Literature Review

Sophisticated caregiver training remains an underutilized retention, ROI tool Home Health Care News; by Audrie Martin; 8/22/24 ... [Only] 43.8% of home-based care staff and 55% of home health and hospice staff feel prepared to care for new clients, according to the 2024 Activated Insights Benchmarking Report. As a possible result, the annual care staff turnover rate has climbed 14% in the last two years to almost 80%. Organizations demonstrating a commitment to continuing education improve employee satisfaction by allowing caregivers to hone their skills and grow in their careers. Investing in employees’ long-term success will impart a sense of purpose and possibility within a role known for turnover and burnout. “The average home-based care provider offers five hours of orientation and eight hours of ongoing training,” the report read. “Those who offer at least eight orientation hours and 12 hours of ongoing training see an increase of $1,103,291 in revenue. However, while establishing a clear path is one of the top strategies to retaining long-term employees, only 39% of providers have one.”

The importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]

TCN podcast: The need to know on the 2025 Hospice Wage Index Telios Collaborative Network (TCN); podcast hosted by Chris Comeaux; 8/21/24 In this episode of TCN Talks, Chris interviews Annette Kiser, Chief Compliance Officer with Teleios and Judi Lund Person, Principal with Lund Person & Associates LLC.  The conversation covers the need to know around the final published 2025 Wage Index for Hospices.  Some of the key points discussed are:

Staff education an anchor amid widespread hospice audits Hospice News; by Holly Vossel; 8/14/24 ... More than half of hospice providers reported having multiple types of audits within a six-month span in a survey earlier this year. ... Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE) audits are among the most common types of audits that hospices undergo simultaneously alongside others. ... Staff need a firm understanding around the potential red flags on regulators’ radars and how to avoid common compliance errors in their roles, ... Compliance training should be focused on staff’s overall responsibilities alongside the larger bottom line of quality, she said. ... Notable mentions: Jason Bring, co-chair of post-acute and long-term care at the law firm Arnall Golden Gregory LLP (AGG)l; Megan Turby, vice president of quality and compliance at Gulfside Healthcare Services; Dr. Lisa Barker, chief medical officer at Gulfside Healthcare Services

Death is inevitable. It's time we learned to talk about it. MedPageToday; by Nidhi Bhaskar; 8/13/24 By fostering honest and compassionate discussions, we can provide patients with more dignity. Years ago, in a busy emergency department, I found myself joining my mentor at the bedside of an elderly man experiencing chest pain. After completing the physical exam, the doctor unceremoniously changed gears to abruptly ask our patient, "If your heart were to stop beating, do you want us to do everything?" Between the stress of the situation and the vague and awkward delivery of the question, our patient seemed (understandably) overwhelmed. So was I. ... End-of-life conversations can feel like a "word soup" of sorts ... it is easy for patients and providers alike to feel lost. ... Providers must also consider the nuances of cultural attitudes towards death; the location and family arrangements surrounding a person at the end of life; and the varying emotional responses and feelings of decision paralysis surrounding how one dies and how one feels about dying.Editor's Note: For a related article in our newsletter today, read "Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication."

Education curricula need to incorporate whole-person care beyond electives Pharmacy Times; by Ashely Gallaher; 7/21/24“[Whole-person care is] simply caring for a person and not just their pills. It's making sure that we're focusing on medications as tools to help people live better, healthier lives, and not as the focus of their lives,” Kashelle Lockman, PharmD, MA, clinical assistant professor and clinical pharmacy specialist at the University of Iowa. ... 3 Key Takeaways:

Factors affecting palliative care collaboration with pain medicine specialists Hematology Advisor; by James Maitlall, MD; 7/22/24 Structured collaboration between physicians working in palliative care (PC) and pain medicine (PM) may increase PC physician referral of seriously ill patients to PM specialists and potentially optimize their care, according to study results published in the Journal of Pain and Symptom Management. ... The investigators concluded, “Although we found that PC physicians have highly positive attitudes about the value of PM specialists, referral rates remain low, even for IDDS implantation, which has perhaps the largest body of evidence for patients with complex cancer-associated pain.” They added, “Facilitating professional collaboration via joint educational/clinical sessions is one possible solution to drive ongoing interprofessional care in patients with complex pain.

