Literature Review

Rising suicide risk among seniors due to loneliness, mobility, financial insecurity, study finds McKnights Home Care, by Adam Healy; 3/5/24As the number of adults over 65 continues to grow, suicide rates among older adults have also been rising, according to data from the National Center for Health Statistics. Between 2008 and 2017, the share of suicide-related emergency department visits among adults 65 years and older more than doubled. These older adults face age-related stressors that can negatively affect mental health, such as declining physical health, reduced mental sharpness, or the loss of friends or loved ones, which can heighten the risk of suicide. 

Creating comfort through communication: Strategies for supporting mental wellbeing in palliative careWorldHealth.net; 3/4/24... To provide comprehensive and compassionate care, this article explores the various strategies for communicating and supporting mental well-being in palliative care. 

Obstacles and opportunities for palliative care in the ICU Palliative Care News, by Rachel Edwards; 3/1/24A growing body of research touts the benefits of palliative care for patients, families, and even providers. However, when evaluated through randomized clinical trials, the results tend to lean toward mediocre. Palliative Care News spoke with experts in the field to unpack the reasons behind those results and identify the obstacles that are getting in the way of a more effective approach.

Many older adults don't receive palliative care before deathMedScape, by Marilynn Larkin; 2/28/24 "One of the challenges and a barrier to accessing palliative home care is the difficulty of predicting survival," Amy Hsu, PhD, an investigator at the Bruyère Research Institute in Ottawa, Ontario, Canada, told Medscape Medical News. "Clinicians are good at prognosticating when a patient might be entering their last 3-6 weeks of life, but they have a harder time predicting if someone will survive 6 months or longer."  The team developed the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) to see whether access to predicted survival data could inform conversations about a patient's status and palliative care needs. The study was published online on February 26 in the Canadian Medical Association Journal.

Facing dementia: Clarifying end-of-life choices, supporting better lives The Hastings Center; 2/28/24The report includes 10 recommendations for policymakers, research funders, clinical and legal practitioners, and professional societies. ... “Facing Dementia: Clarifying End-of-Life Choices, Supporting Better Lives” is the major product of a Hastings Center research project, codirected by Hastings senior research scholar Nancy Berlinger and President Emerita Mildred Z. Solomon. 

Surgeon shares biggest lesson: ‘Never underestimate the power of hope Mofitt Cancer Center, by Corrie Pellegrino; 2/27/24An Interview with Dr. Monica Avila. ...[Question] What is the biggest lesson you’ve learned from a patient?[Response] I think the biggest lesson is to never underestimate the power of hope and the power of the patients’ will to live. I’ve had patients literally placed on hospice care who I have taken to the operating room, had successful optimal debulking for ovarian cancer and who are living life right now after chemotherapy. So I never underestimate patients’ ability to keep going and keep living.

Embracing the platinum rule in palliative care: Treating patients the way they want to be treated Anschutz, by Tari Advani, MD; 2/26/24 One of the first take aways from this journey, for me, in a mid-career directional change from emergency medicine to palliative care was a move away from the golden rule and towards the platinum rule. Treat patients the way they want to be treated, not the way we want to be treated. It is so simple, it allows people to exist in their own context, with their own histories and their own wishes. And, we, as caretakers, take the kind of care of them that they want. Where had that idea been during the past 20 years of my career? How many situations had I judged, wrongly, based on my own preferences, not the preferences of the patient.

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.

Study gives credence to range of dementia caregiver decision toolsMcKnights Home Care, by Kristen Fischer; 2/27/24A new study analyzes some evidence-backed tools to help substitute decision-makers make choices to honor an individual’s medical, personal and end-of-life wishes. ... Substitute decision-makers are family members or friends of older adults who cannot speak for themselves (such as those with dementia). Data from the study, which was published on Saturday in Journal of the American Society of Geriatrics, was derived from 25 articles published between 2003 and 2022. 

Understanding the discordance about prognosis between clinicians and terminally ill patients and their surrogates: A conversation with Douglas B. White, MD, MASThe ASCO Post, by Jo Cavallo; 2/25/24Research shows that about half of adults near the end of life in the United States are too ill to participate in decisions about whether to accept life-prolonging treatment, requiring family members and other proxies to serve as surrogate decision-makers for their critically ill loved ones. However, research also shows that surrogates of patients with advanced illness often have optimistic expectations about prognosis, which often lead to the increased use of invasive treatment (including life support) in dying patients and delays in the integration of palliative care.

Not all mourning happens after bereavement – for some, grief can start years before the death of a loved one The Conversation, by Beth Daley; 2/22/24For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness. Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as anticipatory grief.Editor's Note: All clinical team members need to be equipped to tune into and validate grief that is already underway. Social workers and chaplains--especially--need to be trained to tend grief in the present, and to know how to make high-acuity referrals to bereavement counselors.  

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. 

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