Literature Review

How poor communication is killing patients and burning out doctors Medpage Today's KevinMD.com; by Pamela Buchanan; 1/14/25 This week alone, I had two particularly heart-wrenching encounters [as an Emergency Room physician]: A 65-year-old man with metastatic lung cancer, convinced his shortness of breath was just pneumonia. When I explained the progression of his disease, he was shocked. No one had told him that his cancer was likely incurable. A 97-year-old woman brought in for “failure to thrive.” She was frail, pale, and not eating—classic signs of the final stages of metastatic cancer. When I suggested hospice care, she seemed blindsided, as if this reality was completely new to her. Both cases highlight a troubling trend: Patients often come to the ER not just for care, but for clarity. They don’t understand their diagnosis, prognosis, or treatment plan. ...

Introduction: ‘Those who have made death their life’The Daily Yonder - Keep It Rural; by Hannah Clark; 1/15/25 Hannah Clark spent six months riding along with the nurses and certified nursing assistants (CNAs) of Hearth Hospice who provide in-home care to those living in Northwest Georgia and Southeast Tennessee. These hospice workers often drive up to a hundred miles a day to visit a handful of patients scattered across the Appalachian landscape in both rural towns and urban centers. What will follow this introductory essay is her photo reportage in three parts, documenting what she has witnessed accompanying these caregivers. The intimate portraits and vignettes show tender moments at different stages towards the end of one’s life. Their beauty lies in the companionship Clark captured in moments of need and vulnerability. 

Medical schools report steep drop in enrollment of Black and Hispanic students after Supreme Court ruling STAT; by Usha Lee McFarling; 1/9/25Enrollment of Black and Hispanic students in medical schools dropped precipitously last year after the Supreme Court banned the consideration of race in admissions, according to data released Thursday by the Association of American Medical Colleges. The number of Black enrollees fell by 11.6% compared to last year, while the number of Hispanic enrollees decreased 10.8%. The numbers were even starker for Indigenous students; the number of American Indian or Alaska Natives dropped by 22.1%, while students who were Native Hawaiian or Pacific Islanders dropped by 4.3%. 

Home … where we all want to be The Journal; Dr. Sarah Phillips, Medical Director Hospice of the Panhandle; 1/12/25 Two days before Christmas, I arrived at the home of a patient who had been recently admitted to Hospice services. ... [Story of the patient being on a ventilator in a hospital.] This courageous and self-determined woman expressed the desire to be free from pain, suffering, and the complications and progression of her disease. Knowing that the ventilator was life-sustaining and essentially breathing for her, she made the decision to stop it. To ensure her comfort during discontinuation of the ventilator, the hospice team was present before, during, and after the procedure. Medications were used to ease shortness of breath, pain, and anxiety. ... “It’s a Wonderful Life” was playing on the TV, the Christmas tree was lit. I looked over and see the daughter wiping away her mother’s tears. Each reassured the other that everything will be OK and that they are at peace with this decision. As the medications took effect, the patient drifted off to sleep. The ventilator was stopped. Next, something happens that I will never forget. The daughter leans in and whispers to the patient, “Mom, the ventilator is off now, you are back in total control. This was profound to me on many levels. It certainly spoke to the power and importance of autonomy, the ability to make independent decisions that are aligned with one’s values and goals. ... Despite working in end-of-life care for over a decade, I still have these moments of being overwhelmed by the human spirit.

3 nurse specialties with highest, lowest pay Becker's Hospital Review; by Kelly Gooch; 1/13/25 From January through July 2024, staff registered nurses involved in direct patient care saw their median base pay increase by 2%, compared to 1.4% for those in indirect patient care. However, RNs involved in direct and indirect patient care were poised for annual increases of 3% to 4% to close out 2024. ... The survey includes six-month percentage change data from January through July 2024. It is based on data from more than 700 participating organizations, representing approximately 358,000 individuals across over 115 nursing roles, including RNs, nursing managers and licensed practical nurses. [Click on the title's link for this important data.]

Largest health care strike in Oregon history begins as thousands picket Providence Hospitals FM News 101 KXL, Portland, OR; 1/10/25 Some 5,000 hospital health care workers walked off the job Friday as they picketed all eight Providence hospitals in Oregon, in what the state health workers union described as the largest health care strike in Oregon history — and the first to involve doctors. Most of those participating in the open-ended strike are nurses. But in a rare move, dozens of doctors at a Portland hospital and at six women’s health clinics are also partaking, making it the state’s first physicians strike, according to the Oregon Nurses Association union.

How agilon health trains primary care physicians to provide palliative care Hospice News; by Jim Parker; 1/8/25 The senior care company agilon health (NYSE: AGL) has scaled a palliative care education model for its physician partners throughout most of the markets they serve. ... A 2023 study published in the Journal of Pain and Symptom Management found that the primary care-led, integrated approach to palliative care that agilon employs were two-thirds less likely to die in a hospital and on average spent five more days at home near the end of life. Hospice News sat down with agilon’s CMO, Dr. Karthik Rao, to talk about the ways the company prepares physicians to provide palliative care to their most seriously ill patients. [Key goals include:]

Managing clinical care after M&AHealthleaders; by Christopher Cheney; 1/6/25Coping with the challenges of mergers and acquisitions has become an essential responsibility for CMOs.

