Literature Review

Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementiaJournal of the American Geriatrics Society; by Jason K Bowman, Christine S Ritchie, Kei Ouchi, James A Tulsky, Joan M Teno; 6/24Persons with ADRD frequently use the ED-particularly those with recent hospitalizations, rehab/SNF stays, or home health use-and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.

Key factors for establishing and sustaining a successful palliative radiation oncology program: a survey of the Society for Palliative Radiation Oncology Annals of Palliative Medicine; by Deborah C Marshall, Kavita Dharmarajan, Randy Wei, Yolanda D Tseng, Jessica Schuster, Joshua A Jones, Candice Johnstone, Tracy Balboni, Simon S Lo, Jared R Robbins [Palliative Radiation Oncology Programs] PROPS are not widespread, exist mainly within academic centers, are outpatient, have access to palliative care specialists by referral, and have specialized clinical processes for palliative radiation patients. Lack of committed resources was the single most important perceived barrier for initiating or maintaining a PROP. Best practice guidelines, educational resources, access to palliative care specialists and standardized pathways are most important for those who wish to develop a PROP. These insights can inform discussions and help align resources to develop, grow, and maintain a successful PROP.

Palliative care in the intensive care unit: The standard of care AACN - American Association of Critical-Care Nurses; by Clareen Wiencek, PhD, RN, ACNP, FAAN; 6/7/24Intensive care unit–based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. ... This article provides an overview of the current state of intensive care unit–based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes. [Access to the full article requires subscription or purchase of the individual article.]

Exposure to a loved one’s death and advance care planning: Moderating effects of ageAmerican Journal of Hospice and Palliative Medicine; by Peiyuan Zhang, MS, Sarah Clem, MSW, Roderick Rose, PhD, John G. Cagle, PhD; 6/24Despite documented benefits of Advance Care Planning (ACP), it is still under-utilized in the U.S. Our study aimed to examine whether experiencing a loved one’s death is associated with one’s own ACP behavior among adults in the U.S. and the potential moderating effect of age. ... Exploring an individual’s previous experience with a loved one’s death might be an effective way to broach the concept of ACP among adults of all ages. This strategy may be particularly useful in facilitating discussions of end-of-life medical wishes with doctors among younger adults than older adults.

The role and professional standards of the Adult-Gerontology Nurse Practitioner in hospice and palliative careJournal of Hospice and Palliative Nursing; by Heather Coats, PhD, APRN-BC, Kelly Henrichs, Kelly DNP, RN, GNP-BC; 6/24The adult/gerontology (gero) nurse practitioner (NP) delivers primary and/or specialty palliative care to persons and their families who live each day with a myriad of serious illnesses. In this role, the adult/gero NP uses their skill set to address the whole person (physical, psychological, social, and spiritual/existential) to improve the quality of life for persons they care for. This article is the fourth in a series of 6 highlighting the different roles of the adult/gero NP and the advanced certified hospice and palliative registered nurse, and how these 2 roles overlap. The purpose of this article was to provide details of education and certification pathways for these NP roles, describe the overlaps in clinical care, and illustrate how the adult/gero NP in palliative and hospice care can contribute to leadership in program development for care of persons and their families who live with serious illness.

Stepped palliative care for patients with advanced lung cancer: A randomized clinical trialJAMA; by Jennifer S. Temel, MD, Vicki A. Jackson, MPH, MD, Areej El-Jawahri, MD, Simone P. Rinaldi, MSN, ANP-BC, ACHPN, Laura A. Petrillo, MD, Pallavi Kumar, MD, Kathryn A. McGrath, MD, Thomas W. LeBlanc, MD, Arif H. Kamal, MD, Christopher A. Jones, MD, Dustin J. Rabideau, PhD, Nora Horick, MS, Kedie Pintro, MS, Emily R. Gallagher Medeiros, RN, Kathryn E. Post, PhD, RN, ANP-BC, Joseph A. Greer, PhD; 6/24A stepped-care model, with palliative care visits occurring only at key points in patients’ cancer trajectories and using a decrement in QOL to trigger more intensive palliative care exposure, resulted in fewer palliative care visits without diminishing the benefits for patients’ QOL. While stepped palliative care was associated with fewer days in hospice, it is a more scalable way to deliver early palliative care to enhance patient-reported outcomes.Publisher's note: This article was reference earlier this week in Palliative care for cancer patients is found to be as effective given virtually as in person.

