Literature Review

Poetry, again, confronts death JAMA; by Rafael CAmpo, MD, MA; 10/16/24Poetry can help physicians in many ways at the border between life and death. Though we might think first of the consoling power of elegy in confronting mortality, other poems, like “Again,” [referenced] aid us in wrestling with what death is in the first place—and are even more useful when research falls short in attempting to demystify it. One such scientific controversy surrounds in-hospital resuscitation, especially for older adults, with studies showing inconsistent rates of meaningful survival after these potentially life-saving interventions, confounded by the physical and emotional trauma that accompanies them, poor understanding of patients’ and families’ wishes, unclear definitions of “meaningful,” and varying patient selection criteria. [The poem titled] “Again” distills some sense out of this complexity as only poetry can, with the urgent repetition of “again” expressing the ingrained imperative to act when patients experience cardiac arrest while echoing both the many previous resuscitations hospital staff well remember, along with the 2-beat, up-down muscle memory of performing chest compressions. ... Thus, a reflexive, futile endeavor becomes a human being’s dying moment, allowing us to feel closure. Debates around in-hospital resuscitation suddenly quieted, we recognize life’s inevitable finality, underscored by the poem’s ironically dignified resignation in its concluding line: “Never again did you wake.”Editor's note: Click here to access the poem, "Again."

Clinic combines ILD, palliative care to improve access for underserved patients Healio; by Richard Gawel; 10/18/24 Boston, MA - A subspeciality clinic that combined pulmonary and palliative care improved access to these treatments for diverse and underserved populations, according to an abstract presented at the CHEST Annual Meeting. The clinic also was effective in supporting patients as they completed advanced care planning, compared with a clinic for interstitial lung disease, Meghan Price, MD, internal medicine resident, Johns Hopkins Hospital, and colleagues wrote. ... Rebecca Anna Gersten, MD, assistant professor of medicine, established the Breathlessness Clinic (BC) in 2022 to provide both pulmonary and palliative care to treat patients with significant dyspnea and other symptoms due to their advanced lung disease. The clinic aims to provide targeted management of symptoms in addition to improving access to palliative care for patients who may have encountered obstacles in accessing palliative care, the researchers said.

Communication gaps among clinicians may limit conversations about prognosis, hospice Healio - HemOncToday; by Jennifer Byrne; 10/16/24 Clinicians in acute or post-acute care settings may delay or avoid serious illness conversations with patients whose cancer prognoses are worsening out of deference to the patient’s oncologist, according to study findings. Researchers conducted 37 semi-structured interviews with physicians and leaders in hospital medicine, oncology, palliative care, home health care and hospice. Investigators coded and analyzed the interviews using thematic content analysis. Evaluation of the responses yielded insights into how care silos, lack of clear clinical roles and other factors may affect communication between oncologists and other clinicians. ... "We know that the 3-month window after an older adult with cancer is discharged to a skilled nursing facility can be comprised of complex medical decision making and changing preferences of care. Lack of appropriate serious illness communication during this time can result in unwanted hospitalizations and unwanted, aggressive care at the end of life."

Exploding physician union membership signals a significant labor market shift NJToday.net; 10/16/24 As of 2022, about 70,000 medical doctors in the United States, or about 8% of the physician workforce, belonged to a union—a notable increase of 26.8% since 2014. This shift reflects significant changes in the employment landscape for doctors, with nearly half of all physicians now working for health systems or large medical groups. The rise in union membership comes amidst broader labor movements in healthcare, highlighted by the 2023 Kaiser Permanente strike, recognized as the largest healthcare worker strike in U.S. history. While nurses have typically led these efforts, physicians and residents are increasingly exploring unionization as a means to advocate for improved pay, benefits, and working conditions. 

Care utilization for neurodegenerative diseases compared to patients with cancer Physician's Weekly; 10/14/24 Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood.  Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer. ... The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. ... The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer. 

