Literature Review

Local veterans to be honored at pinning ceremonies Call & Times, East Providence, RI; by John Baker, Pawtucket Times; 2/26/25 It never gets old for Christine Miller. Whenever she places a commemorative pin on a Vietnam War veteran and sees their reaction to it, it warms her heart, sometimes even bringing her to tears. That’s one of the best parts of her job as Beacon Hospice Care Community Engagement Coordinator, which later filtered into her becoming the president of the Rhode Island Hospice Veterans Partnership, which she herself founded. Miller, a Pawtucket resident, announced recently that, with Vietnam War Veterans Day coming up on Saturday, March 29, she will conduct a few [pinning ceremonies] ... Editor's note: Access to the full article may be limited. Pair this with today's post, National Vietnam War Veterans Day, March 29, 2025. 

‘Global problem’: Numerous factors, biases contribute to overtreatment at end of life Healio; by Josh Friedman; 2/26/25 Nathan I. Cherny, MD, has worked all around the world. At every stop — from Australia to Israel, and Memorial Sloan Kettering Cancer Center in between — he has seen people with cancer receive overly aggressive treatment at the end of life. ... In a review published in ESMO Open, Cherny and a cohort of multinational colleagues highlighted numerous reasons why overtreatment occurs among patients approaching the end of life, ... They listed more than 20 contributing factors, including desire for control of the cancer, denial and anger, family pressure and hope preservation. The two factors that contribute most to overtreatment are optimism bias and the “counterphobic determination to treat,” which involves clinicians having a difficult time introducing the suggestion of palliative care revert to offering further treatments, Cherny said. ... Responsibility for decisions does not need to fall solely on oncologists, Cherny added. Palliative care physicians, social workers, chaplains and others can be part of a team to assist patients with their choices. ... The number of patients who are overtreated differs at each institution. “Each institution has its own culture of care,” Cherny said. Editor's note: This article puts forth significant insights for all palliative and hospice clinicians, interdisciplinary teams, and palliative/hospice executive leaders. Apply Cherny's to your referral sources: "Each institution has its own culture of care." Apply these findings to your own palliative and hospice services. 

Leading early conversations about ICD [implantable cardioverter defibrillator] use in end-of-life cancer care  Cancer Network; by Megan Mullins, PhD, MPH; 2/21/25 Earlier and more frequent talks about disabling ICDs with patients receiving end-of-life care and their families may help avoid excessive pain. ... Regarding implantable cardioverter defibrillators (ICDs) in those with fatal cancers, it is critical that patients know what having a device means and how it impacts end-of-life care, according to Megan Mullins, PhD, MPH. CancerNetwork® spoke with Mullins, assistant professor in the Peter O’Donnell Jr. School of Public Health, the Harold C. Simmons Comprehensive Cancer Center, and the Department of Internal Medicine at UT Southwestern Medical Center, about how ICD deactivation prior to end-of-life care could impact clinical practice in patients with advanced cancers. ... She emphasized that device deactivation would allow the body to undergo the natural dying process without unnecessary painful shocks associated with the use of the device.

More than 900 Californians have died of the flu so far this season amid low vaccine rates, state saysLos Angeles Times, CA; by Lila Seidman; 2/22/25More than 900 Californians — including 15 children — have succumbed to the flu this season in what has turned out to be one of the worst surges of the respiratory illness in years, according to a report released Friday by the California Department of Public Health. Most of the influenza victims — 701 — were over 64 years old, which tracks with the conventional notion that the illness disproportionately affects older people. However, the number of children who have died has raised concerns. Four more kids died of the flu during the week ending Feb. 15, increasing the seasonal pediatric death toll by more than a third, according to the report.

Patients without family or health care proxies face overtreatment or limbo in hospitals WHYY - PBS; by Maiken Scott; 2/24/25 A program matches unrepresented patients with volunteers who can make care decisions for them during health care crises. ... [Intensive care physician David] Oxman says unrepresented patients are a small, but growing group. Some have outlived their family members, or are estranged from them. Maybe they’ve moved a lot, sometimes substance use or homelessness plays a role. The situation is especially complicated with patients who have dementia, or who can’t communicate their wishes for other reasons. ... Most states have provisions where medical guardians and medical decision makers can be appointed by a court, but that takes a long time. In the meantime, a search for relatives begins. David Sontag, director of ethics for Beth Israel Lahey Health in Massachusetts, ... created a matching program where health care professionals volunteer to represent patients, not within their own hospital systems because that could cross ethical boundaries, but at other hospitals. “This is an opportunity for us to help some of the most vulnerable members of our communities, those who have nobody to speak for them when they can no longer speak for themselves. And that allows us to respect their autonomy throughout their lives,” he said.

Who cares for the caregivers? The push for laws to protect nurses’ mental health Medscape; by Jodi Helmer; 2/5/25 ... More than 67% of nurses reported feeling depressed or anxious, and two thirds said they were not receiving mental health support. Nurses cite lack of time and financial resources among the reasons for not seeking treatment, but fears about losing their jobs and the impact on their nursing licenses were also top issues. ... Registered nurses (RN) and advanced practice RN (APRNs) can be required to answer invasive questions about their mental health as part of their state licensure and advanced credentialing applications. The questions can be stigmatizing and could require nurses to submit letters from their healthcare providers addressing their mental health status. ... There is a movement to urge licensing and credentialing organizations to remove invasive and stigmatizing mental health questions from their applications. The National Council of State Boards of Nursing is working on national recommendations ...

