Literature Review

Palliative patients can die peacefully at home with paramedic support, claims proposed frameworkRiotack - Australia; by James Day; 5/6/24A proposed national framework suggests paramedics could help ease pressure on emergency departments by supporting palliative care patients who wish to die at home. Published in the leading international peer reviewed journal Palliative Medicine, the framework seeks to embed palliative care into paramedics’ core business and reduce needless transports to hospital. ... Lead author and trained paramedic Dr. Madeleine Juhrmann developed the framework in consultation with paramedics, palliative care doctors, GPs, carers with lived experience and others. The expert group – representing six countries and all the states of Australia – agreed on the framework’s 32 service changes to standardise best practice for paramedics delivering palliative care in community-based settings.Pair this with a USA article in today's newsletter, "Stranded in the ER, seniors await hospital care and suffer avoidable harm." 

Georgia system reopens hospital to inpatient services Hospital CFO Report; by Mariah Taylor; 5/2/24 Piedmont Augusta (GA) is reopening the emergency department and inpatient services at its Summerville campus after converting the location into an outpatient campus over a year ago. Effective May 16, the hospital will open 15 beds in the emergency department, 12 inpatient unit beds, and new imaging services. Outpatient services will continue as normal, according to a May 1 system news release. "What we heard pretty quickly from our community is that they missed the efficiency of that campus," Lily Henson, MD, CEO of Piedmont's Augusta clinical hub, said in the release.

Nonphysical Suffering: An under-resourced and key role for hospice and palliative care social workersJournal of Social Work in End-of-Life & Palliative Care; by Maxxine Rattner & Cheryl-Anne Cait; 11/10/23... Nonphysical suffering is suffering that may be emotional, psychological, social, spiritual and/or existential in nature. The study found an absence of specialist social workers on hospice and palliative care teams or limited time for specialist social workers to address patients’ nonphysical suffering due to high caseloads and complex practical needs. While the study recognizes social workers have expertise in supporting patients’ nonphysical suffering, a competency and skill that has not been sufficiently captured in the existing literature, the systemic barriers they face in providing care may leave patients’ needs unmet. The study also highlights the unique pressure social workers may feel to relieve patients’ nonphysical suffering due to the psychosocial focus of their role.

The spectrum of end-of-life experiences: A tool for advancing death educationOmega; by Shared Crossing Research Initiative; 3/24 Abstract: Studies on end-of-life experiences (ELEs) suggest that caregivers and loved ones of dying patients also have ELEs, though these are rarely explored. This article introduces the Spectrum of End-of-Life Experiences (SELE) as a descriptive list of types of ELEs reported by all members of the care unit, including dying patients, their caregivers, and their loved ones. We applied SELE towards identifying ELEs reported by 143 caregivers and loved ones and successfully identified every experience. Interviews revealed that participants viewed their ELEs as profound communicative events, yet a substantial minority also reported struggling to name and process these experiences. We propose that SELE be included in death education to raise awareness about ELEs that can occur within the care unit, and we suggest that SELE has additional applications, including use as a prognostic aid in end-of-life care and as a therapeutic aid for bereavement support.

More legislation in Illinois deals with ending a person’s life The Center Square - Illinois; by Kevin Bessler; 5/1/24 Another bill has been introduced in Springfield dealing with end of life options for the terminally ill. Illinois state Sen. Julie Morrison’s Senate Bill 2644 would establish a statewide electronic registry that would contain Physician Orders for Life Sustaining Treatment (POLST) forms, which detail what type of medical treatment a critically ill patient does and does not want. “How much or how little treatment a person receives at the end of their life should be up to each individual instead of the one-size-fits-all approach,” said Morrison, D-Lake Forest, during a news conference Wednesday. “This measure will enable physicians to access forms detailing patients wishes in a single, accessible location.” 

A hospice doctor on deathbed visions #shorts #tedx Tedx Talks; by Dr. Christopher Kerr; 4/29/24"When it comes to end-of-life experiences, most of the reports were based on anecdotal reporting. In other words, nobody had asked patients directly or attempted to quantify or measure. So that's what we've done. What we found is that the vast majority, over 80%, reported at least one pre-death dream and vision, described as more real than real and distinct from normal dreaming. 