Hospice workers share the foods that bring patients comfort till the end: Plus, they reveal how families can support their loved ones with scents, small bites and shared memories HuffPost; by Julie Kendrick; 12/30/24... We all live, we all die and we all enjoy food along the way. The memory and meaning of food, along with the bliss of being able to savor a cherished flavor, are still present in our lives, even as we head toward a last meal, a soothing sip of water or a final bit of sustenance. “Food often plays an emotional role in the last stages of life,” said Dr. Kurt Merkelz, the chief medical officer at Compassus, a home-based care company. “Some patients may reminisce about favorite meals or foods that connect them to fond memories and loved ones. There are instances where patients crave a specific dish that reminds them of their family or heritage, even if they can’t eat much.” ... People often ask for things like mashed potatoes, ice cream and chicken soup, according to Gail Inderwies, the founder and president of KeystoneCare, a hospice and home health provider in Pennsylvania. ... Sometimes, those comforts are part of a culinary heritage.

As a hospice nurse, Jaffrey's Nancy Folsom helps make the journey easier The Keene Sentinel, Keene, NH; by Elijah de Castro; 12/28/24 Nancy Folsom has been working around death since she was a teenager in her family’s funeral home, where she was an embalmer apprentice. From there, she took a step back, pursuing a career as a home hospice nurse in the Monadnock Region, where she helps those who are dying confront death. “Death is never easy, at any age or any time,” Folsom said. “We want to make it as human as possible. I’ve always been comfortable with death.” ... Folsom, 62, of Jaffrey, “has never had a boring day” on the job. When she’s not out in the community working, she’s in the Peterborough office of Home Healthcare, Hospice and Community Services, a local nonprofit provider of home health services that also has offices in Keene and Charlestown. ... Over the years, Folsom has gained experience in how to best read a situation when she gets a new patient. Building trust between a hospice nurse and a patient, Folsom said, takes time, something many of her patients don’t have. Folsom resolves this dilemma by first making sure she is comfortable herself and cultivating a calm, abiding presence. ...

Physician union drives skyrocketed in 2023 and 2024, data show MDedge - Cardiology; by Randy Dotinga; 12/20/24 While fewer than 10% of US physicians are unionized, the number of official union drives among private-sector doctors have skyrocketed in the last 2 years, compared with 2 decades prior, according to a new study.  Researchers counted 21 union drives in 2023 and 12 in the first 5 months of 2024, compared with 0-6 drives each year between 2000 and 2022. If the 2023 and 2024 drives succeed, unions will represent 3523 new physicians — nearly equal to the 3541 doctors who sought unionization between 2000 and 2022. “We were able to document a significant uptick in union petitions and success in certification drives,” said corresponding author Hayden Rooke-Ley, JD, of the Center for Advancing Health Policy Through Research, Brown University School of Public Health, Providence, Rhode Island. “We were surprised to see such a marked shift in 2023.” ... The study authors launched their research to better understand trends in physician unionization in light of high-profile union drives, especially among residents. Rooke-Ley said: “We suspected that declining morale and increased corporate employment for physicians were leading them to consider unionization.”

Palliative care, mental health services underutilized in pancreatic cancer Healio; by Jennifer Byrne; 12/19/24 Individuals with pancreatic cancer underutilized palliative care and mental health services, according to a retrospective analysis. ... Researchers from Saint Louis University used electronic health record data from Optum’s Integrated Claims-Clinical Data set to identify 4,029 patients with newly diagnosed pancreatic cancer. The investigators then used ICD-9/10 codes to identify subsequent diagnoses of anxiety and depression, as well as palliative care consultations. ... Results showed higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%) among patients who had palliative care consultations than those who did not have documented consultations. ... Healio: Did any of your findings surprise you? Divya S. Subramaniam, PhD, MPH: It was unexpected to see that palliative care consultations, despite identifying higher levels of anxiety and depression, did not increase treatment rates for these mental health conditions. This suggests mental health might not yet be a central focus in palliative consultations, which often concentrate on managing physical symptoms.

Which skills will survive the AI onslaught? National Association of Corporate Directors (NACD), Arlington, VA; by Vivek Sharma and David C. Edelman; 12/17/24 ... Boards and CEOs are inundated with reports projecting doomsday scenarios of job displacement due to AI. For example, according to the World Economic Forum's The Future of Jobs Report 2020, automation and AI are expected to displace 85 million jobs globally by 2025, especially in industries such as manufacturing, data entry, and customer service due to the repetitive nature and predictable processes of these fields. AI is already disrupting many roles hitherto considered firmly within the human domain. ... Irreplaceable Human Dimensions ... In analyzing a wide range of articles on the topic, when a job scores high along any of the following three dimensions, it creates significant hurdles for displacement by AI: