Literature Review

AAHPM CMO Joe Rotella: Hospice does not exist to save money Hospice News; by Jim Parker; 6/17/24Dr. Joe Rotella, chief medical officer of the American Academy of Hospice and Palliative Medicine (AAHPM), calls on hospices to maintain their core principles amid a churning sea of regulatory and economic changes. Rotella began his medical career as a primary care physician in a small, rural town in central New Hampshire, where he stayed for 12 years [followed by serving Hospice & Palliative Care of Louisville, KY/Hosparus as Chief Medical director for 15 years]. ... Now, Rotella will soon retire from AAHPM. Hospice News sat down with Rotella to discuss the ways hospice and palliative care have changed during his tenure in the space, as well as the forces shaping the field’s future. ...

Why doctors aren’t participating in organ donation after cardiac death Physician's Weekly; by Frank D. Brodkey, MD, FCCM; 6/13/24Organ donation after cardiac death (DCD) differs from the more traditional organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death with cessation of heartbeat and circulation may occur, followed by extraction of organs. This may increase the availability of transplantable organs, leading to improvement in the lives of other humans.  According to the Health Resources and Services Administration, 5896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding three years. There, however, are significant ethical and scientific issues in the performance of DCD with concepts of end-of-life care, personal autonomy, and concepts of dignity of life and death. ...

Effects of a discourse intervention on end-of-life knowledge and attitudes of Bachelor of Science in Nursing studentsJournal of Hospice & Palliative Nursing; by Haynes, Jayme G. PhD, RN, Dingley, Catherine PhD, RN, FAAN; 6/24The findings indicated increased knowledge and positive attitude changes. This study supports the value of theory-based educational interventions, like a discourse intervention, to enhance effective pedagogy when addressing emotionally laden content such as end-of-life care. This study may have also given a glimpse of how a global pandemic may affect end-of-life knowledge and attitudes.

Hope in oncology: Where art and science collide Medscape; by Sharon Worcester, MA; 6/12/24 Carlos, a 21-year-old, laid in a hospital bed, barely clinging to life. Following a stem cell transplant for leukemia, Carlos had developed a life-threatening case of graft-vs-host disease. But Carlos' mother had faith. "I have hope things will get better," she said, via interpreter, to Richard Leiter, MD, a palliative care doctor in training at that time. "I hope they will," Leiter told her. "I should have stopped there," said Leiter, recounting an early-career lesson on hope during the ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2024 annual meeting. "But in my eagerness to show my attending and myself that I could handle this conversation, I kept going, mistakenly." ... Carlos' mother looked Leiter in the eye. "You want him to die," she said. ...Editor's Note: Click on the title's link to continue reading this insightful reflection and discussion about the importance of "hope." Engage your oncology/palliative/hospice chaplains (hopefully CPE trained and Board Certified) with your medical team members to explore this core belief in "hope." Alert: AI referrals for palliative and hospice care are increasing exponentially. Clinicians must be sensitive to the human dimensions and dynamics of "hope" (which shift and change), and not be driven just by technological data.

NAHC, NHPCO comment on revision of Hospice Certifying Physician Enrollment RequirementHomeCare; 6/7/24 The National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO) responded to the Centers for Medicare & Medicaid Services (CMS) recently revised guidance regarding the implementation of the hospice certifying physician enrollment requirement. NAHC and NHPCO identified that some instruction provided by CMS was inconsistent with established law and regulations regarding the certification of a patient’s terminal illness for new hospice elections after the first benefit period. That instruction, if implemented, could have resulted in major negative impacts on hospices and the patients and families they serve. Both organizations requested that CMS retract the guidance to remain consistent with regulation and statute. On June 6, CMS rescinded its guidance in order to align with current regulations, offering clarity for providers. 

National Nurses Honor Guard CoalitionJournal of Hospice and Palliative Nursing; by Betty Ferrell; 6/24As hospice and palliative care nurses, we are very familiar with the importance of rituals at the end of life or after death, which helps us to honor this sacred time. We know that funeral or memorial services offer a time to honor lives and to provide comfort to families. But how often do we pause to honor our own nursing colleagues for their lives of service?I recently learned of an incredible organization, the National Nurses Honor Guard Coalition, which is doing just this—honoring nurses through participation in their funeral services to celebrate these lives well lived and lives dedicated to our profession. ... Hearing about the Honor Guard Coalition brought tears to my eyes to think about this incredible tribute to nurses.Publisher's Note: Thanks for writing about this important group Betty! I also recently learned about the National (and state-specific) Nurses Honor Guard Coalition at the Nebraska Hospice & Palliative Care Association annual conference. A great group with a fantastic mission. 

