Literature Review

AFT launches new union physicians’ organizing effort: Doctors across the country are joining together for rights and respect American Federation of Teachers; by Alexis Lopez; 6/18/24  AFT President Randi Weingarten announced the launch of a brand-new doctors’ organizing initiative and division: Union Physicians of AFT. Doctors across the country are faced with crippling burnout from administrative overload, frustration over financial barriers affecting their patients’ capacity to pay, and lack of respect from corporate owners who put profits over patients—and now they’re organizing with the AFT to fight back. ... These challenges are apparent across the healthcare sector, but less than 10 percent of all U.S. doctors have formed unions. The tide is rapidly turning. ... The ranks of AFT’s physicians have already grown at an unprecedented rate—with over 3,200 new members, from New York to Oregon, joining the union over the last year. The AFT is the fastest growing healthcare union and the second-largest nurses union in the U.S.

Cancer therapy at end of life may not boost survival Cure; by Brielle Benyon; 6/17/24 Patients with advanced solid cancers who received systemic therapy toward the end of life typically did not live any longer than patients who did not receive treatment, according to research published in JAMA Oncology. Because cancer treatments can damper quality of life, it is crucial that patients and their loved ones discuss goals of care and prognosis with their oncology team, two experts emphasized. “I think once we progress to advanced and metastatic cancer when cure is no longer feasible, it’s important to consider goals-of-care conversations,” said study author Maureen Canavan, associate research scientist at Yale School of Medicine.

New AMA president says he's ready to take on big challenges facing doctors amid payment cuts and rising burnout rates Fierce Healthcare; by Emma Beavins; 6/13/24 Bruce Scott, M.D., took the reins of the American Medical Association (AMA) for his first full day on Wednesday, June 12, succeeding immediate past president Jesse Ehrenfeld, M.D. ... During his tenure, Scott said he wants to emphasize the things that unite providers rather than the things that divide them. ... Some of the AMA’s biggest policy priorities include reducing prior authorization, bolstering Medicare payments for physicians and tamping down on increased scope of practice by non-physician providers. Scott said he hopes to follow in the steps of Ehrenfeld in engaging policymakers on these topics. In addition to banding together on those cross-discipline issues, Scott wants to advocate for rural clinics. 

Dying of heart failure: how do we improve the experience? The Medical Journal of Australia - MJA; by Dominica Zentner, Vithoosharan Sivanathan, Jennifer Philip and Natasha Smallwood; published online 6/17/24 ... Despite the improvements afforded by multiple pharmacological, surgical and interventional developments in heart failure, the goal of therapy remains delayed disease progression for many. Cognisant of this reality, recent heart failure guidelines all highlight the important role of palliative care. ... The MJA recently published an article regarding the imperative of reframing palliative care. ... We suggest that ...

'I don't ever trust Epic to be correct': Nurses raise more AI concerns Becker's Health IT; by Giles Bruce; 6/14/24 Nurses continue to voice concerns about artificial intelligence and its integration into EHRs, saying the technology is ineffective and interferes with patient care. Nurses from health systems around the country spoke to National Nurses United, their largest labor union, for a June 5 story about issues with such programs as automated nurse handoffs, patient classification systems and sepsis alerts. Multiple nurses cited problems with EHR-based programs from Epic and Oracle Health that use algorithms to determine patient acuity and nurse staffing levels. "I don't ever trust Epic to be correct," Craig Cedotal, RN, a pediatric oncology nurse at Kaiser Permanente Oakland (Calif.) Medical Center, told the nurses' union. "It's never a reflection of what we need, but more a snapshot of what we've done." ... Hundreds of nurses protested AI at Kaiser Permanente San Francisco Medical Center in April.

AAHPM CMO Joe Rotella: Hospice does not exist to save money Hospice News; by Jim Parker; 6/17/24Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM), calls on hospices to maintain their core principles amid a churning sea of regulatory and economic changes. Rotella began his medical career as a primary care physician in a small, rural town in central New Hampshire, where he stayed for 12 years [followed by serving Hospice & Palliative Care of Louisville, KY/Hosparus as Chief Medical director for 15 years]. ... Now, Rotella will soon retire from AAHPM. Hospice News sat down with Rotella to discuss the ways hospice and palliative care have changed during his tenure in the space, as well as the forces shaping the field’s future. ...

Why doctors aren’t participating in organ donation after cardiac death Physician's Weekly; by Frank D. Brodkey, MD, FCCM; 6/13/24Organ donation after cardiac death (DCD) differs from the more traditional organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death with cessation of heartbeat and circulation may occur, followed by extraction of organs. This may increase the availability of transplantable organs, leading to improvement in the lives of other humans.  According to the Health Resources and Services Administration, 5896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding three years. There, however, are significant ethical and scientific issues in the performance of DCD with concepts of end-of-life care, personal autonomy, and concepts of dignity of life and death. ...

