Literature Review

It's not just pumpkin spice time--it's time for the family conversation! Dunlap Bennet & Ludwig; by George Reilly; 11/13/24 “Quality family time” is a phrase often heard in the period from Thanksgiving to New Year’s, sometimes even with air quotes, to describe what many people believe to be a necessary, but not necessarily enjoyable, time of family togetherness. ... Whatever your perspective on this “quality family time,” chances are that for most of you, it was/will be a missed opportunity to discuss very important matters with your loved ones—namely what happens in the event of disability or death; who takes care of what; a parent’s (or grandparents, or your own) wishes on the end of life medical care and funeral/burial/cremation choices; your wishes on guardians for minor children; and other critical, but admittedly sensitive and gloomy topics. ...  Consider these statistics from surveys conducted by the Conversation Project: ... 92% of Americans say it’s important to discuss their wishes for end-of-life care, but only 32% have had such a conversation! [Click on the title's link to continue reading.]

Startup Guaranteed looks to improve end-of-life care Healthcare Brew; by Cassie McGrath; 11/6/24 After losing her father, Jessica McGlory founded a startup to improve end-of-life care. In August 2019, Jessica McGlory got a call that her father had had a double heart attack and was admitted to a hospital in Chicago. As his health declined, McGlory became his caregiver and healthcare proxy. But she said she never got the opportunity to discuss her father’s end-of-life care or his wishes. “I thought it was going to be an opportunity to really focus on my loved one, but instead, [I] had to focus on everything else and really didn’t get the support [I] expected from the hospice,” she told Healthcare Brew. Hospice is palliative care that typically includes counseling, physical care, medicine, and equipment for patients with terminal illnesses. Two years later, despite having no previous experience in healthcare, McGlory decided to take action. In 2022, she launched Guaranteed, a New York-based hybrid end-of-life care startup that works to support people with terminal illness as well as their loved ones and caregivers. ... Guaranteed has raised $10 million to date and is looking to expand into three more states next year, she said.

“Postponing it any later would not be so great”: A cognitive interview study of how physicians decide to initiate goals of care discussions in the hospitalAmerican Journal of Hospice and Palliative Medicine; by Elizabeth Chuang, Sabrina Gugliuzza, Ammar Ahmad, Michael Aboodi, Michelle Ng Gong, Amber E Barnato; 11/24Participants were hesitant to commit to the present moment as the right time for [goals of care] GOC discussions based on variations in clinical presentation. Clinical decision support systems that include more targeted information about risk of clinical deterioration and likelihood of reversal of the acute condition may prompt physicians to discuss GOC, but more support for managing discomfort with uncertainty is also needed.

"Courageous Conversations" during National Hospice and Palliative Care month NBC Tri-Cities, Yakima, WA; by Laynie Erickson; 11/4/24 November is National Hospice and Palliative Care month. Tri-Cities Chaplaincy is spending this month embracing what they call "courageous conversations".  Laurie Jackson, CEO of Tri-Cities Chaplaincy said this month they are encouraging the community to have conversations early about hospice and palliative care. Jackson said making these kind of decisions in crisis is challenging. "It always seems like its too soon to have 'that' conversation until it's too late," said Jackson. Although these "courageous conversations" can be difficult, Jackson said it is important to explore your options. "It always seems like its too soon to have 'that' conversation until it's too late," said Jackson. Although these "courageous conversations" can be difficult, Jackson said it is important to explore your options.

Guidelines vary when surrogates with power of attorney disagree with advance directives  Healio, Boston, MA; by Richard Gawel; 10/30/24 Inconsistent guidelines can lead to conflicts when surrogates with powers of attorney disagree with what may be described in a patient’s advance directive, according to a poster presented at the CHEST Annual Meeting. ... Key takeaways:

A moral code: Ethical dilemmas in medicine — three physicians face crossroads in patient care MedPage Today; podcast by Genevieve Friedman, Perspectives Editor; 10/25/24 We are back for another episode of our medical podcast, which we hope isn't really a podcast about medicine, but a podcast about life, death, dilemma, the challenges, and sometimes the joys of medicine. ... Now, medicine is complicated because a lot of times there aren't hard and fast rules ... One treatment isn't always right or wrong for someone. One surgery isn't always successful or unsuccessful, and one diagnosis isn't always correct. Decisions aren't black and white, they're varying shades of gray. So we come up with principles to help handle this -- codes if you will. But even those get a bit marred by complexity at times. As you'll hear in this episode of Anamnesis with the theme of "A Moral Code: Ethical Dilemmas in Medicine," one of our biggest codes is "do no harm." But what is harm? Who decides what harm is, what happens if we disagree?

Advance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated.  Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.

Poetry, again, confronts death JAMA; by Rafael CAmpo, MD, MA; 10/16/24Poetry can help physicians in many ways at the border between life and death. Though we might think first of the consoling power of elegy in confronting mortality, other poems, like “Again,” [referenced] aid us in wrestling with what death is in the first place—and are even more useful when research falls short in attempting to demystify it. One such scientific controversy surrounds in-hospital resuscitation, especially for older adults, with studies showing inconsistent rates of meaningful survival after these potentially life-saving interventions, confounded by the physical and emotional trauma that accompanies them, poor understanding of patients’ and families’ wishes, unclear definitions of “meaningful,” and varying patient selection criteria. [The poem titled] “Again” distills some sense out of this complexity as only poetry can, with the urgent repetition of “again” expressing the ingrained imperative to act when patients experience cardiac arrest while echoing both the many previous resuscitations hospital staff well remember, along with the 2-beat, up-down muscle memory of performing chest compressions. ... Thus, a reflexive, futile endeavor becomes a human being’s dying moment, allowing us to feel closure. Debates around in-hospital resuscitation suddenly quieted, we recognize life’s inevitable finality, underscored by the poem’s ironically dignified resignation in its concluding line: “Never again did you wake.”Editor's note: Click here to access the poem, "Again."

Clinical scenario: Patient care through POLST  The Hospitalist; by Mihir Patel, MD, MPH, FACP, CLHM, SFHM; 10/10/24 Physician orders for life-sustaining treatment (POLST) forms are crucial tools in ensuring that patient treatment preferences are respected and followed, particularly during medical emergencies. As hospitalists, integrating POLST into patient care can significantly enhance decision-making processes, aligning treatments with the patient’s wishes. Here, we present a clinical scenario demonstrating the application of POLST in a hospital setting, emphasizing the importance of electronic documentation in the patient’s medical record. ... [Click on the title's link for this Case Study, which includes the Case, Hospitalist Actions,Outcome, and Conclusion.]

How to prepare yourself for death when given a terminal diagnosis Yahoo!Life; by Kate Ng; 10/8/24 Receiving a terminal diagnosis can be a devastating blow, for the individual and their loved ones. There is no right or wrong way to react to such news, and people respond with all sorts of emotions - from anger and denial, to acceptance and peace. Having a terminal illness can also give a person new perspective. ...

Caring for Hindu patients at the end-of-life: A narrative review Cambridge University Press; by Brinda Raval Raniga, MD, Savannah Kumar, MD, Rebecca McAteer Martin, MD, and Craig D. Blinderman, MD; 10/3/24  This paper reviews the existing literature to identify specific challenges that may arise in the context of providing palliative and end-of-life (EOL) care for Hindu patients in the physical, psychological, and spiritual domains. We offer practical strategies where appropriate to mitigate some of these challenges. We review how the Hindu faith impacts EOL decision-making, including the role of the family in decision-making, completion of advance directives, pain management, and decisions around artificial nutrition and hydration (ANH) and cardiopulmonary resuscitation (CPR). 

Hospitalists use POLST to initiate patient conversations about care goals The Hospitalist; by Larry Beresford; 10/1/24 Physician orders for life-sustaining treatment (POLST) is a single-page medical order form, typically printed on bright pink paper, and signed by a physician, nurse practitioner, or physician assistant to spell out treatment preferences for a seriously ill or frail patient. It is also a process for exploring those preferences in conversation with patients and then communicating them to those who might need to know, such as EMS personnel, in some future medical emergency when the patients can no longer speak for themselves. And, said Steven Pantilat, MD, FAAHPM, MHM, a former clinical hospitalist and the inaugural chief of the division of palliative medicine at the University of California San Francisco, it is “solidly within what hospitalists can and should be doing.” That may involve meeting and talking with patients and their families about their values and treatment preferences, reviewing any existing POLST forms, and even filling out and signing a form.

AI shouldn't decide who dies. It's neither human nor humane Fox News; by John Paul Kolcun and Anthony Digiorgio; 9/20/24 [Opinion] As we write this, PubMed ... indexes 4,018 publications with the keyword "ChatGPT." Indeed, researchers have been using AI and large-language models (LLMs) for everything from reading pathology slides to answering patient messages. However, a recent paper in the Journal of the American Medical Association suggests that AI can act as a surrogate in end-of-life discussions. This goes too far. The authors of the paper propose creating an AI "chatbot" to speak for an otherwise incapacitated patient. To quote, "Combining individual-level behavioral data—inputs such as social media posts, church attendance, donations, travel records, and historical health care decisions—AI could learn what is important to patients and predict what they might choose in a specific circumstance." Then, the AI could express in conversant language what that patient "would have wanted," to inform end-of-life decisions. We are both neurosurgeons who routinely have these end-of-life conversations with patients’ families, as we care for those with traumatic brain injuries, strokes and brain tumors. These gut-wrenching experiences are a common, challenging and rewarding part of our job. Our experience teaches us how to connect and bond with families as we guide them through a life-changing ordeal. In some cases, we shed tears together as they navigate their emotional journey and determine what their loved one would tell us to do if they could speak.