Literature Review

What is an end-of-life doula? Psychology Today, by Cheralyn Leeby, PhD, LMFT; 3/31/24"The appellation ‘end-of-life doula’ (EOLD) is increasingly used as an umbrella term to identify lay people, primarily women, who provide a diversity of non-medical supports—social, emotional, practical, and spiritual—for people nearing the end of life, including those close to them" (Krawzik and Rush, 2020). The term doula is derived from the Greek word "doule," which means helper or maidservant. Families hire death coaches to facilitate, guide, and emotionally support the dying process.

Interruptions: Bad for hospitalists and their patientsThe Hospitalist, by Larry Beresford; 4/1/24More than 10 years ago this magazine published an article by Winthrop Whitcomb, MD, MHM, a pioneer of hospital medicine and co-founder of the Society of Hospital Medicine, warning of the hazards of workflow interruptions for hospitalists, which he labeled a career satisfaction issue for clinicians but a safety and quality risk for their patients. A decade later, the problem has surely gotten worse as hospital financial pressures and staff shortfalls push caseloads higher and job stresses drive burnout and premature retirement for doctors who have been pulled in too many directions in their work. 

Integrating palliative care screening in the intensive care unit: A quality improvement projectCritical Care Nurse; by Traci N. Phillips, DNP, APRN, ACNP-BC, CCRN; Denise K. Gormley, PhD, RN; Sherry Donaworth, DNP, APRN, ACNP-BC, FNP-BC; 4/1/24Background: Patients admitted to the intensive care unit have complex medical problems and increased rates of mortality and recurrent hospitalization for the following 10 years ...  Delayed access to palliative care can result in untreated symptoms, lack of understanding of care preferences, and preventable admissions. Conclusion: The screening process can maximize the benefit of palliative care services with early patient identification, improved consultation efficiency, decreased critical care resource use, and reduced readmission rates.

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. 

Tele-palliative care benefits veterans with cardiac, pulmonary diseases Hospice News, by Jim Parker; 3/26/24 Patients with cardiac and pulmonary conditions see improvements in their quality of life after receiving palliative care via telehealth. A randomized clinical trial with 306 participants who suffered from chronic obstructive pulmonary disease (COPD), heart failure (HF), and interstitial lung disease (ILD) found that palliative telehealth resulted in significant improvements. The results were published in the Journal of the American Medical Association.

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. 

4 things nobody tells you about watching a loved one die of cancer The New York Post; by Jessica Ariel Wendroff; 3/23/24 ... “The surgery was successful. However, tests after the operation found cancer had been present,” the Princess of Wales, 42, revealed in a bombshell videotaped statement Friday. ... While the royal insisted she is “well and getting stronger every day,” other patients’ real pain begins when the cancer has spread too far and chemotherapy and radiation no longer work, so doctors stop treatment. As the daughter of a Stage 4 bladder cancer patient, I’ve empirically learned four realities that people usually don’t talk about ...

End-of-life care in heart failure MedPageToday; by Crystal Phend, reviewed by Andrew Perry, MD; 3/22/24 Palliative care has a perception problem. It's often associated with end of life or advanced cancer. However, cardiovascular disease actually accounts for a higher proportion of adults in need of palliative care than does cancer (38.5% vs 34%), according to the World Health Organization. Patients with heart failure (HF) have a median survival of about 5 years -- on par with many types of cancer, yet patients with cancer are much more likely to be referred to palliative care. 

"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.