Literature Review

Gen Z prefers burial over cremation, reversing decades of preferences trending toward cremationPR Newswire; by National Funeral Directors Association; 7/9/24 There is no shortage of social commentary on how Gen Z is redefining norms and challenging older generations to think differently, from fashion to workplace culture. But what about their perspective on death and dying? A first-of-its-kind survey conducted by the National Funeral Directors Association (NFDA) offers definitive data to show how Gen Z thinks differently about end-of-life matters for themselves and their loved ones – as well as similarities with older generations. Notable differences between the generations highlight Gen Z's unique perspective, even compared to Millennials who are the closest in age, highlighting a pivot in end-of-life preferences to come:

Hospice and Palliative Nurses Foundation receives $1.2 million impact grant Cision PR Newswire; by Hospice and Palliative Nurses Foundation; 7/8/24The Hospice and Palliative Nurses Foundation (HPNF) is thrilled to announce that it has been awarded a transformative $1.2 million impact grant from the Hospice and Palliative Credentialing Center (HPCC). The Sandra Lee Schafer Impact Grant, given in memory of the late Sandra Lee Schafer, MN, RN, AOCN®, will empower HPNF to create a legacy of sustainable giving, which will impact the hospice and palliative care community for years to come. "We are deeply honored and grateful to receive this impact grant from HPCC, given in tribute of Sandy," said Virginia (Ginger) Marshall, MSN, ACNP-BC, ACHPN®, FPCN, chief executive officer of HPNF. ... Sandra was an unwavering advocate of specialty nursing certification. Following a stellar nursing career, Sandra served as the director of credentialing of the Hospice and Palliative Credentialing Center from 2004 until her sudden passing in 2018.

How rituals support nursing teams American Nurse Journal - American Nurses Association; by Heather Fitzgerald, DBe, MS, RN; 7/2/24Question: I’m a clinical manager for a pediatric critical care unit. We’ve recently had a significant increase in end-of-life care. I’m proud of our nurses and the skillful, compassionate support they provide to patients and families during these tragic events. In an emotional support debrief, nurses expressed a desire for more opportunities to pause and reflect on meaning and purpose in their challenging work. How do I regularly schedule time to support nurses in ways they value while also adhering to our organization’s budget and productivity expectations? Answer: ... creating a supportive sense of community and connection need not violate your commitment to budget management. You can enact opportunities to orient to meaning and purpose, to shared identity and belonging, and to unit and organizational mission through small rituals that deliver benefits similar to your debriefing forum. Rituals ... have deep, prehistoric roots, which indicate that humans have long sought connection and meaning-making in moments of joy, grief, and uncertainty. Nurses participate in patient-centered rituals in various settings. For example, organ donor honor walks, the ringing of a bell to mark a cancer treatment milestone, discharge celebrations after a long hospitalization, and celebrations of life and of birth. The nursing profession also should pay more attention to the importance of nursing-centered rituals.Editor's Notes: Nurse burnout is a root cause for both high turnover and increased unionization/strikes among nurses, especially nurses in their first year of practice. What nursing-centered ritual(s) might bring meaning and renewal to your nurses? Ask. Create, pilot, and evaluate. Engage them in the process.  

Aligning pill burden and palliative care needs in late-stage CVD: AHA TCTMD - Cardiovascular Research Foundation; by L.A. McKeown; 7/2/24 The first scientific statement from the American Heart Association (AHA) that focuses specifically on pharmacotherapy considerations in the palliative management of patients with CVD [cardiovascular diesease] urges a patient-centered, compassionate approach to de-escalating and deprescribing. ... In addition to shedding light on how and when to start deprescribing and de-escalating common cardiovascular drugs, the statement discusses palliative drugs for pain, shortness of breath, and appetite in the context of CVD, which [Katherine E.] Di Palo [PharmD (Montefoiore Medical Center, NY)] said the committee identified as a gap in knowledge given that much of the evidence for these drugs comes from patients with serious illnesses like cancer. ... Important Takeaways: Di Palo and colleagues note that palliative care complements cardiovascular care in several important ways, including reducing physical symptom burden, managing emotional and spiritual distress, providing sufficient support for caregivers, and helping patients choose treatment in line with their goals for care. Editor's Note: Click here for the American Heart Association's statement, which we posted on 7/2/24. 

Harn Art Museum encourages woman with Alzheimer’s to move again ABC TV WCJB-20; Gainesville, FL; by Kayla Lewis; 6/28/24 Pat Mclaurin’s Alzheimer’s has progressed since her daughter, Diana Dodds took her on a bucket list trip in 2022. ... “So my mom would never use a walker or a cane. She would be more likely to try to hit me with it then use it, so she’s fiercely independent, yet she knows right now she cannot really walk without falling,” Dodds shared. “She’s always grabbing for walls just in the house.” ... Pat used to walk 3-5 miles a day, but in January slowed down. They decided to test out their own walker on a trip to the Harn Museum of Art in Gainesville, but her mom didn’t like it. However, the museum offers walkers and Pat loved them. Diana tells her it’s like a shopping cart. “Four wheels, it has higher bars, it had brakes on it. It felt more like a shopping cart because of the seat,” Dodds shared. Diana described the walker they gave her mother to Haven Hospice officials who then brought her mom a walker just like it a couple days later. “It’s inspiring because I’ve seen her push through every step trying to keep moving, and I want her to be able to keep moving,” said Dodds. 

Empowering ‘deeply undervalued’ caregivers would improve ‘lifeline for older adults’ McKnights Senior Living; by Kimberly Bonvissuto; 6/28/24 Direct care workers and family caregivers remain “deeply undervalued” and often overlooked despite calls for investment in the care economy, according to the authors of a new report. “These caregivers provide a lifeline for older adults, people with disabilities, and people living with chronic conditions,” PHI and the National Alliance for Caregiving said in an issue brief released Wednesday. “Empowering them in their roles will help to ensure high quality, responsive care to meet the needs and preferences of millions of Americans now and in the future.” The organizations called on providers, Congress, the Department of Labor, the Centers for Medicare & Medicaid Services, the federal Health Resources and Services Administration, states, managed care plans and advocates to invest in the “essential partnership” between direct care workers and family caregivers. The new brief includes insights from a variety of stakeholders ...  The result is a list of recommendations that prioritize improvements to direct care jobs.Editor's Note: Our sponsor, Composing Life Out of Loss, equips hospice and palliative care organizations with caregiver education and support video libraries to strengthen relationships between the direct care professional and the family caregiver, with timely information for the entire family. Contents are written to CMS CoPs, CAHPS, and contemporary grief research; English and Spanish.

[American Heart Association] Palliative care beneficial to manage symptoms, improve quality of life for people with CVD [cardiovascular disease] American Heart Association; by NewMediaWire; 7/1/24 Implementing patient-centered palliative care therapies, including prescribing, adjusting or discontinuing medications as needed, may help control symptoms and improve quality of life for people with heart disease, according to “Palliative Pharmacotherapy for Cardiovascular Disease,” a new scientific statement from the American Heart Association, published today in the Association’s journal, Circulation: Cardiovascular Quality and Outcomes. The new scientific statement reviews current evidence on the benefits and risks of cardiovascular and essential palliative medications. The statement provides guidance for health care professionals to incorporate palliative methods as part of holistic medication management at all stages of a patient’s health conditions, emphasizing the importance of shared decision-making and goal-oriented care.

Q&A: What is the ID clinician’s role in end-of-life care? Healio; by Caitlyn Stulpin; 6/27/24 Patients receiving infectious diseases (ID) consultation over the past decade were increasingly complex, generally sicker and more likely to die soon after a consultation was performed, according to a study. Researchers said that the rate of infectious diseases (ID) consultation relative to hospital admissions doubled during that time, suggesting that ID physicians are more often being faced with the challenge of caring for complex patients. Because of this, Alison G.C. Smith, MD, MSC, and Jason E. Stout, MD, MHS, and colleagues aimed to assess the role of these physicians when it came to end-of-life care, leading them to conduct a retrospective cohort study of all patients with an ID consult at the Duke University Health System between Jan. 1, 2014, and Dec. 31, 2023.

