Literature Review

My Dad had an Advance Directive. He still had to fight to die Newsweek - My Turn; by Maggie Schneider Huston; 8/26/24 My mom  died peacefully. My dad died 72 days later, angry at the doctors for ignoring his wishes. ... Dad had heart surgery on December 20, 2023. An hour after the surgery ended, his vital systems started shutting down. A cascade of interventions, one after another, kept him alive. Four days later, he said: "Put me on hospice." The doctor dismissed this request, rolling his eyes and saying: "Everyone on a ventilator says that." On Christmas Day, my father asked for hospice again. He was in pain. He knew his recovery would be long and ultimately futile. He would never have an acceptable quality of life again. ... Dad's care team insisted palliative care was the same as hospice care, but he knew the difference. He wanted hospice care. Finally, they reluctantly agreed and called for a social worker to make arrangements. It wasn't necessary. Once they removed his treatment and relieved his pain, he died five hours later. ... Editor's Note: This article is not about Medical Aid in Dying (MAiD). It is about honoring Advance Directives, person-centered care with communications and actions related to "palliative" vs. "hospice" care.

Hospice student volunteers gain insight into dementia Ahwatukee Foothills News; by Lin Sue Flood; 8/23/24 Once a week, graduate nursing student Merle Tamondong pauses her busy college life to visit Micheline Schulte. They color together, play Micheline’s favorite songs and chat in French, her native language. “When I come here, the only time I’m on my phone is when I’m playing some music, which Micheline likes when we are coloring,” Merle said. “I feel very lucky.” Merle is part of Hospice of the Valley’s College Partners Program, an innovative collaboration with Maricopa Community Colleges, Arizona State University and other schools to provide socialization to people living with dementia and a much-needed break to family caregivers. Hospice of the Valley’s dementia and volunteer departments spearheaded this intergenerational program to help inspire careers in dementia care. ... To date, 106 students have been trained and paired with 123 patients since College Partners launched in 2021 with a grant from Community Care Corps. 

How to recognise the dying phase in palliative and end-of-life care Nursing Times; by Julie Kinley and Cathriona Sullivan; 8/19/24This article gives practical guidance for nurses on providing care in the last days of life. ... Birth and death are two certainties in life. Consequently, during their career, many nurses will support, and indeed lead, the management of the care of dying people. ... [Knowing] how to recognise – and manage – this phase of life remains a career-long key responsibility and role. ... In any setting, nurses are part of a wider team. The recognition of dying and the dying phase can be enhanced if everyone:

The importance of competencies in pain management and palliative care Greenwich Sentinel, Greenwich, CT; by Russell R. Barksdale, Jr.; 8/21/24 ... Competencies, ongoing pharmacological education, regular patient pain assessments, management, and medication adjustments are all crucial processes for healthcare providers in today’s complex medical environment. Regrettably, metabolic and behavioral issues related to pain medications, especially opioids, if not properly managed, poses risk of addiction. Beginning in the late 1990s, the consumption of medical opioids used to treat pain increased in many countries worldwide. Since that time, alarmingly the United States has outpaced every other country in per capita opioid consumption. ... [Click on the title's link to continue reading.]

Integration of palliative pharmacists to elevate oncologic care Pharmacy Times; by Alexis Beachy, PharmD and Jessica Geiger, PharmD, MS, BCPS; 8/20/24... Conclusion: This case demonstrates several aspects of care palliative pharmacists can assist with, though it is certainly not all-encompassing. All things considered, pharmacists are an essential asset of the palliative team. Their experience further enriches the interdisciplinary team and grants all patients and families many benefits. Specifically, patients receiving oncologic care benefit from collaboration with a palliative care pharmacist. In addition to offering a more individualized and holistic approach to care, palliative pharmacists can also provide patients with quicker and improved symptom management, which often improves quality of life and may also increase survival rates.Editor's Note: This article provides excellent history, definitions, and descriptions of the pharmacist's significant role in providing expert palliative and hospice care.

