Literature Review

Bereavement care, often an ‘afterthought,’ should be public health priority Healio; by Jennifer Byrne; 5/26/24 Health care institutions and their staffs must take action to ensure bereavement care shifts from “an afterthought to a public health priority,” according to a position paper published in The Lancet Public Health. Bereavement support often is considered part of palliative care; however, there often is a lack of continuity of care for bereaved individuals after a person dies in palliative or end-of-life care settings, the paper’s authors contend. Healio spoke with [co-author Wendy G. Lichtenthal,PhD] about what bereavement care encompasses, why it should be prioritized and how institutions can support grieving individuals who may require assistance.

Nephrologists' perspectives and experiences with hospice among older adults with end-stage kidney disease Journal of the American Geriatrics Society; by Melissa W Wachterman, Anupallavi Sinha, Tarikwa Leveille, Sushrut S Waikar, Eric Widera, Kai Romero, Barbara Bokhour; 5/22/24 Background: ... Hospice use among older adults with end-stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. ... Conclusions: Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients.

From caregiving to mourning: Navigating the end of the road as a family caregiver The San Diego Union-Tribune; by Lauren J. Mapp; 5/21/24 ... Losing a loved one is universally challenging, but for family caregivers who dedicated themselves to their care, the loss can be especially complicated. When a loved one dies, family caregivers often find themselves grappling with a whirlwind of emotions, from sorrow and grief to relief and sometimes guilt. This emotional roller coaster is compounded by the physical and emotional toll of providing round-the-clock care. ... A significant aspect of the grieving process for family caregivers is the transition from the role of caregiver to that of mourner. This shift can be jarring for many, as their identity may have been closely tied to their caregiving responsibilities. ... Editor's Note: For 24/7 online education for family caregivers throughout their trajectory of serious illness thorhrough hospice care and their bereavement journey, visit our sponsor Composing Life Out of Loss's Video Libraries. 

Life support decisions are usually made within 72 hours. Is that too soon? Advisory Board; by Daily Briefing; 5/21/24After a patient suffers a traumatic brain injury (TBI) and is on a ventilator, when is the right time to withdraw life support? A new study published in the Journal of Neurotrauma suggests that doctors and patient family members should wait a bit longer than usual. ... The researchers found that the majority of patients whose life support wasn't withdrawn ended up dying in the hospital anyways within about six days. However, 42% of patients who continued life support recovered enough within the following year to have some level of independence, and a few even returned to their former lives.

Have a heart – caregivers need care, tooAmerican Heart Association; 5/14/24Living with a chronic medical condition after surviving a heart attack or stroke may come with additional health and personal care needs. Often survivors must rely on a family member or close friend to help. However, there’s a growing body of scientific research that shows people who serve as unpaid caregivers may not be getting the care they need to live longer, healthier lives, according to the American Heart Association.

Nurse resilience, decompression off balance: Press GaneyBecker's Clinical Leadership; by Erica Carbajal; 5/14/24Nurses have a hard time disconnecting from work, and may benefit from additional workplace resources that support them in doing so, according to findings from a new Press Ganey report on nurse resiliency. ... Below are four key findings from the report:

Psychological trauma can worsen symptom burden at end-of-life Hospice News; by Holly Vossel; 5/15/24 Recent research has found that traumatic experiences can lead to increased pain and symptom burden at the end of life, along with a greater likelihood of emotional suffering and isolation. Collective trauma experiences have been associated with higher instances of pain and dyspnea among more than half of seniors nationwide, a recent study found, published in the Journal of Pain and Symptom Management. Traumatized seniors are also more likely to experience loneliness, dissatisfaction with their life and depression. ... Hospices need a greater understanding of both the depth of these patients’ suffering and the scope of their unique needs to improve trauma-informed care delivery, [Dr. Ashwin] Kotwal said, assistant professor of medicine at the University of California San Francisco’s (UCSF) Division of Geriatrics.

Industry professionals reflect on five years of medical marijuana in Arkansas Arkansas Advocate; by Mary Hennigan; 5/13/24Since the launch of medical marijuana in Arkansas in 2019, more than three dozen storefronts have opened, at least 102,000 residents have registered for patient cards and revenue has topped $1.1 billion. The latest card count exceeds 102,000, and there’s no indication of a letup in new applications,  ... As of June 2023, one in three Arkansans with a patient card listed post-traumatic stress disorder as their qualifying condition, ... The next highest qualifying condition was intractable pain, or pain that has not responded to ordinary medications for more than six months, at nearly 30%. 