Palliative care for cancer patients is found to be as effective given virtually as in personSTAT; by Angus Chen; 6/2/24Comfort can be delivered to patients with advanced cancer virtually just as well as in person, according to a new study presented on Sunday at the American Society of Clinical Oncology annual meeting in Chicago. That’s welcome news to palliative care experts who have, in many cases, preferred the convenience and efficacy of telehealth sessions for both themselves and their patients since the Covid-19 pandemic forced virtual visits. ... Palliative care experts are also looking at other ways to help more patients get seen. In another abstract presented at ASCO in Chicago and published in JAMA by MGH’s Temel, she showed the frequency of palliative care visits could be stepped down for patients with fewer physical or emotional symptoms — also without any loss in palliative care efficacy.

The other side of the curtainJAMA; by Paige Stevens; 5/23/24Each day, clinicians have a sacred opportunity to foster the patient-physician bond and provide holistic care to patients. Too many times, the stress and hectic nature of my daily life as a physician has caused me to lose sight of this special connection and sometimes shortchanged the care that I provided. This journey has taught me more about being a physician than any of my years of formal education ever could. Now, having experienced medicine from the other side of the curtain, I am forever thankful that the physicians and nurses who cared for me took the time to learn my story and attend to all my needs—medical, emotional, and spiritual. These are the moments that I am most thankful for and the moments that will stay with me forever.

“When I do have some time, rather than spend it polishing silver, I want to spend it with my grandkids”: a qualitative exploration of patient values following left ventricular assist device implantationBMC Palliative Care; by Avery C. Bechthold, Colleen K. McIlvennan, Daniel D. Matlock, Deborah B. Ejem, Rachel D. Wells, Jesse LeJeune, Marie A. Bakitas, J. Nicholas Odom; 5/24Values are broadly understood to have implications for how individuals make decisions and cope with serious illness stressors, yet it remains uncertain how patients and their family and friend caregivers discuss, reflect upon, and act on their values in the post-left ventricular assist device (LVAD) implantation context. This study aimed to explore the values elicitation experiences of patients with an LVAD in the post-implantation period. ... Clinicians should consider assessing the values of patients post-implantation to facilitate shared understanding of their goals/priorities and identify potential changes in their coping.

Procedural interventions for terminally ill children – Are we aiding palliation?Journal of Palliative Care; by Hannah Phillips, MD, Sarah Perry, MS, Laura A Shinkunas, MS, Erica M Carlisle, MD; 5/24Many children undergo surgery or an invasive procedure during their terminal hospital admission. The types of procedures, patients, and the intent of the procedures has not been well defined. Understanding these details may help pediatric surgeons better determine the clinical settings in which certain procedures will not enhance palliation or survival. ... 132 children met inclusion criteria. Most children were White and less than one year old. The most common type of diagnosis was cardiac in nature. Children underwent an average of three procedures. 75% were intubated and 77.5% had palliative care involved. Patients who were less than one year old at death were more likely to have been intubated, had longer terminal hospital stays, and had more procedures. Those who were intubated underwent more procedures and had longer hospital stays. Those with longer palliative care involvement had fewer procedures. ... Ongoing study may help refine which procedures may have limited impact on survival in the chronically ill pediatric population.

Deaths of despair surged among Black people over past decadeJAMA Network; by Emily Harris; 5/24Guided by findings reported in 2015, researchers have thought that the uptick in midlife deaths of despair—those resulting from suicide, drug overdose, and alcoholic liver disease—disproportionately affected White people. Now, new data published in JAMA Psychiatry illustrate that the decrease in life expectancy from deaths of despair among people aged 45 to 54 years is not unique to White individuals.Publisher's Note: Some hospices exclude suicide, drug overdose, alcoholic liver disease, etc., from hospice utilization calculations or consideration - should we?

The complexity of physician powerScience; by Laura Nimmon; 5/16/24Inequitable variation in physician effort and resource use is revealed. Power is present in all human relationships. Thus, there is no interaction in which power and its potential to exert influence is not relevant in medicine. Although the role of power in medical interactions is important, few studies investigate how physicians allocate effort and execute their power when interacting with patients. ... The nature of physicians’ relationships with patients is characterized as top down and asymmetrical (1). This unequal relationship is thought to be a product of physicians possessing legitimized expert knowledge and legal decision-making authority and patients who are reliant on care and services. Underpinning this power afforded to physicians is societal trust that physicians will always act altruistically and ethically toward patients.Publisher's Note: Also see the related article How power shapes behavior: Evidence from physicians by Stephen D. Schwab, Manasvini in the same issue. [They] investigate how physician power in the US Military Health System interfaces with sociological phenomena such as hierarchy, status, and authority. Their findings reveal the variability and complex mechanisms through which physician power is exerted, ultimately providing nuance about how the ethics of physician power is understood as it interfaces with other hierarchical systems of power.