Literature Review

Use of palliative care for ICU patients, familiesReview of Doherty, C., Feder, S., Gillespie-Heyman, S., & Akgün, K. M. (2023). Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU. Journal of Intensive Care Medicine. Yale School of Medicine, review by Chigoziri Knokwo; 1/8/24... The authors identify the most commonly worrisome symptoms affecting ICU patients as the inability to communicate, pain, difficulty breathing, and thirst. They also highlight distressing experiences for families and caregivers of patients in the ICU, particularly depression and complicated grief. They recommend the continued incorporation of humanistic palliative care principles, considering perspectives from a more diverse representation of countries and cultures, particularly more resource-limited settings.

The prevalence of hospital diagnostic errorsBecker's Clinical Leadership, by Paige Twenter; 1/8/24Nearly a fourth of patients who are transferred to intensive care units or die in hospitals are misdiagnosed or have delayed diagnoses, according to research published Jan. 8 in JAMA. In a study of more than 2,400 patient records, researchers employed physician reviewers trained in error adjudications to inspect each EHR for the admission and events leading up to an ICU transfer or death across 90 hospitals.

Home health agencies grapple with 'acuity creep' as patient needs become more complexHome Health Care News, by Patrick Filbin; 1/5/24As the demand for home-based care continues to rise, so does the need for more intensive care plans as patients continue to be sicker and more complex. Home health agencies are feeling this “acuity creep,” and they’re adjusting. But at times, it’s hard to keep up. “When I’m talking about acuity creep, I’m thinking about how much need do the patients in our care models require?” Michael Johnson, president of home health and hospice at Bayada Home Health Care, said. “It’s not just medical needs, either — there’s a social need as well."

Upcoming e-prescribing regs could give relief to hospice, palliative care providers, advocates sayMcKnights Home Care, by Adam Healy; 1/5/24Proposed rules, if finalized, could make it easier for providers to prescribe controlled substances via telemedicine. The Drug Enforcement Administration is expected to develop a “special registry” for certain controlled substances that could be prescribed without an in-person visit, according to Katy Barnett, director of home care and hospice operations and policy at LeadingAge. Certain substances were already granted similar prescription flexibilities during the COVID-19 public health emergency (PHE); a new registry would subject these substances to oversight by the DEA.

Death anxiety impairs self-esteem, quality of life in older adults with chronic diseaseMcKnights Long-Term Care News, by Kristen Fischer; 1/4/24No surprise here: A new study that shows anxiety about dying can affect self-esteem and quality of life among people with chronic diseases. The authors said they’d like to see more interventions to bolster self-esteem and lower death anxiety in middle-aged and older adults who have chronic diseases. The study was published on Tuesday in BMC Psychiatry. The negative consequences of chronic diseases like cancer, diabetes and cardiovascular disease (along with the unpredictability of death) makes middle-aged and elderly adults who have these diseases more vulnerable to death anxiety, the authors wrote. 

Medscape: Long COVID has caused thousands of US deaths: New CDC dataMedscape Medical News, by Lisa Rapaport; 1/3/24While COVID has now claimed more than 1 million lives in the United States alone, these aren't the only fatalities caused at least in part by the virus. A small but growing number of Americans are surviving acute infections only to succumb months later to the lingering health problems caused by long COVID. ... At least 4600 Americans have died from long COVID since the start of the pandemic, according to new estimates from the CDC.

How to live: What the dying tell usPsychology Today, by Tasha Seiter; 1/2/24Subtitle: The top regrets of the dying and how we can use them to better our lives.Bronnie Ware, a hospice nurse, asked the dying what they regretted most. While it may have been too late for her patients, their answers can tell us about how we should be living while we still have the chance. Here are the top five regrets of the dying, according to her research (both qualitative and quantitative):

Should patients be allowed to die from anorexia?DNYUZ; 1/3/24The doctors told Naomi that she could not leave the hospital. She was lying in a narrow bed at Denver Health Medical Center. Someone said something about a judge and a court order. Someone used the phrase “gravely disabled.” Naomi did not think she was gravely disabled. Still, she decided not to fight it. She could deny that she was mentally incompetent — but this would probably just be taken as proof of her mental incompetence. Of her lack of insight. She would, instead, “succumb to it.” [Read more of Naomi's story, followed by this examination of palliative care.]The field of palliative care was developed in the 1960s and ’70s, as a way to minister to dying cancer patients. Palliative care offered “comfort measures,” like symptom management and spiritual guidance, as opposed to curative treatment, for people who were in pain and would never get better. Later, the field expanded beyond oncology and end-of-life care — to reach patients with serious medical illnesses like heart disease, H.I.V. and AIDS, kidney failure, A.L.S. and dementia. Some people who receive palliative care are still fighting their diseases; in these cases, the treatment works to mitigate their suffering. [Read more of this discussion of emerging issue.]

Biased AI models in healthcare may lead caregivers and clinicians astray, new study warnsMcKnights' Tech Daily News, by Aaron Dorman; 1/2/24Over the past year, studies have highlighted how artificial intelligence models in healthcare sometimes can increase bias. Now, a new study warns that clinicians could follow AI down the wrong path. When reviewing data for respiratory failure, a common problem for older adults, clinicians were 11% less accurate in their diagnoses when using a biased AI model than if they didn’t use AI at all, the study found. Disturbingly, this fact was true even when given explanations about how the AI came to a diagnostic conclusion. 

Rethinking immunotherapy for cancer: When is the best time to stop?Wall Street Journal, by Brianna Abbott and Jared S. Hopkins; 12/26/23Halting treatments earlier could spare patients side effects and costs, but researchers face obstacles.

Nurses ‘bridge the gap’ between patients, doctors to talk end-of-life careCure, by Alex Biese; 12/22/23For patients with cancer and their caregivers, nurses can play an integral role when it comes to communicating wishes for end-of-life care, as one expert explained to CURE®. “Nurses bridge the gap, I feel, oftentimes, between the medical community and patients and caregivers, because … especially with the patients with cancer, they may be getting infusions, or different kinds of treatments, so there's a fair amount of time when nurses are in and out of the room or they're attending to the patients, etc., where physicians obviously wouldn't necessarily be there,” said Sara Douglas, a Gertrude Perkins Oliva professor in oncology nursing at Case Western Reserve University’s Frances Payne Bolton School of Nursing in Cleveland.

Death by Doctor May Soon Be Available for the Mentally Ill in CanadaNew York TimesDecember 27, 2023Canada already has one of the most liberal assisted death laws in the world, offering the practice to terminally and chronically ill Canadians. But under a law scheduled to take effect in March assisted dying would also become accessible to people whose only medical condition is mental illness, making Canada one of about half a dozen countries to permit the procedure for that category of people. That move has divided Canadians, some of whom view it as a sign that the country’s public health care system is not offering adequate psychiatric care, which is notoriously underfunded and in high demand.