Kaiser Health Care: Navigating Aging: Older men’s connections often wither when they’re on their own Tahlequah Daily Press; by Judith Graham; 10/12/24 At age 66, South Carolina physician Paul Rousseau decided to retire after tending for decades to the suffering of people who were seriously ill or dying. It was a difficult and emotionally fraught transition. … Seeking a change of venue, Rousseau moved to the mountains. … Soon, a sense of emptiness enveloped him. … His work as a doctor had been all-consuming. Former colleagues didn’t get in touch, nor did he reach out. His wife had passed away after a painful illness, … His isolation mounted as his three dogs, his most reliable companions, died. Rousseau was completely alone — without friends, family, or a professional identity — and overcome by a sense of loss. “I was a somewhat distinguished physician with a 60-page resume,” Rousseau, now 73, wrote in the Journal of the American Geriatrics Society in May. “Now, I’m ‘no one,’ a retired, forgotten old man who dithers away the days.” In some ways, older men living alone are disadvantaged compared with older women in similar circumstances. Research shows that men tend to have fewer friends than women and be less inclined to make new friends. Often, they’re reluctant to ask for help.

The death issue: Austin’s Children’s hospice professionals advocate for honesty The Austin Chronicle; by Maggie Quinlan; 10/11/24 Sometimes parents wait too long to tell their sick children that they will die. Sometimes, by the point of disclosure, their child can no longer speak. ... She said often the dying child will become an “emotional caretaker” in the hospital room where they’ve just learned that their illness will kill them. “Even though it’s happening to them, they tend to really want to protect their family.” It doesn’t have to be that way. Cosby says a lot of the job is beautiful, even fun. Families make memories, and child life specialists help make it happen. They go to see the ocean. They throw private proms and graduation ceremonies. They finger paint. They crack jokes. They decide to make the most of precious little time. ... “Grief is the price of love, and there’s so much love in there,” says Heather Eppelheimer, another Dell Children’s child life specialist. “We have to be able to love fully in order to also grieve fully.” Child life specialists respect family wishes and also advocate for honest, clear language about death. They say to use that word – death, dying, die – and avoid “passing away” (“To where?” Cosby asks). That kind of straightforward communication isn’t part of our cultural hardwiring, Cosby says, but it makes everything easier. In her life, when people aren’t comfortable talking about death, she asks why. What are they afraid of? ...

University of Maryland bolstering palliative care workforce via master’s degree, certification program Hospice News; by Molly Bookner; 10/7/24 The University of Maryland, Baltimore (UMB) School of Pharmacy is seeking to address the dearth of palliative care-trained clinicians and improve care among seriously ill patients. By 2060, the demand for palliative care is expected to nearly double, according to the World Health Organization. Yet, despite this need, significant gaps in training remain, with many professionals lacking exposure to hospice or palliative care during their schooling. UMB seeks to bolster the palliative care workforce through its online Graduate Studies in Palliative Care program, launched in 2017. While most palliative care clinical education programs see small cohorts of five or fewer students, UMB is seeing a larger crowd of professionals enter the workforce. Of the Class of 2024, 36 students received their Master of Science degree and seven received a graduate certificate. “We have an amazing diversity of students,” Mary Lynn McPherson, professor in the Department of Practice, Sciences, and Health Outcomes Research at the School of Pharmacy and executive program director of Graduate Studies in Palliative Care, told Palliative Care News. 

Caring for Hindu patients at the end-of-life: A narrative review Cambridge University Press; by Brinda Raval Raniga, MD, Savannah Kumar, MD, Rebecca McAteer Martin, MD, and Craig D. Blinderman, MD; 10/3/24  This paper reviews the existing literature to identify specific challenges that may arise in the context of providing palliative and end-of-life (EOL) care for Hindu patients in the physical, psychological, and spiritual domains. We offer practical strategies where appropriate to mitigate some of these challenges. We review how the Hindu faith impacts EOL decision-making, including the role of the family in decision-making, completion of advance directives, pain management, and decisions around artificial nutrition and hydration (ANH) and cardiopulmonary resuscitation (CPR). 

