Literature Review

Pennsylvania signs home care, hospice efficiency bills into law McKnights Home Care; by Adam Healy; 11/5/24 Pennsylvania Gov. Josh Shapiro (D) signed into law two bills that will reduce operational challenges and improve recruitment efforts for home care and hospice agencies. House Bill 155 allows healthcare providers, including home care and hospice agencies, to use remote video technology for interviews with direct care workers. Meanwhile, Senate Bill 1080 allows licensed practical nurses (LPNs) to pronounce death in home-based hospice settings. These two new laws will make direct care worker recruiting processes more accessible and efficient, while improving end-of-life care for both patients and providers, according to the Pennsylvania Homecare Association. “The signing into law of HB 155 and SB 1080 helps create efficiencies in how we deliver home-based care,” Mia Haney, chief executive officer of PHA, said Friday in a statement. “With a growing demand for these services, efforts such as these allow providers to use their time effectively and focus on what’s most important — quality of care.”

Nurse burnout the root of decreased resident safety, medication errors, study shows McKnights Long-Term Care News; by Zahara Johnson; 11/6/24 A new study has found a direct link between nurse burnout and unfavorable patient and facility outcomes, including medication errors and a degraded safety culture. The meta-analysis of 85 studies and 288,581 nurses, compiling more than 30 years of research, concluded that nurses who suffer from burnout – emotional exhaustion, depersonalization and a low sense of personal accomplishment – have a negative impact on patients.

Early palliative care may curb aggressive end-of-life care Medscape; by Marilynn Larkin; 11/6/24 Increasing the uptake of palliative care may decrease the aggressiveness of end-of-life care, an analysis of ovarian cancer decedents suggested. Palliative care initiated earlier than 3 months before death was associated with lower rates of emergency department (ED) visits, hospital admissions, and intensive care unit (ICU) admissions in the last 3 months of life. It was also associated with a lower rate of death in the hospital. “When patients with advanced or incurable cancers experience aggressive end-of-life care, spending their final weeks of life in and out of the ED or admitted to acute care hospital wards or the ICU, where they undergo invasive tests or procedures that may not meaningfully prolong life or address symptoms or suffering, this can be very distressing for patients and their caregivers,” lead author Sarah J. Mah, MD, of McMaster University in Hamilton, Ontario, Canada, told Medscape Medical News.

Physician explores family's end-of-life journey in new podcast: "There were so many places that we ran into unexpected obstacles" MedPage Today; by Rachael Robertson; 11/4/24 As host of the TED Health podcastopens in a new tab or window, Shoshana Ungerleider, MD, is no stranger to podcasting. But now, the internist turned the mic on herself to explore death and mortality through the lens of her own experience losing her father to pancreatic cancer. Her eight-episode show is called "Before We Go" and is available on all podcast platforms (Spotify, Apple) with new episodes each week through early December. ... Ungerleider: My father died from pancreatic cancer in the spring of 2023. In my experience as an internist and as someone who is an expert on end-of-life through my work with End Well, there were so many things that kind of shocked me along the way. Despite the fact that I had the knowledge, the expertise, and the resources to provide him with a good end-of-life experience, there were so many places that we ran into unexpected obstacles. I wanted to share my story, really, with the goal of helping other people who might be facing the same kind of journey, and how to find the balance between being a doctor and being a daughter.  ...

CMS finalizes 2.9% cut in physician payments for 2025, including for palliative care Hospice News; by Jim Parker; 11/4/24 The U.S. Centers for Medicare & Medicaid Services (CMS) has finalized a nearly 2.9% cut for 2025 in physician payment rates used to reimburse palliative care care practitioners, among other professionals. The final rule also states that the telehealth flexibilities implemented during the COVID-19 public health emergency will expire at the end of this year unless Congress intervenes. Physicians and other professionals will have to follow pre-COVID restrictions on telehealth, with few exceptions. Industry organizations were quick to denounce the pay cut. “To put it bluntly, Medicare plans to pay us less while costs go up. You don’t have to be an economist to know that is an unsustainable trend, though one that has been going on for decades,” American Medical Association President Dr. Bruce Scott said in a statement.

