Literature Review

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

Advanced practice providers have an important role in kidney supportive care Healio; by Christine Corbett, DNP, FNP-BC, CNN-NP, FNKF; 7/15/24For more than 2 decades, nephrologists and patients have recognized the key role nephrology advanced practice providers have played in the care of patients with chronic kidney disease. ... With its attention to the psychosocial and spiritual aspects of care in addition to the physical, it is expected that nephrology nurse practitioners would also play a major role in the palliative care for patients with kidney disease. ... As part of the kidney care team, APPs [advanced practice practitionsers] educate patients about kidney failure treatment options, including palliative dialysis and active medical management without dialysis. Also, nurse practitioners have been noted to play a significant role in the palliative care skills of goals-of-care conversations, advance care planning and Portable Orders for Life-Sustaining Treatment (POLST, or similar term depending on the state) completion.

Targeted palliative care enhances outcomes in advanced cancer Physician's Weekly; 7/15/24 ... Excessive polypharmacy is common in patients with cancer, especially older adults. According to a 2023 study published in Cancer, up to 80% of older patients take five or more medications, and up to 40% take 10 or more. Patients who receive numerous medications as part of supportive care may be at increased risk for potentially inappropriate medications and drug-drug interactions, which could impact their QOL. The study authors emphasized the importance of meaningful screening and interventional tools to optimize the use of medications for palliative care in these patients. In a more recent study published in the Journal of Clinical Oncology, Giusti Raffaele, MD, and colleagues aimed to streamline pharmacotherapy by targeting the most impactful symptom.

Erin and Travis Jean’s son, Felix, died in infancy from a rare skin disorder. Here’s what they’d like other families to know about losing a child. The Boston Globe; by Kara Baskin; 7/12/24 In March 2022, Erin and Travis Jean’s son, Felix, died at two-and-a-half months old from complications associated with epidermolysis bullosa (EB), a rare genetic skin disorder that causes severe peeling and blisters. He was cared for in the NICU at Mass General Hospital before spending his final days at home. ...

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.  

Why Nurses QuitMedscape; by Jodi Helmer; 6/27/24Over 262,000 registered nurses (RNs) graduate yearly; 33 percent quit within the first 2 years. "Retention is a huge issue in nursing," says Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA). "COVID highlighted the issue, but these problems existed well before [the pandemic], and what we're seeing is a failure to truly do something about it." ... Diagnosing the Problem: burnout, work environment, inadequate staffing. Finding a Cure: legislation, residencies and mentorship, improved work conditions, resources for self-care.

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.

Palliative care nurses see us in our final hours — these are the life lessons they've learnt ABC News; by Iskhandar Razak; 6/29/24 Anne Myers was once confused and shaken by death. After more than a decade as a nurse, including in hospital ICUs, her mother died. "I'd seen a lot of deaths in my nursing life, but it was the closest human to me that had died," she said. "It kind of sent me down a 'oh my god, I don't know what's happening to me', this grief I'm experiencing." Soon afterwards, she became a palliative care nurse. "I ended up just going down the path of 'what is death, what is death and dying all about?'" she recalled. More than 15 years later, here's what she and other palliative care nurses have discovered on how to die well and live well.

Factors affecting palliative care collaboration with pain medicine specialists Clinical Pain Advisor; by James Maitlall, MD; 6/27/24 Structured collaboration between physicians working in palliative care (PC) and pain medicine (PM) may increase PC physician referral of seriously ill patients to PM specialists and potentially optimize their care, according to study results published in the Journal of Pain and Symptom Management. ... In a survey study, a multicenter team of investigators explored attitudes and beliefs among US PC physicians regarding PM specialists, as well as factors potentially impacting collaboration between physicians in these 2 areas of practice. ... The American Academy of Hospice and Palliative Medicine (AAHPM) approved the survey for distribution to 1000 of its physician members, who were selected at random. ... The investigators concluded, “Although we found that PC physicians have highly positive attitudes about the value of PM specialists, referral rates remain low, even for IDDS implantation, which has perhaps the largest body of evidence for patients with complex cancer-associated pain.”  

AMA Advocacy 2024 efforts American Medical Association; by AMA; Updated June 2024, 6/27/24 There are far too many everyday practice challenges interfering with patient care. That’s why the American Medical Association is advocating to keep physicians at the head of the health care team, reform the Medicare physician payment system, relieve the burdens of overused prior authorizations and so much more. [Key advocacy efforts include:]

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.