Literature Review

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.

In a 1st at ChristianaCare, physicians vote to unionize Becker's Hospital Review; by Kelly Gooch; 7/1/24 Physicians at ChristianaCare locations in Delaware and Maryland voted to join the Doctors Council, an affiliate of the Service Employees International Union. ... The decision marks the first attending physician union in Delaware, the first union at ChristianaCare, and the largest union of private sector physicians in the U.S., according to the Doctors Council. Union representatives said the physicians' decision is a response to ongoing concerns about corporatization and their professional autonomy.

[American Heart Association] Palliative care beneficial to manage symptoms, improve quality of life for people with CVD [cardiovascular disease] American Heart Association; by NewMediaWire; 7/1/24 Implementing patient-centered palliative care therapies, including prescribing, adjusting or discontinuing medications as needed, may help control symptoms and improve quality of life for people with heart disease, according to “Palliative Pharmacotherapy for Cardiovascular Disease,” a new scientific statement from the American Heart Association, published today in the Association’s journal, Circulation: Cardiovascular Quality and Outcomes. The new scientific statement reviews current evidence on the benefits and risks of cardiovascular and essential palliative medications. The statement provides guidance for health care professionals to incorporate palliative methods as part of holistic medication management at all stages of a patient’s health conditions, emphasizing the importance of shared decision-making and goal-oriented care.

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. 

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:]

Coping and end-of-life decision-making in ALS: A qualitative interview study PLoS One, University of Auckland, New Zealand; by Olga Wenzel, Anke Erdmann, Gerald Neitzke, and Irene Hirschberg; 6/26/24 How do people with amyotrophic lateral sclerosis (PALS) deal with their diagnosis and engage in end-of-life decision-making? What informational or supportive needs do they have for counselling about life-sustaining treatment and end-of-life care? Which correlating conditions and influences relate to these needs and how do they connect to the wish to die or wish to live? ... We identified the coping strategies ‘avoid thinking about end-of-life’ and its counterpart, ‘planning ahead to be well-prepared,’ and differentiated the latter into the patterns ‘withdrawing from life and taking precautions against life-prolongation’ and ‘searching for a new meaning in life and preparing for life-sustaining treatment’.  ... These strategies may vary over time, resulting in different support needs. Our findings signify that deep insight is needed into PALS‘ coping processes to understand their decision-making about life-sustaining treatment. Healthcare professionals should be sensitive to illness experiences beyond medical aspects and foster coping as a biographical process to better support people with ALS.Editor's Note: Click on the title to access the full text of this insightful, relevant research. Hospice and palliative educators, use this to strengthen your disease-specific resources and training about care for persons with ALS.

Patient experiences of specialty palliative care in the perioperative period for cancer surgery Journal of Pain and Symptom Management; by Laura M Holdsworth, Rachel Siden, Anna Sophia Lessios, Mae Verano, Elizabeth Rickerson, Bridget Fahy, Fabian M Johnston, Brittany Waterman, Rebecca Aslakson; 6/19/24 online ahead of print  Context: Though patients undergoing treatment for upper gastrointestinal (GI) cancers frequently experience a range of sequelae and disease recurrence, patients often do not receive specialty palliative care soon after diagnosis and it is unknown in what ways they may benefit.  Results: We found five themes that characterized patient experiences and perceptions of specialty palliative care. Patients typically had limited prior awareness of palliative care (theme 1), but during the study, came to understand it as a "talking" intervention (theme 2). Patients whose concerns aligned with palliative care described it as being impactful on their care (theme 3). However, most patients expressed a focus on cure from their cancer and less perceived relevance for integration of palliative care (theme 4). Integrating specialist palliative care practitioners with surgical teams made it difficult for some patients to identify how palliative care practitioners differed from other members of their care team (theme 5).

Experiencing and enduring patient distress: the distress of palliative care patients and its emotional impact on physicians in trainingBMC Medical Education; by Andréa Tarot, Maxence Pithon, Ashley Ridley, Virginie Guastella, Virginie Guastella, Morgane Plancon, Régis Aubry, Helène Vaillant Roussel, and Axelle Maneval; 6/26/24The extreme vulnerability experienced by patients in palliative care may result in significant distress. These patients require appropriate care while not pathologizing their natural distress. ... [The] aim of this study was to explore how professionals in training feel when confronted with the distress of patients undergoing palliative care. ... The interviews revealed the following five themes:

'We may not ever be fully staffed': Health system C-suites plan for the future Becker's Hospital Review - Leadership & Management; by Laura Dyrda; 6/24/24 After the pandemic, most healthcare leaders experienced a "great resignation" as workers left for other service industries and ever since health systems have been dealing with a lack of skilled labor to backfill the vacancies. "As we have realized we may not ever be fully staffed to the degree we were pre-COVID, we now must augment our existing workforce with technology that extends their capabilities," said Mark Moseley, MD, president of USF Tampa General Physicians and executive vice president of Tampa General Hospital. "This is a two-part challenge. First, we need to deploy technology thoughtfully with sound blocking and tackling, which is expensive in both time and capital. Second, we must train our workforce to use these new technologies to aid them in their daily responsibilities in a manner that does not diminish the ethos of why many of us went into healthcare: the interactions with patients and members of the healthcare team." Physicians and nurses can fall on a wide spectrum of excitement or distaste for incorporating technology into their practice. Some may find it impersonal and challenging to understand while others see it as a tool boosting their capacity. ... [Click on the title's link to continue reading.]

