Literature Review

Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

Aligning pill burden and palliative care needs in late-stage CVD: AHA TCTMD - Cardiovascular Research Foundation; by L.A. McKeown; 7/2/24 The first scientific statement from the American Heart Association (AHA) that focuses specifically on pharmacotherapy considerations in the palliative management of patients with CVD [cardiovascular diesease] urges a patient-centered, compassionate approach to de-escalating and deprescribing. ... In addition to shedding light on how and when to start deprescribing and de-escalating common cardiovascular drugs, the statement discusses palliative drugs for pain, shortness of breath, and appetite in the context of CVD, which [Katherine E.] Di Palo [PharmD (Montefoiore Medical Center, NY)] said the committee identified as a gap in knowledge given that much of the evidence for these drugs comes from patients with serious illnesses like cancer. ... Important Takeaways: Di Palo and colleagues note that palliative care complements cardiovascular care in several important ways, including reducing physical symptom burden, managing emotional and spiritual distress, providing sufficient support for caregivers, and helping patients choose treatment in line with their goals for care. Editor's Note: Click here for the American Heart Association's statement, which we posted on 7/2/24. 

Anxiety and resilience in palliative medicine physicians BMJ Supportive & Palliative Care; by Cristhian Alexis Velásquez Marín, Carlos Javier Avendaño-Vásquez; 7/2/24, online ahead of printTo identify the relationship between the degree of anxiety and the capacity for resilience in palliative care physicians ..., [we] included 42 Colombian Palliative Care Physicians and administered a sociodemographic questionnaire, the Zung Anxiety Scale and the Resilience Scale. Results: 42 palliative care physicians with an average age of 41 participated in the study. Anxious symptoms were present in 100% of the physicians evaluated. Mild or moderate anxiety was identified in 93.7% of the population and 6.3% of people with severe anxiety symptoms. ... Our results reflect that the population of palliative care physicians has a higher risk and exposure to developing anxiety and its adverse outcomes. We found higher anxiety levels compared with other studies so this population requires greater vigilance and intervention in treating and preventing mental health difficulties.Editor's Note: Executive leaders for palliative care services, use this research to be aware of possible stress-related tolls on your palliative physicians and team members. Ask. Generate dialogue. Do not assume that this applies, but rather use it to tune into and improve the support your physicians need. While this research was in Columbia, it resonates a U.S.recurring trend of the unionization of physicians, often related to burnout and stress overload.

Muncie hospice nurse accused of obtaining narcotics 'by fraud or deceit' The Star Press, Muncie, IN; by Douglas Walker; 7/2/24 A Muncie hospice nurse is accused of ordering prescription pain medication in the names of nursing home residents who then never received the narcotics. Meredith Griffin Briles, 45, is charged in Delaware Circuit Court 5 with obtaining a controlled substance by fraud or deceit, possession of a narcotic drug and failure to make, keep or furnish a record. All three charges are Level 6 felonies carrying up to 30 months in prison.

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.”  

Evaluating palliative care impact: Insights from Tennessee Oncology's OCM participation The American Journal of Managed Care (AJMC); by Mary Caffrey and Pearl Steinzor; 6/27/24 A study finds limited changes in hospice utilization, highlighting challenges in real-world implementation. In an interview at the 2024 American Society of Clinical Oncology annual meeting, Ravi Parikh, MD, MPP, assistant professor of medicine and health policy, Perelman School of Medicine, University of Pennsylvania, discussed the outcomes of a palliative care study at Tennessee Oncology, providing insights into the challenges and limitations of evaluating hospice utilization and quality-of-life improvements in the real-world setting. 

