Literature Review

Ethics at the end of lifeMedicine; by John Idris Baker; 7/24End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond... Key points:

Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

Variation in specialist palliative care reach and associated factors among people with advanced heart failure in the Department of Veterans AffairsJournal of Pain and Symptom Management; by Shelli L Feder, Ling Han, Yan Zhan, Erica A Abel, Kathleen M Akgün, Terri Fried, Mary Ersek, Nancy S Redeker; 7/24Clinical practice guidelines recommend palliative care for people with advanced heart failure (aHF), yet it remains underutilized. We examined medical center variation in specialist palliative care (SPC) and identified factors associated with variation among people with aHF... SPC reach varies widely across VAMCs for people with aHF. Outpatient palliative is common among high-reach VAMCsbut its role in reach warrants further investigation. Strategies used by high-reach VAMCs may be potential targets to test for implementation and dissemination.

Palliative care for patients with cancer: ASCO guideline updateJournal of Clinical Oncology; by Justin J Sanders, Sarah Temin, Arun Ghoshal, Erin R Alesi, Zipporah Vunoro Ali, Cynthia Chauhan, James F Cleary, Andrew S Epstein, Janice I Firn, Joshua A Jones, Mark R Litzow, Debra Lundquist, Mabel Alejandra Mardones, Ryan David Nipp, Michael W Rabow, William E Rosa, Camilla Zimmermann, Betty R Ferrell; 7/24Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions... The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care. Additional information is available at www.asco.org/supportive-careguidelines. 

The impact of clinical internship experience on nursing students' attitudes towards death and choices of end-of-life care: A self-control study Nursing Opens; Jingyuan Jiang, Jing Zhou, Xiaoli Chen, Xiaolin Zhu, Hao Zhang, Qin Zhang, Jianna Zhang; 6/28/24  Attitude towards death refers to an individual's evaluative and stable reactions to death events, reflecting their psychological tendencies and characteristics. ... Death is an inevitable part of life, and individuals must face the reality of death. ... The findings of this study suggest that real clinical experiences in the emergency department contribute to nursing students' development of a positive attitude towards death and a more positive view of providing end-of-life care in a hospital setting. Incorporating teachings on end-of-life care in a hospital setting into death education courses can further enhance nursing students' understanding and acceptance of end-of-life care. 

International consensus on sleep problems in pediatric palliative care: Paving the way[International] Sleep Medicine; by Anna Mercante, Judith Owens, Oliviero Bruni, Magda L. Nunes, Paul Gringras, Shirley Xin Li, Simonetta Papa, Ulrika Kreicbergs, Joanne Wolfe, Boris Zernikow, Ana Lacerda, Franca Benini, on behalf of the Pediatric Sleep and Palliative Care Group; 7/24Sleep problems constitute a common and heterogeneous complaint in pediatric palliative care (PPC), where they often contribute to disease morbidity and cause additional distress to children and adolescents and their families already facing the burden of life-threatening and life-limiting conditions. Despite the significant impact of sleep problems, clinical evidence is lacking... This study addresses the need to personalize sleep medicine’s approach to the palliative care setting and its peculiarities. It provides the first international consensus on sleep problems in PPC and highlight the urgent need for global guidance to improve sleep-related distress in this vulnerable population and their caregivers. Our findings represent a crucial milestone that will hopefully enable the development of guidelines in the near future.Publisher's Note: I am grateful that sleep issues are being studied and discussed more often, as they can be terribly disruptive to patients and family members.

Why Nurses QuitMedscape; by Jodi Helmer; 6/27/24Over 262,000 registered nurses (RNs) graduate yearly; 33 percent quit within the first 2 years. "Retention is a huge issue in nursing," says Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA). "COVID highlighted the issue, but these problems existed well before [the pandemic], and what we're seeing is a failure to truly do something about it." ... Diagnosing the Problem: burnout, work environment, inadequate staffing. Finding a Cure: legislation, residencies and mentorship, improved work conditions, resources for self-care.

