David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
This small proof-of-concept study introduces a new medium for health care communication: the comic book. This format offers all of the benefits of written information but with the added advantage of graphics to create a more visual experience.
The results of the study suggest that adding a graphic narrative may improve the effectiveness of the information transfer and make the consent process less anxiety-provoking for the patient.
The graphic narrative used in the study is available here.
The authors conclude that dual opioid use (obtaining opioid prescriptions from 2 payer systems) is a risk factor for lethal overdose, possibly related to poor care coordination.
The authors suggest that these data emphasize the importance of consistently using prescription drug monitoring systems (PDMS) when prescribing opioids.
An editorial suggests that PDMS systems should be improved so that they are easier to use and provide more useful information (for example, integrated information for all states).
Both discussants recognize that provision of dedicated palliative care improves outcomes for patients with advanced cancer. The palliative care specialist points out that the involvement of a palliative care specialist increases patient prognostic understanding and quality of life while decreasing health care use. She argues that these benefits are a result of the special skills and resources of the palliative care team and that oncologists may lack the time or the expertise to provide this care.
The palliative care specialist proposes that patients with advanced cancer should receive care from both an oncologist and a palliative care specialist and that the specialist should be consulted early in the disease course.
The oncology discussant suggests that oncologists might be able to provide some of the palliative care (alleviating the need for palliative care specialist referral) by simply dedicating more time to it. He points out that the current shortage of palliative care providers is a major barrier to providing every advanced cancer patient with both an oncologist and a palliative care specialist.
The oncologist suggests that the best way to meet the needs of these patients may be to augment the palliative care training of oncologists and to schedule more visit time in the oncology clinic to address palliative issues. That way, oncologists may be able to provide most of the palliative care, reserving specialty referrals for more difficult situations.
Wesorick DH, Chopra V. Annals for Hospitalists - 16 April 2019. Ann Intern Med. 2019;170:HO1. doi: https://doi.org/10.7326/AWHO201904160
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Published: Ann Intern Med. 2019;170(8):HO1.
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