnership has been designed to streamline the discovery and development process for new analgesic medications and to more generally accelerate the development of pain treatments with improved efficacy and safety. The key objectives of ACTTION involve initiating and supporting strategic collaborations among a broad spectrum of stakeholders—including, but not limited to, academia, the FDA and other government agencies, industry, professional organizations, patient advocacy groups, foundations, and philanthropic organizations—with the goals of sharing data and innovative thinking about the development of novel therapeutics. These strategic collaborations involve a wide range of research projects and other activities, for example, scientific workshops, consensus meetings, and in-depth analyses of analgesic clinical trial data to determine the effects of research methods on study assay sensitivity and efficiency.

The 2nd annual ACTTION Scientific Workshop will be held October 24–26, 2012, at the US Food and Drug Administration's White Oak campus in Silver Spring, Maryland. The theme of the conference will be “Preclinical and Clinical Models and Methods for Accelerating Analgesic Drug Development.” The following individuals are serving as the conference Steering Committee: Ralf Baron, Dr med (University of Kiel, Germany), Allan Basbaum, PhD (University of California San Francisco), Robert Dworkin, PhD (University of Rochester), Allison Lin, PharmD, PhD (FDA), Frank Porreca, PhD (University of Arizona), Bob Rappaport, MD (FDA), Dennis Turk, PhD (University of Washington), and Clifford Woolf, MD, PhD (Harvard University). Registration information and an overview of the conference agenda are available on the ACTTION Web site: http://www.acttion.org.

EVIDENCE LACKING TO SUPPORT SURGERY FOR PELVIC PAIN

Despite the extensive use of invasive surgical procedures to treat women with noncyclic chronic pelvic pain, little evidence supports a surgical approach, according to a new research review from the Agency for Healthcare Research and Quality (AHRQ). No surgical approach was found to be superior to a nonsurgical or comparative surgical approach. Although the prevalence of noncyclic (not occurring during menstruation) chronic pelvic pain rivals other widely studied conditions, there is little research assessing therapies, particularly nonsurgical interventions. The report, Noncyclic Chronic Pelvic Pain Therapies for Women: Comparative Effectiveness, produced by AHRQ's Effective Health Care Program, summarizes evidence on the benefits and harms of surgical and nonsurgical treatments for women over the age of 18 with noncyclic chronic pelvic pain. Given the lack of high-quality evidence, future research is needed to investigate and compare the effectiveness of surgical, pharmacologic, and nonpharmacologic therapies to better understand the causes of the condition and standardize terminology, definitions, and diagnostic approaches. This review and other publications from the AHRQ Web site: www.effectivehealthcare.ahrq.gov.

IAHPC LIST OF ESSENTIAL PALLIATIVE CARE PRACTICES

In a project that included the participation of individuals and representatives of pain and palliative care organizations, the International Association for Hospice and Palliative Care (IAHPC) recently developed a list of essential practices in palliative care. Under the framework of the “essential” concept, the IAHPC decided to work in different projects aimed to identify the “essential” components for palliative care. This list of Essential Practices follows the IAHPC List of Essential Medicines in Palliative Care developed in 2007 and the Opioid Essential Prescription Package developed in 2011. The list of essential practices in palliative care for health workers working in primary care includes those practices aimed at meeting the most prevalent physical, social, psychological, and spiritual needs of palliative care patients and their families. To work on this proposal, IAHPC formed a working group that included board members of IAHPC and external advisors from the field. The working group developed a plan of action and methodology that included a Delphi process among 425 health practitioners, primary care providers, and palliative care experts from 63 different countries around the globe, and a ranking survey with representatives from 45 international palliative care and pain relief organizations.

The IAHPC List of Essential Practices includes 23 practices with different levels of intervention under the following domains of care: Physical Care; Psychological/Emotional/Spiritual Care; Care Planning and Coordination; and Communication Issues. The IAHPC List of Essential Practices in palliative care may help define appropriate primary palliative care and improve the quality of care delivered globally. IAHPC will focus future projects on the evaluation of their uptake and impact in the quality of lives of patients and their families.

The List of Essential Practices in palliative care is available in the IAHPC Web site under the Palliative Care Essentials icon on the homepage at www.hospicecare.com. As the holder of the copyright, IAHPC allows free dissemination for educational purposes with appropriate credit given to the organization. Please feel free to disseminate this announcement to your colleagues and friends.

Declaration of Interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.