Using case studies to bridge the undergraduate nursing education gap in palliative and hospice care
Journal of Hospice & Palliative Nursing; by Katherine Adams, Lisa Cross; 8/26
Undergraduate nursing students struggle with understanding pharmacological pain management, especially in palliative care. New nurses indicate needing more experience with pain management and ethical dilemmas surrounding pain management. This project aimed to develop real-life case scenarios aligned with palliative competencies for use in undergraduate courses. Traditionally, palliative and hospice content is delivered with community courses, possibly limiting student competency across settings. These case studies present an opportunity for formative student assessment in pharmacological and other palliative management over 4 settings. Facilitation requires reflective techniques, and nurse faculty may need support in guiding discussions.

The prevalence of Medical Power of Attorney documentation in a large healthcare system: A retrospective cohort study
Journal of Palliative Care; by Angeli Sirilan, Alexandria Ellershaw, Tony Gaidici, Jacob Lahti, Michael Ruta, Richard Elias, Sandeep Pagali, Kristina Balangue, Sumit Agarwal, Nimit Agarwal; 8/26
Designation of a Medical Power of Attorney (MPOA) is a key component of advance care planning (ACP) that ensures patient preferences are honored when decision-making capacity is not present. This study aimed to quantify MPOA documentation rates [in adult hospitalized patients] and identify demographic and clinical factors associated with documentation presence. Male sex, White race, older age (67.0 vs 54.3 years), and unmarried status were associated with a higher MPOA documentation rate ...  Dementia ...  and malignancy ...  were associated with higher odds, while discharge against medical advice was associated with lower odds ...  of MPOA documentation. Conclusions: MPOA documentation rates were low, highlighting missed opportunities to identify alternate decision makers when a patient lacks capacity.

When end-of-life becomes the beginning of new life: Application of the Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU to the setting of donation after circulatory death
Critical Care Explorations; by Ian M. Oppenheim, Rita N. Bakhru, Carolina B. Maciel, Katharina M. Busl, on behalf of the Donor Care Unit Network for Optimizing Recovery (DONOR) Group; 8/26
The recently published Society of Critical Care Medicine Guidelines on Adult End-of-Life Care in the ICU provide a detailed and well-thought-out approach to a vital component of critical care, although they explicitly refrain from discussing how they may apply to organ donation. As representatives of the Donor Care Unit Network for Optimizing Recovery (DONOR), a group of intensivists experienced in managing donation after circulatory death (DCD), we wish to endorse equal delivery of high-quality end-of-life (EOL) care for organ donors. Although some logistical differences must be addressed, the EOL recommendations outlined in the Guidelines are still applicable to patients being evaluated for or undergoing DCD. Recent accounts of unacceptable patient care in the setting of DCD highlight a critical threat to patient welfare and public trust. Our mandate is clear: implement and audit protocols that guarantee dignity and symptom control while demonstrating that DCD remains wholly consistent with a compassionate, honorable, and fulfilling EOL.

Health and health care access among Afghan refugee women in the United States
JAMA Network Open; by Nazineen Kandahari, Nilufar N. Kayhani, Fareha Moulana Zada, Zahra Kayhani, Zarin Noor, Nicholas Nelson, Susan L. Ivey; 8/26
Afghans are one of the world’s largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US. In this qualitative study of 23 Afghan women residing in the US who shared their experiences accessing health care, key barriers included sociocultural constraints on women’s autonomy, inadequate interpretation services, culturally insensitive health care, intergenerational stigma surrounding sexual and reproductive health knowledge and care, and mental health challenges. Structural barriers produced mistrust in and miscommunication with clinicians and led to use of home remedies. These findings suggest a need for health care interventions that are sensitive to sociocultural contexts and immigration histories to address the needs of Afghan refugee women in the US.

[Portugal] International differences in the technical qualities of place of death classifications and data: A survey of researchers' perspectives
Palliative Medicine; by Mayra Delalibera, Sílvia Lopes, Inês Dias da Silva, Barbara Gomes; 8/26
Place of death is a key population-level indicator for palliative care and health services planning. However, substantial international variation in how it is recorded limits cross-country comparisons and health system evaluations. This is the first study to assess place of death classifications and data from researchers' perspectives. Findings highlight critical limitations in current classification systems and provide guidance for developing an international classification aligned with UN and WHO recommendations. This will enable more meaningful cross-country comparisons and strengthen evidence to inform palliative care and health services planning worldwide.

If opportunity doesn't knock, build a door.  ~Milton Berle