Dr. Oswalt on the effects of palliative care timing on end-of-life care in mNSCLC OncLive, Oncology Specialty Group; by Cameron James Oswalt, MD; 8/15/24 Cameron James Oswalt MD, fellow, Hematology-Oncology, assistant professor, medicine, Department of Medicine, Duke University School of Medicine, discusses findings from a study evaluating the timing of palliative care referral and its effect on end-of-life care outcomes in patients with metastatic non–small cell lung cancer (mNSCLC). ...  Investigators found that fewer than half of patients received palliative care during their treatment course, and fewer than one-third of the patients who received palliative care accessed this care within 2 months of diagnosis, ... The low referral rate in this cohort could be attributed to several factors, including patient preferences, preconceived notions, barriers to referral, and overall disease burden, he says. Among patients who died, 59.1% were enrolled in hospice. 

Factors associated with Do Not Resuscitate status and palliative care in hospitalized patients: A national inpatient sample analysis Palliative Medicine Reports; by Jean-Sebastien Rachoin, Nicole Debski, Krystal Hunter, Elizabeth CerceoIn the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.

Person-centered, goal-oriented care helped my patients improve their quality of life Journal of the American Board of Family Medicine; by Lee A. Jennings and James W. Mold; orignially posted 5/24 issue, again on 8/15/24 When the goal is to help patients improve their quality of life, it makes sense to focus directly on the activities and relationships that are most important to each patient. This can be accomplished most effectively by following a three-step process that includes 1) connecting with the patient around what matters to them, 2) co-creating a goal-oriented plan, and 3) collaborating with patient, family, team members, and consultants to increase the probability of success. Once this approach has been mastered and the necessary systems, processes, and relationships are in place, this should not take more time than a problem-oriented approach, and it will almost certainly be more satisfying for both physician and patient. Editor's Note: Simple. Effective. Meaningful.

Thrive Alliance donates robotic pets to Our Hospice dementia patients Local News Digital, Columbus, IN; by LND Staff; 8/13/24 Our Hospice of South Central Indiana has announced that it has received a generous donation from Thrive Alliance that will significantly improve the quality of life for dementia patients. The donation includes several lifelike robotic animals designed to provide sensory-based stimulation and comfort to patients experiencing dementia. The innovative pets calm patients, encouraging them to smile, hug, and stroke the robotic animal’s fur. ... President of Our Hospice Steph Cain said, “These robotic animals will make the transition from home to our care center much smoother. They not only provide comfort but also act as a catalyst for social connection, sparking positive interactions with staff, visitors, and fellow patients.”

3 components of virtual nursing MarketScale, Dallas, TX; by David Jastrow; 8/12/24 As healthcare adopts digital innovations, virtual nursing is increasingly significant. This study delves into the key components driving this transition, analyzing the benefits, and exploring future trends. [The 3 key components identified include:]

Death is inevitable. It's time we learned to talk about it. MedPageToday; by Nidhi Bhaskar; 8/13/24 By fostering honest and compassionate discussions, we can provide patients with more dignity. Years ago, in a busy emergency department, I found myself joining my mentor at the bedside of an elderly man experiencing chest pain. After completing the physical exam, the doctor unceremoniously changed gears to abruptly ask our patient, "If your heart were to stop beating, do you want us to do everything?" Between the stress of the situation and the vague and awkward delivery of the question, our patient seemed (understandably) overwhelmed. So was I. ... End-of-life conversations can feel like a "word soup" of sorts ... it is easy for patients and providers alike to feel lost. ... Providers must also consider the nuances of cultural attitudes towards death; the location and family arrangements surrounding a person at the end of life; and the varying emotional responses and feelings of decision paralysis surrounding how one dies and how one feels about dying.Editor's Note: For a related article in our newsletter today, read "Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication."

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

9 powerful lessons on life you can learn from experts on death Forbes; by Robert Pearl, MD; 8/12/24 As a physician, I have been present at the end of many lives, witnessing the profound agony families face during a loved one’s final moments. While most family members express deep gratitude for the care provided by doctors and nurses, some recount harrowing stories of unnecessary pain their loved ones endured in the final days. These distressing accounts highlight a troubling ambiguity in the care we provide, blurring the line between compassionate treatment and what can feel like unbearable torture. Motivated by my encounters with grieving families, I dedicated the ninth season of the Fixing Healthcare podcast to exploring life’s final chapter and addressing the shortcomings in end-of-life care. ...