Mayo Clinic Minute: How extreme heat, humidity affect your health News Tribune; by Tribune News Service; 7/16/24 Many parts of the U.S. continue to grapple with oppressive heat and humidity. This can prevent the body from cooling down, increasing the risk of heat cramps, exhaustion and heatstroke. Dr. Jesse Bracamonte, a Mayo Clinic family medicine physician, said the extreme heat and high humidity can be a dangerous mix. "High heat and high humidity can place one at risk for serious illness if people aren't careful. The heat can affect people's bodies by increasing the core body temperature and ability to sweat, and cause dehydration that can cause further medical problems and ensuing issues, and eventually can lead to heat exhaustion, in some cases, severe heat illness, known as heatstroke," Bracamonte said. Editor's Note: What information and support are you providing for your clinicians who travel between visits and for your patients who might be affected by extreme heat and humidity? What simple, practical adaptations might you create, like disposable water bottles for staff as they leave your building (with a sign of support and basic info)?

Report shows substantial financial opportunity in prioritizing research, education on women’s heart health Pharmacy Times; by Alexandra Gerlach; 7/13/24 A report published by authors from the American Heart Association (AHA) and the McKinsey Health Institute showed that addressing the gender gaps prevalent in the treatment of cardiovascular disease (CVD) could boost the US economy by $28 billion annually by 2040 and potentially address the 1.6 million years of life lost due to barriers to care experienced by women. The paper identifies multiple pathways to addressing the lack of representation and access to care for women with CVD... CVD is the leading cause of death in women in the United States, affecting nearly 60 million individuals, and it makes up over a third of the health gap between men and women. 

The impact of clinical internship experience on nursing students' attitudes towards death and choices of end-of-life care: A self-control study Nursing Opens; Jingyuan Jiang, Jing Zhou, Xiaoli Chen, Xiaolin Zhu, Hao Zhang, Qin Zhang, Jianna Zhang; 6/28/24  Attitude towards death refers to an individual's evaluative and stable reactions to death events, reflecting their psychological tendencies and characteristics. ... Death is an inevitable part of life, and individuals must face the reality of death. ... The findings of this study suggest that real clinical experiences in the emergency department contribute to nursing students' development of a positive attitude towards death and a more positive view of providing end-of-life care in a hospital setting. Incorporating teachings on end-of-life care in a hospital setting into death education courses can further enhance nursing students' understanding and acceptance of end-of-life care. 

Coping and end-of-life decision-making in ALS: A qualitative interview study PLoS One, University of Auckland, New Zealand; by Olga Wenzel, Anke Erdmann, Gerald Neitzke, and Irene Hirschberg; 6/26/24 How do people with amyotrophic lateral sclerosis (PALS) deal with their diagnosis and engage in end-of-life decision-making? What informational or supportive needs do they have for counselling about life-sustaining treatment and end-of-life care? Which correlating conditions and influences relate to these needs and how do they connect to the wish to die or wish to live? ... We identified the coping strategies ‘avoid thinking about end-of-life’ and its counterpart, ‘planning ahead to be well-prepared,’ and differentiated the latter into the patterns ‘withdrawing from life and taking precautions against life-prolongation’ and ‘searching for a new meaning in life and preparing for life-sustaining treatment’.  ... These strategies may vary over time, resulting in different support needs. Our findings signify that deep insight is needed into PALS‘ coping processes to understand their decision-making about life-sustaining treatment. Healthcare professionals should be sensitive to illness experiences beyond medical aspects and foster coping as a biographical process to better support people with ALS.Editor's Note: Click on the title to access the full text of this insightful, relevant research. Hospice and palliative educators, use this to strengthen your disease-specific resources and training about care for persons with ALS.

Experiencing and enduring patient distress: the distress of palliative care patients and its emotional impact on physicians in trainingBMC Medical Education; by Andréa Tarot, Maxence Pithon, Ashley Ridley, Virginie Guastella, Virginie Guastella, Morgane Plancon, Régis Aubry, Helène Vaillant Roussel, and Axelle Maneval; 6/26/24The extreme vulnerability experienced by patients in palliative care may result in significant distress. These patients require appropriate care while not pathologizing their natural distress. ... [The] aim of this study was to explore how professionals in training feel when confronted with the distress of patients undergoing palliative care. ... The interviews revealed the following five themes: