Literature Review

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

Nursing strategies to mitigate separation between hospitalized acute and critical care patients and families: A scoping review Intensive Critical Care Nurse; Sonja Meiers, Véronique de Goumoëns, Lorraine Thirsk, Kristen Abbott-Anderson, Petra Brysiewicz, Sandra Eggenberger, Mary Heitschmidt, Blanche Kiszio, Natalie S Mcandrew, Aspen Morman, Sandra Richardson; 7/26/24 Implications for clinical practice: Permanent policy changes are needed across acute and critical care settings to provide support for nurses in mitigating patient and family separation. We recommend that family members be considered as caregivers and care receivers, not visitors in patient and family-centered care in acute and critical care settings. 

Prognostication in hospice care: Challenges, opportunities, and the importance of functional statusFederal Practitioner - Case Reports; by David B. Brecher, MD and Heather J. Sabol, MSN, ARNP; 7/24 Predicting life expectancy and providing an end-of-life diagnosis in hospice and palliative care is a challenge for most clinicians. Lack of training, limited communication skills, and relationships with patients are all contributing factors. These skills can improve with the use of functional scoring tools in conjunction with the patient’s comorbidities and physical/psychological symptoms. The Palliative Performance Scale (PPS), Karnofsky Performance Scale (KPS), and Eastern Cooperative Oncology Group Performance Status Scale (ECOG) are commonly used functional scoring tools.

Amid trauma and burnout, it ‘takes courage’ to reflect on mental, emotional well-being Healio; by Jennifer Byrne; 7/31/24 ... [William E. Rosa, PhD, MBE, MS] began to realize that in the stressful, devastating situations he and his colleagues faced daily, there was much to be learned from the principles of trauma-informed care. ... “This is the idea that cultivating an awareness can prevent us from re-traumatizing ourselves and others,” he said. “I think it starts with reflecting on — and telling the truth about — our mental and emotional well-being. That takes courage.” In acknowledging the emotional scars, brokenness and vulnerability that comes from tragedy and loss, individuals can begin to heal a lifetime of stored and unresolved trauma, Rosa said. “As a workforce, you and I see unacceptable rates of suicide, burnout, moral distress and attrition,” he said. “It’s time that we come to safe and supported terms with our trauma — not just as individuals, but as a collective, not only for the patients and families we serve, but for us to survive.”Editor's Note: In this article, Dr. Rosa identified "the emotional impact of taking yet another patient off the ventilator at the end of life." Recent articles we've posted in this newsletter about trauma-informed care been in our "Top Reads." While those articles focused on trauma-informed care of the persons you serve, this focuses on the persons who serve, your all-important direct patient care clinicians.

Proactive fall prevention: Elevating patient safety and healthcare excellenceHealthCare Business News; by Amy Hester; 7/26/24... The significance of fall prevention cannot be overstated, as it directly impacts patient outcomes and overall healthcare quality. With the patient safety solutions market growing at an expected rate of 11.2%, the importance of proactive fall prevention strategies becomes even more evident. ... In the United States, preventable medical errors, including falls, are the third leading cause of death. The impact of falls on patient health and recovery is profound, often leading to longer hospital stays, delayed recovery and increased risk of subsequent falls.Editor's Note: Proactive fall prevention is especially important for persons needing palliative or hospice care. As the person's health and mobility declines, they have to adjust to these changes mentally, emotionally, physically, and relationally. Recognizing decline can feel like defeat. Asking for help can be tough. Family members can expect the person to move more independently more than possible, leading to falls.

‘Good’ death different for everyone Altoona Mirror, Altoona, PA; 7/26/24 The social and economic inequities patients suffer in life often shapes their death” was a key point of a July 13-14 article in the Review section of the Wall Street Journal. ... In the article, which was written by Dr. Sunita Puri, a palliative care physician and the author of “That Good Night: Life and Medicine in the Eleventh Hour,” Puri focuses on the conundrum many families face when dealing with the question of where to spend the final days of life. ... “New research classifies the rise in home deaths as progress,” the message immediately under the article’s headline begins, “but we need to look more closely at what these deaths look like.” ... Puri, now 10 years into her physician career, says it is now clear to her that there is much more to a “good” death than where it occurs. “Presuming a home death is a success obscures important questions about the process,” she wrote. “Did this person die comfortably? Did their caregivers have the resources and guidance they needed? Was dying at home a choice or simply the only option?” 