Chronic loneliness can raise stroke risk in older adults, findings show McKnights Long-Term Care News; by Kristen Fischer; 6/24/24 A new study links loneliness to stroke risk, showing that those who are regularly lonesome have a 56% higher risk for stroke than those who are more socially connected. Situational loneliness wasn’t linked to a higher risk for stroke, which indicates that the stroke risk stems from chronic loneliness. Investigators led by a team from Harvard T.H. Chan School of Public Health published their report Monday in eClinicalMedicine. Research has already linked loneliness to an increased risk for cardiovascular disease. The new report is one of the first to evaluate the association between loneliness and stroke risk.

Palliative care physician: ‘Healing is possible’ even when cure is not Healio, Chicago, IL; by Jennifer Byrne; 6/26/24During her fellowship as a palliative care physician, Sunita Puri, MD, met a patient who taught her that healing is possible even when cure is not. Alice, a 35-year-old woman, had acute myeloid leukemia. ... Nobody wanted to say it out loud, but Alice was dying. “She was only a couple years older than me. She’d lived in San Francisco, a few streets away from where I lived in my residency,” Puri, program director of the hospice and palliative medicine fellowship program at UMass Chan School of Medicine. ... “She had a vibrancy that I had always hoped to embody, but she was intubated, wide awake, on dialysis and starting to suffer from ascending paralysis.” ... During rounds one day, Puri told her attending that she was at a loss about how to help Alice and didn’t feel she was doing anything meaningful for her. “My attending said, ‘What if just being at her bedside is achieving something meaningful?’” Puri recalled. “I’d always understood healing and cure to be different, but this was when I really felt it.” ... “What if healing is choosing to understand that there’s going to be suffering that we can’t alleviate — and sometimes that’s our own — but the most important thing to bring to that is presence?” she said. [Click on the article's title to continue reading.] Editor's Note: Though not directly related to this article, read "Today's Encouragement" at the end of today's newsletter.

Children’s Healing Center opens in Ypsilanti Township in July DBusiness Magazine, Detroit, MI; by R. J. King; 6/24/24 The Children’s Healing Center will open its doors in Ypsilanti Township on July 8, offering children with weakened immune systems and their families a safe and clean place to play. ... The facility is the Children’s Healing Center’s second location after first opening its doors in Grand Rapids in 2015. The new state-of-the-art 11,000-square-foot facility features a hospital-grade environment where families can engage in a diverse range of innovative programming free of charge. “It has always been our goal to open a second location of the Children’s Healing Center,” says Amanda Barbour, founder and CEO of Children’s Healing Center. “The kids, young adults, and families who rely on us have very few options for social interaction, so we provide an invaluable outlet to build friendships and fight the effects of isolation and loneliness. The Children’s Healing Center states it is a first-of-its-kind year-round recreational facility for kids and young adults aged 0-26 with weakened immune systems and their families that provides opportunities for play, programming, education, and socialization. 

The Opaque Industry Secretly Inflating Prices for Prescription DrugsThe New York Times; by Rebecca Robbins and Reed Abelson; 6/21/24Pharmacy benefit managers are driving up drug costs for millions of people, employers and the government. This is the first article in a series about how pharmacy benefit managers prioritize their interests, often at the expense of patients, employers and taxpayers. Americans are paying too much for prescription drugs. It is a common, longstanding complaint. And the culprits seem obvious: Drug companies. Insurers. A dysfunctional federal government.Publisher's Note: Pharmacy costs are second only to staffing for hospices. Dr. Drew Mihalyo and I presented on the complexities of prescription drug pricing at the 2017 Louisiana~Mississippi Hospice & Palliative Care Organization conference. This article, and others like them, will likely both educate and infuriate readers. The more things change, the more they stay the same...