Literature Review

Financial hardship: A qualitative study exploring perspectives of seriously ill patients and their familyJournal of Pain and Symptom Management; by Danae G. Dotolo, Christina Clare Pytel, Elizabeth L. Nielsen, Jennifer Im, Ruth A. Engelberg, Nita Khandelwal; 11/24Our analysis revealed three themes: 1) Prioritizing Survival and Recovery; 2) Living with Uncertainty—including experiences of prolonged uncertainty, navigating bureaucratic barriers, and long-term worries; and 3) Preferences for Financial Guidance. Our results suggest patients and families prioritize survival over financial hardship initially, and feelings of uncertainty about finances persist. However, patients and family caregivers are reluctant to have their physicians address financial hardship.

“Postponing it any later would not be so great”: A cognitive interview study of how physicians decide to initiate goals of care discussions in the hospitalAmerican Journal of Hospice and Palliative Medicine; by Elizabeth Chuang, Sabrina Gugliuzza, Ammar Ahmad, Michael Aboodi, Michelle Ng Gong, Amber E Barnato; 11/24Participants were hesitant to commit to the present moment as the right time for [goals of care] GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.

Clinician staffing and quality of care in US health centersJAMA Network Open; Q. Wilton Sun, BA; Howard P. Forman, MD, MBA; Logan Stern, DNP, APRN; et alBenjamin J. Oldfield, MD, MHS; 10/24In this cross-sectional study of 791 US health centers, 5 distinct clinician staffing ratio models were identified, and models emphasizing physicians, advanced practice registered nurses, and physician associates were positively associated with distinct sets of individual quality metrics. Clinician staffing may be associated with certain aspects of care quality, underscoring the importance of strategic, tailored staffing to optimize primary care delivery. In this cross-sectional study of health centers, physician FTE [full time equivalent] ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination.

To calm and to commend: Veterans’ musical preferences anticipating end of lifeMilitary Medicine; by Beatrice J Krauss; 11/24Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch.Publisher's note: Anticipating Veteran's Day on Monday.

Concurrent care and use of advanced cardiac therapies for hospitalized Veterans with heart failureJournal of Pain and Symptom Management; by Tander Simberloff, Laura Godinez, Tiffany Chen, Lan Jiang, Wen-Chih Wu, Jensy Stafford, James L Rudolph, Mitchell Wice; 11/24Veterans with HF receiving concurrent care were few and experienced higher mortality. Rate of burdensome transitions was similar between Veterans receiving concurrent care and those not on hospice. Further research may explore why Veterans infrequently utilize concurrent care at the end of life.

Most heart failure patients miss out on guideline-recommended palliative care Cardiovascular Business; by Dave Fornell; 11/6/24 Over the past decade, the American Heart Association (AHA) and European Society of Cardiology have recommended integrating palliative care into heart failure management. Despite these recommendations, the use of palliative care for heart failure remains low in the United States. Racial and geographic variations in access and use of palliative care are also pronounced, highlighting health disparities. These were the findings of a recent study in the Journal of the American Heart Association. Researchers at Saint Louis University led the study and said only one in eight patients with heart failure in the United States receive palliative care consultations within five years of diagnosis. Their study highlights the alarmingly low uptake of palliative care among adults with heart failure in the U.S., especially compared to patients with cancers that have the same mortality rates. The study also pointed out significant racial and geographic disparities. Black patients were 15% less likely to receive palliative care compared to their white counterparts. They said this disparity is particularly concerning given the higher cardiovascular risk and mortality rates in the Black population.

Nebraska voters approve legalization of medical marijuana. Here's what to know USA Today; by Greta Cross; 11/6/2 Medical marijuana is now legal in the state of Nebraska, approved by voters on Tuesday. Two ballot measures dealing with medical marijuana were on the Nebraska ballot. A total of 70.7% of voters approved Initiative Measure 437 and 66.9% of voters approved Initiative Measure 438. Initiative Measure 437 establishes a new statute that will allow the use, possession and acquisition of up to 5 ounces of cannabis for medical purposes by a qualified patient with a written recommendation from a health care practitioner. The statue will also allow for a caregiver to assist a qualified patient with these activities. Initiative Measure 438 establishes a new statute that makes penalties inapplicable under state law for the possession, manufacture, distribution, delivery and dispensing of cannabis for medical purposes by registered private entities. The statute will also establish a Nebraska Medical Cannabis Commission to regulate such activities.

