Literature Review

Rhode Island: Physician-assisted suicide bill reintroduced in state legislature The Brown Daily Herald, by Maya Kelly; 3/1/24House Bill 7100 would legalize prescription of lethal medications to patients wiht less than six months to live. ... [Read this article for more history.] ... Joan Teno, an adjunct professor of health services, policy and practice, noted that medical professionals are “strictly protected” by the bill: if a healthcare provider does not wish to prescribe a lethal medication, they are under no obligation to do so. Physicians are also immune from accusations of unprofessional conduct as long as the patient meets all requirements. 

"The great escape": How an incident of elopement gave rise to trauma informed palliative care for a patient experiencing multiple disadvantage BMC Palliat Care, by Sam Quinn, Libby Ferguson, Derek Read, and Naomi Richards; 2/28/24Background: This case report ... illustrates how unresolved traumatic experiences across the life course can affect a patient's engagement with palliative care and offers insights into the flexibility and adaptations necessary for taking a trauma informed approach to care for an individual experiencing multiple disadvantage. 

Many older adults don't receive palliative care before deathMedScape, by Marilynn Larkin; 2/28/24 "One of the challenges and a barrier to accessing palliative home care is the difficulty of predicting survival," Amy Hsu, PhD, an investigator at the Bruyère Research Institute in Ottawa, Ontario, Canada, told Medscape Medical News. "Clinicians are good at prognosticating when a patient might be entering their last 3-6 weeks of life, but they have a harder time predicting if someone will survive 6 months or longer."  The team developed the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) to see whether access to predicted survival data could inform conversations about a patient's status and palliative care needs. The study was published online on February 26 in the Canadian Medical Association Journal.

House set to vote on bill that could give dramatic boost to nurse-aide training efforts McKnights Long-Term Care News, by Josh Henreckson; 2/28/24 A bill that could reshape how new workers enter the long-term care workforce is scheduled for a vote in the US House of Representatives this week, according to a spokesperson for House Majority Leader Steve Scalise (R-LA). If passed, HR 6585 — referred to as the Bipartisan Workforce Pell Act — would make work training programs of as short as eight weeks with a minimum of 150 hours of training eligible for the federal aid through the Pell Grant program. Previously, grants were available only to programs with a minimum of 15 weeks and 600 hours of training.

Are we consulting, sharing care, or taking over? A conceptual frameworkPalliat Med Rep, by José Pereira, Christopher Klinger, Hsien Seow, Denise Marshall, Leonie Herx; 2/23/24Background: Primary- and specialist-level palliative care services are needed. They should work collaboratively and synergistically. Although several service models have been described, these remain open to different interpretations and deployment.Aim: This article describes a conceptual framework, the Consultation-Shared Care-Takeover (C-S-T) Framework, its evolution and its applications.

Is healthcare paying enough attention to nurse leaders?Becker's Clinical Leadership, by Erica Carbajal; 2/26/24 Early this year, the American Organization for Nursing Leadership Foundation released findings from more than 2,400 nurse leaders who were surveyed in November. Thirty-five percent of respondents indicated they were considering an exit from their roles: 12% said they intend to leave and 23% said they may leave within the next six months. When asked what the top reasons were for thinking about an exit, nurse leaders pointed to work having a negative affect on their health and well-being and not having the resources to do their job — a parallel to what bedside nurses consistently point to as drivers of burnout or reasons they've stepped away from the job. 

Embracing the platinum rule in palliative care: Treating patients the way they want to be treated Anschutz, by Tari Advani, MD; 2/26/24 One of the first take aways from this journey, for me, in a mid-career directional change from emergency medicine to palliative care was a move away from the golden rule and towards the platinum rule. Treat patients the way they want to be treated, not the way we want to be treated. It is so simple, it allows people to exist in their own context, with their own histories and their own wishes. And, we, as caretakers, take the kind of care of them that they want. Where had that idea been during the past 20 years of my career? How many situations had I judged, wrongly, based on my own preferences, not the preferences of the patient.

Racial differences in shared decision-making about critical illnessJAMA Intern Med, by Deepshikha C. Ashana, MD, MBA, MS; Whitney Welsh, PhD; Doreet Preiss, PhD; et al; published online 2/26/24Question: How do critical care clinicians approach shared decision-making with Black compared with White caregivers of critically ill patients?Findings: In a thematic analysis of 39 audio-recorded clinician-caregiver meetings, racial differences were most evident in the following clinician behaviors: providing emotional support to caregivers, acknowledging trust and gratitude expressed by caregivers, disclosing medical information, and validating caregivers' treatment preferences.

Being there for a loved one's final breaths NextAvenue, by Elaine Soloway; 2/26/24"I'll be downstairs," I told him one night. "And I'll be up to kiss you goodnight before I go to sleep." He smiled and squeezed my hand. I had barely settled on the couch when the hospice worker appeared at the top of the stairs. "He's gone," she said. I learned this pause is not unusual. Hospice workers report that some people who are dying wait to be alone for their final breaths.

Understanding the discordance about prognosis between clinicians and terminally ill patients and their surrogates: A conversation with Douglas B. White, MD, MASThe ASCO Post, by Jo Cavallo; 2/25/24Research shows that about half of adults near the end of life in the United States are too ill to participate in decisions about whether to accept life-prolonging treatment, requiring family members and other proxies to serve as surrogate decision-makers for their critically ill loved ones. However, research also shows that surrogates of patients with advanced illness often have optimistic expectations about prognosis, which often lead to the increased use of invasive treatment (including life support) in dying patients and delays in the integration of palliative care.

From classroom to clinic: End-of-life conversations — there’s empathy in foresightThe Tufts Daily, by Deeksha Bathini; 2/21/24Palliative care physicians have conversations with families to identify patient wishes, particularly when they are facing death. These physicians are equipped with training that emphasizes empathy, comfort and patient autonomy. Freedom of choice during the dying process gives patients the power to reclaim their agency amidst a process rife with uncertainty.

Vancouver hospital asked wrong family whether to pull the plug on patientKGW8 NBC News; 2/21/24In a terrible case of mistaken identity that has never been publicly disclosed, KGW found PeaceHealth Southwest Medical Center in Vancouver allowed a family to pull the plug on the wrong man. “We made life-ending decisions for a person we don’t even know,” said Danielson’s husband, Gary.

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.