The latest research indicates massage therapy has benefits from birth to end of life Cision PR Newswire; by American Massage Therapy Association; 6/5/24 The American Massage Therapy Association (AMTA) is sharing recent research on how massage therapy can provide benefits from infancy through end of life. Across all ages, massage therapy can be a therapeutic approach to enhancing physical and emotional well-being. Explore the latest studies on how massage therapy can help improve the quality of life for infants, middle-aged individuals, and older adults. ... A nationwide survey of physicians, physician assistants, and nurse practitioners in palliative care documented recommendation rates of integrative therapies to target symptoms of palliative care patients. The survey found that massage therapy was the third most recommended integrative care modality behind mind-body interventions like meditation and biofeedback. The integrative therapies aimed to reduce pain, anxiety, mood disturbances, and distress.Editor's Note: While hiring a professional massage therapist might not be practical for your budget, explore contracting with massage therapist who is trained in working with medically-fragile persons to provide simple trainings for your nurses and nurse aides. Additionally, professionally trained massage therapists might be interested in volunteering their services, within appropriate parameters (i.e., not transferring the medically-fragile patient to a massage table, having a caregiver present to assist with communication, etc.). 

Palliative care significantly improves discussion and documentation of end-of-life care preferences among patients with AML and MDS Oncology Learning Network; transcribed interview featuring Areej El-Jawahri, MD; 6/1/24 Areej El-Jawahri, MD, Massachusetts General Hospital, Boston, Massachusetts, discusses results from a clinical trial comparing a collaborative palliative and oncology care model vs usual care for adult patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). The study showed that palliative care significantly improved the rates of discussion and documentation of end-of-life (EOL) care preferences, reduced hospitalization at the EOL, and improved the quality of life in patients. 

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

Over 400 physicians from Delaware’s ChristianaCare move to unionize Portside; by Jennifer Henderson / MedPageToday; 5/28/24 More than 400 physicians from Delaware's Christiana Hospital, Wilmington Hospital, and Middletown Free-standing Emergency Department -- all part of the ChristianaCare health system -- filed to unionize with Doctors Council SEIU Local 10MD. "If successful, this will be the first physician union in Delaware and the first union of any kind at ChristianaCare," Doctors Council SEIU said in an announcement of the filing, which pointed to the ongoing corporatization of medicine as driving the physicians' efforts. Some of the specific concerns that physicians detailed in regard to their filing included understaffing and inadequate resources, corporate influence on medical decision making, limited input in matters affecting patient care and physician safety and autonomy, and moral injury caused by pressure to place profit over patients. Editor's Note: These "specific concerns" reflect consistent themes with other, recent healthcare unionization and strikes throughout the nation, within the scope of one's practice (e.g., physicians vs. nurses). 

‘We don’t talk about death’: Winston-Salem journalist seeks to help people understand dying, deathbed visions Fox 8 WGHP - High Point, NC; by Bob Buckley; 5/29/24 There may not be anything that fascinates people more than death. It may be the thing many people avoid confronting the most. “In our culture, we’re pretty separated from death. And I don’t know the figures, but the vast majority … take place in hospitals. We don’t talk about death a lot in our culture,” said Phoebe Zerwick, a journalist based in Winston-Salem who recently wrote about deathbed visions for the New York Times Magazine. ... Zerwick became aware of the work of Dr. Christopher Kerr. ... “The biggest difference between hallucinations and these experiences is how the person is made to feel,” Dr. Kerr said. “Most hallucinations leave the person distressed and agitated and would be further confused. These experiences bring comfort. They bring meaning. They’re drawn from life. They really validate the life.” ... “I think the moral of the story is to be present and to be present with people when they are terminally ill. Be present when they’re dying,” Zerwick said.

From theory to practice: Collaboration shows how law and healthcare work together in real life Iowa College of Law; 5/22/24 A recent workshop collaboration between the [Iowa] College of Law and College of Nursing gave students preparing for both professions an opportunity to learn more about legal and healthcare issues surrounding end-of-life decision-making. The two-hour event, “Navigating the Intersection of Law and Healthcare: An Interactive Workshop for Future Practitioners,” brought together students from the Estate Planning and Law & Policy in Action clinics and graduate students in the College of Nursing. Topics included Medical Powers of Attorney (Medical POA), Living Wills, and other decision-making considerations for critical health issues. Elise Fenton, JD Candidate (2025), said the workshop illustrated the difference between how advance directives like Living Wills work in theory versus how they may be utilized in practice. 

Educating the future of hospice and palliative carePortage.life; by Center for Hospice Care; 5/21/24This spring students at the University of Notre Dame gained insight into the delivery of care to patients and families dealing with serious advanced illnesses. The university, in partnership with Center for Hospice Care (CHC), once again offered the course “Introduction to Hospice and Palliative Care” that was designed by Dr. Dominic Vachon, Director of Ruth M. Hillebrand Center for Compassionate Care in Medicine and Mike Wargo, COO and vice president of the Hospice Foundation. The five-week class covered a variety of topics focused on hospice and palliative care and was taught by CHC staff including physicians, social workers, chaplains, bereavement counselors and other hospice and palliative care support staff.