Literature Review

Interventions provided by palliative care social workers: Provide interventions that lessen suffering in patients living with serious illnessUniversity of Colorado Anschutz Medical Center email; by Melissa C Palmer; 9/3/24... Reflecting on my own years of experience as a palliative care social worker, the work we do is not as clear-cut as being able to prescribe medication for a symptom or titrate pain medication. The art of the intervention for social work takes time, patience, and congruent presence. To the layperson, it may appear that our interventions are just to talk with people. But that is just a small piece of the beauty and grace that evolves from our work.

Why one health system thinks its new PBM can disrupt the marketModern Healthcare; by Lauren Berryman; 8/23/24The University of North Carolina-affiliated health system announced a plan this month to launch UNC Health Pharmacy Solutions, a "transparent" PBM for employers seeking an alternative to CVS Health subsidiary CVS Caremark, Cigna division Express Scripts and UnitedHealth Group unit OptumRx, which dominate the market... “Our costs were skyrocketing,” DeFalco said. UNC Health has since in-sourced key PBM functions and customized its formulary to focus on lower net cost drugs. UNC Health Pharmacy Solutions is similar to others that market themselves as transparent. UNC Health will charge clients administrative fees and pass through all rebates to plan sponsors. The health system has saved 32% on employee pharmacy costs and expects to deliver similar results to employers in North Carolina and South Carolina, DeFalco said. The health system may consider partnering with businesses in bordering states down the line, she said... The landscape comprises around 70 players, but CVS Caremark, Express Scripts and OptumRx have a combined market share of about 80%, and the top six PBMs control 90%. Larger PBMs generally can use scale to extract better rebates from drugmakers, which at face value could look attractive to benefits brokers even though it may not mean lower overall savings.

Hoffmann Hospice to host Grief Support Camp for Children of first responders KGET Bakersfield, California; by Jaspreet Multani; 8/29/24 Hoffmann Hospice will host its second annual free grief support camp for children and teens of first responders on Saturday, Sept 14, 2024. The event called “A Heart for Hero’s Art Camp,” provides a safe space for young people grieving the loss of a loved one such as a parent, sibling, or grandparent. ...  Led by experienced grief counselors, the camp offers therapeutic activities and support to help children express their grief in a nurturing environment. ... “We have a huge heart for kids, especially those who put themselves on the line for us every day,” said Ryan D’ Amato of Hoffmann Hospice.Editor's Note: While many hospices provide excellent grief camps for children and teens, this one stands out for tending the unique experiences for families of first responders. Many of these deaths will have been sudden and tragic--without hospice care--and often more complex to grasp and grieve. Hoffman Hospice's website indicates support for other non-hospice deaths: Miscarriage, Still Birth or Sudden Loss; Suicide. Bravo and thank you to Hoffman Hospice and other hospices who utilize your grief services to support your larger communities through often-disenfranchised deaths and grief.

This was the year advanced practice nurses thought they’d get full practice authority in NC. They were wrong.NC Health News - NC Board of Nursing; by TwumasiD-Mensah; 8/29/24 Every so often, Megan Conner, a nurse anesthetist in Greenville said she sees a patient who’s driven for hours to come for a screening colonoscopy but who instead has to be sent to the emergency department. ... It frustrates Conner that so many patients, who have to travel sometimes hours for care in eastern North Carolina, end up not getting it because of common ailments they can’t get treated closer to home.That’s why Conner is a big believer in the Safe, Accessible, Value-directed and Excellent Health Care Act (SAVE Act), which would give advanced practice registered nurses (APRNs) like her full practice authority. She argues the data show that more nurse practitioners would provide primary care in rural North Carolina if the state would give them autonomy to practice, bringing care to small burgs that often go without. And now, the demands for care are being driven by hundreds of thousands of patients newly eligible for care because of Medicaid expansion. Along with a growing number of lawmakers who believe the legislation is overdue, advanced practice nurses thought this would be the year that the SAVE Act finally passed. They were wrong. [Click on the title's link to continue reading.]

Grief Memoir: ‘It was my turn to do everything for her We Are The Mighty; by Jessica Hall; 8/28/24 ... I joined the phone call with the doctor where he told us all the worst news. The cancer was growing everywhere along the spine. ... He told us that it was time for hospice. ... Even though I had been preparing for this for months, I was truly not ready to go from child to caretaker. ... For my entire life, my mom had cared for me. She had been there when I was sick or hurt. She cleaned my house (sometimes to my chagrin). She cooked my favorite meals and she let me take breaks. Now it was my turn to do everything for her. It hit me like a ton of bricks, but I also just knew that I had to do it. We all had to do everything for her to make her final days easy for her. Hospice came by to get everything set up. ... [Click on the title's link to continue reading this beautiful, personal story.]Editor's Note: Calling all hospice executive leaders who do not have clinical, direct patient care experience--read this article to grasp common family dynamics, decisions, actions, emotions, and life-changing moments for each patient you serve. Multiply this out for the many family members of each patient you serve. How do your hospice services tune into and support these family members?

