Literature Review

Palliative care pharmacist discusses how building relationships with patients leads to rewarding career Drug Topics - Voice of the Pharmacist; by Killian Meara; 10/22/24 A discussion with Madison Irwin, PharmD, BCPS, clinical pharmacist specialist in palliative care at University of Michigan Health and clinical assistant professor at the University of Michigan College of Pharmacy. ... Irwin currently works as a clinical pharmacist specialist in palliative care in both inpatient and outpatient settings. She supports a palliative care consult team and outpatient palliative care clinics by seeing patients who are transitioning out of the hospital or patients who have more complex medication management needs. Although there are plenty of challenges that she faces in her practice, Irwin said that really getting to know patients through her work is extremely rewarding. ... In a conversation with Drug Topics, Irwin discussed how her career has unfolded, a program that she worked on that exemplifies the value of pharmacists in patient care, opportunities out there for pharmacists to expand their role, and how high rates of chronic pain will impact the pharmacy profession in the coming years.

Music therapist helps patients navigate end-of-life journey on Long Island CBS New York / YouTube; by Jenna DeAngelis; 10/15/24 Music therapy helps with emotional and physical health, and now the healing power of music is being brought to hospice patients on Long Island.

Communication gaps among clinicians may limit conversations about prognosis, hospice Healio - HemOncToday; by Jennifer Byrne; 10/16/24 Clinicians in acute or post-acute care settings may delay or avoid serious illness conversations with patients whose cancer prognoses are worsening out of deference to the patient’s oncologist, according to study findings. Researchers conducted 37 semi-structured interviews with physicians and leaders in hospital medicine, oncology, palliative care, home health care and hospice. Investigators coded and analyzed the interviews using thematic content analysis. Evaluation of the responses yielded insights into how care silos, lack of clear clinical roles and other factors may affect communication between oncologists and other clinicians. ... "We know that the 3-month window after an older adult with cancer is discharged to a skilled nursing facility can be comprised of complex medical decision making and changing preferences of care. Lack of appropriate serious illness communication during this time can result in unwanted hospitalizations and unwanted, aggressive care at the end of life."

The death issue: Austin’s Children’s hospice professionals advocate for honesty The Austin Chronicle; by Maggie Quinlan; 10/11/24 Sometimes parents wait too long to tell their sick children that they will die. Sometimes, by the point of disclosure, their child can no longer speak. ... She said often the dying child will become an “emotional caretaker” in the hospital room where they’ve just learned that their illness will kill them. “Even though it’s happening to them, they tend to really want to protect their family.” It doesn’t have to be that way. Cosby says a lot of the job is beautiful, even fun. Families make memories, and child life specialists help make it happen. They go to see the ocean. They throw private proms and graduation ceremonies. They finger paint. They crack jokes. They decide to make the most of precious little time. ... “Grief is the price of love, and there’s so much love in there,” says Heather Eppelheimer, another Dell Children’s child life specialist. “We have to be able to love fully in order to also grieve fully.” Child life specialists respect family wishes and also advocate for honest, clear language about death. They say to use that word – death, dying, die – and avoid “passing away” (“To where?” Cosby asks). That kind of straightforward communication isn’t part of our cultural hardwiring, Cosby says, but it makes everything easier. In her life, when people aren’t comfortable talking about death, she asks why. What are they afraid of? ...

Man accused of choking terminally ill wife accepts plea deal KSL.com; by Pat Reavy; 9/27/24 A man who prosecutors say attempted to end his terminally ill wife's life by choking her has accepted a plea deal. DeWayne McCulla, 46, pleaded guilty on Thursday in 5th District Court to an amended charge of attempted manslaughter, a third-degree felony. The charge comes with a domestic violence sentencing enhancement. Arenda Lee McCulla, 47, died on Dec. 21, 2021, following her battle with breast cancer. The night before, however, as a small group of family members were by her side in La Verkin, DeWayne McCulla "choked the victim in an attempt to kill her to ease her suffering while they were with her during her terminal cancer and being on hospice," according to charging documents. Other family members pulled McCulla off of his wife.Editor's note: Crucial information that is not reported in this article: Where was the hospice team in managing this patient's pain? In educating and supporting the caregiver (the husband?) and family about contacting the hospice? In making required visits when the patient is actively dying? In assessing the caregiver's ability to provide care, especially any history or risks of domestic violence, neglect, or abuse? What safety-in-the-home protocols were used by this hospice, especially when hospice team members followed up? Aware of not-knowing these many factors, I do not ask these with judgment but rather to raise awareness of core, preventive measures for other hospice patients.

