Literature Review

Person-centered, goal-oriented care helped my patients improve their quality of life Journal of the American Board of Family Medicine; by Lee A. Jennings and James W. Mold; orignially posted 5/24 issue, again on 8/15/24 When the goal is to help patients improve their quality of life, it makes sense to focus directly on the activities and relationships that are most important to each patient. This can be accomplished most effectively by following a three-step process that includes 1) connecting with the patient around what matters to them, 2) co-creating a goal-oriented plan, and 3) collaborating with patient, family, team members, and consultants to increase the probability of success. Once this approach has been mastered and the necessary systems, processes, and relationships are in place, this should not take more time than a problem-oriented approach, and it will almost certainly be more satisfying for both physician and patient. Editor's Note: Simple. Effective. Meaningful.

Thrive Alliance donates robotic pets to Our Hospice dementia patients Local News Digital, Columbus, IN; by LND Staff; 8/13/24 Our Hospice of South Central Indiana has announced that it has received a generous donation from Thrive Alliance that will significantly improve the quality of life for dementia patients. The donation includes several lifelike robotic animals designed to provide sensory-based stimulation and comfort to patients experiencing dementia. The innovative pets calm patients, encouraging them to smile, hug, and stroke the robotic animal’s fur. ... President of Our Hospice Steph Cain said, “These robotic animals will make the transition from home to our care center much smoother. They not only provide comfort but also act as a catalyst for social connection, sparking positive interactions with staff, visitors, and fellow patients.”

Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication

Death is inevitable. It's time we learned to talk about it. MedPageToday; by Nidhi Bhaskar; 8/13/24 By fostering honest and compassionate discussions, we can provide patients with more dignity. Years ago, in a busy emergency department, I found myself joining my mentor at the bedside of an elderly man experiencing chest pain. After completing the physical exam, the doctor unceremoniously changed gears to abruptly ask our patient, "If your heart were to stop beating, do you want us to do everything?" Between the stress of the situation and the vague and awkward delivery of the question, our patient seemed (understandably) overwhelmed. So was I. ... End-of-life conversations can feel like a "word soup" of sorts ... it is easy for patients and providers alike to feel lost. ... Providers must also consider the nuances of cultural attitudes towards death; the location and family arrangements surrounding a person at the end of life; and the varying emotional responses and feelings of decision paralysis surrounding how one dies and how one feels about dying.Editor's Note: For a related article in our newsletter today, read "Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication."

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

9 powerful lessons on life you can learn from experts on death Forbes; by Robert Pearl, MD; 8/12/24 As a physician, I have been present at the end of many lives, witnessing the profound agony families face during a loved one’s final moments. While most family members express deep gratitude for the care provided by doctors and nurses, some recount harrowing stories of unnecessary pain their loved ones endured in the final days. These distressing accounts highlight a troubling ambiguity in the care we provide, blurring the line between compassionate treatment and what can feel like unbearable torture. Motivated by my encounters with grieving families, I dedicated the ninth season of the Fixing Healthcare podcast to exploring life’s final chapter and addressing the shortcomings in end-of-life care. ...

Exploring AI-powered music therapy as a solution to chronic pain management and the opioid crisisNeurologyLive; by Neal K. Shah; 8/6/24While the opioid crisis continues to ravage communities across America, many with chronic pain are in dire need of solutions. As a result, healthcare providers and researchers are urgently seeking alternative treatments for chronic pain management. One innovative solution is the use of music therapy, particularly when enhanced by artificial intelligence (AI) and neurotechnology. This combination could offer a powerful, non-pharmacological intervention to help millions of Americans suffering from chronic pain while potentially reducing opioid dependence.

CMS rule will align hospitals with age-friendly care for older adultsBecker's Clinical Leadership; by Ashleigh Hollowell; 8/2/24Starting in 2025, a new CMS measure will require public reporting on a hospital's capability to provide age-appropriate care for older adults, the agency announced Aug. 1. The measure is included as part of its FY2025 Inpatient Prospective Payment Systems final rule. Hospitals that participate in Medicare's Hospital Inpatient Quality Reporting Program must begin to report on how they meet each element across five areas, the John A. Hartford Foundation explained via a news release shared with Becker's:

How healthcare is dealing with pain management disparitiesModern Healthcare; by Mari Devereaux; 7/29/24Patients of color receive different pain care than white patients, and universities are turning to implicit bias training for clinicians and revamping medical school curricula to help fix the problem. Disparities between racial groups in pain management largely exist due to the widespread, incorrect belief among providers that race is biological rather than a social construct, according to experts. This ingrained, sometimes unconscious assumption that people of color experience pain differently means marginalized communities often go without adequate medication or treatment for their pain... Here are strategies institutions and states are trying to reduce bias and improve pain treatment among marginalized groups.

Dr. Susan Bray-Hall brings leadership, proven experience to the VA Rocky Mountain NetworkUtah Business; 7/5/24The U.S. Department of Veterans Affairs (VA) announced today the appointment of Susan Bray-Hall, M.D., FACP, as Chief Medical Officer (CMO), VA Rocky Mountain Network (Veterans Integrated Service Network [VISN] 19). She is responsible for overseeing all clinical programs, operations, and services in VISN 19, a system with 18,000 employees that serves nearly 750,000 eligible Veterans at eight health care systems, and more than 100 additional sites of care.Publisher's note: Congratulations Susan!

The Last 30 Days: How Oncologists' Choices Affect End-of-Life Cancer CareMedscape; by Katie Lennon; 8/2/24Oncologists show significant variability in prescribing systemic cancer therapies in the last 30 days of life. Patients treated by oncologists in the top quartile for end-of-life prescribing behavior were almost four and a half times more likely to receive end-of-life therapy than those treated by these specialists in the bottom quartile... "Given calls to rein in overutilization of end-of-life six to eight cancer therapies, our findings highlight an underappreciated area for further research: How treatment discontinuation before death is shaped by oncologists' unique treatment propensities. Elucidating the reasons for this remarkable variability in oncologist treatment behavior could inform efforts to reduce end-of-life cancer treatment overutilization," wrote the authors of the study. [Free subscription may be required.]

Providers, patients would benefit from hospice telehealth extension, doc offers McKnights Senior Living; by Rachael Zimlich; 7/31/24 The COVID-19 pandemic triggered many changes in healthcare, and not all were bad. In the years since the coronavirus forced worldwide lockdowns and limited access to care, the healthcare industry increasingly has embraced measures such as remote care and telehealth. One surprising area that has benefitted from those changes is hospice care. Hospice care by telehealth provides an obvious convenience for patients, but [Sean Oser, MD, MPH] shared his surprise at how much the increased frequency and ease of visits — plus better insight into the patient’s home environment —could improve his own experience as the provider. ... The latest extension of rules to allow hospice provided via telehealth to be paid through Medicare will end in December. ... Representatives called out the need to extend the hospital-at-home waiver, which is set to expire at the end of 2024.

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.