Literature Review

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.

HopeHealth CMO: Hospice rules for ‘unrelated care’ getting stricter Hospice News; by Jim Parker; 9/25/24 Dr. Ed Martin began working in hospice in 1987 after hearing families talk about their experiences with those services. Today, he is chief medical officer of Rhode Island-based HopeHealth. The more than 50-year-old nonprofit organization also serves parts of Massachusetts. Martin recently spoke about the complicated issue of care that is deemed “unrelated” to a patient’s terminal diagnosis at the National Hospice and Palliative Care Organization’s Annual Leadership Conference in Denver. Hospice News sat down with Martin at the conference to discuss how he and his organization are addressing the matter of unrelated care, as well as the efficacy of requirements for an addendum to the election statement. [Click on the title's link to continue reading this interview.]

Hospital nurse turnover, vacancy rates by year Becker's Clinical Leadership; by Mackenzie Bean; 9/24/24 Nurse turnover and vacancy rates have declined since their pandemic-era peaks but remain elevated, according to data from the "2024 NSI National Health Care Retention & RN Staffing Report." The report, released in April, includes survey findings from 400 hospitals in 36 states on registered nurse turnover, retention, vacancy rates, recruitment metrics and staffing strategies. Survey data covers more than 194,000 nurses and was collected in 2023. ... Below are the average rates of registered nurse turnover and vacancy in hospitals between 2019 and 2024, according to the report. The data suggests hospitals have made progress in reducing nurse turnover and vacancy rates since their peak during the pandemic. However, sustained efforts to stabilize the workforce, improve working conditions and address burnout are needed to fully recover.

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.

The evolving landscape of Amyotrophic Lateral Sclerosis: A fatal disease!  Delveinsight; 9/24/24 Amyotrophic Lateral Sclerosis (ALS) is a devastating neurodegenerative disease characterized by the progressive degeneration of motor neurons, leading to muscle weakness, paralysis, and ultimately, death. ... Despite ALS being relatively rare, affecting 2-5 per 100,000 people worldwide, the question Is ALS on the rise? is gaining attention. While global prevalence has not significantly increased, improved diagnostic techniques, earlier detection, and greater awareness have led to a more accurate identification of ALS cases. Many researchers believe that enhanced surveillance and better tools for genetic testing are uncovering more cases than previously recognized, rather than a true rise in the disease’s incidence. However, with an aging global population, the burden of ALS may grow, as age is a major risk factor. Editor's note: Do you provide disease-specific training for your staff? ALS patients' and families' needs are unique. A significant disease comparison is between ALZ (Alzheimer's) and ALS. With ALZ (Alzheimer's), the brain decreases its abilities to function while the body can remain strong; the person is mobile with cognitive limitations. In contrast, with ALS, the body decreases its abilities to function while the brain/mind/emotions can remain strong. The person is immobile with cognitive awareness, but extreme physical limitations in communicating one's thoughts, emotions, and needs. ALS-specific communication tools provide crucial help for all. For more information in your location, visit The ALS Association's USA map.

How Gen Z is being courted by post-acute providers Modern Healthcare; by Diane Eastabrook; 9/18/24 Some post-acute care companies are revamping their recruitment playbooks to attract Generation Z workers as they battle for talent with other healthcare companies. Providers such as Good Samaritan Society, Bayada Home Health Care and Right at Home are developing strategies to recruit the demographic, which ranges in age from 12 to 27 and makes up a quarter of the U.S. population. Those organizations want to hire Gen Z because they are purpose-driven and adept at using technology, according to a 2023 study by financial services company Mercer. 

Death is no enemy Psychiatric Times; by Sidney Zisook, MD; 9/17/24... As mental health clinicians, we often confine our conversations about death and dying to recognizing suicide risk and preventing suicide. And for good reason. Suicide is the 11th leading cause of death in the United States, ... Far less attention is paid by mental health clinicians to other aspects of death and dying. But we are human, first and foremost, and coping with a host of issues related to the end of life is inextricably bound to both our professional and personal lives. Like it or not, death is part of life. We, as mental health clinicians, are not always as prepared as we would like to be to help ourselves, our loved ones, our patients, and their loved ones deal with loss, dying, death, and bereavement. For many physicians, 1 or 2 hours in medical school and perhaps another few hours during residency are all the training we receive in these complex and challenging clinical issues. ...  Chochinov provides a clinician’s guide for “being with” dying patients. He offers ways of providing intensive caring to enhance empathy, respect, connectivity, and hope, and to make the experience of a dying patient more tolerable than it otherwise might be. ... I have utilized his Patient Dignity Question, which asks, “What do I need to know about you as a person to take the best care of you possible?” on several occasions with gratifying results for both the patient and me.

AI 'early warning' system shows promise in preventing hospital deaths, study says Pique NewsMagazine, Toronto, Canada; by Nicole Ireland; 9/16/24 An AI early-warning system that predicts which patients are at risk of deteriorating while in hospital was associated with a decrease in unexpected deaths, a new study says. The study, published Monday in the Canadian Medical Association Journal, found a 26 per cent reduction in non-palliative deaths among patients in St. Michael's Hospital's general internal medicine unit when the AI tool was used. "We've seen that there is a lot of hype and excitement around artificial intelligence in medicine. We've also seen not as much actual deployment of these tools in real clinical environments," said lead author Dr. Amol Verma, a general internal medicine specialist and scientist at the hospital in Toronto. "This is an early example of a tool that's deployed that was rigorously tested and evaluated and where it's showing promise for actually helping improve patient care." ... The technology called CHARTwatch continuously analyzed more than 100 different pieces of information about each patient in the unit, Verma said. When the AI tool predicted that a patient was deteriorating, it sent an alert to physicians and nurses, prompting them to quickly intervene.

Talk about death, but live your life: What people working in end-of-life care have learned Yahoo Life; by Elena Sheppard; 9/16/24 Eventually, we are all going to die. It’s a reality that most people are uncomfortable with and do everything they can to avoid thinking about. But for people who work in end-of-life care, such as hospice workers and death doulas, death is both a fact of the job and a part of their everyday reality. While the work may sound grim, those who do it say that their daily proximity to death doesn't cast a shadow over their lives; rather, it has enabled them to more purposefully celebrate life’s beauty. ... Yahoo Life spoke to hospice professionals to hear the life lessons they’ve learned by working so closely with death. Here’s what they said. ...