Story Rounds inspires real talk by doctors about their toughest work Standford Medicine - SCOPE Beyond the Headlines; by Mark Conley; 6/27/24 Jay Shah, MD, took a deep breath as he stood on the Berg Hall stage and looked out across the crowd. It was made up of 150 of his Stanford Medicine peers, some of them longtime mentors and collaborators. ... Shah had been chosen to lead off the latest rendition of Story Rounds, the WellMD and WellPhD and the Medical Humanities and Arts Program (MedMuse) co-sponsored live storytelling program -- a safe place for MDs, clinical students and residents to share with their colleagues. ... Shah's tale was an impassioned 13-minute story of metamorphosis: Of going from a doctor determined to trudge forward without self-reflection, watching it destroy his marriage and spiral his mental health, to one who recognized the harm in not processing the difficult situations and emotions that come with the job -- such as the pain, guilt and loneliness of losing a patient and feeling like it was all his fault. His was the first of five stories that evening, delivered in a personal storytelling format inspired by Public Radio Exchange's podcast The Moth. It encapsulated a growing movement toward doctors talking openly about burnout, stress and mental health -- and trying to support one another, whether they're a wide-eyed first-year resident or a veteran health care leader like Shah.

[Four-day workweeks:] A flexibility trend gaining steam in nursing Becker's Clinical Leadership; by Erica Carbajal; 6/26/24 A growing number of health systems are embracing  four-day workweeks for nurse leaders — a strategy that has helped some boost recruitment, retention and staff engagement. Over the past year, the needs and well-being of nurse managers have come into focus, with hospitals and health systems taking a closer look at how to best support them in addition to bedside nurses. Survey findings have indicated nurse managers have a hard time fully disconnecting from work, and they crave much of the same work environment factors that front-line nurses do, such as the ability to take time off when needed and work-life balance support. As such, four-day schedules have increasingly become part of the conversation at many hospitals and health systems. 

A palliative care curriculum may promote resident self-reflection and address moral injury The Journal of Surgical Research; by Shruti Koti, Lyudmyla Demyan, Danielle Deperalta, Sophia Tam, Gary Deutsch; 6/22/24 online ahead of print Introduction: There is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents.Conclusions: The described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.

Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of U.S. older adults eClinical Medicine, Part of THE LANCET Discovery Science; by Yenee Soh, Ichiro Kawachi, Laura D. Kubzansky, Lisa F. Berkman, and Henning Tiemeier; 6/24/24 Loneliness has been implicated as a stroke risk factor, yet studies have examined loneliness at only one time point. The association of loneliness changes and risk of incident stroke remains understudied. Our aim was to examine the association of loneliness with incident stroke, particularly the role of loneliness chronicity. Chronic loneliness was associated with higher stroke risk independent of depressive symptoms or social isolation. Addressing loneliness may have an important role in stroke prevention, and repeated assessments of loneliness over time may help identify those particularly at risk.Editor's Note: This is the source research for an article we posted yesterday, 6/28/24, titled 

From nurse to CEO: 2 executives reflect on their paths to the top Becker's Hospital Review - Leadership & Management; by Erica Carbajal; 6/25/24 Throughout their careers, Laureen Driscoll, MSN, RN, and Kathy Tussey, DNP, RN, remained open to change and said yes more often than no, even to opportunities about which they were skeptical or knew would be a challenge. Today, Ms. Driscoll is chief executive of Providence's South Division, which spans 17 hospitals in Northern and Southern California, and Dr. Tussey is CEO of Harrison Memorial Hospital in Cynthiana, Ky. Neither envisioned pursuing a path to the top role when they began their healthcare careers as bedside nurses. ... Hospital and health system CEOs with a background in nursing appear to be few and far between, though the true proportion of nurse CEOs in healthcare is unclear due to a lack of data. Becker's recently caught up with Ms. Driscoll and Dr. Tussey to learn more about their career trajectories and their top pieces of advice for other nurses eyeing a path to the helm. 

Advanced lung cancer: Studies explore palliative care delivered by telehealth and in a stepped-care approachThe ASCO Post - American Society of Clinical Oncology; by Alice Goodman; 6/25/24 Early palliative care can be integrated into the course of treatment for patients with advanced lung cancer via delivery by telehealth with outcomes similar to when palliative care is delivered via in-person visits, according to results of the REACH PC trial presented by Joseph Greer, PhD, of Harvard Medical School, Boston, at the 2024 ASCO Annual Meeting Plenary Session. A separate randomized noninferiority study presented at the ASCO meeting by Jennifer S. Temel, MD, FASCO, also of Harvard Medical School, Boston, found that stepped palliative care was noninferior to monthly visits with early integrated palliative care. Results of the stepped-care study were published in JAMA to coincide with the presentation at ASCO. [This article includes:]