Literature Review

Racial differences in shared decision-making about critical illnessJAMA Intern Med, by Deepshikha C. Ashana, MD, MBA, MS; Whitney Welsh, PhD; Doreet Preiss, PhD; et al; published online 2/26/24Question: How do critical care clinicians approach shared decision-making with Black compared with White caregivers of critically ill patients?Findings: In a thematic analysis of 39 audio-recorded clinician-caregiver meetings, racial differences were most evident in the following clinician behaviors: providing emotional support to caregivers, acknowledging trust and gratitude expressed by caregivers, disclosing medical information, and validating caregivers' treatment preferences.

Being there for a loved one's final breaths NextAvenue, by Elaine Soloway; 2/26/24"I'll be downstairs," I told him one night. "And I'll be up to kiss you goodnight before I go to sleep." He smiled and squeezed my hand. I had barely settled on the couch when the hospice worker appeared at the top of the stairs. "He's gone," she said. I learned this pause is not unusual. Hospice workers report that some people who are dying wait to be alone for their final breaths.

From classroom to clinic: End-of-life conversations — there’s empathy in foresightThe Tufts Daily, by Deeksha Bathini; 2/21/24Palliative care physicians have conversations with families to identify patient wishes, particularly when they are facing death. These physicians are equipped with training that emphasizes empathy, comfort and patient autonomy. Freedom of choice during the dying process gives patients the power to reclaim their agency amidst a process rife with uncertainty.

Advance praise for Oncology and Palliative Social Work: Psychosocial Care for People coping with Cancer Oxford Academic - Oxford University Press; 2/23/24Oncology and Palliative Social Work: Psychosocial Care for People Coping With Cancer (OPSW) fills an important gap in the serious illness literature. The book illustrates the need for integrating palliative care early in the lives of patients with cancer and illuminates the important role that social workers have in providing psychosocial support services across the cancer trajectory. 

Why long-term hospice care might be goodNBC KPRC TV, interview with Joseph Rotella, MD MBA HMDC FAAHPM, Chief Medical Director American Academy of Hospice and Palliative Medicine; 2/21/24Most people receiving hospice care don't live for more than a few weeks. Doctor explains why receiving hospice care earlier can be beneficial.

Psychological issues in palliative care: Elissa Kozlov and Des AzizoddinGeriPal podcast, by Alex Smith; 2/22/24Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes.  Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life.

Exploring whether a diagnosis of severe frailty prompts advance care planning and end of life care conversationsNurs Older People, by Stacey Dodson; 2/21/24Findings: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.

Identity shifts throughout HCT: A holistic approach to patient, caregiver supportHematology Advisor; by Katie Schoeppner, MSW, LICSW; Leah Christianson, OPN-CG; Hailey Hassel, MSW, LICSW; Cortney Alleyne, MPH; 2/20/24Patients undergoing hematopoietic cell transplant (HCT), their caregivers, and family members often experience dramatic shifts in their identity during and after the transplant process. These shifts can cause significant disruption in their lives, even among the most stable family and friend units. With holistic guidance and informed, empathetic care from professionals on healthcare teams, these patients and their support persons can better cope with the identity-related challenges they face.Editor's Note: See the patients you serve as persons. While this article focuses on person undergoing hematopoietic cell transplant, its rich insights about the patient/person's "tangible and intangible identity shifts" apply to the persons you serve, whatever the diagnosis. Read this article to develop your empathy and its practical applications throughout the services your organizations provide.

AI-generated clinical summaries require more than accuracyJAMA Network; by Katherine E. Goodman, JD, PhD; Paul H. Yi, MD; and Daniel J. Morgan, MD, MS; Originally published 1/29/24, redistributed 2/20/24 ... Currently, there are no comprehensive standards for LLM-generated [Large Language Model] clinical summaries beyond the general recognition that summaries should be consistently accurate and concise. Yet there are many ways to accurately summarize clinical information. Variations in summary length, organization, and tone could all nudge clinician interpretations and subsequent decisions either intentionally or unintentionally. To illustrate these challenges concretely, we prompted ChatGPT-4 to summarize a small sample of deidentified clinical documents. [Click on the title's link to view the example.]

Barriers and facilitators to end-of-life care delivery in ICUs: A qualitative studyCrit Care Med; by Lauren M Janczewski, Adithya Chandrasekaran, Egide Abahuje, Bona Ko, John D Slocum, Kaithlyn Tesorero, My L T Nguyen, Sohae Yang, Erin A Strong, Kunjan Bhakta, Jeffrey P Huml, Jacqueline M Kruser, Julie K Johnson, Anne M Stey; 2/19/24Objectives: To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU.Setting: Seven ICUs across three hospitals in an integrated academic health system.Subjects: ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains).Conclusions: Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.

Death can be isolating and dehumanizing. But what if it didn’t have to be?City Life, by Ben Seal; 2/17/24... In the three years since Elaine’s passing, I’ve longed for a world where more people could be given the chance to die as she did — with the fullness of life surrounding her, and with complete support, emphasizing the emotional and spiritual, not just the medical. In Philadelphia and beyond, a growing community of death-care workers — doulas, nurses, grief counselors, social workers, even funeral directors — is trying to build that world. They are reclaiming death and dying from the institutional model that has become the norm over the past century. Editor's Note: Has hospice now become so institutionalized and medical/regulatory focused that we have lost sight of "emphasizing the emotional and spiritual, not just the medical"? I ask the question, but do not draw judgment, as answers must be contextualized. 

Causes and ways of death in patients with head and neck cancerJAMA Otolaryngol Head Neck Surg; by Boyd N. van den Besselaar, MD; Aniel Sewnaik, PhD; Arta Hoesseini, MD; et al; 2/15/24 The results of this study potentially illuminate causes and ways of death in patients with HNC and support health care professionals in providing more patient-centered care, particularly for those in the palliative phase.

Is the patient dead?AMA Journal of Ethics; email 2/14/24Debate over the criteria by which doctors declare brain death has some bioethicists concerned. The AMA Journal of Ethics offers the following educational resources: