Literature Review

Indiana music therapy specialists talk about the practice BallStateDailyNews.com; by Hannah Amos; originally posted 9/3/24, distributed 9/12/24 The strum of a guitar, the hum of a voice and the steady beat of a drum makes more than just music. It provides a way for people to work through their emotions.  Kirby Gilliam, owner and founder of Plainsong Music Services in Anderson, Indiana, said she noticed music creates a safe space.  ... [She] uses different techniques: expressive, receptive, recreated and the ISO principle. Expressive music therapy is when the patient makes music. The receptive technique is when the therapist makes music and the patient listens. Recreated is when patients sing songs made by other artists. Finally, the ISO principle is when the music matches the patient’s mood, and through music, they shift the mood in a positive direction, Gilliam said.  “Music therapy is an evidence-based field, based and rooted in science and research,” Gilliam said. “If it didn't have the evidence base, it would be more like hippie-dippy and anecdotal … The why is [that] music opens up your entire brain — all of the pathways.” ... Another worker at Plainsong is Hospice Coordinator Kinsey Lavy, who primarily works with geriatrics and individuals with intellectual and developmental disabilities.  Editor's note: For a book specific to music therapy and music for hospice and grief care, with practical uses by mental health practitioners, I invite you to examine my book, Music of the Soul - Composing Life Out of Loss, published in Routledge's Series in Death, Dying and Bereavement, edited by Robert A. Neimeyer.

Competency standards for quality are needed now more than everModern Healthcare; by Stephanie Mercado; 9/11/24Stephanie Mercado is CEO of the National Association for Healthcare Quality. Healthcare quality is foundational to achieving the overarching goals of every care provider: improving population health, enhancing patient experiences, controlling costs, and more. Yet we are not where we need to be – and sustainably achieving quality and safety goals continues to be just outside of our reach. Why? New research from the National Association for Healthcare Quality reveals that people working in healthcare define quality very differently from one another. They use a range of terms like compliance, utilization management, safety, equity, population health, value. When stakeholders see quality differently and see each effort to advance quality as separate and distinct, it’s no wonder we are not further along in this quest for quality.Publisher's note: This article discusses concerns including care, cost, the workforce cliff, and how quality is achieved.

A dying wish: Longtime hospice volunteer has a challenge for GV Green Valley News, Green Valley, AZ; by Dan Shearer; 9/10/24 ... The woman who walked alongside dying patients as a hospice volunteer for more than 20 years is now herself in hospice. She smiles but says the glistening in her eyes are sad tears. But cancer hasn't taken her joy, and she’s emotionally strong enough to meet with a reporter in her final weeks to make a request of Green Valley: Please consider taking up just the kind of work she’s been doing for two decades. It’s tough, but it comes with lessons and blessings that last a lifetime. ...

Too Much, Too Little, Just Right: Optimizing cancer care for older adults The ASCO Post, American Society of Clinical Oncology; by Ramy Sedhom, MD; Bobby Green, MD; and Julia  Frydman, MD, MS; 9/10/24 Imagine walking into a fancy restaurant only to find a menu consisting mostly of kids’ dishes. It would make no sense. Just 25% of restaurant diners are younger than age 12, and they rarely write Yelp reviews. But when it comes to cancer treatment, this is not very far from what we do. The median age for a new cancer diagnosis is 67, and among those who die of cancer each year, 73% are older adults. Yet just one in four clinical trial participants is aged 70 or older. Consequently, guidelines for most new cancer therapies are based on a median age that is significantly younger than the patient population who actually receives these therapies. That’s quite a conundrum. More than half of patients older than age 65 experience toxicity of grade 3 or worse while undergoing standard chemotherapy. ... Palliative Care—For a 40-year-old mother of two young children, the goal of cancer treatment is usually clear: complete remission and long-term survival. But when you ask older patients with cancer about their priorities, a majority regard symptom control, emotional coping, and other quality-of-life measures at least as much as longevity and sometimes more.

One healthcare job poised for the greatest shortage Becker's Hospital Review; by Molly Gamble; 9/6/24 Nursing assistants face the greatest projected deficit over any other analyzed healthcare occupation, with a projected shortage of more than 73,000 assistants nationwide by 2028. The forecast comes from Mercer, which projects a nationwide shortage of more than 100,000 healthcare workers by 2028. The need for nursing assistants is expected to be greatest, with only 13 states expected to meet or exceed future demand. "The projected supply of nursing assistants — an occupation that constitutes 8% of the total US healthcare workforce and 40% of healthcare support occupations in 2023 — is discouraging," Mercer consultants wrote in their Aug. 29 report, "Future of the U.S. Healthcare Industry: Labor Market Projections by 2028."

Hugo man dies in house fire  [hospice patient] KXII 12 TV, Hugo, OK; by KXII Staff; 9/5/24 A fire at a home in Hugo claims the life of a former Choctaw County assistant district attorney. Officials said the fire happened Sunday afternoon. The Choctaw County Emergency Manager told News 12 that John Bounds, who was in hospice care, was unable to escape. All others in the house got out safely.Editor's note: What emergency discussions do your interdisciplinary team members have with home hospice patients and their caregivers? Regular fire safety training (and other forms of patient care safety, workplace safety, etc.) are required by OSHA and accreditation organizations. 

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

Beers Criteria update for medication use in older adultsMedscape Nurses; by Linda Girgis; 8/30/24Primary care physicians know the complexities of treating older patients, from increased complications from medications and procedures to comorbidities stemming from having multiple medical conditions. The Beers Criteria were established by the American Geriatrics Society as a guide for physicians about medications that may possess more risks than benefits in older patients, specifically those aged 65 years and older. There are approximately 100 medications on the list. Criteria used to establish the list include medications to avoid over the age of 65 in an outpatient setting, medications to avoid in certain medical conditions, medications to avoid that may interact with other medications, medications to avoid with renal impairment, and medications to avoid where harmful side effects outweigh the possible benefits. The American Geriatrics Society updates the list as new published evidence becomes available.

“Rehabbed to Death” in oncology: Where do we go from here?JCO Oncology Practice; by Daniel E. Lage, Craig D. Blinderman, Corita R. Grudzen; 9/3/24You can go to rehab to see if you get stronger for chemo. These are words that every clinician caring for hospitalized patients with cancer has heard or said countless times. And yet, especially when it comes to older adults with advanced solid tumors, less than a third of these patients will ever receive systemic therapy again. Furthermore, their symptom profile is more similar to those discharged to hospice than to those discharged home, and they face debilitating functional decline and early mortality—leading some to coin the term “rehabbed to death” to describe this phenomenon. We suggest a few keys area of focus: (1) reframing hospital discharge conversations, including incorporating practices of disclosing prognoses using validated tools or other algorithms; (2) empowering team-based care and inclusion of palliative care clinicians in the SNF setting; and (3) identifying patients failing to make functional progress early. [Also see accompanying article: Respect for the Patient-Oncologist Relationship May Limit Serious Illness Communication by Acute and Postacute Care Clinicians After Discharge to a Skilled Nursing Facility by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer.]

Doctors use problematic race-based algorithms to guide care every day. Why are they so hard to change?Stat email and article; by Katie Palmer, Usha Lee McFarling; 9/3/24Doctors use clinical algorithms every day to make decisions about the care they provide to patients. This math determines things like our surgical risk or likelihood of disease using factors such as blood pressure, age, weight, surgical history, and, often, our race. But one of these is not quite like the others — for years, clinicians have pushed back against the use of race in clinical algorithms. Publisher's note: Interesting article, although accessing full article may require subscription.

Loneliness tied to death ideation in older adults, study findsMcKnight's Long-Term Care News; by Kristen Fischer; 8/29/24A new study explored the relationship between loneliness, suicidal thoughts and death ideation in older adults. Overall, feeling lonely was linked with thoughts of wanting to die, according to the results... The researchers found that the subjective feeling of loneliness was more strongly linked with death ideation than with other measures of social disconnection, such as living alone or being socially isolated. The association between loneliness and a wish to die remained strong after the team controlled for depression and other markers of social disconnection. Regular attendance at religious services and other communal activities helped lower death ideation among the adults. Cognitive-behavioral therapy targeting depression and anxiety may also reduce the impact of loneliness.Publisher's note: It is difficult to underestimate the impact of loneliness and social disconnection. This article and study provide interesting implications for hospice patients and those who love them.

Rounds with Leadership: Focusing on the outcomes of NP practice American Association of Colleges of Nursing - The Voice of Academic Nursing; by American Colleges of Nursing (AACN); 8/28/24 ... In a synopsis of more than 50 research studies, the American Association of Nurse Practitioners found that patients under the care of NPs have fewer unnecessary hospital readmissions, higher patient satisfaction scores, and fewer unnecessary emergency room visits than patients under the care of physicians only. Recent studies have shown that ... NPs engaging in end-of-life care had fewer hospitalizations and higher hospice use; ... Despite such compelling evidence, challenges to NP education and practice continue. More than 20 states have yet to grant full scope of practice authority to NPs, denying these expert clinicians the opportunity to exercise the full range of their clinical expertise.

Not intervening as a form of care: Negotiating medical practices at the end-of-life AnthroSource, by the American Anthropological Association; by Simon Cohn, Eric Borgstrom, and Annelieke Driessen; 8/27/24 ... The story of Keith, a patient living with multiple sclerosis but now with limited time left, introduces a common feature of biomedicine; once set on a particular trajectory, clinicians are often committed to a cascade of options without really questioning their ultimate value: "When I saw the doctor, the first thing he said was, ‘Oh, we can do this, or we can do that…’ So I said, ‘No, you won't. You won't do any of those things, thank you very much.’ And then when he suggested a drug that will give me ‘an extra few months’, I replied ‘Does that give me an extra few months now, or an extra few months at the end? Because I want the few months now, I don't want them at the end.’" Here, Keith recounts how his doctor seemed compelled to suggest one treatment after another with the intention of prolonging his life, rather than acknowledge that because he was dying, a different approach might be more appropriate. ...