How end-of-life dreams and visions are bringing comfort to dying patients: A conversation with Christopher W. Kerr, MD, PhD The ASCO Post (American Society of Clinical Oncology); by Jo Cavallo; 11/1/24 Just weeks or even days or hours away from death, the majority of conscious terminally ill patients often experience growth and meaning in their lives and the absence of fear through end-of-life dreams and visions, according to research by Christopher W. Kerr, MD, PhD. Dr. Kerr is Chief Executive Officer and Chief Medical Officer of Hospice and Palliative Care Buffalo, New York, and coauthor of Death Is But a Dream: Finding Hope and Meaning at Life’s End (Avery, 2020). ... In this interview with The ASCO Post, Dr. Kerr discussed how end-of-life dreams and visions bring comfort to dying patients, the difference between these experiences and hallucinations, and the importance of ensuring that patients understand the reality of their prognosis when cure is no longer attainable.

An authentic learning experience for medical students on conducting a family meetingAmerican Journal of Hospice and Palliative Care; by Mariana Khawand-Azoulai, Elisse Kavensky, Julia Sanchez, Ileana M Leyva, Corinne Ferrari, Marcio Soares, Khin M Zaw, Maria H van Zuilen; 9/24Medical schools often lack training for serious illness conversations with patients and caregivers. We developed a curriculum in our elective Transitioning to Residency medical student course, focused on end-of-life discussions. This paper provides an overview of the curriculum and outcomes from an advanced preparation assignment and student evaluations.

Guidelines vary when surrogates with power of attorney disagree with advance directives  Healio, Boston, MA; by Richard Gawel; 10/30/24 Inconsistent guidelines can lead to conflicts when surrogates with powers of attorney disagree with what may be described in a patient’s advance directive, according to a poster presented at the CHEST Annual Meeting. ... Key takeaways:

Palliative care in the ED reduces costs, improves patient outcomes Hospice News; by Jim Parker; 10/28/24 The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs. A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver. ... “When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

What is narrative medicine? Finding humanity in health care Rheumatology Advisor; by Matthew Eck, MS; 10/25/24 Health care requires humanity. At its roots, narrative medicine embodies this ideology. Coined in 2000 by internist and scholar Rita Charon, MD, PhD, the field is “medicine practiced with the narrative competence to recognize, interpret, and be moved to action by the predicament of others.” ... Narrative medicine is less a specific practice and more a theoretical framework that equips caregivers and health care professionals with tools to provide more holistic care. These tools stem from storytelling principles and literature, which can hone our empathic and listening skills. ... Medical schools across the country are increasingly tailoring their curricula to include humanities-focused aspects, ... Conclusion: Regardless of one’s feelings about health care infrastructure in the United States, narrative medicine illuminates a profound truth — more can be done to accommodate patients of different backgrounds. Narrative medicine can offer health care providers a new way of thinking, attending, and recognizing. It could bring us closer to the human condition than ever before.

Doctor sues to save Medicare billing rights over hospice role Bloomberg Law; by Ganny Belloni; 10/24/24 A medical director designee at a California hospice sued the US Department of Health and Human Services to prevent the termination of his physician billing privileges after an independent contractor found his affiliation with the facility posed a fraud risk to the Medicare program. The lawsuit filed Wednesday by internal medicine physician Rami Shaarawy seeks injunctive relief from the US District Court for the Central District of California preventing the HHS’ Centers for Medicare & Medicaid Services from sanctioning the doctor until his dispute is resolved through Medicare’s internal appeals process.

Advance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated.  Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.

Lawsuit filed against Visiting Nurse Service entities and individual defendant for assault of hospice patient NewRamp; by NewRamp Editorial Staff; 10/22/24 The Law Offices of Robert E. Brown has filed a lawsuit against three Visiting Nurse Service entities and individual defendant Joy Odunze-Matthew following the violent assault of Carolyn Albanese, a terminally ill hospice patient under their care. The complaint alleges gross negligence by VNS and its affiliates for failing to properly vet, train, and supervise their staff, specifically the defendant Odunze-Matthew. The lawsuit seeks compensatory and punitive damages to address the physical, emotional, and psychological harm suffered by Ms. Albanese and her family.