Literature Review

The hurdles providers may face when setting up a palliative care program Hospice News; by Jim Parker; 10/30/24 Health care providers can have a bumpy road ahead of them when it comes to launching a new service like palliative care, in part due to complex legal and regulatory requirements. Before they launch a new program, operators must have a clear picture of their target population and the structure they want to build, according to Rachel Carey, counsel with the Virginia-based law firm Whiteford. Carey advises hospices establishing new services, pursuing acquisitions and other issues. Hospice News spoke with Carey about the regulatory and legal obstacles that health care providers may encounter when setting out to build a new program and what they should do to prepare. 

Delivering palliative care by telehealth meets the needs of people with cancer National Institutes of Health (NIH) - National Cancer Institute; by Linda Wang; 10/28/24 The use of telehealth in cancer care surged during the COVID-19 pandemic, when, for a period of time, in-person medical care was limited and many visits to the doctor went virtual. Despite some recent pullbacks in telehealth flexibilities, many experts believe that telehealth will continue to have a role in cancer care. But how well does telehealth perform when it comes to delivering palliative care for people with cancer, which can rely on a deeper level of connection between patients and providers than may be possible with a virtual visit? A study of 1,250 people with advanced lung cancer has now provided some insights into that question. The study found that virtual and in-person palliative care were similarly effective in improving patients’ quality of life and other important measures of well-being, according to findings published September 11 in JAMA. It also found benefits for caregivers. The results show that “we can successfully deliver … high-quality [palliative] care in person and virtually,” said Joseph A. Greer, Ph.D., of Massachusetts General Hospital, who led the study. 

Palliative care access for indigenous populations: Removing barriers and reducing disparities ECRI, Plymouth Meeting, PA; by Eileen Cornish; 10/22/24 ... Indigenous populations across North America face barriers to healthcare due to a combination of historical, social, economic, and systemic factors. Key barriers include historical trauma and distrust, remote or rural geography, economic disparities, cultural differences, systemic racism, and discrimination.  ... For this topic, ECRI librarians identified 35 studies, including six systematic reviews, that discuss barriers to palliative care for Indigenous people across North America. ...  Removing Barriers: Here are several key takeaways from the studies we identified. Other barriers are likely exist; however, these common themes emerged from the studies identified in ECRI’s review.

Clinic combines ILD, palliative care to improve access for underserved patients Healio; by Richard Gawel; 10/18/24 Boston, MA - A subspeciality clinic that combined pulmonary and palliative care improved access to these treatments for diverse and underserved populations, according to an abstract presented at the CHEST Annual Meeting. The clinic also was effective in supporting patients as they completed advanced care planning, compared with a clinic for interstitial lung disease, Meghan Price, MD, internal medicine resident, Johns Hopkins Hospital, and colleagues wrote. ... Rebecca Anna Gersten, MD, assistant professor of medicine, established the Breathlessness Clinic (BC) in 2022 to provide both pulmonary and palliative care to treat patients with significant dyspnea and other symptoms due to their advanced lung disease. The clinic aims to provide targeted management of symptoms in addition to improving access to palliative care for patients who may have encountered obstacles in accessing palliative care, the researchers said.

From bedside to mountaintop, she advocates for meaningful palliative care UCLA Health; by Jennifer Karmarker; 10/14/24 In a society that places a premium on prolonging life, celebrating the end of life is sometimes overlooked. Lindsay Brant, BSN, RN, CCRN, EOLD, MFA, is on a mission to change that. Brant started her work as a critical care nurse in the cardiothoracic ICU at UCLA Health in 2013. Since then, her journey has taken her from the bedside of the critically ill to a mountain retreat in New Mexico to remote high-altitude villages in the Himalayas and back again. Along the way, she’s discovered something she is passionate about sharing: Death can be a beautiful experience, if we let it. “It’s that constant question of how can end of life be as peaceful and meaningful as possible for the patient and their loved ones,” Brant says. 

How poor health literacy can diminish access to palliative care Hospice News; by Jim Parker; 10/11/24 Low health literacy among seriously ill patients can impede access to palliative care and complicate efforts to improve health equity. Health literacy is the degree to which individuals can obtain, process and understand basic health information and services needed to make appropriate health decisions, according to the Institute of Medicine. A health illiterate patient may have a strong overall ability to read or have an advanced education but have a limited understanding of information specific to health care. ... The issue deepens when it comes to palliative care. An estimated 71% of adults in the United States are unaware that palliative care exists, studies have shown, even though nearly 80% of consumers who received background information on palliative care say they would choose it for themselves or their loved ones. 

