Literature Review

MUSC working to spread awareness about palliative care WCSC 5, Charleston, SC; by Autumn Klein; 11/19/24 The Medical University of South Carolina is prioritizing palliative care education for both MUSC students, faculty and patients. The month of November is recognized as National Hospice and Palliative Care Month. ... Dr. Carrie Cormack is a professor at MUSC and leads the palliative care faculty. She says that treating a patient for the mental and emotional strain that comes with an illness can be just as important as treating the illness itself. ... At MUSC, they are pushing the importance of palliative care education. They are weaving palliative care into the educational curriculum for nursing students while also offering palliative care programs. The palliative care team also works hand in hand with primary care providers. At MUSC, they are even talking with international leaders and traveling internationally to offer palliative care education. Cormack just returned from an international trip offering palliative care education.

Expert advocates for timely palliative care for patients experiencing heart failure during address to URI College of Nursing The University of Rhode Island. Kingston, RI; by Patrick Luce; 11/14/24 While palliative care is common for patients diagnosed with life-threatening conditions like cancer or Alzheimer’s Disease, it is less commonly prescribed to patients suffering from heart failure, a missed opportunity to provide enhanced care for those critical patients, according to Yale University Professor Shelli Feder, who addressed Rhode Island nurses, students and professors during [the URI College of Nursing Distinguished Lecture] on Nov. 13. ... Feder detailed a study ... that shows access to palliative care varies widely among patients suffering from heart failure. Reasons vary from heart failure often being diagnosed late, rendering palliative care irrelevant, to some local hospital systems lacking processes to refer cardiovascular patients to palliative care providers. Feder urges medical facilities to adopt specific policies for referring patients to palliative care to help guide providers’ behavior toward timely referral to palliative experts.

Knowledge of palliative care in men and women diagnosed with metastatic breast cancerAmerican Journal of Hospice and Palliative Medicine; Evelyn Robles-Rodriguez, DNP, APN, AOCN; Ashley Weinmann, MSN, APN-C; Generosa Grana, MD, FACP; Teralyn Carter, MD; Bonnie Jerome-D’Emilia, PhD, MPH, RN; 10/24This sample of men and women diagnosed with metastatic breast cancer and being treated in a Cancer Center had limited knowledge and exposure to Palliative Care services across race and ethnicity. While no specific disparity was noted, the utilization of PC [palliative care] was low. Whether a function of a lack of referrals or patient preference, an effort should be made to increase PC referrals for all patients diagnosed with cancer.

Timing of palliative care, end-of-life quality indicators, and health resource utilizationJAMA Network Open; Sarah J. Mah, MD, MSc; Daniel M. Carter Ramirez, MD, PhD; Kara Schnarr, MD, PhD; Lua R. Eiriksson, MD, MPH; Anastasia Gayowsky, MSc; Hsien Seow, PhD; 10/24In this cohort study of 8,297 individuals with ovarian cancer decedents, initiating palliative care earlier than 3 months before death was associated with lower rates of death in the hospital, late chemotherapy, intensive care unit admission, and aggressive care at the end-of-life. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

Meals on Wheels substantially reduces risk of senior hospitalizations: report McKnights Home Care; by Adam Healy; 11/8/24 Home-delivered nutritious foods programs can help keep seniors out of the hospital and reduce their feelings of social isolation, according to a new report by Meals on Wheels and home care technology firm WellSky. The report examined how Meals on Wheels programs helped seniors recover after being discharged from a hospital stay. Each meal delivery also involved a social determinants of health assessment, which allowed Meals on Wheels staff to engage with participants and gauge their wellness and safety. After 30 days of the program, the researchers observed an 85% decrease in hospitalizations among participants. Approximately 98% of meal recipients said that Meals on Wheels helped their recovery, and 61% said it lowered their feelings of social isolation.Editor's note: While we know hospice patients experience a significant decline in appetite, the person's changing needs for nutrition continue. Pair this data with several recent articles we've posted regarding seniors' struggles compounded by living alone, isolation, and depression. We invite you to explore this educational/support video for caregivers/families of persons experiencing serious illness, palliative, or hospice care: Small Words - Big Meanings: EAT. Disclosure: Composing Life Out of Loss is a sponsor of our newsletter.

