Literature Review

Talk about death, but live your life: What people working in end-of-life care have learned Yahoo Life; by Elena Sheppard; 9/16/24 Eventually, we are all going to die. It’s a reality that most people are uncomfortable with and do everything they can to avoid thinking about. But for people who work in end-of-life care, such as hospice workers and death doulas, death is both a fact of the job and a part of their everyday reality. While the work may sound grim, those who do it say that their daily proximity to death doesn't cast a shadow over their lives; rather, it has enabled them to more purposefully celebrate life’s beauty. ... Yahoo Life spoke to hospice professionals to hear the life lessons they’ve learned by working so closely with death. Here’s what they said. ...

Indiana music therapy specialists talk about the practice BallStateDailyNews.com; by Hannah Amos; originally posted 9/3/24, distributed 9/12/24 The strum of a guitar, the hum of a voice and the steady beat of a drum makes more than just music. It provides a way for people to work through their emotions.  Kirby Gilliam, owner and founder of Plainsong Music Services in Anderson, Indiana, said she noticed music creates a safe space.  ... [She] uses different techniques: expressive, receptive, recreated and the ISO principle. Expressive music therapy is when the patient makes music. The receptive technique is when the therapist makes music and the patient listens. Recreated is when patients sing songs made by other artists. Finally, the ISO principle is when the music matches the patient’s mood, and through music, they shift the mood in a positive direction, Gilliam said.  “Music therapy is an evidence-based field, based and rooted in science and research,” Gilliam said. “If it didn't have the evidence base, it would be more like hippie-dippy and anecdotal … The why is [that] music opens up your entire brain — all of the pathways.” ... Another worker at Plainsong is Hospice Coordinator Kinsey Lavy, who primarily works with geriatrics and individuals with intellectual and developmental disabilities.  Editor's note: For a book specific to music therapy and music for hospice and grief care, with practical uses by mental health practitioners, I invite you to examine my book, Music of the Soul - Composing Life Out of Loss, published in Routledge's Series in Death, Dying and Bereavement, edited by Robert A. Neimeyer.

Mental health jobs to grow 3X more than the rate of all US jobs Becker's Hospital Review; by Erica Carbajal; 9/9/24 By 2033, employment growth in mental health professions is expected to triple that of average job growth in the U.S., according to a CNN analysis of data from the Bureau of Labor Statistics. While the median projected employment growth for all occupations across the next decade is 4%, the rate for mental health-related jobs is 12%. This includes psychiatrists, psychologists, therapists, counselors, psychiatric aids and social workers, according to CNN's report published Sept. 7. Editor's note: Too often, mental health health jobs in hospice and palliative care are relegated to low status on priorities for staffing, instead of the regulatory high priority for "whole-person" care defined throughout the CMS Hospice Conditions of Participation. As significant changes continue to unfold for hospice and palliative services, we will continue to report trends and shifts that emerge in the healthcare landscape for mental health jobs.  

Bittersweet bouquet: Hospice worker transforms her grief into a garden of memories ABC 13, Grand Rapids, MI; by Matt Gard; 9/5/24For the most part, Kaitlyn Dawson’s desk at the Emmanuel Hospice office is exactly what you’d expect it to be. On her left, she has office supplies, ... but it’s what’s on the wall over her left shoulder that really gives this workspace character. Inside three separate picture frames are hundreds of flowers. Kaitlyn was an art major at Grand Valley State University before she switched to social work, and she still has a passion for creativity. Every one of those flowers – whether red, purple or orange - was her creation. ... “These flowers represent patients that I have been able to be a part of their journey at end of life,” said Kaitlyn, who has worked in hospice for about four years. “I had one particular case that was really difficult, and I remember leaving that visit and thinking ‘I'm going to start doing this process in honor of her.’ And I went to the store and I bought pencils and a notebook and decided I was going to do flowers. It was easy. It was simple. It was something I could sit down and do in the evening, and if I lost a couple of people that day, I could draw a couple of flowers.” Before Kaitlyn knew it, she had a "bittersweet bouquet."

