Literature Review

The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregiversContemporary Clinical Trials Communications; by O McAnirlin, J Thrift, F Li, J K Pope, M H E M Browning, P P Moutogiannis, G Thomas, E Farrell, M M Evatt, T Fasolino; 6/24Nature-based and other outdoor virtual reality (VR) experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Using personalized, nature-based and other outdoor VR content, the patient-caregiver dyads can simultaneously engage in an immersive encounter may help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress.

Prognostication in hospice care: Challenges, opportunities, and the importance of functional statusFederal Practitioner - Case Reports; by David B. Brecher, MD and Heather J. Sabol, MSN, ARNP; 7/24 Predicting life expectancy and providing an end-of-life diagnosis in hospice and palliative care is a challenge for most clinicians. Lack of training, limited communication skills, and relationships with patients are all contributing factors. These skills can improve with the use of functional scoring tools in conjunction with the patient’s comorbidities and physical/psychological symptoms. The Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS), and Eastern Cooperative Oncology Group Performance Status Scale (ECOG) are commonly used functional scoring tools.

Pain Management at the End of LifeJournal of Hospice and Palliative Nursing; HPNA position statement; 8/24.Pain management is essential from the time of diagnosis of a serious illness and throughout the disease trajectory. Unfortunately, the prevalence of pain in those with serious illness remains unacceptably high. In most cases, pain experienced by people with advanced disease can be prevented or relieved through optimal care, yet studies reveal that patients continue to experience uncontrolled pain in the final weeks, days, and hours of their lives...

Saturday newsletters focus on headlines and research - enjoy!

UnitedHealth and Amedisys reach divestiture agreement in effort to complete merger  Open Minds - Industry Bulletins; 7/29/24 UnitedHealth Group and home health and hospice provider Amedisys entered an agreement to sell certain assets to a subsidiary of VitalCaring Group (VCG) as part of an effort to obtain regulatory approval for a merger first announced in June 2023.  The deal, valued at $3.3 billion, has been held up due to concerns from the Department of Justice. UnitedHealth and Amedisys declined to provide more information on the divestiture. According to an SEC filing, the deal with VCG Luna would only go through if UnitedHealth and Amedisys complete their merger. Earlier in 2024, Amedisys agreed to divest upwards.

Help improve the PEPPER ProgramPEPPER email; 7/30/24There is a temporary pause in distributing Program for Evaluating Payment Patterns Electronic Reports (PEPPERs) as the Centers for Medicare & Medicaid Services (CMS) work to improve and update the program and reporting system. This pause will remain in effect through the fall of 2024. We recognize the importance of these reports to your practice. Therefore, during this time, CMS will be working diligently to enhance the quality and accessibility of the reports. In fulfilling this commitment, CMS seeks responses to a series of questions listed in the Request for Information (RFI). These questions will provide CMS with information that may be used to reevaluate PEPPERs and improve the effectiveness and accessibility of the program. The RFI (PDF) is available here. Responses are due on or before 08/19/2024 and must be provided via online submission at the following address: CBRPEPPERInquiries@cms.hhs.gov. 

Hospice of the Western Reserve Acquires Hospice of North Central Ohio Longview News-Journal, Cleveland, OH; by Hospice of the Western Reserve; 8/1/24 Hospice of the Western Reserve (HWR), a premier provider of hospice and palliative care services in Northern Ohio, has completed its acquisition of Hospice of North Central Ohio (HNCO) effective today. This strategic alliance aims to expand access to high-quality, comprehensive end-of-life care across a broader region. The news follows a February 2024 announcement that the two community-based, nonprofit agencies had entered a management services agreement, allowing HWR to begin a due diligence process in preparation for the full transition. The acquisition comes because of increased competition within the HNCO service area, economic challenges, and a need to stabilize and ultimately grow the organization. 

Mercy Health Home Care and Hospice programs rebranding under new partnership The Paducah Sun, Paducah, KY; by Sun Staff; 7/30/24 Mercy Health Home Care and Hospice programs in the Paducah area now have a new name: Mercy Health Home Care and Hospice by Compassus. Announcing the name change in a news release on Monday, Bon Secours Mercy Health said the change reflects a partnership between the Catholic health system and Compassus, which it said is a “leading national provider of innovative home-based health care services.” Locations in Paducah and Metropolis, Illinois, formerly managed by Mercy Health will be managed by the partnership — which was finalized earlier this year — and included in the name change, except the Ray and Kay Eckstein Hospice Care Center at Mercy Health. 

Signs that cognitive changes are worrisome —and what you can do about it CU Anschutz (Colorado University) Department of Medicine; by Tayler Shaw; 7/26/24 ... As a geriatrician and palliative medicine physician, Hillary Lum, MD, PhD, has spent her career working to better the lives of older adults and their families, often raising awareness about what cognitive decline can look like and when it is concerning. She is currently involved in the Colorado Alzheimer’s Disease and Related Dementias State Plan, a state initiative to improve awareness and actions to address dementia in Colorado, specifically looking at how to build a competent workforce related to Alzheimer’s disease and related dementias.  We recently sat down with Lum ... to talk about what cognitive decline is, symptoms to look out for, and how people can best protect their brain health.  

The most urgent needs in medical education Becker's Hospital Review; by Mariah Taylor; 7/30/24 Healthcare is rapidly changing, presenting challenges to new physicians and the organizations that train them. The rise of AI, new technologies, patient demands and increased awareness in social determinants of health and equity have pushed leaders and organizations to change how they evaluate healthcare workers' preparedness as they enter the field. ...

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.

End-of-life care planning ‘needs to become routine’ Nursing Times; by Gemma Mitchell; 7/30/24 Nurses need to support a "culture change" in end-of-life care whereby people's are better recorded and respected, a new report has urged. [Free trial / subscription required for full access.]

When you first get a hill in sight, look at the top of it only once. Then imagine yourself at the bottom of the other side. ~ Florence Griffeth Joyner, also known as Flo-Jo, Olympic runner 1984 and 1988, in Time's 2020 list of the most influential women of the past century.