Early palliative care perceptions by patients with cancer and primary caregivers: metaphorical languageBMJ Supportive & Palliative Care; by Elena Bandieri, Sarah Bigi, Melissa Nava, Eleonora Borelli, Carlo Adolfo Porro, Erio Castellucci, Fabio Efficace, Eduardo Bruera, Oreofe Odejide, Camilla Zimmermann, Leonardo Potenza, Mario Luppi; 5/13/24Methods: Data were collected through a pen-and-paper questionnaire on respondents’ perceptions of the disease, its treatment and their idea of death, before and after receiving EPC [early palliative care]. The data were analysed by identifying all metaphorical uses of language, following the ‘metaphor identification procedure’ proposed by the Praggjelaz Group.Results: Metaphors were used from a variety of semantic fields. EPC was described using spiritual terms, to indicate that this approach was instrumental in ‘restoring life’, ‘producing hope’ and making patients feel ‘accompanied’. The most recurrent metaphors were those referring to light and salvation; spatial metaphors were used to describe the treatment and the hospital as a ‘safe haven’ and ‘an oasis of peace’. 

Musician grants dying wish to hospice patient The Platte County Citizen; by Rimsie McConiga; 5/14/24 Jazz musician Stanton Kessler was surprised when he was contacted recently by his friend, a hospice nurse, who reached out to him with an unusual request. A patient at the Kansas City hospice where she works told her his last wish would be to hear his favorite song, ‘Feels So Good’ before he died. During their conversations Kessler’s impression was that this was his friend’s first experience with a request such as this. “There was an element of urgency,” Kessler said. “She said he was near death.” ... An incredibly emotional and rewarding moment followed when Kessler began to play the patient’s beloved song. The man’s eyes remained closed, but his fingers began to move. ...Editor's Note: For research-based, hospice clinical stories, and rich music metaphors for ways use music with the dying and bereaved, examine the book, Music of the Soul, Chapter 7 "The Final Cadence," in Routledge's international Series in Death, Dying, and Bereavement (series edited Robert A. Neimeyer), authored by Joy S. Berger, DMA, FT, BCC, MT-BC (editor for this newsletter).

“Mental wellbeing is as important as physical wellbeing – both are interconnected” Marie Curie Hospice; by Anne Finucane, Marie Curie Senior Research Fellow, and David Gillanders, Senior Lecturer, Clinical Psychology, The University of Edinburgh, United Kingdom; 5/13/24 At least one in every four people living with a terminal diagnosis will experience depression, anxiety, adjustment disorder or low mood. Many more will experience distress because of deteriorating health and related uncertainty. Feelings of hopelessness, discouragement and even a desire for hastened death can occur. People have reported that psychological support helps them develop better coping strategies, helps them be more open to their situation and improves communication with their families and those involved in their care.Editor's Note: Executive leaders, what value do you give to your interdisciplinary team members and their contributions to patients' mental/emotional care? What advocacy, support and recognition do you have for your social workers, chaplains, counselors? What mental wellbeing measures do your employees experiences throughout your organization--and more directly--from your leadership with them? Perhaps it's time to "take the pulse" of your culture's mental wellbeing.

HopeWest selected as Childhood Bereavement ChangemakerHigh Country Spotlight; Press Release; 5/9/24 In partnership with Colorado-based Judi’s House/JAG Institute HopeWest is one of 11 grief-centered organizations selected by Judi’s House/JAG Institute to participate in the 2024 Childhood Bereavement Changemaker program to build capacity for data collection and program evaluation through a series of trainings, workshops, and collaborative learning sessions. Over the course of a year, Changemakers will receive guidance and practical recommendations to address data and evaluation needs that can inform strategic planning, support funding opportunities, and enhance the overall impact organizations like HopeWest have on the 96,000 Colorado children estimated to experience the death of a parent or sibling by age 18.

A narrative review of risk mitigation strategies in the management of opioids for chronic pain and palliative care in older adults: interprofessional collaboration with the pharmacist Annals of Palliative Medicine; by Insaf Mohammad, Candice L Garwood, Lisa Binns-Emerick Key content and findings: A variety of risk mitigation strategies to improve safety for older adults using opioids exist. They include risk assessment, tapering opioids, reducing high-risk concomitant medications, utilizing non-opioid therapies, screening for and treatment of opioid use disorder (OUD), toxicology testing, co-prescribing naloxone, utilizing controlled substance agreements, reviewing prescription drug monitoring program data, prescriber and patient education, and collaboration with pharmacists and palliative care specialists.