This paper reports the findings of an exploratory study comparing morphine to placebo for patients with chronic refractory breathlessness. Study participants (N=65) were diagnosed with heart failure or chronic obstructive pulmonary disease and had moderately severe breathlessness on a dyspnea scale.
Morphine was preferred over placebo (43% for morphine versus 32% placebo and 25% no preference), however sedation and nausea may outweigh the benefit for some patients. Younger patients (Age< 70) preferred morphine more than older patients, which may be due to less nausea experienced by the younger group.
The study helps to support the use of morphine for breathlessness in patients with refractory dyspnea but reminds clinicians that addressing potential side effects of morphine is key to patient preference.
Link to Journal of Pain and Symptom Management (10/24/2015)
In a recent JAMA article, physicians Epstein and Back implore us to recognize that diagnosing and treating symptoms and illness is only a part of addressing patient suffering. Suffering “manifests as indirect emotional expressions, inconsistencies in patients’ narratives, or discomfort within clinicians themselves”. An awareness of patient’s suffering and responding, even before knowing the reason why the patient is suffering, is often missing in patient care today. In this article, the authors’ recommend two clinical approaches to suffering that they synthesized from literature review.
Complement Link to JAMA article abstract (12/22/2015)
The Clinical Guidelines Committee of the American College of Physicians just published a free online article that is a must read for hospice organizations interested in promoting cost effective use of generics.
The article describes findings from a review of the literature to answer 5 questions about generic medications. The article explores 1) how often brand-name medications are used when generics are available?; 2) does the use of generic medications influence adherence?; 3) do brand-name and generics have similar clinical effects?; 4) What are the barriers to using generics?; and 5) what strategies can be used to promote cost savings through greater use of generics?
Despite the availability of identical generic versions and clinical practice guidelines promoting their use, health care providers frequently continue to prescribe brand name medications. It’s estimated that prescribing of newer, brand name drugs instead of generics leads to billions of dollars in excess costs. Medicare could save $1.4 billion for patients with diabetes alone by combining generic substitution with generic interchange.
The article concludes with a recommendation that clinicians should prescribe generic medications, if possible, rather than more expensive brand name medications. Unfortunately, provider and patient perceptions continue to pose obstacles to improving the use of generics.
Link to Annals of Internal Medicine (11/24/2015)
In order to prescribe the most effective cancer therapy, doctors use formal guidelines to assist in decision-making. However, these guidelines usually do not consider cost of therapy for patients, leading to therapy decisions based solely on their doctor’s recommendations and unexpected personal financial burden.
An article posted in Bloomberg Business on 10/13/15 describes a new tool that will provide patients with information about the cost of drugs used in their treatment. The guidelines, developed by an alliance of top U.S. cancer hospitals, will be available to all, not just hospitals in the cancer network. The information is general and does not account for how much of the cost insurance will cover. Drugs are ranked on a scale of 1 to 5 for affordability, in the same way the group ranks other aspects of a therapy, such as how toxic or how effective it was in clinical trials.
Link to article Bloomberg Business (10/13/2015)