Effects of a discourse intervention on end-of-life knowledge and attitudes of Bachelor of Science in Nursing studentsJournal of Hospice & Palliative Nursing; by Haynes, Jayme G. PhD, RN, Dingley, Catherine PhD, RN, FAAN; 6/24The findings indicated increased knowledge and positive attitude changes. This study supports the value of theory-based educational interventions, like a discourse intervention, to enhance effective pedagogy when addressing emotionally laden content such as end-of-life care. This study may have also given a glimpse of how a global pandemic may affect end-of-life knowledge and attitudes.

Hope in oncology: Where art and science collide Medscape; by Sharon Worcester, MA; 6/12/24 Carlos, a 21-year-old, laid in a hospital bed, barely clinging to life. Following a stem cell transplant for leukemia, Carlos had developed a life-threatening case of graft-vs-host disease. But Carlos' mother had faith. "I have hope things will get better," she said, via interpreter, to Richard Leiter, MD, a palliative care doctor in training at that time. "I hope they will," Leiter told her. "I should have stopped there," said Leiter, recounting an early-career lesson on hope during the ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2024 annual meeting. "But in my eagerness to show my attending and myself that I could handle this conversation, I kept going, mistakenly." ... Carlos' mother looked Leiter in the eye. "You want him to die," she said. ...Editor's Note: Click on the title's link to continue reading this insightful reflection and discussion about the importance of "hope." Engage your oncology/palliative/hospice chaplains (hopefully CPE trained and Board Certified) with your medical team members to explore this core belief in "hope." Alert: AI referrals for palliative and hospice care are increasing exponentially. Clinicians must be sensitive to the human dimensions and dynamics of "hope" (which shift and change), and not be driven just by technological data.

Union ratifies RN contract with Ascension Genesys WNEM-TV5, Genessee Co., Mich; by Hannah Mose; 6/5/24 The union representing the registered nurses (RNs) at Ascension Genesys Hospital announced the tentative agreement between the union and the hospital has been ratified. On May 20, Teamsters Local 322 president Dan Glass said there had been months of failed negotiations between the union and the hospital, and if there wasn’t an agreement made by May 24, the union would strike. However, on May 22, Teamsters Local 322 said a tentative agreement had been reached between the union and the hospital.

The role and professional standards of the Adult-Gerontology Nurse Practitioner in hospice and palliative careJournal of Hospice and Palliative Nursing; by Heather Coats, PhD, APRN-BC, Kelly Henrichs, Kelly DNP, RN, GNP-BC; 6/24The adult/gerontology (gero) nurse practitioner (NP) delivers primary and/or specialty palliative care to persons and their families who live each day with a myriad of serious illnesses. In this role, the adult/gero NP uses their skill set to address the whole person (physical, psychological, social, and spiritual/existential) to improve the quality of life for persons they care for. This article is the fourth in a series of 6 highlighting the different roles of the adult/gero NP and the advanced certified hospice and palliative registered nurse, and how these 2 roles overlap. The purpose of this article was to provide details of education and certification pathways for these NP roles, describe the overlaps in clinical care, and illustrate how the adult/gero NP in palliative and hospice care can contribute to leadership in program development for care of persons and their families who live with serious illness.

The latest research indicates massage therapy has benefits from birth to end of life Cision PR Newswire; by American Massage Therapy Association; 6/5/24 The American Massage Therapy Association (AMTA) is sharing recent research on how massage therapy can provide benefits from infancy through end of life. Across all ages, massage therapy can be a therapeutic approach to enhancing physical and emotional well-being. Explore the latest studies on how massage therapy can help improve the quality of life for infants, middle-aged individuals, and older adults. ... A nationwide survey of physicians, physician assistants, and nurse practitioners in palliative care documented recommendation rates of integrative therapies to target symptoms of palliative care patients. The survey found that massage therapy was the third most recommended integrative care modality behind mind-body interventions like meditation and biofeedback. The integrative therapies aimed to reduce pain, anxiety, mood disturbances, and distress.Editor's Note: While hiring a professional massage therapist might not be practical for your budget, explore contracting with massage therapist who is trained in working with medically-fragile persons to provide simple trainings for your nurses and nurse aides. Additionally, professionally trained massage therapists might be interested in volunteering their services, within appropriate parameters (i.e., not transferring the medically-fragile patient to a massage table, having a caregiver present to assist with communication, etc.). 

Palliative care significantly improves discussion and documentation of end-of-life care preferences among patients with AML and MDS Oncology Learning Network; transcribed interview featuring Areej El-Jawahri, MD; 6/1/24 Areej El-Jawahri, MD, Massachusetts General Hospital, Boston, Massachusetts, discusses results from a clinical trial comparing a collaborative palliative and oncology care model vs usual care for adult patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). The study showed that palliative care significantly improved the rates of discussion and documentation of end-of-life (EOL) care preferences, reduced hospitalization at the EOL, and improved the quality of life in patients.