Palliative care physician: ‘Healing is possible’ even when cure is not Healio, Chicago, IL; by Jennifer Byrne; 6/26/24During her fellowship as a palliative care physician, Sunita Puri, MD, met a patient who taught her that healing is possible even when cure is not. Alice, a 35-year-old woman, had acute myeloid leukemia. ... Nobody wanted to say it out loud, but Alice was dying. “She was only a couple years older than me. She’d lived in San Francisco, a few streets away from where I lived in my residency,” Puri, program director of the hospice and palliative medicine fellowship program at UMass Chan School of Medicine. ... “She had a vibrancy that I had always hoped to embody, but she was intubated, wide awake, on dialysis and starting to suffer from ascending paralysis.” ... During rounds one day, Puri told her attending that she was at a loss about how to help Alice and didn’t feel she was doing anything meaningful for her. “My attending said, ‘What if just being at her bedside is achieving something meaningful?’” Puri recalled. “I’d always understood healing and cure to be different, but this was when I really felt it.” ... “What if healing is choosing to understand that there’s going to be suffering that we can’t alleviate — and sometimes that’s our own — but the most important thing to bring to that is presence?” she said. [Click on the article's title to continue reading.] Editor's Note: Though not directly related to this article, read "Today's Encouragement" at the end of today's newsletter.

Column: Hospice offers redirection of care The Andalusia Star News; by Vickie Wacaster; 6/22/24 Watching someone you love grow weaker and weaker with each passing day is challenging. Yet, sadly, many of us experience this. In my own life, when my late husband was diagnosed with a terminal, non-curable, yet treatable disease, I felt we were living on a roller coaster of emotions, appointments, and treatment options. ... Every day was a journey into uncharted territory for both of us. ... It was only during the last few days that we found the strength to say “no more treatments” and asked for hospice. ... Physicians recognize that hospice is not a withdrawal of care but a redirection of care to meet the needs of patients with an advanced terminal illness/disease. ...Editor's Note: The word "redirection" powerfully, easily shifts the course of care. The person remains at the center, with the focus being the person, not the disease. This is not a denial of dying and death, but rather a signpost, a gentle way to open the difficult conversation for providing information and asking "what matters most to you, now?" 

171K+ clicks saved: Inside Johns Hopkins' nurse documentation revamp Becker's Clinical Leadership; by Erica Carbajal; 6/17/24 Across healthcare, efforts to advance documentation are often focused on enhancing physicians' workflow. But at Baltimore-based Johns Hopkins Hospital, leaders are equally focused on improving documentation in nursing. ... [The] American Nurses Credentialing Center recognized Johns Hopkins with 10 exemplars, one of which recognized the hospital as a leader in nursing informatics. Case in point: The hospital has saved nurses 170,620 clicks in four months, April Saathoff, DNP, RN, vice president and chief nursing information officer at Johns Hopkins Medicine, told Becker's. ... "Instead of the nurse having to go in and document on every single row on a head-to-toe reassessment for the patient, we now have some fields added to the top where the nurse can document reassessment changes noted or reassessed no changes," Dr. Saathoff said, adding that the changes are saving nurses an average of 13 minutes per reassessment. Editor's Note: What might your organization be able to streamline in your online documentation? Before IT or clinical management decides unilaterally, get input from your clinicians who make the visits and use the system. Include your psychosocial/spiritual care team members as well, as you might delete something crucial that they need.

Interdisciplinary Pain Board for managing patients with palliative care needs and substance use disorder: A pilot study Journal of Palliative Medicine; Sarah Hauke Given, Patricia Reid Ponte, Kate Lally, Isaac S Chua; 6/20/24 online ahead of print Context: Patients with cancer-related pain and concurrent substance use disorder (SUD) present a unique set of challenges for palliative care clinicians. A structured forum for interdisciplinary collaboration is needed to effectively manage this complex population. Objectives: Describe the feasibility and acceptability of a palliative care Complex Pain Board (CPB), an interdisciplinary team meeting to provide concrete care recommendations for patients with cancer-related pain and concurrent SUD and/or psychosocial complexity.