Literature Review

Clinicians’ perceptions about institutional factors in moral distress related to potentially nonbeneficial treatmentsJAMA Network Open; Teva D. Brender, MD; Julia K. Axelrod, BA; Sofia Weiss Goitiandia, MA, MSc; Jason N. Batten, MD, MA; Elizabeth W. Dzeng, MD, PhD, MPH; 6/25In this qualitative study, we described institutional factors that may exacerbate, prevent, or mitigate the influence of societal factors contributing to moral distress related to potentially nonbeneficial LST [life-sustaining treatments]. Health systems should consider how health care consumerism influences patients’, families’, and clinicians’ expectations regarding potentially nonbeneficial LST, particularly at hospitals with advanced technological interventions (eg, organ transplantation, extracorporeal membrane oxygenation, salvage chemotherapies). Future studies should explore the societal and institutional factors contributing to moral distress for clinicians at lower-resourced hospitals, such as inaccessible advanced treatments and barriers to transferring patients for higher levels of care. While some institutions lacked sufficient structures to support clinicians’ efforts to de-escalate potentially nonbeneficial treatments, policies empowering clinicians across the medical hierarchy, as well as conflict resolution and emotional support resources (eg, palliative care) might prevent or mitigate moral distress.

Top ten tips palliative care clinicians should know about managing diabetes at end-of-lifeJournal of Palliative Medicine; by Rebekka DePew, Tonya Hershman, Monica Giles, William E Rosa, Kimberly Curseen; 6/25Palliative care clinicians will regularly take care of patients with diabetes and play numerous roles in educating not only patients but also families and care partners regarding the changing balance of harms and benefits of blood glucose control as patients near end of life (EOL). There is limited evidence regarding the optimal timing and process for de-escalation of blood sugar monitoring and diabetes medications (including insulin) in the hospice and EOL setting.

Palliative care in the ICU: From oxymoron to standard of careIntensive Care Medicine; Nancy Kentish-Barnes, Judith E. Nelson; 6/25 Palliative care can be integrated into intensive care through ICU clinicians and palliative care specialists, and these approaches are complementary and synergistic. One study found that proactive specialist involvement in ICU rounds for high-risk patients led to more and earlier family meetings and shorter hospital stays. However, collaboration challenges, such as continuity of communication, highlight the need for close team cooperation. The integrative model trains intensivists and ICU nurses to embed palliative care into routine practice, ideally starting in medical and nursing education. Research has shown that improved communication and support from intensivists and ICU nurses are associated with better bereavement outcomes for families, including reduced post-traumatic stress, anxiety, depression, and prolonged grief.

[Italy] Palliative Performance Scale predicts mortality in cardiac intensive care unitOpen Heart; by Laura Sofia Cardelli, Lorenzo Gamberini, Beatrice Dal Passo, Silvia Zagnoni, Francesca Sciarra, Federica Frascaro, Alice Vitagliano, Valeria Carinci, Maria Laura Canale, Gianni Casella; 6/25Patients with PPS ≤70 had significantly higher 1-year all-cause mortality and in-hospital all-cause mortality. The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.

Medicare Advantage plan disenrollment: Beneficiaries cite access, cost, and quality among reasons for leavingHealth Affairs; by Geoffrey J. Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine; 6/25Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA... Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy. ~ Martin Luther King, Jr.

May we think of freedom, not as the right to do as we please, but as the opportunity to do what is right. ~ Peter Marshall

I guess we all like to be recognized not for one piece of fireworks but for the ledger of our daily work. ~ Neil Armstrong

True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost. ~ Arthur Ashe

With freedom comes responsibility. ~ Eleanor Roosevelt

Those who deny freedom to others deserve it not for themselves. ~ Abraham Lincoln

America, you great unfinished symphony, you sent for me. You let me make a difference. A place where even orphan immigrants can leave their fingerprints and rise up. ~ Lin Manuel Miranda, as Alexander Hamilton, in Broadway's 2014 Hamilton