Literature Review

Racial/ethnic differences in care intensity at the end of life for patients with lung cancer The ASCO Post, by Matthew Stenger; 3/21/24 The study used data from the California Cancer Registry linked to patient discharge data abstracts. The primary outcome measure was intensity of care in the last 14 days before death, with greater intensity defined as any hospital admission or emergency department visit, intensive care unit (ICU) admission, intubation, cardiopulmonary resuscitation (CPR), hemodialysis, and death in an acute care setting. ... The authors concluded: “Compared with [non-Hispanic White] patients, [Asian/Pacific Islander], Black, and Hispanic patients who died with lung cancer experienced higher intensity of [end-of-life] care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the [end of life].”

End-of-life care in heart failure MedPageToday; by Crystal Phend, reviewed by Andrew Perry, MD; 3/22/24 Palliative care has a perception problem. It's often associated with end of life or advanced cancer. However, cardiovascular disease actually accounts for a higher proportion of adults in need of palliative care than does cancer (38.5% vs 34%), according to the World Health Organization. Patients with heart failure (HF) have a median survival of about 5 years -- on par with many types of cancer, yet patients with cancer are much more likely to be referred to palliative care. 

8 likely next in-demand nursing roles, per Tampa General's chief nurse Becker's Clinical Leadership, by Laura Dyrda; 3/15/24 ... "In the next two to three years, the nursing team may require new roles and skills to adapt to the changing healthcare landscape," said Wendi Goodson-Celerin, DNP, APRN, senior vice president and chief nursing executive at Tampa (Fla.) General Hospital. Dr. Goodson-Celerin outlined potential roles and skills that may be in demand over the next two to three years:

Physicians often shy away from preparing their patients to dieToday'sHospitalist, by Colleen Poggenburg, MD, MS; 3/22/24 There's beauty in death if we can tolerate looking. ... The beauty in death is the reflections that occur in the weeks, days and minutes prior to it, which together make up a summary of someone’s life. Why then do physicians view this time-honored decline as a series of clustered medical problems, when it really is just someone moving toward death? Are we so concerned about treating just one more condition, and do we actually think it will solve the growing list of medical problems that dying patients have? ... I compared dying to pregnancy to “soften” the description of this decline. Here’s how I see that comparison: ...Editor's Note: The author offers a fascinating, meaningful comparison of physician/patient conversations with someone who is pregant versus someone who is dying. I encourage you to share this article with your clinical leaders (and adapt it for staff), as this model beautifully reframes important conversations that can empower patients and their families.

Palliative care in the older adult with cancer and the role of the geriatrician: a narrative review Annals of Palliative Medicine, by Bibban Bant Deol, Lisa Binns-Emerick, MOhammad Kang, Pragnesh Patel; 3/15/24 online ahead of print Conclusions: Embedding primary care geriatrics in the palliative care arena helps to provide more access to this care. This integration helps providers address basic symptom management, advance care planning and work with individuals on goals of care to assure the care being provided is congruent individual's priorities. Older adults respond to symptoms different than their younger counterparts. Management of these symptoms has to be addressed in a manner commiserate with their age.

Bill to help health workers with burnout moves ahead in Congress Modern Healthcare, by Michael Mcauliff; 3/20/24 A bill designed to help counter depression, burnout and suicide among healthcare providers cleared a key hurdle Wednesday, passing unanimously out of the House Energy and Commerce Committee. The Dr. Lorna Breen Health Care Provider Protection Reauthorization Act of 2024 updates and extends for five years an earlier version of the law. It funds grants for healthcare organizations and associations to run programs aimed at improving workers' mental health amid staff shortages and ongoing fallout from the COVID-19 pandemic. 

Frailty needs to be a factor in drug development, proposed guidelines suggest McKnights Long-Term Care News, by Kristen Fischer; 3/20/24A new report on strategies for geriatric drug development and assessment determined that drugs need to consider age as well as other factors that older adults face such as cognitive impairment, frailty and polypharmacy. This is according to the International Union of Basic and Clinical Pharmacology (IUPHAR) Geriatric Committee, which published the report. The strategies specifically focused on integrating frailty as a factor in drug development. The report, published in the Journal of the American Geriatrics Society earlier this month, includes 12 principles pertaining to frailty in reference to drug development. The recommendations include measuring frailty at the start of when a person goes on a drug they’ll likely take regularly.

Nurses practicing primarily in care homes ‘improve end-of-life care’ Nursing Times, by Steve Ford; 3/19/24 Nurses and other clinicians who specialise in working in care homes represent an important resource when it comes to improving the quality of end-of-life care for residents, a large US study suggests. Researchers found nurse practitioners working mostly in care homes may decrease the likelihood of residents experiencing stressful hospital admissions and improve the quality of life in their last days. 

SNFists found to reduce ‘burdensome’ end-of-life care McKnights Long-Term Care News, by Josh Henreckson; 3/18/24 Advanced practice clinicians who specialize in skilled nursing care help reduce the use of unnecessary care at end of life, according to new study results released Friday in JAMA Network Open. These physicians, nurse practitioners and physician assistants — who provide at least 80% of their evaluation and care visits in nursing homes — were referred to collectively as “SNFists” by the report authors. They reduced the burdensome care transitions that many residents face, benefiting both caregivers and their patients, the study confirms.

Giving hospice patients a dignified end-of-life experience Steve Adubato On the Air, with Charles Vialotti, MD; 3/13/24On--location at Villa Marie Claire Residential Hospice, Steve Adubato is joined by medical director, Charles Vialotti, MD to talk about his personal commitment to hospice care and giving residents and their families a dignified end-of-life experience.

Improvements in Interdisciplinary Communication Following the implementation of a standardized Handoff Curriculum: SAFETIPS (Statistics, Assessment, Focused Plan, Pertinent Exam findings, to Dos, If/Thens, Pointers/Pitfalls, and Severity of Illness) Cureus, by Shaefali Shandilya and Justen M. Aprile; 3/18/24 Handoffs between medical providers serve a crucial patient safety function. While most published literature on the topic studies the handover process among physicians, robust literature is available on interdisciplinary medical communication. Little is known about the downstream effects of effective physician handover on subsequent physician and nursing interactions. ...Results: Statistical analysis revealed significant post-intervention mean score increases of one full point in four categories, namely organization and efficiency, communication, content, and clinical judgment.

Navigating difficult conversations with patients with terminal cancer diagnoses Oncology Nursing News, by Darlene Dobkowski, MA; 3/18/24 Although oncology nurses need strong communication skills to help all of their patients navigate their cancer journeys, it is critical to have the ability to have difficult conversations with patients who received a terminal diagnosis, ... Betty Ferrell, Ph.D., M.S.N., CHPN, director and professor in the Division of Nursing Research and Education in the Department of Population Sciences at City of Hope in Duarte, California, said in an interview with Oncology Nursing News. For the past 24 years, her institution has been directing a project called the End-of-Life Nursing Education Consortium (ELNEC), which is a palliative care training program and includes a module focused on communication.  ... “One of the things that we teach nurses is … that your No. 1 job is to listen,” Ferrell said. “Another thing that we say to nurses is, it is not your job to have all the answers. Patients ask very unanswerable questions. ‘Why me?’ is not an answerable question. But when a patient says, ‘Why me,’ then we want nurses to have good communication skills to say, ‘I can imagine why you're asking that question. Because as you've shared with me, you had no idea that you might be diagnosed with cancer, or you're the first person in your family to ever have cancer.’”