Palliative care ‘ahead of the game’ in approaches to treating rare diseases Hospice News; by Holly Vossel; 10/9/24 Researchers are ramping up efforts to better understand the complex trajectories of rare diseases, with evidence mounting around palliative care’s potential to improve outcomes among those patients. The Center for Innovation & Value Research recently launched the second phase of its Rare Disease Project, an initiative aimed at examining the diverse range of these illnesses and the patients impacted by them. The project is designed to learn more about the innovative, person-centered care models that can help address common challenges that these patients and their caregivers face — including approaches that integrate palliative care services. A pivotal point of the research for palliative care providers is understanding how their services help support patients — physically, practically and spiritually — as their diseases progress, according to Rick Chapman, chief science officer at the Center for Innovation & Value Research, which is part of the National Health Council.

Clinical capacity palliative care leaders’ top concern for 2025Hospice News; by Holly Vossel; 10/2/24Balancing rising demand with recruitment and retention tops the list of palliative care providers’ concerns heading into next year. Nearly 800 palliative care program leaders and interdisciplinary team members from across the country recently weighed in on a survey from the Center to Advance Palliative Care (CAPC). Respondents included both adult and pediatric palliative care providers who provided feedback on their 2025 outlook in the organization’s first iteration of its annual Palliative Pulse survey. [Survey results included:]

Building a clinic-based palliative care program Hospice News; by Jennifer Murtoff; 9/25/24 Palliative care is often delivered in the hospital setting or in the home, but a number of organizations have set up clinics to deliver those services. These locations often assist patients by offering a variety of services beyond symptom management. While they offer an alternative to home-based services, they present their own unique benefits and challenges. One of the agencies that uses the clinic model is Hospice of Northwest Ohio, which serves both Ohio and Michigan. Their palliative care subsidiary, Sincera — Supportive Care and Symptom Relief, launched in 2008 and recently opened a location in Oregon City, Ohio. At Sincera clinics, patients of any age who have chronic, serious illnesses can receive expert palliative care services. Creating the clinic-based model was a challenge, according to Richard Russell, president and CEO of Hospice of Northwest Ohio.

Mayo Clinic Minute: Palliative medicine for cancer patients Mayo Clinic; by Sonya Goins; 9/16/24 Patients undergoing cancer treatments often use palliative medicine to cope with nausea, fatigue and other bothersome symptoms. Palliative medicine is a medical specialty whose main focus is supporting patients and families/caregivers who need help managing symptoms related to cancer or side effects related to the treatment of cancer, along with other life-limiting diseases. Dr. Touré Barksdale, a Mayo Clinic cancer rehabilitation and palliative medicine specialist, explains the benefits of palliative care.

The ‘Holy Grail’ of palliative care payment through ACOs Hospice News; by Jim Parker; 9/11/24 As opportunities to provide palliative care through Accountable Care Organization (ACO) relationships continue to arise, operators will likely need to understand the varying types of reimbursement that exist in that arena. ACOs are groups of physicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to their Medicare patients. Hospices and palliative care providers can collaborate with ACOs by becoming members of those organizations themselves, or by contracting with them through a preferred provider network. Community-based palliative care’s track record of reducing costs and hospitalizations could make providers of those services attractive to ACOs, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.

Telehealth palliative care helps people living with advanced cancer Cancer Health; by Liz Highleyman; 9/9/24 Virtual palliative care can be as effective as in-person care, according to a recent study. Oncology palliative care is intended to relieve symptoms and improve quality of life. It is not the same as hospice care, and it can help people at any stage of cancer. National guidelines recommend integrating palliative care from the time of diagnosis for people with advanced cancer, but it is underutilized in part due to a shortage of trained providers. This study included 1,250 adults at 22 U.S. cancer centers who were diagnosed with advanced non-small-cell lung cancer. They had palliative care sessions every four weeks conducted either via video or in person. After six months, quality-of-life scores were equivalent in the two groups. They also did not differ significantly in terms of depression or anxiety, coping skills, understanding treatment goals or perception of their prognosis.

CHCF unveils palliative care mural California Department of Corrections and Rehabilitation (CHCF); by Lt. M. Orozco; 9/9/24 California Health Care Facility (CHCF) staff joined the incarcerated population and outside stakeholders to unveil the palliative care mural Aug. 23. Warden Gena Jones had a vision to normalize CHCF’s environment, making it more appealing for the incarcerated population and staff to enjoy while working. The vision consists of murals being painted throughout the institution with this mural setting the path for many more to come. In April 2024, incarcerated artists Issac Sinsun, Antiono Garcia, Loreto Arizpe, and Francsico Olivares started the palliative care mural. Little did they know it was the start to a new beginning. With the combined efforts of the four artists, the mural took 81 days and about 2,268 hours to complete. The ideas for the artwork were a combined effort from custody and medical staff as well incarcerated population within the housing unit. [Click on the title's link to see photos.]