Aveanna revs hospice, home health M&A engine Hospice News; by Holly Vossel; 11/7/24 Aveanna Healthcare Holdings (Nasdaq: AVAH) is ramping up its merger and acquisition activity in the home health and hospice space heading into next year. The Atlanta-headquartered company has set its strategic sights on both private duty nursing and hospice and home health, according to Aveanna CEO Jeff Shaner. The company has been quiet on the M&A front in recent years, taking a cautious approach to growth, Shaner said during an earnings call on Thursday. Aveanna is in the process of reviewing a few potential acquisitions, which could close in 2025, he indicated.

Adopting tomorrow’s tech: 5 steps to effective AI training in hospice Hospice News; by Mick Stahlberg; 11/7/24 In today’s hospice environment, providers are continually asked to do more with less. Staffing shortages, rising costs and growing patient demands make efficiency a critical component of success. Enter artificial intelligence (AI). From automating administrative tasks to improving scheduling and optimizing resource allocation, AI is poised to significantly enhance operational efficiency at every level. In turn, proper training will play a monumental role in helping teams get comfortable incorporating this technology into their clinical and administrative workflows from day one. Providers will be best served to follow 5 key steps to effective AI training as they work with their technology partners to articulate a comprehensive strategy based on their organization and its unique needs. These steps incorporate:

Nurse burnout the root of decreased resident safety, medication errors, study shows McKnights Long-Term Care News; by Zahara Johnson; 11/6/24 A new study has found a direct link between nurse burnout and unfavorable patient and facility outcomes, including medication errors and a degraded safety culture. The meta-analysis of 85 studies and 288,581 nurses, compiling more than 30 years of research, concluded that nurses who suffer from burnout – emotional exhaustion, depersonalization and a low sense of personal accomplishment – have a negative impact on patients.

Specialized hospice care program honors and supports veterans facing terminal illness NBC 10 News - WSLS, Southwest and Centeral Virginia; by Kelly Marsh; updated 11/7/24 In Southwest Virginia, a quarter of people with a terminal illness is a veteran, a statistic that highlights the unique challenges many former service members face in their final days. In response to this, several specialized hospice programs in the region have been developed to offer care that specifically addresses the needs of veterans as they navigate the end-of-life journey. For many veterans, the experience of facing terminal illness is compounded by the physical and emotional toll of their military service, particularly conditions like Post-Traumatic Stress Disorder (PTSD), depression, and anxiety. ... The We Honor Veterans program, created through a partnership between the National Hospice and Palliative Care Organization and the U.S. Department of Veterans Affairs, encourages hospice centers to offer a heightened level of care for veterans. Across Southwest Virginia, multiple hospice programs have achieved the highest level of recognition—Level 5—demonstrating their commitment to providing veterans with the best possible care. One such program is based in Franklin County. Despite its size, Carilion Hospice in Franklin County has earned a five-star status for its exceptional veteran services ...Editor's note: We thank and recognize all hospice organizations that find meaningful ways to support and honor your veterans. Click here for more information about NHPCO/The Alliance for Care at Home's We Honor Veterans program.

Fridays are made for catching your breath, expanding your wings, and showing the Universe what you're made of. ~ Anonymous

Study: People with dementia more apt to be admitted to nursing homes with lower star ratings McKnights Long-Term News; by Kristen Fischer; 11/5/24 People living with dementia are less likely to be admitted to high-rated nursing homes compared to people who don’t have the disease, a new study finds. Researchers looked at admission to nursing homes with higher staffing ratings after hospitalization and how individuals fared in the nursing homes based on having or not having dementia. The report was published on Oct. 29 in Alzheimer’s & Dementia. The team evaluated traditional Medicare beneficiaries discharged to nursing homes between 2011 and 2017 along with the relationship between facility staffing star-ratings, short-term readmission and mortality. The number of vacant beds in nursing homes with high ratings was also considered. Data was derived from 5.6 million people who were discharged to nursing homes; 23.1% of the people had dementia.