Palliative care, ACO collaborations fuel ‘historical savings’ in MSSP Program Hospice News; by Holly Vossel; 11/11/24 Palliative care providers that form collaborative partnerships with Accountable Care Organizations (ACOs) may be lending to a landmark downward trend in health care spending in the value-based payment landscape. The U.S. Centers for Medicare & Medicaid Services (CMS) recently announced that its Medicare Shared Savings Program (MSSP) yielded more than $2.1 billion net savings in 2023 — the largest amount in the program’s inception more than a decade ago, according to the agency. ACOs participating in MSSP earned an estimated $3.1 billion in shared savings payments during the program’s 2022 to 2023 performance year, the highest dollar amount thus far, CMS reported. [Click on the title's link to continue reading.]

Older Americans living alone often rely on neighbors or others willing to help California Healthline; by Judith Graham; 11/12/24Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he’s raised the blinds in his dining room window. If not, she’ll call Hammen or let herself into his house to see what’s going on. Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022. Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. ... American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million. ... [Click on the title's link to continue reading.]Editor's note: This important article includes "a noteworthy study published by researchers at Emory University

Most heart failure patients miss out on guideline-recommended palliative care Cardiovascular Business; by Dave Fornell; 11/6/24 Over the past decade, the American Heart Association (AHA) and European Society of Cardiology have recommended integrating palliative care into heart failure management. Despite these recommendations, the use of palliative care for heart failure remains low in the United States. Racial and geographic variations in access and use of palliative care are also pronounced, highlighting health disparities. These were the findings of a recent study in the Journal of the American Heart Association. Researchers at Saint Louis University led the study and said only one in eight patients with heart failure in the United States receive palliative care consultations within five years of diagnosis. Their study highlights the alarmingly low uptake of palliative care among adults with heart failure in the U.S., especially compared to patients with cancers that have the same mortality rates. The study also pointed out significant racial and geographic disparities. Black patients were 15% less likely to receive palliative care compared to their white counterparts. They said this disparity is particularly concerning given the higher cardiovascular risk and mortality rates in the Black population.

Early palliative care may curb aggressive end-of-life care Medscape; by Marilynn Larkin; 11/6/24 Increasing the uptake of palliative care may decrease the aggressiveness of end-of-life care, an analysis of ovarian cancer decedents suggested. Palliative care initiated earlier than 3 months before death was associated with lower rates of emergency department (ED) visits, hospital admissions, and intensive care unit (ICU) admissions in the last 3 months of life. It was also associated with a lower rate of death in the hospital. “When patients with advanced or incurable cancers experience aggressive end-of-life care, spending their final weeks of life in and out of the ED or admitted to acute care hospital wards or the ICU, where they undergo invasive tests or procedures that may not meaningfully prolong life or address symptoms or suffering, this can be very distressing for patients and their caregivers,” lead author Sarah J. Mah, MD, of McMaster University in Hamilton, Ontario, Canada, told Medscape Medical News.

‘Stop Requested’: To Lakeview, Oregon’s ‘Mile High City’ OPB (Oregon Public Broadcasting); by Lillian Karabaic; 10/27/24 Lakeview isn‘t close to much, but locals figure out how to get ’er done. ... OPB “Weekend Edition” host Lillian Karabaic and producer Prakruti Bhatt experience the joys and difficulties of rural transit and talk to many people along the way. ... To reach Lakeview, we turn to the Lake County Cloud, a transit service run by the Lakeview Senior Center. Lake County Cloud doesn‘t have any fixed route services. Its crew of eight part-time drivers mostly do by-reservation trips to medical appointments and a few shopping trips. This became even more important after Lakeview’s only specialty clinic and hospice closed in 2023. ... Because the nearest city is Klamath Falls, more than 90 miles away, Lake County Transit puts in a lot of miles. It also goes up to Medford, down to California, and even all the way to Portland for chemotherapy. “We do about 30,000 [or] 40,000 miles a month … it’s a lot for a little town and little crew," says Linda Mickle, transportation coordinator for Lake County Transit.

[Spain] Age-and gender-based social inequalities in palliative care for cancer patients: a systematic literature reviewFrontiers in Public Health; Marina Rodríguez-Gómez, Guadalupe Pastor-Moreno, Isabel Ruiz-Pérez, Vicenta Escribà-Agüir, Vivian Benítez-Hidalgo; 9/24Cancer is a major public health problem worldwide, given its magnitude and growing burden, in addition to the repercussions on health and quality of life. Palliative care can play an important role improving quality of life and it is cost-effective, but some population groups may not benefit from it or benefit less based on age and gender inequalities. This review reveals difficulties for older persons and men for access to key elements of palliative care and highlights the need to tackle access barriers for the most vulnerable population groups. Innovative collaborative services based around patient, family and wider community are needed to ensure optimal care.

Palliative care in the ED reduces costs, improves patient outcomes Hospice News; by Jim Parker; 10/28/24 The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs. A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver. ... “When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

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.