I watched "His Three Daughters" on Netflix, and have to talk about how relatable the family conflict is Y!entertainment.com; by Corey Chichizola; 9/25/24 The streaming wars are showing no signs of slowing down, with the various services offering a variety of new and exciting content. One new film that might end up being one of the best Netflix movies out there is Azazel Jacobs' His Three Daughters, which is streaming now for those with a Netflix subscription. I recently streamed the flick, and have to talk about the family dynamics, especially as we slowly get closer to The Holidays. His Three Daughters focuses on (you guessed it) three sisters, adult women who are forced to cohabitate as their father is in hospice care. Director Azazel Jacobs put tributes to hospice nurses in the film, but other than that its largely about the three women's relationships with each other. And I loved how realistic it felt, especially in the way that family occasions tend to bring out honesty among relatives... for better or worse. Editor's note: This movie is getting alot of media buzz. I watched it and found the family's dynamics through their father's final days of actively dying to be spot-on. However--especially since "hospice" is core to the story--I was concerned about some basic communications and practices from the the hospice nurse. Examples include discussions about calling 911, what to do when the death occurs, no sense of a larger hospice team or  agency support (just these 2 nurses), an ICU-like monitor, and (yikes!) smoking inside a small apartment with the father's oxygen machine nearby. (Oh no!) I put these forth as you hear others talk about this "hospice" movie. Still, the family conflicts--specific to their father's dying--are indeed "relatable," authentic, and worth the watch.

‘Think like a reviewer’: How hospices can use communication, documentation to boost quality McKnights Home Care; by Adam Healy; 9/24/24 Regulators are tightening their scrutiny of the hospice industry, so providers must prioritize the documentation and communication practices that help them obtain higher quality scores. That’s according to hospice industry experts who spoke during an educational session at the National Hospice and Palliative Care Organization’s annual meeting in Denver. “They’re looking closely at the hospice industry,” Angela Huff, senior managing consultant at Forvis Mazars, said last week during the conference. “They have increasing concerns about fraud, waste and abuse in this space. … Don’t think this is going to stop.” ... A key part of hospice quality assurance is communication, Gallarneau said. Providers should support open, friendly channels of communication. This helps staff and clients feel comfortable raising concerns, making quality issues easier to tackle quickly and effectively. Also, prioritizing accuracy in documentation will help providers stay ready for any surveys or audits, Gallarneau noted. Hospices should ensure patient consent and election of benefit forms are properly filled out, signed and dated, and staff should all be trained to do so accordingly. 

The power of collaboration: Pharmacists and nurses partner to enhance patient care American Society of Health-System Pharmacists (ASHP) News Center; by Karen Blum; 9/23/24 Pharmacists and nurses work together on today's most pressing health challenges - from managing heart failure to deprescribing in palliative care to tackling obesity in pre-transplant patients. The Collaborative Care Grant for Nurses and Pharmacists from the ASHP Foundation and American Nurses Foundation recognizes the potential impact of this interdisciplinary teamwork on improving healthcare outcomes. At UPMC Presbyterian Hospital, the grant program helped fund the creation of a medication optimization clinic (MOC) for those with heart failure with reduced ejection fraction. “It made a lot of sense to bring together our collective expertise to manage these patients to get them on more optimal medications,” said James Coons, a clinical pharmacist in cardiology at UPMC Presbyterian Hospital. Coons, an ASHP member and professor at the University of Pittsburgh School of Pharmacy, worked with nurse practitioner and longtime collaborator, Jennifer Kliner, on the project.

Oncology leaders call for ‘ethical deployment’ and ‘responsible use’ of AI in cancer care Healio; by Josh Friedman and Matthew Shinkle; 9/25/24 The AI revolution already has transformed delivery of cancer care. New algorithms rapidly identify patterns or abnormalities on imaging, improving diagnostic accuracy. Large language models can craft responses to patient questions, and machine learning predicts treatments to which a patient is most likely to respond. ... Oncologists are grappling with complex issues as they integrate AI into cancer care, according to results of a nationwide survey. Most oncologists believe they should have the ability to explain how AI models work and must protect patients from biased AI, findings published in JAMA Network Open showed. Most respondents also indicated patients should consent to use of AI before it is implemented in practice. ... Despite the potential benefits of AI to improve decision-making and outcomes, clinicians have expressed concerns about ... AI bias; the ability of AI to detail its decision-making process; who bears responsibility for errors or misuse; and whose treatment recommendation takes precedence when a physician and AI do not agree.