Literature Review

Ethics at the end of lifeMedicine; by John Idris Baker; 7/24End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond... Key points:

Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

Variation in specialist palliative care reach and associated factors among people with advanced heart failure in the Department of Veterans AffairsJournal of Pain and Symptom Management; by Shelli L Feder, Ling Han, Yan Zhan, Erica A Abel, Kathleen M Akgün, Terri Fried, Mary Ersek, Nancy S Redeker; 7/24Clinical practice guidelines recommend palliative care for people with advanced heart failure (aHF), yet it remains underutilized. We examined medical center variation in specialist palliative care (SPC) and identified factors associated with variation among people with aHF... SPC reach varies widely across VAMCs for people with aHF. Outpatient palliative is common among high-reach VAMCsbut its role in reach warrants further investigation. Strategies used by high-reach VAMCs may be potential targets to test for implementation and dissemination.

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. 

International consensus on sleep problems in pediatric palliative care: Paving the way[International] Sleep Medicine; by Anna Mercante, Judith Owens, Oliviero Bruni, Magda L. Nunes, Paul Gringras, Shirley Xin Li, Simonetta Papa, Ulrika Kreicbergs, Joanne Wolfe, Boris Zernikow, Ana Lacerda, Franca Benini, on behalf of the Pediatric Sleep and Palliative Care Group; 7/24Sleep problems constitute a common and heterogeneous complaint in pediatric palliative care (PPC), where they often contribute to disease morbidity and cause additional distress to children and adolescents and their families already facing the burden of life-threatening and life-limiting conditions. Despite the significant impact of sleep problems, clinical evidence is lacking... This study addresses the need to personalize sleep medicine’s approach to the palliative care setting and its peculiarities. It provides the first international consensus on sleep problems in PPC and highlight the urgent need for global guidance to improve sleep-related distress in this vulnerable population and their caregivers. Our findings represent a crucial milestone that will hopefully enable the development of guidelines in the near future.Publisher's Note: I am grateful that sleep issues are being studied and discussed more often, as they can be terribly disruptive to patients and family members.

A palliative care curriculum may promote resident self-reflection and address moral injury The Journal of Surgical Research; by Shruti Koti, Lyudmyla Demyan, Danielle Deperalta, Sophia Tam, Gary Deutsch; 6/22/24 online ahead of print Introduction: There is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents.Conclusions: The described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.

Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of U.S. older adults eClinical Medicine, Part of THE LANCET Discovery Science; by Yenee Soh, Ichiro Kawachi, Laura D. Kubzansky, Lisa F. Berkman, and Henning Tiemeier; 6/24/24 Loneliness has been implicated as a stroke risk factor, yet studies have examined loneliness at only one time point. The association of loneliness changes and risk of incident stroke remains understudied. Our aim was to examine the association of loneliness with incident stroke, particularly the role of loneliness chronicity. Chronic loneliness was associated with higher stroke risk independent of depressive symptoms or social isolation. Addressing loneliness may have an important role in stroke prevention, and repeated assessments of loneliness over time may help identify those particularly at risk.Editor's Note: This is the source research for an article we posted yesterday, 6/28/24, titled 

California hospice ownership changes from 2018-2020: A spatial analysis and case illustrationAmerican Journal of Hospice and Palliative Care; by Heather A. Davis, PhD, Christy Torkildson, PhD, RN, PHN, FPCN, HEC-C, Lisa C. Lindley, PhD, RN, FPCN, FAAN; 6/24Hospices in California have undergone significant and complicated ownership changes in recent years. ... Our findings showed that ownership changes were significant and complicated. An influx of for-profit organizations into the California market was primarily responsible for these changes. Additionally, lack of corporate financial public disclosure and voluntary hospice accreditation, certification, and reporting result in a lack of free, publicly available, definitive comprehensive data on for-profit hospice ownership. This hinders information gathering on and provider/familial choice-making regarding hospices. Our study provides critical insight into the impact of ownership changes and lack of definitive, free, publicly available information on adult hospices in California caring for children and has important clinical, research, and policy implications.

How do enrollees feel about support in Big Hospices? - The caregiver experience of emotional, spiritual, and bereavement support by profit status among large US providersPalliative and Supportive Care; by Jason T Hotchkiss, Emily Ridderman, Brendan T Hotchkiss; 4/24Recent findings narrate profiteering detrimentally impacting hospice care quality. However, no study has examined the caregiver experience of emotional and spiritual support expressed online. The purpose was to evaluate the hospice caregiver's experience of emotional, spiritual, and bereavement support and whether the care was respectful and compassionate to the care unit. ... Compassionate professionals were thanked and praised regardless of profit status. Sadly, anger was expressed toward large, for-profits more fixated on census than emotional, spiritual, and bereavement support; thankfully nonprofits were more supportive.

Psychological health in Palliative Care: Thematic analysis of a psychiatrist's and an art therapist's clinical reflexive journals Palliative Medicine; by Wen Phei Lim, Roxanne Jia Yu Chew, Clare O'Callaghan; 6/19/24 online ahead of print Aim: This study aims to describe how patients receiving palliative care experience psychological health, explore the meaning of a palliative care clinician's work and contribute to the understanding of psychological health in palliative care through the reflexive and visual journals of clinicians.

Exploring Experiences of Pain Management Among Family Caregivers of Community-Dwelling Older Adults With DementiaAmerican Journal of Hospice and Palliative Care; by Hui Zhao, Pamela A Kulbok, Ishan C Williams, Carol Manning, Jeongok G Logan, Rafael D Romo; 8/24Pain is often underreported and under-treated in older adults with dementia. The role of family caregivers (FCGs) in managing pain for their loved ones with dementia living in community has been significantly burdensome. ... Family caregivers follow their values to make decisions in pain management. Barriers existed for effective pain management. Adaptation and support from professional or formal caregivers greatly improved FCGs' perception of their competence in pain management. The finding underscores the need for further research and the development of interventions aimed at enhancing FCGs' perception of self-efficacy in this crucial aspect of caregiving.

Psychosocial distress among spouses of persons with dementia before and after their partner's deathJournal of the American Geriatrics Society; by Ashwin A Kotwal, Irena Cenzer, Lauren J Hunt, Claire Ankuda, Jacqueline M Torres, Alexander K Smith, Melissa Aldridge, Krista L Harrison; 6/24Results emphasize a need for clinical and policy approaches to expand support for the psychosocial needs of spouses of partners with dementia in the years before their partner's death rather than only bereavement.Publisher's Note: Also see McKnight's Long-Term Care News story Spousal caregivers need emotional support before losses, not just after, study finds.

The efficacy of Hospice-In-Place Care versus Traditional Inpatient CareAmerican Journal of Hospice and Palliative Care; by Emily Butler, Claire Hanson, Taaseen Khan, Tuzo Mwarumba, Derek Daniels, Maxim Turchan, Kemberlee Bonnet, David Schlundt, Kelly Harper, Marc Bennett, David Charles; 8/24The hospice-in-place program at Vanderbilt University Medical Center (VUMC) is available to patients and families who elect for hospice benefits and are too unstable to be transported for hospice care. The goal of this study was to assess the satisfaction of family members of patients who died while hospitalized at VUMC and received hospice-in-place compared to the families of patients who did not receive hospice care. ... Quantitative findings of this study showed improved satisfaction but were unable to show a significant difference in satisfaction with hospice-in-place compared to traditional care. Questionnaire results suggest that both types of care yield high satisfaction scores and are successfully supporting patients and families. The conceptual framework also adds to the understanding of end-of-life experiences at VUMC.