Literature Review

Curricular reform in serious illness communication and palliative care: Using medical students' voices to guide change  Academic Medicine: Journal of the Association of American Medical Colleges; by Jennifer A Reidy, Kate Brizzi, Stephanie H Chan, Hollis Day, Scott K Epstein, Melissa Fischer, Priya S Garg, Anna Gosline, Carolina Jaramillo, Emma Livne, Suzanne Mitchell, Sarah Morgan, Molly W Olmsted, Patricia Stebbins, Isabella Stumpf, Tamara Vesel, Irene M Yeh, Megan E Young, Roberta E Goldman; 5/1/24 Purpose: To gather and leverage the voices of students to drive creation of required, integrated palliative care curricula within undergraduate medical education in Massachusetts, which is lacking in a majority of U.S. medical schools. Conclusions: This study confirms long-standing themes on students' experiences with SIC and palliative care topics, including feeling inadequately prepared to care for seriously ill patients as future physicians. Our study collected students' perspectives as actionable data to develop recommendations for curricular change.

Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians Cambridge University Press; by Eran Ben-Arye, Noah Samuels, Yael Keshet, Miri Golan, Erez Baruch, and Jama Dagash; 4/8/24 Objectives: The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients’ unmet needs and quality of life (QoL)-related concerns.Conclusions: While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.

Shocked at end-of-life: An educational video for hospice workers about Implantable Cardioverter-Defibrillators Journal of Pain and Symptom Management; by Sarah Godfrey, MD, MPH; Christine L. Chen, MD; Melanie S. Sulistio, MD; Sharika Kumar, MD; and Kelley Newcomer, MD; 2/24 Introduction: Hundreds of thousands of patients with implantable cardioverter-defibrillators (ICDs) die yearly. Though ICD shocks can be lifesaving, they can also be severely painful. One third of ICD patients are shocked in the last day of life irrespective of DNR status. Over 97% of hospice programs admit patients with ICDs, yet only 10% have deactivation policies and less than 50% of hospice patients have their ICD deactivated. ...  Conclusion: Hospice personnel have limited knowledge about ICDs, prohibiting best care of patients with these devices at EOL. A short educational video increased knowledge and may serve as a helpful tool. Improving ICD knowledge amongst hospice personnel is essential to ensuring the unique needs of hospice patients with ICDs are met.

Hospital CEOs chart paths into healthcare's futureBecker's Hospital Review; by Kelly Gooch; 4/24/24Hospital and health system CEOs understand the need to meet demand for healthcare services while also focusing on the well-being of employees and strengthening the talent pipeline. They are also focusing on healthcare education and workforce development. Additionally, they are zeroing in on technology or partnerships that can expand capacity, help improve care and drive innovation. The innovation piece particularly resonates with Bert O'Malley, MD, president and CEO of Baltimore-based University of Maryland Medical Center.

Mercy Hospital surgeon teaches high school student future of surgical medicine CBS News TV 13 Sacramento, CA; 4/21/24 A unique experience for high school students, taking a step into the world of robotic surgery. Mercy Hospital hosted students to learn the ins and outs of the future of surgical medicine.

Health care system eats away at the doctor-patient relationship The Boston Globe; updated 4/17/24... The system economically rewards throughput (the number of patients seen per unit time) and procedures rather than the time needed to develop an open and communicative doctor-patient relationship. While a good physician might understand the tests and evaluations that are indicated by a presenting medical problem, the excellent clinician knows which tests and evaluations should not be done. This is primarily ascertained by delving into details of the patient’s physical, psychological, social, family, and economic history. This process, as James highlights, can lead to collaborative and more effective care. ...Editor's Note: This article highlights "Dr. Thea James’s remarkable work at Boston Medical Center in addressing structural inequity in medical care as a means of enhancing outcomes brings up an underlying structural problem across the entire medical care system (“Her health equity message being heard,” April 13, 2024.)

