Literature Review

Palliating serious illness during disasters and public health emergenciesAm J Nurs, by Masako Mayahara, Djin L Tay, Jeannette Kates, William E Rosa; 2/23/24, ahead of print 3/1/24The increase in disasters and public health emergencies in recent years is a serious public health concern. The needs of suffering victims can be multifaceted, particularly the needs of those who are from systematically marginalized populations. Palliative care nurses play a vital role in mitigating the suffering of those affected by these events. 

Why long-term hospice care might be goodNBC KPRC TV, interview with Joseph Rotella, MD MBA HMDC FAAHPM, Chief Medical Director American Academy of Hospice and Palliative Medicine; 2/21/24Most people receiving hospice care don't live for more than a few weeks. Doctor explains why receiving hospice care earlier can be beneficial.

Racial differences in hospice care outcomes among patients with advanced heart failure: Systematic review and meta-analysisAm J Cardiol, by Diego Chambergo-Michilot, Victor G Becerra-Gonzales, Veraprapas Kittipibul, Rosario Colombo, Katia Bravo-Jaimes; 2/19/24There remains a paucity of investigational data about disparities in hospice services among people with non-cancer diagnoses, specifically in heart failure. Black patients with advanced heart failure have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced heart failure who were enrolled in hospice services.

Psychological issues in palliative care: Elissa Kozlov and Des AzizoddinGeriPal podcast, by Alex Smith; 2/22/24Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes.  Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life.

We gave palliative care patients VR therapy. More than 50% said it helped reduce pain and depression symptomsThe Conversation; 2/22/24Our study, published this week in the journal BMJ Supportive & Palliative Care, found more than 50% of patients experienced clinically meaningful reductions in symptoms such as pain and depression immediately after a 20-minute VR session. ... Personalised VR means each person experiences content that is meaningful to that individual. So rather than asking patients to choose, for example, between a rainforest and a beach VR experience, we interviewed the patients before their sessions to gauge their interests and create a VR session tailored to them.

AI-generated clinical summaries require more than accuracyJAMA Network; by Katherine E. Goodman, JD, PhD; Paul H. Yi, MD; and Daniel J. Morgan, MD, MS; Originally published 1/29/24, redistributed 2/20/24 ... Currently, there are no comprehensive standards for LLM-generated [Large Language Model] clinical summaries beyond the general recognition that summaries should be consistently accurate and concise. Yet there are many ways to accurately summarize clinical information. Variations in summary length, organization, and tone could all nudge clinician interpretations and subsequent decisions either intentionally or unintentionally. To illustrate these challenges concretely, we prompted ChatGPT-4 to summarize a small sample of deidentified clinical documents. [Click on the title's link to view the example.]

Studies conducted at University of New Mexico on Hospice and Palliative Medicine recently published (Cultural advocacy for indigenous individuals with serious illness) American Journal of Hospice and Palliative Medicine, by Jeanna Ford, DNP, APRN, ACNS-BC, ACHPN, FPCN, FCNS, and Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; first published 2/2/24, posted in Health & Medicine Daily 2/20/24Indigenous American (I.A.) individuals with serious illness and their families have unmet needs. Often, this group is viewed as a minority within a minority. Numerous health challenges exist within the I.A. populations resulting in dire health care situations. Historical trauma and mistrust of the healthcare system impacts access to quality palliative care by this marginalized population. ... The aim is to empower palliative care clinicians the knowledge to provide culturally sensitive and congruent care to I.A. individuals with serious illness and their community.

Embodied decisions unfolding over time: a meta-ethnography systematic review of people with cancer's reasons for delaying or declining end-of-life careBMC Palliat Care, by Jessica Young, Antonia Lyons, Richard Egan, and Kevin Dew; 2/19/24Conclusions: Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making. ... The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.

Death can be isolating and dehumanizing. But what if it didn’t have to be?City Life, by Ben Seal; 2/17/24... In the three years since Elaine’s passing, I’ve longed for a world where more people could be given the chance to die as she did — with the fullness of life surrounding her, and with complete support, emphasizing the emotional and spiritual, not just the medical. In Philadelphia and beyond, a growing community of death-care workers — doulas, nurses, grief counselors, social workers, even funeral directors — is trying to build that world. They are reclaiming death and dying from the institutional model that has become the norm over the past century. Editor's Note: Has hospice now become so institutionalized and medical/regulatory focused that we have lost sight of "emphasizing the emotional and spiritual, not just the medical"? I ask the question, but do not draw judgment, as answers must be contextualized. 

Looking at the challenges involving hospice careNPR WOSU PBS, podcast by All Sides with Anna Staver; 2/19/24Hospice care prioritizes comfort and quality of life by reducing pain and suffering for patients facing the end of life. However, physicians are voicing concerns about a prevalence of serious deficiencies in hospice care and believe it is in need of fixing.Host: Mike Thompson, WOSU chief content director of radioGuests: Dr. Ira Byock, palliative care physician and advocate; Dr. Jennifer Hirsh, hospice & palliative medicine specialist, Mt. CarmelEditor's Note: Originally aired 7/24/23; reposted 2/19/24

Palliative care doctor: What dying feels like Mind Matters, by Denyse O'Leary; 2/15/24What does dying actually feel like? Most human beings have always believed that the essence of a human being survives the death of the body though the outcome is envisioned in a variety of ways. But, assuming that pain and distress are controlled, what does dying actually feel like? Can science tell us anything about that? 

Causes and ways of death in patients with head and neck cancerJAMA Otolaryngol Head Neck Surg; by Boyd N. van den Besselaar, MD; Aniel Sewnaik, PhD; Arta Hoesseini, MD; et al; 2/15/24 The results of this study potentially illuminate causes and ways of death in patients with HNC and support health care professionals in providing more patient-centered care, particularly for those in the palliative phase.

The administrative burden on palliative academic physiciansJournal of Pain and Symptom Management, by Rida Khan, Michael Tang, Ahsan Azhar, Eduardo Bruera; 1/24Every faculty member spends annually an approximate average of 5,300 minutes on administrative activities (approximately the equivalent of 29 consults plus 133 follow-ups). Using the department net average per encounter, the approximate value of these encounters is $36, 936 for each faculty member (about 11 clinical days)... We recommend that regulatory agencies and institutions work together to better regulate this list of tasks and their frequency.