Literature Review

Nurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: studyMcKnights Long-Term Care News; by Josh Henreckson; 5/13/24[Nurse pracitioners'] NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum. ... Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide. ...  Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University [describes,] “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.” Editor's Note: We posted this JAMA Health Forum article on : Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia. 

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.

Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia JAMA Health Forum - JAMA Network; by Cyrus M. Kosar, PhD; Bishnu B. Thapa, MPA, PhD; Ulrike Muench, RN, PhD; Christopher Santostefano, RN, MPH; Emily A. Gadbois, PhD; Hyesung Oh, MA, MBA; Pedro L. Gozalo, PhD; Momotazur Rahman, PhD; Elizabeth M. White, APRN, PhD; 5/10/24 Question: Is nurse practitioner (NP) care associated with end-of-life outcomes for nursing home residents with Alzheimer disease and related dementias (ADRD), and do these associations differ between states with full vs restrictive NP scope of practice regulations? Findings: The results of this cohort study including 334 618 US nursing home residents with ADRD indicated that decedents with greater NP involvement at end of life had fewer hospitalizations and higher hospice use. The adjusted differences in outcomes between decedents with extensive vs minimal NP care were larger in states with full scope of practice regulations than in states with restrictive regulations.

Impact of implementing serious illness conversations across a comprehensive cancer center using an interdisciplinary approach The American Journal of Hospice & Palliative Care; by Karen Guo, Garrett Wasp, Maxwell Vergo, Matthew Wilson, Megan M Holthoff, Madge E Buus-Frank, James J Perry, Amelia M Cullinan; 5/10/24Objectives: (1) Increase Serious Illness Conversation (SIC) use across oncology teams via an interdisciplinary quality improvement (QI) approach and (2) assess patient reported shared decision making (SDM) experiences with clinicians engaged in SIC implementation.Results: Oncology teams screened a total of 538 patients, identified 278 eligible patients, and completed 144 SIC conversations. The teams improved the proportion of documented SIC among eligible patients from near 0% to a collective frequency of 52%.

Volunteering in hospice helps Macalester students contemplate death's mysteries up close MSN - Minneapolis Star Tribune; by Katy Read; 5/10/24 "You think it will never happen to you, that it cannot happen to you, that you are the only person in the world to whom none of these things will ever happen," author Paul Auster wrote about humans' difficulty confronting our own mortality. ... Auster himself died last month at age 77. ... How can humans fully grasp the inevitability of our own death? It's a tough question to answer, maybe close to impossible. Three Macalester College students who just finished a course called the Anthropology of Death and Dying don't have the answer. Their professor, who has spent much of his career studying death as an anthropologist and a former hospice nurse, doesn't have an answer. A hospice nurse doesn't have the answer. And a hospice patient with lung cancer doesn't have the answer, even knowing he soon will confront its reality firsthand.

Paris in spring, Bali in winter. How ‘bucket lists’ help cancer patients handle life and death The Conversation; by Vivan Lam; 5/8/24 In the 2007 film The Bucket List Jack Nicholson and Morgan Freeman play two main characters who respond to their terminal cancer diagnoses by rejecting experimental treatment. Instead, they go on a range of energetic, overseas escapades. Since then, the term “bucket list” – a list of experiences or achievements to complete before you “kick the bucket” or die – has become common. ... But there is a more serious side to the idea behind bucket lists. One of the key forms of suffering at the end of life is regret for things left unsaid or undone. So bucket lists can serve as a form of insurance against this potential regret. The bucket-list search for adventure, memories and meaning takes on a life of its own with a diagnosis of life-limiting illness. Editor's Note: Health acuity (especially for hospice patients), finances, and other practical factors can prevent acutalization of the person's bucket list wishes. Yes, fulfilling items can happen! And when not possible (perhaps the most common response), the clinician's sensitive presence, validation of the person's hope, and gentle exploration of why it matters can bring relevant, meaningful support. Involving family members (with the patient's permission) can inspire other generations to fulfill the person's wish, bringing new purpose to mourning and grief-restoration processes ahead.

Action is key to continue to break down barriers for equitable cancer care OncLive; by Ryan Scott; 5/8/24 Experts from the University of Wisconsin (UW) School of Medicine and Public Health, including Catherine Zhang, MD, MPH, ... Monica Patel, MD, ... Janelle N. Sobecki, MD, ... and Loyda Braithwaite, NP ... participated in an interview with OncLive® on disparities in cancer care. In [this] interview, these experts addressed significant barriers to equitable cancer treatment and highlighted challenges for rural communities to access specialized oncologic care. Furthermore, they emphasized financial limitations affecting treatment access, specifically for marginalized groups, and the need to push for health policy changes.  ... 

Improving inclusive palliative care for transgender patients Hospice News; by Holly Vossel; 5/7/24... Nearly a quarter (21.3%) of 865 interdisciplinary palliative professionals indicated that they had observed some form of discriminatory care delivered to a transgender patient in a recent study published in Cambridge University Press’ journal Palliative Support Care. Furthermore, 85.3% of study participants said they witnessed disrespectful care, while inadequate and abusive care was observed by 35.9% and 10.3% of palliative teams, respectively. ... [Read more for descriptions and interventions, as discussed with Zachary Fried, licensed clinical social worker and training supervisor of Optum at Home, a subsidiary of UnitedHealth Group.] 

Early-career physicians working temp roles to 'test drive' practice settings, survey finds Becker's Hospital Review; by Alan Condon; 5/3/24Physicians and advanced practice providers are opting for the flexibility of temporary, locum tenens work in seek of improved job conditions and to relieve burnout, according to an April 23 survey conducted by AMN Healthcare. AMN, the largest provider of healthcare interim leadership and executive search services in the U.S., asked physicians, physician assistants and nurse practitioners who recently have worked locum tenens why they do so. The number one reason, according to 86% of respondents, was a better work schedule, followed closely by addressing feelings of burnout (80%).

The power of art in palliative care InSight+, Melbourne, Australia; by Caitlin Wright; 5/6/24 ... Melbourne artist Jeffrey Kelson is known for his thought-provoking portraits, several of which have been exhibited at the Melbourne Holocaust Museum. He believes a portrait is a window into a subject’s heart and mind. However, after being diagnosed with late-stage pancreatic cancer, it wasn’t this style of art that Mr. Kelson was drawn to. As soon as he felt well enough to return to his studio, he started work on a series of colourful collages. “At one point, my wife came into the room and commented on how bright they were and how full of life force. She was surprised that I could create pieces that were so energetic when I felt so ill. I hadn’t really thought about it. I just needed to work,” he told InSight+. ... Palliative care specialist Dr Eric Fairbank was one of Mr Kelson’s art students for several years before Mr. Kelson’s diagnosis. He said Mr Kelson’s approach to his diagnosis has confirmed his belief that the best outcomes of cancer treatment are achieved when they’re complemented by the patient’s own resources of mind, will and spirit. [Click on the title's link to view several of his paintings.]

Chesapeake Life Center offers monthly LGBTQIA+ drop-in grief support group Southern Maryland News Net; 5/6/24 Chesapeake Life Center will host a monthly drop-in grief support group for members of the LGBTQIA+ community. ... Grief is a hard and vulnerable time, and it is important to have safe spaces to process what we are going through. This group is intended for adult members of the LGBTQIA+ community who are grieving a past or approaching death. The group will be facilitated by a licensed queer therapist but will be loosely structured to offer an opportunity for participants to share their feelings and grieve with community.Editor's Note: Hospice & Palliative Care Today does not post upcoming, local hospice events, grief support groups, volunteer trainings, etc. However, we're posting this LGBTQIA+ grief support due to its unique need, with opportunities for replication in other hospices. 

Empathy exhaustion in nursing Psychiatry Advisor; by Elizabeth Quaye; 5/5/24 This article looks at the role of empathy in nursing, the causes and symptoms of empathy exhaustion, and steps nurses can take to address it. ...

Breaking the silence: The mounting need for trauma-informed hospice care Hospice News; by Holly Vossel; 5/3/24Traumatized and abused hospice patients and providers often experience an array of lingering physical, emotional and psychological effects that can fall into a silent abyss of unmet needs. ... Many seniors have experienced some form of trauma or abuse in their lifetime. ... More data has become available in recent years around the prevalence of different types of abuse and trauma. Roughly 10% of seniors 65 and older nationwide are victims of some type of abuse each year, the U.S. Department of Justice (DOJ) reported. Caregiver neglect represents 5.1% of these cases, with psychological and physical abuse impacting 4.6% and 1.6% of seniors, respectively. ...Editor's Note: This article highights interviews with Dr. Ashwin Kotwal, assistant professor at the University California San Francisco; Carole Fisher, president, National Partnership for Healthcare and Hospice Innovation (NPHI); Dr. Cameron Muir, chief innovation officer, NPHI; Andrea Devoti, executive vice president at the National Association for Home Care & Hospice (NAHC); Lindsey Owen, executive director of Disability Rights Vermont.