Literature Review

Why difficult conversations matter: How delivering bad news with clarity and empathy impacts both provider and patient Cedars Sinai, by Cassie Tomlin; 4/8/24Good physicians rely on a battery of hard-won skills to treat serious illness—they observe, predict, test, prescribe and diagnose. But many physicians haven’t been taught how to have productive, mutually beneficial conversations—such as sharing a life-changing diagnosis or informing patients about disease trajectory and symptoms, prognosis and end-of-life care. High-impact communication tools can be learned at any point in a physician’s career, says Jessica Besbris, MD, director of Neuropalliative Care and the Neurology Supportive Care Medicine Program at Cedars-Sinai. Here, Besbris shares why such careful conversations matter for everyone involved, and ways physicians can improve how they discuss serious illness.

New hospice physician requirements sow claims submission confusionMcKnights Home Care, by Adam Healy; 4/8/24As hospice providers prepare for new physician certification rules going into effect next month, many are still seeking clarification from the Centers for Medicare & Medicaid Services on how the new rules will affect claims processes, experts said in a recent webinar. “The new requirement is effective May 1, 2024,” Katie Wehri, director of regulatory affairs for the National Association for Home Care & Hospice, said during the webinar Thursday. “We know that is right around the corner, and we have some concerns about that date, frankly, because of some of the inconsistent instructions that we have seen from CMS.”

Translation and validation of the Chinese version of Palliative Care Self-Efficacy ScalePalliative & Supportive Care; by Junchen Guo, Yongyi Chen, Boyong Shen, Wei Peng , Lianjun Wang, Yunyun Dai; 4/8/24[This] study aimed to translate, adapt, and validate the Palliative Care Self-Efficacy Scale (PCSS) among Chinese palliative care professionals. ...Significance of results: The findings from this study affirmed good validity and reliability of the C-PCSS [Chinese-PCSS]. It can be emerged as a valuable and reliable instrument for assessing the self-efficacy levels of palliative care professionals in China.

Medicine—Both a Science (Care) and an Art (CARE) JAMA Network - Viewpoint; by Theodore J. Strange, MD and Mario R. Castellanos, MD; 4/3/24In the current era, health care is increasingly characterized by the integration of big data, predictive analytics, medical devices, and artificial intelligence. These technological advancements have undoubtedly transformed the landscape of medical care, offering unprecedented precision and efficiency in diagnosis and treatment. Yet, amidst this surge of scientific innovation, the timeless art of medicine (compassion and caring) remains a foundational aspect of patient-centered health care ... The acronym CARE (compassion, assistance, respect, and empathy) encapsulates these enduring values. ... In a world increasingly driven by data and algorithms, these qualities foster a trusting and supportive relationship between health care professionals and patients, thereby enhancing the healing process and enriching the overall health care experience.

A day in the life: Hospice nurseDaily Nurse - The Pulse of Nursing; blog by Renee Hewitt; 4/8/24 Supporting someone with a life-limiting diagnosis or talking about death can be difficult for many people, but not for a hospice nurse. What’s it like to care for patients and their families in the end-of-life process? Maryette Williamson, RN, BSN, knows firsthand from working as a BAYADA Hospice Nurse in Fayetteville, North Carolina. We asked her about her work. What follows is our interview ... [From Maryette] ... "There was a learning curve from long-term care to hospice. The most significant difference in hospice is our focus on quality of life rather than a cure. That was the most important change for me."Editor's Note: Consider linking to this resource with your nurse recruitment tools. Hospice executives, this nurse's common transition when moving from long-term care to hospice. Ensure solid orientation/onboarding/precepting training, time, resources, support, and accountability for new hospice employees. Do not assume that they will automatically translate their years of practice into hospice principles and best practices. 

Improved onboarding process could boost worker retentionMcKnights Senior Living, by Kathleen Steel Gaivin; 4/8/24As long-term care providers navigate post-pandemic workforce challenges, they also need to improve the onboarding process, according to the results of a new survey by Viventium. ... The study detailed in the company’s 2024 Caregiver Onboarding Experience Report solicited responses from 175 administrators and caregivers in skilled nursing, assisted living, independent living, home health, home care and hospice care in November and December. The survey, Viventium said, found a “shockingly low bar for what passes as a ‘good’ onboarding experience, with strong indications that raising that bar could correlate to higher retention rates.”Editor's Note: See the article in today's newsletter, "A day in the life: Hospice nurse" for the importance of onboarding hospice nurses to to differences between long-term care and hospice care.

How a CU biostatistician is helping improve palliative care research University of Colorado - Anschutz Medical Campus, by Tayler Shaw; 4/3/24 

Study shows strong social ties may ease the way for older adults in life's final chapter Medical & Life Sciences, by Vijay Kumar Maleus; 4/4/24  Study Results: ... The analysis revealed that higher levels of loneliness were significantly associated with increased odds of experiencing anxiety, sadness, and pain in the last month of life, suggesting a pivotal link between social isolation and end-of-life symptomatology. Furthermore, marital status and the receipt of personal care were predictors of dying in a hospital, pointing to the influence of social support structures on the location of death. Interestingly, a larger social network was correlated with a higher likelihood of receiving hospice or palliative care, highlighting the potential benefits of broader social connections. 

Qualitative analysis of initial palliative care consultations in amyotrophic lateral sclerosis Journal of Pain and Symptom Management; by Christine L Watt, Ian C Smith, Jill Rice, Rebekah Murphy, Ari Breiner, Maria Duff, Danica Nogo, Shirley H Bush, Susan McNeely, Usha Buenger, Belinda Zehrt, Jocelyn Zwicker; 4/2/24, online ahead of print Background: Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs.

Neuropsychiatric effects associated with opioid-based management for palliative care patients

Palliative care could be a game changer for public health Harvard Public Health, by Meredith Lidard Kleeman; 4/4/24California and Hawaii are pioneering ways to expand access. ... California is one of the first states in the country to require insurance companies that administer Medicaid benefits to fully cover palliative care services for eligible residents. ... Palliative care is poised to be a game changer for public health. Nearly 50 percent of states now include palliative care services for eligible Medicaid recipients, according to C-TAC. And in California and Hawaii, two paths are being forged toward wider palliative care access. ... 

Blue Shield's Palliative Care Program wins national recognition for improving lives Blue Shield California; 3/28/24 During the first quarter of this year, the Journal of Palliative Medicine published results of a study entitled “Cost and Utilization Implications of a Health Plan’s Home-Based Palliative Care Program” from leaders at Blue Shield and researchers from West Health Research Institute that garnered attention from industry publications. ...  Major findings from the study were that home-based palliative care delivered to people not yet eligible for hospice reduced their hospital and emergency room use, showed trends towards an increased length of life, and extended the continuum of care for people with serious illness and their caregivers.

Ethical conflicts: Making care decisions when the right choice isn't clear Medical Economics, by Jeff Bendix; 3/29/24 What should a physician do when their ethical training conflicts with the circumstances or needs of a particular situation or patient? ... Ethical battlegrounds are growing. [Dr. Melissa] Lucarelli’s experience epitomizes, in a small way, a problem with which doctors have grappled for as long as medicine has existed as a profession: what to do when their ethical training conflicts with the circumstances or needs of a particular situation or patient. That question has taken on new urgency in recent years due to several converging trends.