Literature Review

Legislation allowing doctor-assisted suicide narrowly clears Delaware House, heads to state Senate

Clinician burnout and effectiveness of guideline-recommended psychotherapies JAMA Network - Psychiatry; by Nina A. Sayer, PhD; Adam Kaplan, PhD; David B. Nelson, PhD; et al; 4/17/24 Importance: Clinician burnout has been associated with clinician outcomes, but the association with patient outcomes remains unclear. Conclusions: This prospective cohort study suggests that clinician burnout was negatively associated with patient outcomes from evidence-based psychotherapies. Findings support research to test the hypothesis that interventions to reduce burnout may improve outcomes from guideline-recommended psychotherapies for PTSD. Future work should determine when and how burnout is associated with intervention delivery and patient outcomes.Editor's Note: Most research on hospice and palliative clinician burnout focuses on physicians and nurses. Examine this in light of your psychosocial/spiritual professionals, i.e. social workers, chaplains/spiritual care, and bereavement counselors. 

What home health providers can learn from CMS’ other proposed rules for 2025Home Health Care News, by Joyce Famakinwa; 4/19/24... CMS released the 2025 proposed payment rules for hospice and skilled nursing facilities (SNFs) in March. On the hospice side, the proposed rule included a 2.6% increase in the per diem base rate. Aside from the pay raise for hospices, the proposal also included a market basket index update, and notable changes to some of the geographic areas subject to particular indices. “There are rural areas that became urban and urban areas that became rural in the new CBSs — core based statistical areas,” William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Health Care News.

Hospice handoffs may lower odds of Medicare denials Medscape, by Lara Salahi; 4/29/24Clearer communication between primary care clinicians and hospice providers may decrease the number of denied Medicare approvals for end-of-life treatment, according to a small study presented on April 18 at the American College of Physicians Internal Medicine Meeting 2024. Tyler Haussler, MD, acting medical director at  Brookestone Home Health & Hospice in Carney, Nebraska, said he conducted the study. ... CMS requires a "face-to-face encounter" between a physician and hospice caregiver to communicate clinical findings and determine the patient's terminal status. Missing or incomplete documentation of a patient's medical condition remains one of the main reasons the agency denies hospice coverage. 

“To prescribe or not to prescribe, that is the question”: Perspectives on opioid prescribingfor chronic, cancer‐related pain from clinicians who treat pain in survivorshipCancer, by Hailey W Bulls, Megan Hamm, Julia Wasilewski, Donna Olejniczak, Sarah G Bell, Jane M Liebschutz; 4/24Opioid pain management in cancer survivorship is a complex and understudied topic. ... Participants suggested that opportunities to improve chronic cancer pain care include developing clear, systematic guidance for chronic cancer pain management, facilitating clinician communication and consultation, creating tailored survivorship care plans in partnership with patients, and developing accessible, evidence-based, complementary pain treatments.

A process evaluation of a palliative care social work intervention for cancer patients in skilled nursing facilitiesJournal of Palliative Medicine, by Sarguni Singh, MD; Ashley Dafoe, MA; Dana Lahoff, LCSW; Laurel Tropeano, LCSW; Bree Owens, LCSW; Erin Nielsen, LCSW; John Cagle, MSW, PhD; Hillary D. Lum, MD, PhD; Brooke Dorsey Holliman, PhD; Stacy Fischer, MD; 4/24Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care social work intervention that aims to improve delivery of goal-concordant care for hospitalized older adults with cancer discharged to skilled nursing facilities. ... ALIGN offers support in prognostic understanding, communication, and decision making during a pivotal time when patient and caregivers' goals have not been met and they are reassessing priorities.

Executive Personnel Changes - 4/19/24

LGBTQ+ individuals have higher rates of cancer because of disparities in modifiable risk factors, ACS says ONS Voice [Oncology Nursing Society]; by Magdalen Millman; 4/18/24 About 7% of the U.S. population identifies as LGBTQ+, but understanding cancer in this population is difficult because surveillance data are limited to national surveys on risk factors and screening, the American Cancer Society (ACS) observed in a special section of its Cancer Facts and Figures 2024 report on cancer in the LGBTQ+ community. More than 50% of LGBTQ+ individuals have experienced harassment such as slurs, violence, microaggressions, and sexual harassment, even in healthcare settings. “One in 6 LGBTQ+ adults, and 1 in 5 transgender adults specifically, avoid health care due to previous discrimination,” ACS reported. It’s one factor implicated for the disparities affecting LGBTQ+ individuals’ access to cancer care, including prevention, screening, diagnosis, treatment, and palliative care. Editor's Note: Click here for this site's downloadable pdf, Cancer Facts and Figures 2024, Special Section: Cancer in People Who Identify as Lesbian, Gay, Bisexual, Transgender, Queer, or Gender-nonconforming. Pair this with another article in today's newsletter, "Stillwater Hospice earns SAGECare credential for LGBTQ+ care."

Physician coaching by professionally trained peers for burnout and well-being: A randomized clinical trial JAMA Network; by Stephanie B. Kiser, MD, MPH; J. David Sterns, MD, MPH; Po Ying Lai, MS; et al; 4/12/24Findings: In this randomized clinical trial of 138 physicians, participants who received 3 months of coaching by professionally trained physician peers had a statistically significant reduction in interpersonal disengagement and burnout, with improvement in professional fulfillment and work engagement.

Volunteers make best days possible for 600 people a day at VNA Hospice NWIGreatNews.Life, Valparaiso, IN; 5/19/24VNA Hospice NWI serves over 600 people a day. From Hospice and Palliative Care, Grief Support services for adults and children to the Medical Guardian help button and a Meals on Wheels program, the impact of VNA services around the region is tremendous. The VNA staff work tirelessly to ensure these essential services are available each day – but they can’t do it alone. Their team relies on an army of volunteers, who do everything from stuffing envelopes and labeling meal bags, to working directly with hospice patients and bereaved children, and delivering the meals. Maria Galka, Director of Development for VNA Hospice, said that the organization’s volunteers outnumber its staff by about five to one. Editor's Note: April's Volunteer Appreciation Month is still underway. Learn from this superb article, posted on an online community site. VNA Hospice NWI's astonishing volunteer program bears repeating: "... the organization’s volunteers outnumber its staff by about five to one."

Lens X: A practical approach to taking care of your peopleThe Journal of Character & Leadership Development, by Daphne DePorres, Matthew Orlowsky, Matthew Horner, David Levy; 4/24Graduates of the United States Air Force Academy (USAFA), as commissioned officers, are charged to “take care of their people.” While this leadership aphorism makes sense, this article describes what it means in practice.  An  interdisciplinary  USAFA  team  explored  the  dynamics  of  leader  development  from  multiple  angles, resulting in a focus on two dimensions (or “lenses”) that help a leader understand what actions can be taken to help an employee achieve subjective well-being at work. The intent is to draw attention to the nature of the interaction with organizational members that foster engagement and need fulfillment. We do that by focusing a leader’s attention on needs, narratives, and micro-exchanges. Those interactions, behav-iors, and micro-exchanges are the foundations of and the most tangible, changeable element of climate and culture. This practical lens equips any leader to seize every opportunity to foster fulfillment of the psychological needs for belonging, agency, and efficacy. This framework can be used by anyone but is particularly relevant to supervisors and USAFA cadets who will be entrusted to lead an all-volunteer military force.Publisher's note: An interesting article on leadership and change management by my friend and colleague Dave Levy, PhD, Professor of Management and Leadership at the US Air Force Academy. He also co-authored three books: The 52nd floor: Thinking deeply about leadership, Attitudes aren't free: Thinking deeply about diversity in the US Armed Forces and Echoes of mind: Thinking deeply about humanship.

Automated electronic health record score to predict mortality risk at the US Department of Veterans AffairsAmerican Journal of Hospice and Palliative Medicine, by Thomas F Osborne, Zachary P Veigulis, Anna Ware, David M Arreola, Catherine Curtin, Marianne Yeung; 4/24A readily available risk score, automatically calculated from EHR data, was able to identify patients at high risk for 30-day mortality in the acute care setting. Next steps will be to assess how the CAN score can be utilized to in improve end of life care for high-risk hospitalized Veterans.