Literature Review

Hospices stepping up performance on visits-in-last-days-of-life measure Hospice News, by Jim Parker; 3/14/24 Hospices, in aggregate, are showing improvement on the quality measure for visits in the last days of life. The number of registered nurse and social worker visits during a patient’s final week is one of the seven quality measures that CMS uses to evaluate providers. In Calendar Year 2021, the share of hospice care days with nurse visits in the last seven days of life rose to 63%, up from 62% year over year, according to the National Hospice and Palliative Care Organization (NHPCO). 

Preventing adverse drug events in hospice care Hospice News, by Holly Vossel; 3/15/24 Documentation errors and a fragmented health system pose the greatest risks for adverse drug events among hospices. ... Evaluating these risks involves having solid medication reconciliation processes in place — both at the time of a patient’s admission and throughout their end-of life care experience, according to Mary Lynn McPherson, professor and executive program director of advanced post-graduate education in palliative care at the University of Maryland’s School of Pharmacy. McPherson also serves on the board of the American Academy of Hospice and Palliative Medicine (AAHPM).

Responding to Soul Injury: Tools for hope and healing Journal of Hospice & Palliative Nursing; by Deborah Grassman, Abi Katz, Luann Conforti-Brown, Josephine F Wilson, Angie Snyder; 3/13/24Soul Injury is defined as a wound that separates a person from their real self, caused by unmourned loss and hurt, unforgiven guilt and shame, and fear of helplessness or loss of control. Tools and interventions have been developed to guide people impacted by Soul Injury. This study assessed the effectiveness of 12 tools and interventions, ... The Anchor Your Heart tool was the most frequently used tool and had the most enduring utilization across time and settings.Editor's Note: Click here for The Anchor Your Heart Tool identified in this article. Share this research and article with your clinical teams and bereavement counselors.

Heart failure staging and indications for advanced therapies in adults with Congenital Heart DiseaseHeart Failure Clinics / Elsevier, by Alexander C Egbe and Heidi M Connolly; pre-publish 4/24 via onlineSummary: Heart Failure (HF) is common in adults with Congenital Heart Disease (CHD), United States, and it is the leading cause of death in this population. Adults with CHD presenting with stage D HF have a poor prognosis, and early recognition of signs of advanced HF, and referral for advanced therapies for HF offer the best survival as compared with other therapies. The indications for advanced therapies for HF outlined in this article should serve as a guide for clinicians to determine the optimal time for referral. Palliative care should be part of the multidisciplinary care model for HF in patients with CHD.

In the resuscitation discussion, do words matter between doctors and patients? Rutgers, by Patti Zielinski; 3/12/24Rutgers Health researchers seek to reduce barriers to physicians having code status conversations with older adults. ... The study, published in the Journal of the American Geriatrics Society, sought to determine the best language doctors could use when discussing a patient’s code status to reduce the barrier to having these conversations. It found that it takes less than five minutes on average for doctors to have discussions going over what CPR is, what a patient’s preference might be and making a decision that patients felt comfortable with regarding whether they want to be resuscitated, according to the study.Editor's Note: Click on the title above for the summary description; click here for the detailed research article, "Aligning patient values and code status: Choice of Diction's Effect (CODE) study.

Can we make more accurate prognoses during last days of life?Journal of Palliative Medicine; by Sylvie Bouchard, Andreea Paula Iancu, Elena Neamt, François Collette, Sylvie Dufresne, Patricia Maureen Guercin, Suganthiny Jeyaganth, Desanka Kovacina, Taliá Malagón, Laurie Musgrave, Marilisa Romano, Jenny Wong, Sybil Skinner-Robertson; 3/8/24Background: ... Established methods (Palliative Performance Scale [PPS], Palliative Prognostic Index [PPI]) have been validated for intermediate- to long-term prognoses, but last-weeks-of-life prognosis has not been well studied. Patients admitted to a palliative care facility often have a life expectancy of less than three weeks. Reliable last-weeks-of-life prognostic tools are needed. Conclusions: ... Using SPS [Short-Term Prognosis Signs] along with PPS and PPI during the last weeks of life could enable a more precise short-term survival prediction across various end-of-life diagnoses. The translation of this research into clinical practice could lead to a better adapted treatment, the identification of a most appropriate care setting for patients, and improved communication of prognosis with patients and families.

Palliative care cuts costs for metastatic cancer

Oncology hospitalists improve hospice transitions for patients with advanced cancers Yale School of Medicine, by Osman Moneer; 3/11/24Unplanned hospitalizations for patients with advanced cancer often trigger discussions about care goals and transitions to hospice. Late referrals to hospice, particularly near the end of life, have been associated with reduced quality of life and increased healthcare costs. A new research study published in Cancer investigates the impact of oncology hospitalists on the timing of hospice transitions for patients with advanced cancers. 

Whistleblower cases on the rise nationwide; Sarbanes-Oxley, Dodd-Frank laws open door for more to speak out PressReader, Herald-Tribune; by Esteban Parra and Xerxes Wilson; 3/10/24A former medical director specializing in neurosurgery at southern Delaware's largest health care provider claims in a lawsuit that Bayhealth Medical Center misclassified "brain-dead" patients in order to overbill for services. 

In the ICU, what is a good death? Understanding why clinicians and patients' families may disagree in Intensive Care Unit Northwestern Now, by Marla Paul; 3/7/24What is a good death for a patient in the Intensive Care Unit (ICU)? The answer to that question may depend on whether you ask a family member of a patient or the physician, who are not necessarily aligned. ... Approximately 20-30% of people who die in the U.S., die in the ICU, according to previous research. Nearly 60% of ICU admissions result in death. Wide discrepancies have been documented between a patient’s stated preferences and the end-of-life care actually delivered.

NYC Health + Hospitals/Bellevue opens new Palliative Care Serenity Unit for patients and families NYC Health+Hospitals Press Release; 3/7/24 NYC Health + Hospitals/Bellevue today announced the opening of a new Palliative Care Serenity Unit for patients and families. ... “We created the Serenity Unit because we noted an increasing number of patients either spending their dying days at the hospital or in need of extra support and symptom management expertise that palliative care provides,” said Susan E. Cohen, MD, director of the Palliative Care Program at NYC Health + Hospitals/Bellevue. “We want to ensure that patients who are here in their final days are being treated with dignity and expertise.”Editor's Note: NYC Health + Hospitals/Bellevue is the oldest hospital in America, tracing their roots back to 1736 when a six-bed infirmary opened on the second floor of the New York City Almshouse.

Patients with metastatic cancer state more accurate prognosis when in poor healthMedscape / YouTube, Dr. Maurie Markman; 3/7/24Dr. Maurie Markman discusses a paper focused on the controversial oncology topic of prognosis beliefs among patients with metastatic cancer.Editor's Note: For the transcript, click on the link beneath the YouTube's description that has the text "medscape.com/viewarticle."