Cleveland Clinic eHospital expands to monitor 300,000 patients Becker's Health IT; by Naomi Diaz; 4/24/24 Cleveland Clinic's eHospital program has expanded and now monitors 248 patient beds in ICUs and other units across the organization's network. The eHospital program launched in 2014 as a pilot in one intensive care unit. ... The program has enabled more patients to receive care at community hospitals, reducing the need for transfers to the main campus, according to Cleveland Clinic. It has also helped decrease ICU lengths of stay and minimize the volume of calls received at night. 

Leadership's perceptions of palliative care during the COVID-19 pandemic: A qualitative study Journal of Pain and Symptom Management, by Tamara Vesel, Audrey Covaleski, Veronica Burkarth, Emma Ernst, Linda Vesel; 4/19/24Background: This study aimed to explore the perceptions, understanding, and utilization of palliative care before compared to during the COVID-19 pandemic among health system leadership. Results: ... Emerging themes included the role of palliative care before compared to during the COVID-19 pandemic, facilitators and barriers to palliative care delivery, and recommendations for future practice. Participants reported that the COVID-19 pandemic increased palliative care utilization, reinforced positive perceptions of the specialty, and emphasized its role in maximizing healthcare efficiency. Many participants found palliative care financing to be a barrier to delivery; ... 

Comparative effectiveness of acupuncture vs massage for relieving pain in patients with advanced cancer The ASCO Post; by Jun J. Mao, MD, MSCE and Andrew S. Epstein, MD; 4/17/24... The IMPACT study was conducted at Memorial Sloan Kettering Cancer Center and regional sites in New York, New Jersey, and Florida to evaluate the long-term comparative effectiveness of acupuncture vs massage for pain in patients with advanced cancer. ... The primary outcome—change in worst pain intensity score from baseline to 26 weeks—was measured using the Brief Pain Inventory (BPI ranging from 0–10; higher numbers indicate worse pain intensity or interference). The secondary outcomes included fatigue, insomnia, and quality of life. ... To use these therapies, it is important to seek credentialed practitioners who have training or experience in working with patients who have cancer. 

Defining metrics for assessing end-of-life care quality in children with cancer Physician's Weekly; 4/16/24 In this study, the researchers sought to define the target population for applying newly developed quality measures in end-of-life (EOL) care for children with cancer. Through a series of nominal groups, panelists addressed the question: “Which children, diagnoses, conditions, or prognoses should be included when examining the quality of EOL care for children with cancer?” ... A team of pediatric oncology and palliative care clinician-scientists developed a coding structure to analyze responses and identify associated themes and subthemes. 

Health care system eats away at the doctor-patient relationship The Boston Globe; updated 4/17/24... The system economically rewards throughput (the number of patients seen per unit time) and procedures rather than the time needed to develop an open and communicative doctor-patient relationship. While a good physician might understand the tests and evaluations that are indicated by a presenting medical problem, the excellent clinician knows which tests and evaluations should not be done. This is primarily ascertained by delving into details of the patient’s physical, psychological, social, family, and economic history. This process, as James highlights, can lead to collaborative and more effective care. ...Editor's Note: This article highlights "Dr. Thea James’s remarkable work at Boston Medical Center in addressing structural inequity in medical care as a means of enhancing outcomes brings up an underlying structural problem across the entire medical care system (“Her health equity message being heard,” April 13, 2024.)

Implementing spiritual care education into the teaching of palliative medicine: An outcome evaluation BMC Medical Education; by Yann-Nicolas Batzler, Nicola Stricker, Simone Bakus, Manuela Schallenburger, Jacqueline Schwartz, and Martin Neukirchen; 4/15/24 Objective: This is a novel, interprofessional approach in teaching undergraduate medical students about spiritual care in the format of a seminar. The aim of this study is to assess if an increase in knowledge about spiritual care in the clinical context is achievable with this format. ... Conclusions: We conclude that implementing spiritual care education following an interprofessional approach into existing medical curricula, e.g. palliative medicine, is feasible and well perceived among medical students. ...

Goals of care among patients with advanced cancer and their family caregivers in the last years of life JAMA Network; by Semra Ozdemir, PhD; Isha Chaudhry, MSc, Chetna Malhotra, MD; et al; 4/11/24 Conclusions and Relevance: In this cohort study of patient-caregiver dyads, findings suggested the importance of interventions aimed at reducing discordance in goals of care between patients and caregivers and helping them develop realistic expectations to avoid costly, futile treatments.