Caregivers of end-of-life patients reveal the last words they hear most often and the most common regrets from patients WhatsNew2Day; by Alexander; 7/27/24... While each person’s final moments are different, chaplains and palliative care nurses have said most people approach their death with “radical acceptance.” People who are actively dying also often have a new sense of clarity about the universe and may even have a temporary burst of energy or sudden moments of clarity if they have dementia. The last words patients usually say to their families are to tell them they love them... [Often, people] who are in the midst of dying want to be surrounded by their loved ones and pets. Their final words are often words of love and pleas for forgiveness, as well as expressions of regret, ... [Another described that people show] "a desire for connection" with loved ones and faith. Editor's Note: This article provides a balanced scope of descriptions from several professionals, notably Catherine Duncan, Annemarie Switchulis, Neal Shah, and Zackary Price. In this day of social media, some hospice professionals (past or present) tout definitive, authoritative descriptions of what all dying persons experience, with too many assumptions and generalizations. Beware what you read and distribute, especially if the tone and language (of other articles) are sensationalized in a way to garner social media "expertise," followers and Shares--at the expense of more balanced, sensitive, diverse, personalized experiences.

“At home, even the walls help”: Exploring the palliative care needs, experiences, preferences, and hopes of older people with serious illness in Ukraine (July 2024) OCHA Services; by HelpAge; 7/24/24 Older Ukrainians living with serious illness face significant concerns and challenges within the political, environmental, and social context of the ongoing armed conflict, according to a new report published by HelpAge International, in partnership with HelpAge USA. ... The report highlights an innovative project funded by GlobalGiving which provides palliative care services in Ukraine. It underscores the profound challenges faced by older people due to the combined toll of disease and the ongoing war, and offers key recommendations to enhance their care and support. “Our findings reveal the unimaginable burden faced by older people living with serious illnesses in the midst of war. We are deeply grateful for the generous support of GlobalGiving, which has allowed us to highlight these issues and work to ensure that older people’s needs and preferences are included in healthcare system planning during humanitarian crises,” said Cindy Cox-Roman, CEO and president of HelpAge USA.

Acupuncture as a support in palliative care at Sun City Center HAW The Tidewater News, Ruskin, FL; 7/22/24 Sun City Center Health and Wellness (HAW) is dedicated to providing comprehensive care for patients managing serious illnesses, championing the use of acupuncture as a key supportive treatment in palliative care. This practice, grounded in traditional Chinese medicine, offers relief from common symptoms and enhances overall well-being. ... The role of acupuncture in palliative care is gaining recognition for its potential to improve the quality of life for patients dealing with serious illnesses.

Positive aging: Can a broken heart kill you?

Why are some people happy when they are dying? StudyFinds; by The Conversation, Mattias Tranberg, Lund University; 7/18/24Simon Boas, who wrote a candid account of living with cancer, passed away on July 15 at the age of 47. In a recent BBC interview, the former aid worker told the reporter: “My pain is under control and I’m terribly happy – it sounds weird to say, but I’m as happy as I’ve ever been in my life.” It may seem odd that a person could be happy as the end draws near, but in my experience as a clinical psychologist working with people at the end of their lives, it’s not that uncommon. There is quite a lot of research suggesting that fear of death is at the unconscious center of being human. William James, an American philosopher, called the knowledge that we must die “the worm at the core” of the human condition. But a study in Psychological Science shows that people nearing death use more positive language to describe their experience than those who just imagine death. This suggests that the experience of dying is more pleasant – or, at least, less unpleasant – than we might picture it.

Ethical challenges in the treatment of patients with severe anorexia nervosa Psychiatry Online; by Patricia Westmoreland, MD; Jole Yager, MD; Jonathan Treem, MD; and Philip S. Mehler, MD; 7/15/24 Ethical principles assist us in determining the best course of action with regard to patients with [anorexia nervosa] AN. The vast majority of patients with AN should be offered high-quality, restorative-informed care. But for a minority of patients (e.g., those with SE-AN) other treatment options need to be considered. Clinicians are obliged to realistically assess each patient’s potential for recovery or ability to engage in harm reduction and palliative care approaches, and be cognizant of the wishes of the patient, family, and treatment team. In addition, the burden on caregivers and stewardship in the expenditure of health care resources should also be considered when deciding whether involuntary treatment, harm reduction, palliative care, or end-of-life care be recommended for a particular patient.

Can palliative care consults in hospitals improve end-of-life care? National Institute on Aging; 7/18/24 Having clinicians automatically order palliative care increased consultation rates and expedited consultations for seriously ill hospitalized people but did not decrease length of stay, according to an NIA-funded study. The findings, published in JAMA, suggest that while ordering by default rather than by choice improves certain end-of-life care processes, the impact on hospital stay length is limited. ... Overall, while default orders for palliative care consultations did not reduce hospital stays, they did improve the frequency and timing of consultations as well as some end-of-life care processes, aligning with clinical guidelines for high quality palliative care.