Potential CMS measure shows divide over quality training standards Modern Healthcare, by Mari Devereaux; 4/12/24 Hospitals may soon be required to provide set quality training to staff as part of a Medicare reporting program, but health systems and advocacy organizations are split on whether the standardization of quality-related skill sets is necessary to improve patient care.

Expanding perinatal palliative care, hospice Hospice News, by Holly Vossel, 4/10/24A lack of trained staff and evolving health laws are among the leading barriers to expanding perinatal palliative and hospice care among underserved populations. ... Mistrust and fear of discrimination are among the common barriers, along with social determinants of health such as insurance coverage, socioeconomic status and transportation, according to recent analysis from researchers at the Morehouse School of Medicine’s Department of Obstetrics and Gynecology.

Why so many nurses are fleeing healthcare — and how hospitals can address the problem MedCity News, by Katie Adams; 4/10/24Nearly one-fifth of nurses are projected to leave the healthcare workforce by 2027. The American Organization for Nursing Leadership published a report revealing one of the biggest reasons nurses are exiting the industry: their managers are too busy to train and support them.

Anti-DEI initiatives in medicine harm us all MedPage Today - Perspectives; by Aderonke Pederson, MD; 4/9/24I entered into medical school as a top student at the University of Chicago with a high GPA ... and a stellar CV exhibiting strong leadership qualities. I had beaten all odds, despite being a Black orphan migrant with no financial means. Medical school was a grueling process ... I would likely have felt even more socially isolated at my predominantly white institution if not for three essential factors. First, I was welcomed by Diversity, Equity, and Inclusion (DEI) administrators and participants ... Second, I had a dean of DEI who... said, "You can do this, Ronke." Finally, without my deep faith, ... I would not be where I am today. My experience is not unique from other underrepresented physicians of color. Despite this, DEI programs across the country are under attack.

Why difficult conversations matter: How delivering bad news with clarity and empathy impacts both provider and patient Cedars Sinai, by Cassie Tomlin; 4/8/24Good physicians rely on a battery of hard-won skills to treat serious illness—they observe, predict, test, prescribe and diagnose. But many physicians haven’t been taught how to have productive, mutually beneficial conversations—such as sharing a life-changing diagnosis or informing patients about disease trajectory and symptoms, prognosis and end-of-life care. High-impact communication tools can be learned at any point in a physician’s career, says Jessica Besbris, MD, director of Neuropalliative Care and the Neurology Supportive Care Medicine Program at Cedars-Sinai. Here, Besbris shares why such careful conversations matter for everyone involved, and ways physicians can improve how they discuss serious illness.

South Dakota State University Nursing School: Hitting the mark where it matters South Dakota State University, "A Message from Dean Krogh," by Mary Anne Krogh; 4/2/24As we welcome the blooming of spring (and the melting of snow), it brings me great joy to reflect on the remarkable achievements and growth within the SDSU College of Nursing. ... One area that fills me with pride is the remarkable expansion we have experienced in the areas of palliative care, rural health and simulation research. These vital areas not only represent the forefront of nursing innovation but also reflect our dedication to addressing critical health care needs in diverse communities. Editor's Note: Congratulations to South Dakota State University School and Dean Krogh! You are hitting the mark for several crucial, timely issues that continue to emerge in the news feeds we receive and distribute to our readers. 

Improved onboarding process could boost worker retentionMcKnights Senior Living, by Kathleen Steel Gaivin; 4/8/24As long-term care providers navigate post-pandemic workforce challenges, they also need to improve the onboarding process, according to the results of a new survey by Viventium. ... The study detailed in the company’s 2024 Caregiver Onboarding Experience Report solicited responses from 175 administrators and caregivers in skilled nursing, assisted living, independent living, home health, home care and hospice care in November and December. The survey, Viventium said, found a “shockingly low bar for what passes as a ‘good’ onboarding experience, with strong indications that raising that bar could correlate to higher retention rates.”Editor's Note: See the article in today's newsletter, "A day in the life: Hospice nurse" for the importance of onboarding hospice nurses to to differences between long-term care and hospice care.