Literature Review

The Tandem VR™ protocol: Synchronized nature-based and other outdoor experiences in virtual reality for hospice patients and their caregiversContemporary Clinical Trials Communications; by O McAnirlin, J Thrift, F Li, J K Pope, M H E M Browning, P P Moutogiannis, G Thomas, E Farrell, M M Evatt, T Fasolino; 6/24Nature-based and other outdoor virtual reality (VR) experiences in head-mounted displays (HMDs) offer powerful, non-pharmacological tools for hospice teams to help patients undergoing end-of-life (EOL) transitions. However, the psychological distress of the patient-caregiver dyad is interconnected and highlights the interdependence and responsiveness to distress as a unit. Using personalized, nature-based and other outdoor VR content, the patient-caregiver dyads can simultaneously engage in an immersive encounter may help alleviate symptoms associated with declining health and EOL phases for the patient and the often overburdened caregiver. This protocol focuses on meeting the need for person-centered, non-pharmacological interventions to reduce physical, psychological, and spiritual distress.

Role of Hospice and Palliative Nurses in Advancing Research and ScholarshipJournal of Hospice and Palliative Nursing; HPNA position statement; 8/24.The Hospice and Palliative Nurses Association (HPNA) aims to advance palliative care science and provide high-quality, evidence-based care to patients, families, and communities. Specifically, HPNA believes...

The Uniform Determination of Death Act is not changing. Will physicians continue to misdiagnose brain death?The American Journal of  Bioethics; Michael Nair-Collins; 7/24Efforts to revise the Uniform Determination of Death Act [UDDA] in order to align law with medical practice have failed. It has long been common practice to declare some patients dead by neurologic criteria even though they do not meet the legal standard for death. Thus, legally living people will continue to be declared dead, not because of a mistake, but because of a choice. The decision to continue misdiagnosing death according to the law will create routine violations of civil rights, will continue to violate the DDR [dead donor rule] that allegedly is such an important red line for organ transplantation, and will contribute to a well-deserved mistrust in the determination of death.

Psychiatric manifestations of neurological diseases: a narrative reviewCureus Journal of Medical Science; Anthony J. Maristany, Brianna C. Sa, Cameron Murray, Ashwin B. Subramaniam, Sean E. Oldak; 7/24Neurological diseases like Alzheimer's, FTD [frontotemporal dementia], Parkinson's, MS [multiple sclerosis], stroke, epilepsy, Huntington's, ALS [amyotrophic lateral sclerosis], TBI [traumatic brain injury], andMSA [multiple system atrophy] are not only characterized by neurological symptoms but also by various psychiatric manifestations, complicating diagnosis and treatment. For instance, Alzheimer's induces cognitive decline and emotionaldistress, Parkinson's leads to motor impairments and mood disorders, and MS intertwines physicalsymptoms with emotional disturbances. Understanding these complex relationships is crucial forcomprehensive care. Collaboration, innovation, and ethical commitment are essential for improvingoutcomes.

Longitudinal analysis of cancer family caregiver perception of sleep difficulty during home hospice American Journal of Hospice & Palliative Care; William Hull, Gary Donaldson, Kristin G Cloyes, Lee Ellington, Kathryn Lee, Kathleen Mooney; 7/22/24 Our findings indicate that family caregivers who cohabitate exhibit increased perception of sleep difficulty over the course of hospice. Future studies and interventions for hospice family caregivers' sleep should consider cohabitation between the patient and the caregiver as a significant predictor of sleep difficulty to observe and potentially mediate the negative outcomes associated with caregiver sleep difficulty. Further, determining the underlying reasons for sleep difficulty in cohabitation (e.g., patient symptoms or treatments) should be explored.

Medicare-Covered Services Near the End of Life in Medicare Advantage vs Traditional MedicareJAMA Health Forum; by Lauren Hersch Nicholas, Stacy M Fischer, Alicia I Arbaje, Marcelo Coca Perraillon, Christine D Jones, Daniel Polsky; 7/24Financial incentives in Medicare Advantage (MA), the managed care alternative to traditional Medicare (TM), were designed to reduce overutilization. For patients near the end of life (EOL), MA incentives may reduce potentially burdensome care and encourage hospice but could also restrict access to costly but necessary services. MA enrollment was associated with lower rates of potentially burdensome and facility-based care near the EOL. Greater use of home-based care may improve quality of care but may also leave patients without adequate assistance after hospitalization.

What does "palliative care" represent in research using secondary data? Journal of Pain and Symptom Management; by J. Brian Cassel; 7/18/24 While much research has been done regarding "palliative care" using retrospective cohort studies of large datasets, the data sources may not be capturing specialty palliative care services. This article aims to clarify what source data are used in such studies, how specialty palliative care services are determined to have been provided or not, and mismatches between the nature of the data and the interpretation of researchers. 

Enhancing end-of-life care with home-based palliative interventions: A systematic reviewJournal of Pain and Symptom Management; by Diana Rodrigues Feliciano, Paulo Reis-Pina; 7/24Home-Based Palliative Care (HPC) interventions have emerged as a promising approach to deliver patient-centered care in familiar surroundings, aligning with patients' preferences and improving quality of life (QOL). HPC interventions demonstrate significant benefits in addressing the complex needs of patients with advanced illnesses. These findings underscore the importance of integrating HPC into healthcare systems to optimize outcomes and promote quality end-of-life care.Editor Note: blah.

Bridge the gap: Addressing rural end-of-life care disparities and access to hospice services Journal of Pain and Symptom Management; by Asif Anwar, Muhammad Kashif Amin, Sherezaad Anwar, Moazzam Shahzad; 7/11/24 online ahead of print Rural hospices face many obstacles in delivering palliative and end-of-life care in the United States. We aimed to identify these barriers and their potential solutions. ...  We propose several potential solutions to overcome these hurdles and improve access. ... Advanced practice providers should be considered to serve as physician heads in rural hospices, which would expand resources in areas with physician shortages. A single per diem payment model should be implemented for rural hospices, regardless of the level of care provided, to help offset the higher cost of care. he Critical Access Hospital program and offering cost-based reimbursement for swing-bed stays could improve access to post-acute care, including hospice services. Telehealth can improve the timeliness of care and reduce travel costs for patients and providers.  [Continue reading for more solutions.]

It starts with a story: A four-step narrative-based framework for serious illness conversations Journal of Palliative Medicine; by Natalie Lanocha, Sara Taub, Jason N Webb, Mary Wood, Tyler Tate; 7/5/24 online ahead of print An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). ... By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill. 

Compassion fatigue in palliative care: Exploring its comprehensive impact on geriatric nursing well-being and care quality in end-of-life[Saudi Arabia] Geriatric Nursing; by Abeer Nuwayfi Alruwaili, Majed Alruwailia, Osama Mohamed Elsayed Ramadan, Nadia Bassuoni Elsharkawy, Enas Mahrous Abdelaziz, Sayed Ibrahim Ali, Mostafa Shaban; 7/24This study examines the experiences of geriatric nurses in palliative care... The analysis reveals main themes: 1) the deep emotional connections between nurses and their patients; 2) the challenges faced, including compassion fatigue, high patient mortality, and communication hurdles; 3) the impact of these challenges on the quality of care, highlighting issues like diminished empathy; 4) the coping strategies used by nurses, such as self-care practices and continuous education. The study concludes that coping strategies, including self-care and ongoing professional development, are vital for sustaining the nurses’ well-being and ensuring the continued provision of high-quality care to Older Adults patients.

Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States Supportive Care in Cancer: Official journal of the Multinational Association of Supportive Care in Cancer; by Khushi Kohli, Mahi Kohli, Bhav Jain, Nishwant Swami, Sruthi Ranganathan, Fumiko Chino, Puneeth Iyengar, Divya Yerramilli, Edward Christopher Dee; 7/9/24 Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. Conclusions and relevance: Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.

The promise and challenge of value-based paymentJAMA Internal Medicine; by Daniel K Shenfeld, Amol S Navathe, Ezekiel J Emanuel; 7/24Fee-for-service (FFS) systems pay physicians and health care institutions based on the number of services provided, whereas value-based payment (VBP) links payment to quality and outcomes. In 2021, the Centers for Medicare & Medicaid Services (CMS) announced the goal to use VBP for all Medicare beneficiaries’ health care by 2030. Some commercial insurers are also aligning their contracts to VBP. This broad alignment stems from increasing recognition that to reduce health care costs, incentives must be realigned to change practice patterns, prioritizing quality and cost lowering over quantity of services... Paying for value rather than more health care is without any question a wise approach. VBP fits with the intrinsic motivation of doing good, which led most physicians to medicine. Yet, achieving this is difficult due to operational and financial challenges inherently associated with the transition to VBP. A more efficient, economical method of assessing the underlying risk of a population and measuring the value and quality of care is needed. Various stakeholders across the public and private sectors are working to realize this vision.