My Dad had an Advance Directive. He still had to fight to die Newsweek - My Turn; by Maggie Schneider Huston; 8/26/24 My mom  died peacefully. My dad died 72 days later, angry at the doctors for ignoring his wishes. ... Dad had heart surgery on December 20, 2023. An hour after the surgery ended, his vital systems started shutting down. A cascade of interventions, one after another, kept him alive. Four days later, he said: "Put me on hospice." The doctor dismissed this request, rolling his eyes and saying: "Everyone on a ventilator says that." On Christmas Day, my father asked for hospice again. He was in pain. He knew his recovery would be long and ultimately futile. He would never have an acceptable quality of life again. ... Dad's care team insisted palliative care was the same as hospice care, but he knew the difference. He wanted hospice care. Finally, they reluctantly agreed and called for a social worker to make arrangements. It wasn't necessary. Once they removed his treatment and relieved his pain, he died five hours later. ... Editor's Note: This article is not about Medical Aid in Dying (MAiD). It is about honoring Advance Directives, person-centered care with communications and actions related to "palliative" vs. "hospice" care.

Hospice student volunteers gain insight into dementia Ahwatukee Foothills News; by Lin Sue Flood; 8/23/24 Once a week, graduate nursing student Merle Tamondong pauses her busy college life to visit Micheline Schulte. They color together, play Micheline’s favorite songs and chat in French, her native language. “When I come here, the only time I’m on my phone is when I’m playing some music, which Micheline likes when we are coloring,” Merle said. “I feel very lucky.” Merle is part of Hospice of the Valley’s College Partners Program, an innovative collaboration with Maricopa Community Colleges, Arizona State University and other schools to provide socialization to people living with dementia and a much-needed break to family caregivers. Hospice of the Valley’s dementia and volunteer departments spearheaded this intergenerational program to help inspire careers in dementia care. ... To date, 106 students have been trained and paired with 123 patients since College Partners launched in 2021 with a grant from Community Care Corps. 

How to recognise the dying phase in palliative and end-of-life care Nursing Times; by Julie Kinley and Cathriona Sullivan; 8/19/24This article gives practical guidance for nurses on providing care in the last days of life. ... Birth and death are two certainties in life. Consequently, during their career, many nurses will support, and indeed lead, the management of the care of dying people. ... [Knowing] how to recognise – and manage – this phase of life remains a career-long key responsibility and role. ... In any setting, nurses are part of a wider team. The recognition of dying and the dying phase can be enhanced if everyone:

“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.

Integration of palliative pharmacists to elevate oncologic care Pharmacy Times; by Alexis Beachy, PharmD and Jessica Geiger, PharmD, MS, BCPS; 8/20/24... Conclusion: This case demonstrates several aspects of care palliative pharmacists can assist with, though it is certainly not all-encompassing. All things considered, pharmacists are an essential asset of the palliative team. Their experience further enriches the interdisciplinary team and grants all patients and families many benefits. Specifically, patients receiving oncologic care benefit from collaboration with a palliative care pharmacist. In addition to offering a more individualized and holistic approach to care, palliative pharmacists can also provide patients with quicker and improved symptom management, which often improves quality of life and may also increase survival rates.Editor's Note: This article provides excellent history, definitions, and descriptions of the pharmacist's significant role in providing expert palliative and hospice care.

Navigating the complexities of life and caregiving WorldHealth.net; by Pat Baker; 8/16/24 As individuals advance through different life stages, especially when tasked with caregiving or managing the challenges of aging, they encounter a complex web of intertwined challenges. ... This article explores the multifaceted nature of caregiving and aging, offering insights and strategies that can help individuals manage these demanding situations effectively. ... As the population ages and the demand for caregiving increases, it is crucial to continue developing strategies and policies that support caregivers and enhance the quality of care. Editor's Note: Examine 75+ caregiver education and support videos designed for hospices to use with the primary caregiver and family members you serve: Family Support through Serious Illness; Hospice Training for Caregivers and Families; Want to Understand Your Grief? Includes 10 hospice & 11 grief videos in Spanish. Designed and delivered via our newsletter's sponsor, Composing Life Out of Loss.

Factors associated with Do Not Resuscitate status and palliative care in hospitalized patients: A national inpatient sample analysis Palliative Medicine Reports; by Jean-Sebastien Rachoin, Nicole Debski, Krystal Hunter, Elizabeth CerceoIn the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.