Literature Review

Improving advanced care planning for late-stage cancer Medical Xpress; by Melissa Rohman; 6/24/24 Multilevel care interventions improved clinician–documented advanced care planning (ACP) compared with a clinician-level intervention alone for patients with genitourinary cancer, according to findings published in JAMA Oncology. "Clinicians often have limited time to assist patients in fully understanding ACP. This intervention is one approach to improve ACP and care delivery among patients with advanced stages of genitourinary cancer," said Gladys M. Rodriguez, MD, MS, assistant professor of Medicine in the Division of Hematology and Oncology and lead author of the study. For patients diagnosed with late-stage cancer, ACP can help reduce unnecessary acute care, increase palliative care and improve quality of life. However, previous reports have found that less than 20% of patients will engage in ACP with their health care providers. ... The primary outcome was ACP documentation in the electronic health record by the patient's oncology clinician within 12 months. Secondary outcomes included shared decision-making, palliative care use, hospice use, emergency department visits and hospitalizations within 12 months.

It’s your funeral! How to plan ahead for the best party you’ll never attend The Guardian; by Doosie Morris; 6/14/24 Years before the indomitable Joan Rivers died in 2014 she immortalised hopes for her own farewell in her memoir. ... The rise in so-called “death positivity”, along with the mortal reality check wreaked on us by the pandemic, has helped to reframe death as a part of life for many of us. Taboos around discussing death are breaking down and planning your own funeral is increasingly considered as responsible as writing a will. ... While the latest Australian Funeral Industry report found less than one in five Australians have actually planned their own funeral, a definite vibe shift is occurring and 90% of people say they want to. ... “When people say ‘I don’t want a funeral’ I remind them it’s not actually for them,” Griffith says. “You might think you’re doing your loved ones a favour, but you are actually denying everyone who needs somewhere to put their grief.” ...

End-of-life talks, planning benefit all racial groups, study finds McKnights Long-Term Care News; by Kristen Fischer ... Having formal advanced care planning (ACP) in place was linked to higher odds of receiving care that aligned with individuals’ goals, the researchers found. The study evaluated how ACP and goal-concordant care (GCC) — an approach that aims to meet the patient’s goal and includes ACP and conversations about care goals —  affected people of different races. The report was published on May 18 in the Journal of the American Geriatrics Society.  The framework is especially important for people in racial or ethnic minority populations who have a greater risk of poor end-of-life outcomes and don’t receive GCC. ... Older adults are more likely to receive hospice care at the end of life compared to previous decades, but a lot of people still report care that didn’t meet their preferences, the authors noted.

Early palliative care perceptions by patients with cancer and primary caregivers: metaphorical languageBMJ Supportive & Palliative Care; by Elena Bandieri, Sarah Bigi, Melissa Nava, Eleonora Borelli, Carlo Adolfo Porro, Erio Castellucci, Fabio Efficace, Eduardo Bruera, Oreofe Odejide, Camilla Zimmermann, Leonardo Potenza, Mario Luppi; 5/13/24Methods: Data were collected through a pen-and-paper questionnaire on respondents’ perceptions of the disease, its treatment and their idea of death, before and after receiving EPC [early palliative care]. The data were analysed by identifying all metaphorical uses of language, following the ‘metaphor identification procedure’ proposed by the Praggjelaz Group.Results: Metaphors were used from a variety of semantic fields. EPC was described using spiritual terms, to indicate that this approach was instrumental in ‘restoring life’, ‘producing hope’ and making patients feel ‘accompanied’. The most recurrent metaphors were those referring to light and salvation; spatial metaphors were used to describe the treatment and the hospital as a ‘safe haven’ and ‘an oasis of peace’. 

Utah man angry: "Why am I still alive?" Cat Country 107.3/94.9; by Andy Griffin; 5/10/24 George Ball (not his real name) is angry. He's dying soon, he knows that. But what he's really mad about is that he's still alive. "I signed the paper. I made the request," he said. "So, why am I still alive?" ... The 72-year-old Utahn recently had a heart attack (cardiac arrest), and was essentially dead for a few minutes before being resuscitated at a Utah hospital. Life-saving measures were taken, including shooting adrenaline into his heart. He was gone, but they brought him back. Happy ending, right? The only problem was, Ball had signed and certified a DNR -- a do not resuscitate order -- so that if he, well, died, heroic measures would not be taken to bring him back to life. ...

Home care clinicians' perspectives on Advance Care Planning for patients at risk for becoming incapacitated with no evident advance directives or surrogates Journal of Hospice & Palliative Nursing; by Landau, Aviv Y. PhD, MSW; Venkatram, Chinmayi BA; Song, Jiyoun PhD, AGACNP-BC, APRN; Topaz, Maxim PhD; Klitzman, Robert MD; Shang, Jingjing PhD; Stone, Patricia PhD; McDonald, Margaret MSW; Cohen, Bevin PhD; 4/24 Abstract: ... This qualitative descriptive study elicited perspectives of home health nurses and social workers regarding barriers and facilitators to creating advance care plans in home health settings, with particular attention to patients with few familial or social contacts who can serve as surrogate decision-makers. ...  Participants reported a multitude of barriers to supporting patients with advance care planning at the provider level ... Participants noted that greater socialization and connection to existing educational resources regarding the intended purpose, scope, and applicability of advance directives could benefit home care patients.

Living our lives – and planning for the inevitableForbes; by Naomi Cahn; 4/28/24 More than half of those with at least $100,000 in investable assets and who have retired – or are planning to do so – do not yet have an estate plan, according to an April 2024 Ameriprise report. ... Recent news about advance medical planning, retirement stability and estate planning show that few are prepared. Approximately two of every three adults do not have an advance directive, a plan in place for when they are incapacitated or need end-of-life decisionmaking.Editor's Note: Executive leaders, are your advance directives in place? If not, what conversations and decisions are you avoiding? Ask some seasoned clinicians what kinds of patient/family situations they have experienced when advance directives were not ready; and potential conflicts that were diverted because of previous decisions and documents.

Health care workers aid community members with end-of-life care directives The Journal - Martinsburg, WV; by Tom Markland; 4/16/24Health care workers from Berkeley Medical Center and Hospice of the Panhandle came together on Tuesday to help members of the community learn and assemble various advanced directives concerning end-of-life care. According to a study by the University of Chicago, only 22% of U.S. adults have completed any advanced directive for their end-of-life care. Tuesday’s event aimed to help boost that that number in the Eastern Panhandle. As of 2 p.m. on Tuesday afternoon, more than 35 people had been through the program, completing paperwork for their medical power of attorney, living will or both for free.Editor's Note: We thank and celebrate all hospice and palliative organizations that participated in the National Healthcare Decisions Day, Tuesday April 16, 2024! Collectively, what supportive connections you have made. Individually for each person and with their families, these conversations and advance directives will continue to unfold through years ahead, when needed most.

Goals of care among patients with advanced cancer and their family caregivers in the last years of life JAMA Network; by Semra Ozdemir, PhD; Isha Chaudhry, MSc, Chetna Malhotra, MD; et al; 4/11/24 Conclusions and Relevance: In this cohort study of patient-caregiver dyads, findings suggested the importance of interventions aimed at reducing discordance in goals of care between patients and caregivers and helping them develop realistic expectations to avoid costly, futile treatments.

3 ways advance care planning empowers people TCPalm, Visiting Nurse Association, by Lauren Gruber; 4/10/24 ... National Healthcare Decisions Day on April 16th, which seeks to inspire, educate and empower the public and providers on the importance of health planning, is a prime opportunity to consider enrolling in an advance care plan. Identifying the right caregiving plans may seem daunting at first, but it’s important that patients solidify an advance care plan for the security and peace of mind of themselves and their loved ones. ... Here are three ways why choosing an advance care plan through the VNA can empower patients to ensure the best care possible during their health care journey:

Reminder: April 16 is National Healthcare Decisions Day The Conversation Project, Institute for Healthcare Improvement; ongoing until 4/16/24[Read for] specific ideas and suggestions for ways to implement National Healthcare Decisions Day (NHDD) activities in your community and at your facility. First and foremost, lead by example…be sure you have thoughtfully considered and made your own healthcare decisions known. Editor's Note: from The Conversation Project's "About Us": "The Conversation Project began 2010, when Pulitzer Prize-winning writer Ellen Goodman and a group of colleagues and concerned media, clergy, and medical professionals gathered to share stories of 'good deaths' and 'hard deaths' within their own circle of loved ones."

LTC planning’s power lies in relationships, not revenue Insurance NewsNet, by John McWilliams; 4/1/24 Long-term care planning is having a moment right now. There was a time when conversations with clients about their long-term care needs were like pulling teeth. No one wants to confront the point in their lives at which they will no longer be able to do the things they associate with independent life as an adult. Long-term care was a talk to have with people in their 60s. Now, I have those talks with folks in their 40s and 50s. What happened?