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

Avoid these mistakes in palliative care to enhance your loved one's well-being Leesville Leader, Lake Charles, LA; by Evertise Digital; 8/26/24 For people with life-threatening diseases, palliative care is crucial in providing comfort and improving quality of life. It’s essential to focus on the details and avoid common mistakes in order to deliver good treatment. Mistakes in palliative care can inadvertently cause discomfort or diminish the quality of the support provided. It’s critical to recognize and steer clear of certain mistakes to guarantee that your loved one receives the finest treatment possible. By focusing on these key areas, you can enhance their well-being and provide the compassionate, attentive care they need during this challenging time.

“What I wish I knew about dementia”: A caregiving only child’s experience The Healthy; by Dr. Patricia Varacallo, DO; 8/20/24 It's no secret dementia affects the brain of the patient, and tests the hearts of their loved ones. Through one woman's personal journey, experts advise on the emotional, medical, and financial aspects of caregiving for dementia. ... Drawing from Ann’s caregiving journey and insights from Dr. Wint and Lucille Carriere, PhD, Cleveland Clinic Angie Ruvo Endowed Caregiving Chair, we share their collective wisdom on what they wish more people knew about dementia.

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.

Caregivers of end-of-life patients reveal the last words they hear most often and the most common regrets from patients WhatsNew2Day; by Alexander; 7/27/24... While each person’s final moments are different, chaplains and palliative care nurses have said most people approach their death with “radical acceptance.” People who are actively dying also often have a new sense of clarity about the universe and may even have a temporary burst of energy or sudden moments of clarity if they have dementia. The last words patients usually say to their families are to tell them they love them... [Often, people] who are in the midst of dying want to be surrounded by their loved ones and pets. Their final words are often words of love and pleas for forgiveness, as well as expressions of regret, ... [Another described that people show] "a desire for connection" with loved ones and faith. Editor's Note: This article provides a balanced scope of descriptions from several professionals, notably Catherine Duncan, Annemarie Switchulis, Neal Shah, and Zackary Price. In this day of social media, some hospice professionals (past or present) tout definitive, authoritative descriptions of what all dying persons experience, with too many assumptions and generalizations. Beware what you read and distribute, especially if the tone and language (of other articles) are sensationalized in a way to garner social media "expertise," followers and Shares--at the expense of more balanced, sensitive, diverse, personalized experiences.

Further psychometric evaluation of the eight-item Hospice Philosophy Scale: Results from a national sample of interdisciplinary hospice clinicians Journal of Applied Gerontology; by Todd D Becker, Sarah E Clem, Paul Sacco, John G Cagle, Joan K Davitt, Nancy Kusmaul; 7/20/24 online ahead of print This study examined the psychometric properties of the eight-item Hospice Philosophy Scale (HPS-8) through confirmatory factor analysis; differential item functioning by age, gender, race, and professional discipline; and internal consistency reliability. ... Our results support the HPS-8 as a valid and reliable measure of attitudes toward the hospice philosophy of care in hospice clinicians.

Mayo Clinic Minute: How extreme heat, humidity affect your health News Tribune; by Tribune News Service; 7/16/24 Many parts of the U.S. continue to grapple with oppressive heat and humidity. This can prevent the body from cooling down, increasing the risk of heat cramps, exhaustion and heatstroke. Dr. Jesse Bracamonte, a Mayo Clinic family medicine physician, said the extreme heat and high humidity can be a dangerous mix. "High heat and high humidity can place one at risk for serious illness if people aren't careful. The heat can affect people's bodies by increasing the core body temperature and ability to sweat, and cause dehydration that can cause further medical problems and ensuing issues, and eventually can lead to heat exhaustion, in some cases, severe heat illness, known as heatstroke," Bracamonte said. Editor's Note: What information and support are you providing for your clinicians who travel between visits and for your patients who might be affected by extreme heat and humidity? What simple, practical adaptations might you create, like disposable water bottles for staff as they leave your building (with a sign of support and basic info)?