Literature Review

Dying of heart failure: how do we improve the experience? The Medical Journal of Australia - MJA; by Dominica Zentner, Vithoosharan Sivanathan, Jennifer Philip and Natasha Smallwood; published online 6/17/24 ... Despite the improvements afforded by multiple pharmacological, surgical and interventional developments in heart failure, the goal of therapy remains delayed disease progression for many. Cognisant of this reality, recent heart failure guidelines all highlight the important role of palliative care. ... The MJA recently published an article regarding the imperative of reframing palliative care. ... We suggest that ...

Spousal caregivers need emotional support before losses, not just after, study findsMcKnight's Long-Term Care News; by Donna Shryer; 6/9/24A recent study suggests that healthcare professionals and policymakers should expand their focus on supporting the emotional well-being of individuals whose spouses have dementia, especially in the years leading up to their partners’ deaths. The clinical investigation, published in the Journal of the American Geriatrics Society, indicates that these caregivers experience heightened levels of psychological distress compared to those whose partners have normal cognitive function. ... After the partner’s death, the levels of loneliness and depression were similar across all groups, regardless of the deceased partner’s cognitive status. This suggests that the period before the loss is particularly challenging for those caring for a spouse with dementia. Furthermore, about two-thirds (64%) of these spouses reported lower life satisfaction compared to nearly three-quarters (74%) of those with cognitively healthy partners. However, the study found no significant difference in social isolation levels among the groups.

Why doctors aren’t participating in organ donation after cardiac death Physician's Weekly; by Frank D. Brodkey, MD, FCCM; 6/13/24Organ donation after cardiac death (DCD) differs from the more traditional organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death with cessation of heartbeat and circulation may occur, followed by extraction of organs. This may increase the availability of transplantable organs, leading to improvement in the lives of other humans.  According to the Health Resources and Services Administration, 5896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding three years. There, however, are significant ethical and scientific issues in the performance of DCD with concepts of end-of-life care, personal autonomy, and concepts of dignity of life and death. ...

Hope in oncology: Where art and science collide Medscape; by Sharon Worcester, MA; 6/12/24 Carlos, a 21-year-old, laid in a hospital bed, barely clinging to life. Following a stem cell transplant for leukemia, Carlos had developed a life-threatening case of graft-vs-host disease. But Carlos' mother had faith. "I have hope things will get better," she said, via interpreter, to Richard Leiter, MD, a palliative care doctor in training at that time. "I hope they will," Leiter told her. "I should have stopped there," said Leiter, recounting an early-career lesson on hope during the ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2024 annual meeting. "But in my eagerness to show my attending and myself that I could handle this conversation, I kept going, mistakenly." ... Carlos' mother looked Leiter in the eye. "You want him to die," she said. ...Editor's Note: Click on the title's link to continue reading this insightful reflection and discussion about the importance of "hope." Engage your oncology/palliative/hospice chaplains (hopefully CPE trained and Board Certified) with your medical team members to explore this core belief in "hope." Alert: AI referrals for palliative and hospice care are increasing exponentially. Clinicians must be sensitive to the human dimensions and dynamics of "hope" (which shift and change), and not be driven just by technological data.

Navigating Aging: New help for dealing with aggression in people with dementia Northern Kentucky Tribune; by Judith Graham, KFF Health News; 6/9/24Caring for older adults with dementia is stressful, especially when they become physically or verbally aggressive, wander away from home, develop paranoia or hallucinations, engage in inappropriate or repetitive behaviors, or refuse to let caregivers help them. Upward of 95% of patients experience these neuropsychiatric symptoms of dementia, which tend to fluctuate over time and vary in intensity. They’re the primary reasons people with dementia end up in assisted living facilities or nursing homes. At some point, families and friends trying to help at home simply can’t manage. “When people think about dementia, they usually think about forgetfulness and memory impairment,” said Mary Blazek, director of the geriatric psychiatry clinic at the University of Michigan. “But it’s behavioral and psychological disturbances that are most disruptive to patients’ and caregivers’ lives.”

Managing palliative care challenges for patients with complex symptoms Pharmacy Times; 6/7/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. ... Pharmacy Times: What do you wish pharmacists understood about hospice and palliative care in terms of patient care for patients with complicated symptoms? Kullgren: So, I think, number 1, pharmacists across all healthcare systems, in the hospital, at community pharmacies, long-term care, you are all going to be involved in these patients— it’s just to what degree. ... We want to do those therapies that ... are going to have the least amount of risk for our patients, or at least side effects for our patients. ...

Navigating the complexities of palliative care for patients with comorbidities and complicated symptomsPharmacy Times; 6/6/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. He discusses the complex nature of patient cases in palliative care, emphasizing the importance of effective treatment management, pain tolerance, and overcoming patient barriers to treatment.

Rural pharmacy owners say it's getting harder to stay open Times West Virginian; by Devi Shastri; 6/5/24 Rural pharmacies can be a touchstone for their communities. The staff knows everyone’s names and drugs, answers questions about residents’ mail-order prescriptions or can spot the signs of serious illness. But their business models face unrelenting pressures to the point that sometimes they have to close. An AP analysis of data from 49 states and the National Council for Prescription Drug Programs shows that several largely rural states have some of the lowest number of pharmacies per ZIP code. Editor's Note: This trend for closures in rural areas is rampant for hospitals, emergency departments, physicians, and more. Click here for a letter from NHPCO and numerous hospice providers to Congress, Jan. 5, 2024: Protect rural and frontier American's access to hospice and palliative care.

Sexual function in serious illness: Areej El-Jawahri, Sharon Bober, and Don DizonGeriPal Podcast; Eric Widera, Alex Smith, Areej El-Jawahri, Sharon Bober, Don Dizon; 6/6/24As Eric notes at the end of today’s podcast, we talk about many difficult issues with our patients. How long they might have to live. Their declining cognitive abilities. What makes their lives meaningful, brings them joy, a sense of purpose. But one issue we’re not as good at discussing with our patients is sexual health. On today’s podcast Areej El-Jawahri, oncologist specializing in blood cancers at MGH, says that sexual health is one of the top if not the top issue among cancer survivors. Clearly this issue is important to patients.

The latest research indicates massage therapy has benefits from birth to end of life Cision PR Newswire; by American Massage Therapy Association; 6/5/24 The American Massage Therapy Association (AMTA) is sharing recent research on how massage therapy can provide benefits from infancy through end of life. Across all ages, massage therapy can be a therapeutic approach to enhancing physical and emotional well-being. Explore the latest studies on how massage therapy can help improve the quality of life for infants, middle-aged individuals, and older adults. ... A nationwide survey of physicians, physician assistants, and nurse practitioners in palliative care documented recommendation rates of integrative therapies to target symptoms of palliative care patients. The survey found that massage therapy was the third most recommended integrative care modality behind mind-body interventions like meditation and biofeedback. The integrative therapies aimed to reduce pain, anxiety, mood disturbances, and distress.Editor's Note: While hiring a professional massage therapist might not be practical for your budget, explore contracting with massage therapist who is trained in working with medically-fragile persons to provide simple trainings for your nurses and nurse aides. Additionally, professionally trained massage therapists might be interested in volunteering their services, within appropriate parameters (i.e., not transferring the medically-fragile patient to a massage table, having a caregiver present to assist with communication, etc.). 

Controversial conversations: Key takeaways from The Jeffrey Fudin Debates on pain and palliative care practices Pharmacy Times; Interview with Lee Kral, PharmD, FASHP, NBC-HWC, CPMC, CPE; 6/5/24In an interview with the Pharmacy Times®, Lee Kral, PharmD, FASHP, NBC-HWC, CPMC, CPE, clinical pharmacy specialist of pain management at the University of Iowa Hospitals and Clinics, shares her insights into pain management in palliative care for patients with cancer-related chronic pain. She highlights the crucial role of pharmacists in managing patient treatment regimens, including administration of opioids, the role of off-label prescribing, and the potential of deprescribing to improve patients’ quality of life. 

The lonely Americans paying $3,000 for 'death doulas' to hold their hand while they dieDailyMail; by Alexa Lardieri; 6/1/24When it became clear that 88 year-old John Binder was dying, his daughter started making preparations to quit her job and travel nearly 1,000 miles across the country to take care of her elderly dad. The retired mechanic, who suffered kidney failure as a result of diabetes, couldn't be looked after by his wife, as she was also elderly and had recently undergone cancer treatment, and he refused to go to a hospice center. But then, a church leader recommended the family contact a death doula.Publisher's Note: Opportunities (missed opportunities?) hospices might consider.

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.