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

Bereaved mum shares 'what not to say' in new book BBC News; by Roger Johnson and Jonny Humphries; 9/24/24 A bereaved mother has written a book exploring the sensitive topic of how to speak to a parent struck by the loss of a child. Singer and entertainer Kiki Deville, from Earby, said she felt as if she would "never experience joy again" after losing her four-week-old son Dexter in 2007. Dexter died from the rare genetic condition Zellweger Syndrome and spent his last days in Chorley children's hospice Derian House, of which Ms. Deville is now a patron.  Her work there, including countless conversations with other parents, informed her book 'What Not To Say: A Practical Guide to Supporting Bereaved Parents'. Ms. Deville said 17 years after the loss of Dexter, she still remembers the first time someone made the well-meaning but painful comment: "At least he was just a baby." "Now that infers were he older, his death would have mattered more," she told the BBC.  From speaking to other mothers, Ms. Deville also gave examples such as "at least you have other children" and "they're in a better place" as things not to say. She said: "It's really important to recognise that nobody says anything out of malice, I don't think anybody sets out to hurt."Editor's note, calling all non-clinical hospice and palliative care leaders: Your interactions with bereaved parents speak volumes. Do you convey cheap platitudes or wise empathy? Incorporate these human vulnerabilities into your leadership skills. Open yourself to the pain of experiencing the pain and joys of your organization's palliative/hospice pediatric families. Invest a day of shadowing with a pediatric interdisciplinary team member. Be willing to go there. Be willing to be there: physically, mentally,  emotionally, and spiritually (without imposing your own onto others).

How can we make dementia care more human? Practical insights for providers. CHAP - Community Health Accreditation Partner; by Jennifer Kennedy, PhD; 9/20/24 This year’s World Alzheimer’s Day brings a renewed focus on advancing dementia care, especially with the recent launch of the CMS GUIDE Model. This groundbreaking approach emphasizes comprehensive, coordinated care, not only improving the lives of patients but also significantly easing the burden on caregivers. As healthcare providers, there’s a critical opportunity to adopt strategies that go beyond clinical treatment, focusing on the human experience and addressing the emotional, physical, and financial challenges that dementia brings. ... As we reflect on the progress made in dementia care, there are several actionable strategies healthcare providers can implement to enhance their programs:

Death is no enemy Psychiatric Times; by Sidney Zisook, MD; 9/17/24... As mental health clinicians, we often confine our conversations about death and dying to recognizing suicide risk and preventing suicide. And for good reason. Suicide is the 11th leading cause of death in the United States, ... Far less attention is paid by mental health clinicians to other aspects of death and dying. But we are human, first and foremost, and coping with a host of issues related to the end of life is inextricably bound to both our professional and personal lives. Like it or not, death is part of life. We, as mental health clinicians, are not always as prepared as we would like to be to help ourselves, our loved ones, our patients, and their loved ones deal with loss, dying, death, and bereavement. For many physicians, 1 or 2 hours in medical school and perhaps another few hours during residency are all the training we receive in these complex and challenging clinical issues. ...  Chochinov provides a clinician’s guide for “being with” dying patients. He offers ways of providing intensive caring to enhance empathy, respect, connectivity, and hope, and to make the experience of a dying patient more tolerable than it otherwise might be. ... I have utilized his Patient Dignity Question, which asks, “What do I need to know about you as a person to take the best care of you possible?” on several occasions with gratifying results for both the patient and me.

Global collaboration launches culturally inclusive palliative care education tool Hospice News; by Holly Vossel; 9/16/24 An international collaboration has led to the development of a new palliative care training tool aimed at improving quality and equitable access. Health systems across the globe are recognizing a growing need to boost the supply of providers able to care for a swelling, aging population of serious and terminally ill patients. Rising demand was among the driving forces behind the newly unveiled COllaboratively DEveloped culturalY Appropriate and inclusive Assessment tool for Palliative Care Education (CODE-YAA@PC-EDU). The palliative care education tool was developed in concert by the Council of Europe, the World Health Organization (WHO) and the United Nations. The organizations joined forces to design a sustainable training model that could build up the palliative workforce. The project is supported in part by the research network European Cooperation in Science and Technology (COST).

The 9 college majors that lead to the most fulfilling careers ... NBC 7 San Diego, CA; by Kamaron McNair; 9/14/24 If you want your degree to help you land a fulfilling job, consider studying music therapy. The medical and therapeutic fields are among the college majors helping graduates get jobs that make the world a better place, according to graduates surveyed in a recent Payscale report.24/7 San Diego news stream: Watch NBC 7 free wherever you are Alumni with bachelor's degrees in music therapy are most likely to do this kind of fulfilling work, with 95% of degree-holders saying their work makes the world a better place, Payscale finds. Music therapy programs cover coursework in music, music therapy, science and psychology, according to the American Music Therapy Association. ... Music therapists may work in traditional settings, offering services to clients working through physical disabilities or mental health issues. People in hospice care, substance abuse programs and cancer treatment centers have also benefited from music therapist visits, according to the AMTA.Editor's note: Click here for facts and descriptions about "Music Therapy in Hospice Care," by the American Music Therapy Association (AMTA). To recruit a certified music therapist for hospice (or other setting), visit AMTA's Job Hotline.  

Why so many patients are confused about CPR and do-not-resuscitate orders STAT; by Lindsey Ulin; 9/11/24 Inherently difficult conversations are made more so by a lack of physician training. When a patient is admitted to the hospital in the U.S., there’s a standard question physicians like me are supposed to ask: “If your heart stops beating, do you want us to do CPR?” On the surface, this may seem like a mechanic asking a customer, “If your car stalls, do you want us to jumpstart the engine?” Who would say no to this, especially in a hospital? The problem is that this exchange, which we call asking about “code status” in medicine, centers around a closed-ended question. Talking to a patient about their preferences for cardiac resuscitation, intubation, and/or other life-sustaining treatments needs to be a complete, often lengthy discussion, not just a box to check. ...