Literature Review

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.

Reply to: Frailty and ethics at the end of life: The importance of a comprehensive assessmentJournal of the American Geriatrics Society; by Colum Thomas MD, Eduardo Bruera MD, William Breitbart MD, Yesne Alici MD, Liz Blackler MBE, LCSW-R, Julia D. Kulikowski MD, Daniel P. Sulmasy MD, PhD; 6/5/24The care of older persons at the end of life often involves competing concerns and highly value-sensitive decisions. In a recent article, we proposed a set of ethical rules—the canons of therapy—to help clinicians navigate complex cases involving older adults with delirium at the end of life. The canons of therapy most pertinent to such cases are restoration, means-end proportionality, discretion, and parsimony (see Table 1 for a description). These canons provide a structured toolset aligned with practical wisdom, which can serve as an ethical heuristic for guiding therapeutic judgments. ...

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.

Hospice patient in Red Wing died after being given morphine by mistakeBring Me the News (MN); by Tommy Wiita; 5/29/24A hospice patient at a Red Wing assisted living facility suffering a diabetic emergency died after being given morphine by mistake. A Minnesota Department of Health State Rapid Response Investigative Report found that the allegation of neglect against the Mayo Clinic Hospice at 906 College Way was substantiated as the staff member "failed to provide timely care, monitoring, and safe medication administration services. The report says the staff member provided five times the resident's prescribed dose of morphine "in error" and didn't provide interventions when the resident was having a seizure and had a critically low blood sugar of 29.

‘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.

Disparities in palliative care use for patients with blood cancer who died in the hospital The American Journal of Hospice & Palliative Care; by Tien-Chan Hsieh, Yee Hui Yeo, Guangchen Zou, Chan Zhou, Arlene Ash; 5/27/24 online ahead of printBackground: Palliative care can enhance quality of life during a terminal hospitalization. Despite advances in diagnostic and treatment tools, blood cancers lag behind solid malignancies in palliative use. It is not clear what factors affect palliative care use in blood cancer. Conclusions: This study highlights disparities in palliative care use among blood-cancer patients who died in the hospital. It seems likely that many of the 46% who did not receive palliative care could have benefitted from it. Interventions are likely needed to achieve equitable access to ideal levels of palliative care services in late-stage blood cancer.

Nephrologists' perspectives and experiences with hospice among older adults with end-stage kidney disease Journal of the American Geriatrics Society; by Melissa W Wachterman, Anupallavi Sinha, Tarikwa Leveille, Sushrut S Waikar, Eric Widera, Kai Romero, Barbara Bokhour; 5/22/24 Background: ... Hospice use among older adults with end-stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. ... Conclusions: Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients.

Psychological trauma can worsen symptom burden at end-of-life Hospice News; by Holly Vossel; 5/15/24 Recent research has found that traumatic experiences can lead to increased pain and symptom burden at the end of life, along with a greater likelihood of emotional suffering and isolation. Collective trauma experiences have been associated with higher instances of pain and dyspnea among more than half of seniors nationwide, a recent study found, published in the Journal of Pain and Symptom Management. Traumatized seniors are also more likely to experience loneliness, dissatisfaction with their life and depression. ... Hospices need a greater understanding of both the depth of these patients’ suffering and the scope of their unique needs to improve trauma-informed care delivery, [Dr. Ashwin] Kotwal said, assistant professor of medicine at the University of California San Francisco’s (UCSF) Division of Geriatrics.

Top ten tips palliative care clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatments Journal of Palliative Medicine; by Gregg A Robbins-Welty, Paul A Riordan, Daniel Shalev, Danielle Chammas, Paul Noufi, Keri O Brenner, Joshua Briscoe, William E Rosa, Jason A Webb; 5/10/24... Among patients receiving palliative care (PC), psychiatric comorbidities are common and impact patient quality of life. ... This article, created collaboratively with a team of psychiatric-palliative care experts, is the second in a two-part series examining the bidirectional relationship between medical and psychiatric illness in PC. This article explores 10 prevalent psychiatric manifestations associated with severe illness and its treatment. [Additional access requires journal subscription or additional payment]

Action is key to continue to break down barriers for equitable cancer care OncLive; by Ryan Scott; 5/8/24 Experts from the University of Wisconsin (UW) School of Medicine and Public Health, including Catherine Zhang, MD, MPH, ... Monica Patel, MD, ... Janelle N. Sobecki, MD, ... and Loyda Braithwaite, NP ... participated in an interview with OncLive® on disparities in cancer care. In [this] interview, these experts addressed significant barriers to equitable cancer treatment and highlighted challenges for rural communities to access specialized oncologic care. Furthermore, they emphasized financial limitations affecting treatment access, specifically for marginalized groups, and the need to push for health policy changes.  ... 

How Mass General Brigham provides emergency care at home Becker's Health IT; by Giles Bruce; 5/6/24Somerville, MA-based Mass General Brigham now treats patients needing emergency or urgent care at home. The health system's patients can request referrals to the Home Hospital Emergency Care program through their primary care providers, who decide if patients are stable enough to be treated at home. If they are, a nurse talks to the provider and schedules a home visit, where a paramedic completes a physical exam joined virtually by an emergency medicine physician. Editor's Note: Pair this article with others in today's newsletter: "Stranded in the ER, seniors await hospital care and suffer avoidable harm" (in our Post-Acute Care section), and "[Australia] Palliative patients can die peacefully at home with paramedic support, claims proposed framework" (in our International section). 

Terminal cancer: What matters to patients and caregivers Medscape Medical News; by Megan Brooks; 5/6/24 What's most important to patients with terminal cancer and their caregivers? New research found that patients and caregivers both tend to prioritize symptom control over life extension but often preferring a balance. Patients and caregivers, however, are less aligned on decisions about cost containment, with patients more likely to prioritize cost containment. ... As patients approached the end of life, neither patients nor caregivers shifted their priorities from life extension to symptom management.