Literature Review

It’s a poor sort of memory that only works backwards… ~Lewis Carroll, Through the Looking-Glass, And What Alice Found There

[Netherlands] Potentially inappropriate end of life care and healthcare costs in the last 30 days of life in regions providing integrated palliative care in the Netherlands: A registration-based studyInternational Journal of Integrated Care; by Chantal F R Pereira , Anne-Floor Q Dijxhoorn, Berdine Koekoek, Monique van den Broek, Karin van der Steen, Marijanne Enge, Marjon van Rijn, Judith M Meijers, Jeroen Hasselaar, Agnes van der Heide, Bregje D Onwuteaka-Philipsen, Marieke H J van den Beuken-van Everdingen, Yvette M van der Linden, Manon S Boddaert, Patrick P T Jeurissen, Matthias A W Merkx, Natasja J H Raijmakers; 7/24This study aimed to assess the effect of integrated palliative care (IPC) on potentially inappropriate end- of-life care and healthcare-costs in the last 30 days of life in the Netherlands. In regions providing IPC deceased adults (n = 37,468) received significantly less potentially inappropriate end-of-life care post-implementation compared to pre-implementation. Mean hospital costs significantly decreased for deceased adults who received IPC ... while mean costs increased for general practitioner services. This study shows less potentially inappropriate end-of-life care and a shift in healthcare costs from hospital to general practitioner and home care with IPC.

Mid-Atlantic primary care providers’ perception of barriers and facilitators to end-of-life conversationPalliative Care and Social Practice; by Melanie A. Horning, Barbara Habermann; 8/24Primary care providers are ideal people to facilitate end-of-life conversations, but these conversations rarely occur in the out-patient setting. Reported barriers in descending order included resistance from patients and families, insufficient time, and insufficient understanding of prognosis and associated expectations. Reported facilitators in descending order included established trusting relationship with provider, physical and/or cognitive decline and poor prognosis; and discussion standardization per Medicare guidelines. The involvement of primary care providers is associated with earlier ACP [advance care planning].

Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort reviewPediatric Blood and Cancer; by Sarah Daniels, Nelson D Franqui-Rios, Suraj S Mothi, Elizabeth Gaitskill, Kathryn Cantrell, Erica C Kaye; 8/24Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. [In this study] fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely ... to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely ... to receive interventions compared to patients who passed away at SJCRH [St. Jude Children's Research Hospital] locations. Hispanic patients ... and those in palliative care ... were more likely to receive interventions.

Crowdsourced feedback to improve resident physician error disclosure skills-A randomized clinical trialJAMA Open Network; Andrew A. White, MD; Ann M. King, MA; Angelo E. D’Addario, MA; Karen Berg Brigham, JD, MPH; Joel M. Bradley, MD; Thomas H. Gallagher, MD; Kathleen M. Mazor, Ed; 8/24Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents’ error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm.

Novel drug treatments for pain in advanced cancer and serious illness: a focus on neuropathic pain and chemotherapy-induced peripheral neuropathyPalliative Care and Social Practice; by Mellar P Davis; 7/24This review will discuss haloperidol, miragabalin, palmitoylethanolamide (PEA), and clonidine as adjuvant analgesics or analgesics. Haloperidol [demonstrates] ... only low-grade evidence that [it] improves pain when combined with morphine, methadone, or tramadol in patients who have cancer, pain from fibrosis, radiation necrosis, or neuropathic pain. Miragabalin is a gabapentinoid approved for the treatment of neuropathic pain ... [and] in randomized trials, patients with diabetic neuropathy have responded to miragabalin. Multiple randomized trials and meta-analyses have demonstrated PEA's effectiveness in reducing pain severity arising from diverse pain phenotypes. Intravenous clonidine has been used in terminally ill patients with poorly controlled symptoms, in particular pain and agitation.

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Does a patient’s ability to pay for health care make their life worth saving?JAMA Open Network; by Zara Cooper, MD, MSc; 7/24In this well-executed study using data from the American College of Surgeons Trauma Quality Improvement Program (TQIP), Hoit et al demonstrated that the timing of withdrawal of life-sustaining treatment (WLST) in critically injured adults between ages 18 and 64 years was statistically associated with the type of insurance they carried. Specifically, the authors showed that even after accounting for patient and hospital characteristics, individuals without insurance were approximately 50% more likely to undergo WLST earlier than others who were insured (eg, private insurance or Medicaid). ... it is incumbent upon individual clinicians and health systems to closely and uncomfortably examine how bias either creeps or marches into the life-and-death decisions we make for everyone under our care.

New bill in Congress would improve end-of-life carePublic News Service; Suzanne Potter; 8/23/24A bill just introduced in Congress would raise public awareness of issues surrounding the end of life, including palliative care, and hospice. The Compassionate Care Act [co-sponsored by Rep. Nanette Barragán, D-CA, and Sen. Richard Blumenthal, D-CT] would establish guidelines for advance care planning between health providers and patients... The bill would direct the government to develop education resources for providers, expand telehealth options and facilitate a study of a national advance care planning registry, which would allow patients to transfer their advance directives from state to state.

Carolina Caring’s second hospice resale shop location in Mountain View opens 8/28 FOCUS Newspaper; 8/21/24 Carolina Caring is delighted to announce the grand opening of its second Hospice Resale Shop location on Wednesday, August 28, at 10 a.m. This new shop will be located at 2920 S. Highway 127 in Mountain View, just a few miles from the nonprofit serious illness provider’s Catawba Valley Hospice House. ... Carolina Caring, founded in 1979, is an independent, community-based, nonprofit healthcare provider. ... Carolina Caring serves 12 counties across western North Carolina and the Charlotte Region.

Project Linus brings comfort to children in need through handmade blankets and quilts Concho Valley, College Station, TX; by Zoria Goodley; 8/21/24 Project Linus, a nonprofit organization dedicated to providing handmade blankets and quilts to children facing serious illness, trauma or other needs, continues its impactful mission across the United States. There are 17 chapters in the state of Texas alone. Patricia Perry, the Brazos Valley Chapter Coordinator, highlights the broad spectrum of needs the organization addresses.

Granite VNA launches virtual nurse program Eagle Times, Concord, NH; by Eagle Times Staff; 8/22/24 Granite VNA recently introduced a virtual nurse program, connecting patients with skilled home and hospice care nurses through telephone and video calls. The virtual nurses complement the agency’s field nursing team by conducting regular check-ins with their patients, reinforcing education, addressing patients’ physical and mental health needs, supporting case management and more. Granite VNA currently has three virtual visiting nurses, two who specialize in home care and one who specializes in hospice care. Similar to the agency’s field nurses, the virtual visiting nurses see multiple patients each day. “Virtual visiting nurses play a crucial role in enhancing community health and providing support to Granite VNA’s home and hospice care field nurses,” said Granite VNA Vice President of Education and Quality Tammi Mozier, MBA, PT, ATC, COS-C.