Literature Review

Bereaved parent preferences on quality end-of-life care for children with cancer in the South Cancer - American Cancer Society; by Isaac Martinez BA, Erin Currie PhD, RN, Elizabeth S. Davis MS, Rohail Kumar MD, Valerie Lawhon MS, ALC, NCC, Jennifer M. Snaman MD, Raba B. Tefera BA, Smita Bhatia MD, MPH, Abby R. Rosenberg MD, MS, MA, Emily E. Johnston MD, MS; 8/18/24 The authors sought to understand bereaved family preferences for end-of-life (EOL) care, particularly among Black families and those in the South. ... Family decision-making involved maintaining hope, not causing harm, doing what was best for their child and themselves, and religious beliefs. There was no clear preference for home versus hospital death (3.0 [1.8–4.0]). Instead, parents considered their child’s desires and/or medical needs, siblings, and prior experiences with death. To have a comfortable death, parents highlighted the need for comprehensive education about their child’s EOL, a caring and comfortable environment, and 24/7 access to their care team. Families expressed a dual preference for comfort care ... and chemotherapy ... at EOL.

3 keys to palliative care marketing Hospice News; by Jennifer Murtoff; 8/16/24 While palliative care is an important part of medical care for many patients and providers, marketing messaging for these services must be carefully crafted. ... Given the rampant misconceptions about palliative care, education is an essential component of a marketing strategy, including for patients and families, referral partners and payers. A key point is to distinguish palliative care from hospice, according to Tony Kudner, chief strategy officer for Transcend Strategy Group. ... [Marketers] need to educate patients, family members, and payers as to the specific suite of services their organizations offer and how they can benefit patients. 

African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care Annals of Palliative Medicine; by Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston; 8/5/24 Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial. ... Results: Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer.  

Factors associated with Do Not Resuscitate status and palliative care in hospitalized patients: A national inpatient sample analysis Palliative Medicine Reports; by Jean-Sebastien Rachoin, Nicole Debski, Krystal Hunter, Elizabeth CerceoIn the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.

Capitalizing palliative care startups Hospice News; by Jesse Floyd; 8/14/24 As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses. ... This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space. When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. ... “Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.” They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors. ... 

Virtual palliative care improves quality of life in advanced lung cancer MedPage Today; by Greg Laub; 8/13/24 In this exclusive MedPageToday video, Roy Herbst, MD, PhD, of Yale Cancer Center in New Haven, Connecticut, discusses a studyopens in a new tab or window presented at the recent American Society of Clinical Oncology (ASCO) meeting, which showed that patients with advanced non-small cell lung cancer receiving palliative care via video consultation had outcomes comparable to those treated in person. Following is a transcript of his remarks: ... 

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

Dr. El-Jawahri on the impact of palliative care on end-of-life care for AML and MDS OncLive; by Areej R. El-Jawahri, MD; 8/12/24 Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals. Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (P < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says. These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes.

Alzheimer’s prognosis models should expand data sources McKnights Senior Living; by Kristen Fischer; 8/12/24 Integrating data from nursing home electronic health records and claims in addition to the minimum data set — data required for nursing home residents — could be better than just relying on the MDS sources to produce an accurate prognosis for nursing home residents with Alzheimer’s disease and related dementias, according to a report published Thursday in the Journal of the American Geriatrics Society. ... The authors of the report noted that a recent review of prognostic models for late-stage ADRD found that assessments commonly used to evaluate prognosis-based eligibility for hospice weren’t reliable. ... Only 15% of people enrolled in hospice have a primary diagnosis of ADRD. That’s because it’s challenging to estimate the six-month prognosis required to be eligible for hospice, and dementias have a prognosis of 12 to 18 months when they are in the late stage, the authors pointed out.

Hospice market surge: Expected to hit $182.1 billion by 2033 Market.us Media; by Trishita Deb; 7/29/24 The global hospice market is projected to grow significantly from USD 72.8 billion in 2023 to around USD 182.1 billion by 2033, achieving a CAGR of 9.6%. This expansion is primarily driven by an aging population requiring increased palliative and end-of-life care. The demographic shift necessitates services that address chronic illnesses and provide compassionate care, predominantly offered by hospices. Additionally, technological advancements, particularly in telemedicine, facilitate broader access to comprehensive care, especially in remote areas. Interdisciplinary approaches in palliative care are also pivotal, involving collaborative efforts from doctors, nurses, social workers, and chaplains. This holistic method not only enhances the quality of care but also boosts patient and family satisfaction, key metrics in healthcare evaluations. 

Cultivating humility, making connections in a contentious world Tallahassee Democrat; by Rev. Candace McKibben; 7/27/24 The first time I remember hearing about “cultural humility” was some years ago when I served as a member of the Diversity and Inclusion Team at Big Bend Hospice. I recall reading an article by Silvia Austerlic, a Bereavement Manager and Hospice Latino community liaison, at Hospice of Santa Cruz County. She explained what is required to relate in the best interests of patients and families is not “cultural competence,” which is where our team had been focused, but “cultural humility.” “Cultural competence,” while it may be well-meaning, is a framework to help providers understand, appreciate, and work with individuals from diverse cultures. It is focused on gaining knowledge. “Cultural humility,” on the other hand, is focused on relationships. ... Yet another form of humility that seems critically important to me in our time is “religious humility.” This form of humility involves celebrating the inherent dignity of every individual, regardless of their religious affiliation.

Palliative Medicine - June 2024 Issue