Hospice of the Chesapeake Advanced Cardiac Care Program seeks to reduce hospital visits Southern Maryland News Net; Press Release; 2/20/25Hospice of the Chesapeake, in collaboration with the American Heart Association (AHA) and the National Partnership for Healthcare and Hospice Innovation (NPHI) announces the Advanced Cardiac Care Program to address one of the nation’s largest killers of Americans – heart disease. Each year, more Americans die from heart disease than any other condition, including cancer. Heart disease is also a leading cause of hospitalization: patients with congestive heart failure alone account for more than one million inpatient admissions annually. By offering heart disease patients the right educational resources, we empower them to take control of their health,” Hospice of the Chesapeake Vice President of Medical Affairs & Hospice Medical Director Dr. Sonja Richmond said. “The resources available through the Advanced Cardiac Care Program can help patients and caregivers better manage their condition, reducing the likelihood of hospital visits and improving their quality of life.” ... Carole Fisher, President of NPHI [said,] “Far too many die alone in a hospital or nursing facility, when instead our hospice teams could care for them wherever they reside and they could enjoy a far higher quality of life surrounded by loved ones.”Editor's note: Links to Hospice of the Chesapeake; AHA'sHospice Care" webpage; NPHI's Advanced Cardiac Care.rogram.   

Over a quarter of adolescents, young adults with cancer who want to die at home do not Healio; by Jennifer Byrne; 2/20/25 More than one-fourth of adolescents and young adults with cancer who wished to die at home did not attain this goal, according to research published in JAMA Network Open. Researchers conducted a retrospective cohort study that included adolescents and young adults (AYA; age range, 12 to 19 years) with cancer who died between 2003 and 2019. The cohort included patients treated at Dana-Farber Cancer Institute, Kaiser Permanente Northern California or Kaiser Permanente Southern California. ... Healio spoke with Odejide about the rationale for the study, the importance of the findings, and strategies oncologists can employ to ensure more goal-concordant end-of-life care for AYA patients with advanced cancers. [Click here for Helio's discussion with the lead researcher, Oreofe O. Odejide, MD, MPH, associate professor of medicine at Dana-Farber Cancer Institute.]  Editor's note: Examine this JAMA article, which we posted in our Saturday Research issue, 1/18/25: "Preferred and actual location of death in adolescents and young adults with cancer."

Improving quality of life and end-of-life care: Standardizing goals of care notes in EHRs EurekAlert! - American Association for the Advancement of Science (AAAS), Indianapolis, IN; Regenstrief  Institute, peer-reviewed publication; 2/19/25 ... A new study by researchers from Regenstrief Institute, the Indiana University School of Medicine and Indiana University Health presents the standardized goals of care note they developed, deployed and evaluated as a quality improvement initiative at IU Health, a large, statewide healthcare system. ... The study authors report:

Addressing overtreatment in end-of-life cancer care Medscape; by David J. Kerr, CBE, MD, DSc; 2/19/25 ... What do we mean by overtreatment? This means that many patients who are approaching the end of life receive treatments, like directed anticancer therapies, that are unlikely to provide clinically meaningful benefits and may do more harm than good. This is an expression that I use often in the clinic when I'm explaining to patients that we have reached the end of the road in active interventions, such as chemotherapeutic drugs, that will do more harm than good. It doesn't stop us from doing our very best to look after patients. We focus on improving the quality of life and maintaining that for as long as we can, while continuing to care and look after the patients. ... Overtreatment may even, one would argue, accelerate death when you consider those 1% or 2% mortality rates that can be associated with some treatments that we offer. ...

Influenza vaccination cuts deaths by up to four times Medscape Medical News; by Olga Fernandez Castro; 2/17/25 Influenza vaccination significantly reduces flu-related morbidity and mortality across all age groups, according to a large-scale Spanish study analyzing data from more than 38 countries and 6.5 million patients. ... The analysis confirms that vaccination against the influenza A (H1N1) virus and the influenza B virus (IBV) effectively reduces infection rates and flu-related complications in children aged under 5 years, individuals aged 5-65 years, and older adults aged over 65 years. However, protection against influenza A (H3N2) virus appears lower in older adults, despite being effective in younger children. Editor's note: Click here for the Centers for Disease & Prevention Control (CDC) "Weekly Influenza Surveillance Preport," with a map for flu activity levels for each state and drilled down to counties. Click on the "CBSA" button to change from the state view to the counties' view and downloadable data. 

 St. Francis Hospice hosts Sweetheart Lunch for those grieving lost partners Fox 23 News, Tulsa, OK; 2/14/25 St. Francis Hospice in partnership with Moore Fitzgerald Funeral Service hosted their Sweetheart Lunch to help those grieving a lost partner or spouse on Valentine's Day. "We're having a Valentine's Day party—we call it Sweetheart Lunch—for people that have lost a loved one during the past year, most often a spouse," explained Joseph Moore, the owner of Moore Fitzgerald Funeral Service. "Valentine's Day is such a difficult time for people that have recently lost a spouse. There are so many memories associated with Valentine's Day and so forth. We just want to provide a place where they'll feel loved and not alone today." Charlie Dodd, a bereavement coordinator with St. Francis Hospice, said events like this give people a sense of community during a difficult time.

Americans who’ve become caregivers rose by a third in 10 years The Daily Sentinel, Grand Junction, CO; 2/14/25 A growing numbers of family members now provide care for older adults who live at home or in residential care settings, a new study shows. Their ranks increased 32%, from 18.2 million to 24.1 million, between 2011 and 2022, according to new research in the journal Health Affairs. The number of hours that these folks spent caring for older adults with dementia jumped by nearly 50%, from an average 21.4 hours per week in 2011 to 31 hours in 2022. Exactly what is driving the increase in family or unpaid caregiving is not fully understood, but researchers speculate that it may be due to a rise in the number of people who live with the folks who they assist. For the study, researchers culled data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) in 2011 and 2022.