Literature Review

High intensity of end-of-life care for minority patients with lung cancerU.S. Medicine; 3/27/24While disparities in lung cancer mortality among racial and ethnic minorities are well documented, not as much is understood about how racial and ethnic minority patients with lung cancer are treated at the end of life. A study led by researchers from the Indiana University School of Medicine and the Richard L. Roudebush VAMC, both in Indianapolis, sought to determine if those patients experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic white (NHW) patients.

Antibiotics in end-of-life care NEJM Journal Watch, by Abigail Zuger, MD; 3/27/24Antibiotics often are considered to be among the gentler and more comfort-oriented interventions in end-of-life care, certainly far less aggressive than intubation or last-ditch surgery. ... Still, antibiotics do entail their own costs in the form of toxicities and need for intravenous access, and liberal antibiotic use reliably worsens institutional and community drug-resistance profiles. ... A new review was written for infectious disease consultants but contains specific suggestions that should interest both generalists and other subspecialists caring for dying patients. 

Palliative care in the cardiovascular intensive care unit: A systematic review of current literatureCardiovascular Revascularization Medicine, by Agastya D Belur, Aryan Mehta, Mridul Bansal, Patrick M Wieruszewski, Rachna Kataria, Marwan Saad, Annaliese Clancy, Daniel J Levine, Neel R Sodha, Douglas M Burtt, Gregory S Rachu, J Dawn Abbott, Saraschandra Vallabhajosyula; 3/24/24, online ahead of print Results: Of 5711 citations, 30 studies were included. All studies were published in the last seven years and 90 % originated in the United States. Heart failure was the most frequent diagnosis (47 %), and in-hospital mortality was reported in 67 % of studies. There was heterogeneity in the timing, frequency, and background of the care team that determined palliative care consultation. In two randomized trials, there appeared to be improvement in quality of life without an impact on mortality.

Hospice of Santa Barbara offers insights into family grievingSanta Barbara Independent, by Hospice of Santa Barbara; 3/26/24Grieving the loss of a family member is a deeply intricate emotional journey. Shared bonds and histories make family grief especially unique. Family grief extends beyond the individual and intertwines with the collective fabric of shared experiences, roles and responsibilities. ... It is common for death to change the family dynamic. This can be a result of several factors, including age, relationship, role, difference in coping mechanisms, heightened stress and emotions, and unresolved family issues which can lead to the resurfacing of past grievances.Editor's Note: CMS Hospice COPs §418.3 defines: "Bereavement counseling means emotional, psychosocial, and spiritual support and services provided before and after the death of the patient to assist with issues related to grief, loss, and adjustment." The interdisciplinary team needs to understand individual and family grief, within the scope of their roles and responsibilities with family members.

The grief you feel is realPsychology Today, by Rosemary K.M. Sword and Philip Zimbardo PhD; 3/25/24We might think grief is all the same. But there are many kinds. [This articles briefly identifies various kinds of grief, including the following:]

At Levine Children’s Hospital, therapy dogs provide “a special kind of medicine” Charlotte Magazine, by Jen Tota McGivney; 3/25/24 Last winter, after a little boy at Levine Children’s Hospital entered end-of-life care, his doctors and nurses wanted to give the boy and his family happy moments together in the hospital. They called in a specialist. Enter Sprout, a 4-year-old Labrador retriever. Sprout is the key member of the Art & Barks program at the oncology and hemophilia clinic at Levine Children’s Hospital.  ... The family spent hours that day at Art & Barks, drawing and taking pictures together and cuddling Sprout. The mementos became priceless works of art. 

‘You can become a husband again’ National Association of Federal Retirees (Canada); by Jennifer Campbell; 3/25/24When his wife got a much-needed bed in palliative care, a perceptive nurse told Brian Hills he could concentrate on being a husband again, instead of a caregiver. 

Incurable but not hopeless: How hope shapes patients’ awareness of their advanced cancer prognosis The Conversation, by Jean Mathews and Michael Brundage; 3/24/24Hope is defined as the expectation of achieving a future good. Patients with cancer, whether it is curable or not, prioritize cure as their highest hope. ... Previous research indicates that less than half of patients with incurable cancer are aware of their prognosis. This is often attributed to a failure of communication. ... In the context of advanced cancer, the relationship between hope and hopelessness is balanced by acceptance, which can re-direct hope to new goals beyond cure, such as hope for connection with others and enjoyment of daily pleasures. 

"A strong reason why I enjoy coming to work": Clinician acceptability of a palliative and supportive care intervention (PACT) for older adults with acute myeloid leukemia and their care partners Journal of Geriatric Oncology; by Ayomide Okanlawon Bankole, Natasha Renee Burse, Victoria Crowder, Ya-Ning Chan, Rachel Hirschey, Ahrang Jung, Kelly R Tan, Susan Coppola, Mackenzi Pergolotti, Daniel R Richardson, Ashley Leak Bryant; 3/20/24 Introduction: ... In this study, we examined clinician acceptability of a NIH-funded interdisciplinary PAlliative and Supportive Care inTervention (PACT) for older adults with acute myeloid leukemia (AML) and their care partners that transcends both inpatient and outpatient settings. Results: ... Five themes were identified in the thematic analysis: (1) Emotions and affect towards the intervention, (2) Intervention coherence and self-efficacy, (3) Barriers, burden, and opportunity costs of delivering the intervention, (4) Usefulness and effectiveness of the intervention, and (5) Recommendations to improve intervention delivery.

Racial/ethnic differences in care intensity at the end of life for patients with lung cancer The ASCO Post, by Matthew Stenger; 3/21/24 The study used data from the California Cancer Registry linked to patient discharge data abstracts. The primary outcome measure was intensity of care in the last 14 days before death, with greater intensity defined as any hospital admission or emergency department visit, intensive care unit (ICU) admission, intubation, cardiopulmonary resuscitation (CPR), hemodialysis, and death in an acute care setting. ... The authors concluded: “Compared with [non-Hispanic White] patients, [Asian/Pacific Islander], Black, and Hispanic patients who died with lung cancer experienced higher intensity of [end-of-life] care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the [end of life].”

$4.25 million gene therapy for kids becomes world's priciest drug NBC LEX18, by Alex Arger; 3/20/24 A lifesaving gene therapy for children born with a rare and debilitating disease has just been approved by the U.S. Food and Drug Administration. The catch? Its wholesale cost has been set at $4.25 million, making it the most expensive medicine in the world. Orchard Therapeutics announced the hefty price for Lenmeldy Wednesday, two days after the FDA approved the therapy as the only treatment for kids with metachromatic leukodystrophy, or MLD. 

Multinational Association of Supportive Care in Cancer (MASCC) expert opinion/guidance on the use of clinically assisted hydration in patients with advanced cancer

Are the robots coming for my nursing job? Minority Nurse; 3/20/24 While medication-dispensing robots, telemetry, electronic fetal monitoring, artificial intelligence, and other technological advances have altered our work as nurses, fears that robots will replace us and send nurses into the historical career dustbin are likely unfounded. ... The human side of nursing is the art that maintains the sacredness of the nurse-patient bond. Nursing may be partially driven by plans of care developed within the parameters of the nursing process, but where the rubber hits the road is where person-to-person interaction informs the patient experience and the nurse’s calling.