6 guidelines from ASCO on AI, cancer care Becker's Hospital Review; by Ashleigh Hollowell; 6/25/24 Leaders at the American Society of Clinical Oncology published a formal document June 25 that outlines what the group deems as the most appropriate use of artificial intelligence when it comes to clinical oncology care. ... When considering AI technology for oncological care, the American Society of Clinical Oncology says clinicians should keep the following principles in mind to guide their use: 

[Certificate of Need] Diagnosis for 6.26.24: Checking the pulse of Florida health care news and policy Florida Politics, scroll down to "Death and Dying"; 6/26/24 Florida health care regulators this week announced they tentatively denied 21 Certificate of Need (CON) applications for new hospice programs and approved 9 others. Heavily populated Broward and Hillsborough counties drew the most interest, with seven providers wanting to establish new hospice programs in each area. [For details, click on the title's link and scroll down to "Death and Dying."]

Grief care efforts should include settings outside of hospice, provider group say McKnights Senior Living; by Kimberly Bonvissuto; 7/3/24 If standards are developed for high-quality bereavement and grief care, they must apply to settings outside of traditional hospice care, such as affordable senior housing, where there is a “critical lack” of mental health services. That’s according to LeadingAge, which submitted comments last week to the Agency for Healthcare Research and Quality on a draft report from a research project that will inform an independent panel that will develop standards for high-quality bereavement and grief care. Katy Barnett, LeadingAge director of home care and hospice operations and policy, highlighted the need for cross-continuum grief and bereavement assessments, interventions and resources, including in settings outside of traditional hospice care, such as affordable senior housing.

Senior care experts detail how to build a coveted ‘destination workplace’ McKnights Home Care; by Josh Henreckson; 6/27/24 Faced with today’s complex array of financial, staffing and regulatory challenges, senior care operators need to rely on a broad range of workplace solutions, a panel of experts said. ... Providers should be actively listening to their employees’ needs and trying to meet the evolving desires of the labor market, they emphasized at McKnight’s “Meeting of the Minds” thought-leader discussion. This must take place whether they’re pursuing recruiting strategies, trying to improve staff retention, integrating new technological advances or investing in new benefits and professional development. “The one area that’s going to undergird everything for your success is paying attention to the most important capital, which is human capital,” said Navin Gupta, CEO at software provider Viventium. “Pay attention to the caregiver experience from recruitment … to retention to recognition and development — the entire journey."

CHAPcast: Top 10 Deficiencies for Home Health and Hospice[Podcasts] Email; 7/3/24CHAP's Clinical Nurse Educator, Keri Culhane, dissects the top 10 deficiencies for 2023 in home health and hospice care. Keri highlights trends, issues, and practical strategies to improve care planning and compliance.

Anxiety and resilience in palliative medicine physicians BMJ Supportive & Palliative Care; by Cristhian Alexis Velásquez Marín, Carlos Javier Avendaño-Vásquez; 7/2/24, online ahead of printTo identify the relationship between the degree of anxiety and the capacity for resilience in palliative care physicians ..., [we] included 42 Colombian Palliative Care Physicians and administered a sociodemographic questionnaire, the Zung Anxiety Scale and the Resilience Scale. Results: 42 palliative care physicians with an average age of 41 participated in the study. Anxious symptoms were present in 100% of the physicians evaluated. Mild or moderate anxiety was identified in 93.7% of the population and 6.3% of people with severe anxiety symptoms. ... Our results reflect that the population of palliative care physicians has a higher risk and exposure to developing anxiety and its adverse outcomes. We found higher anxiety levels compared with other studies so this population requires greater vigilance and intervention in treating and preventing mental health difficulties.Editor's Note: Executive leaders for palliative care services, use this research to be aware of possible stress-related tolls on your palliative physicians and team members. Ask. Generate dialogue. Do not assume that this applies, but rather use it to tune into and improve the support your physicians need. While this research was in Columbia, it resonates a U.S.recurring trend of the unionization of physicians, often related to burnout and stress overload.