Literature Review

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.

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.

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. 

Scaling palliative care requires adherence to best practicesAJMC, by Tina Basenese, MA, APN, ACHPN; 2/14/24An important milestone came January 1, 2024, when a new add-on code [G2211] took effect for reimbursement for complex Medicare patient visits, including palliative care. ... Having patients map out their wishes through advance directives is an important metric, but it’s not the goal of palliative care, nor is it the only way to measure whether a program works. Rather, comprehensive palliative care must be truly patient centered. This requires building trust and training palliative care specialists in a manner similar to other subspecialties to create and scale processes that are infused with a culture of communication.

How to support adolescents and young adults with cancer at the end of lifeThe Oncology Nursing Society Voice, by Kimberly Rivera DNP, RN-BC, OCN®, NPD-BC; 2/12/24... [Cancer] is the fourth leading cause of death in adolescents and young adults (AYAs), following accidents, suicide, and homicide. ... Appropriately defining the difference between palliative and end-of-life care can improve AYAs’ engagement with services such as advance care planning—a specific step that increases AYAs’ likelihood of receiving early palliative care. However, many palliative and hospice care services are geared toward pediatric or adult populations and may not meet AYAs’ unique needs, impeding effective care planning.

What is a good death? End-of-life doulas can help the dying have one.Boston Globe, by Sherrie Dulworth; 2/9/24... Home hospice agencies offer vital services for terminally ill people who wish to die at home, assisting with, among other things, pain management and helping the terminally ill avoid needless medical procedures. ... But while it is often thought that home hospice workers are the primary caregivers for the dying, this is not so. Instead, it is loved ones who often do the heavy lifting, both physically and emotionally, that comes with tending to the dying. ... This is where a death doula comes in, and the work they do speaks to the nonmedical, more spiritual side of what it means to have a good death.

NHPCO Publishes Culturally Sensitive Communications to Enhance Care Delivery: A resource guide for healthcare professionalsNHPCO Press Release; 1/30/24The National Hospice and Palliative Care Organization’s (NHPCO) Diversity Advisory Council (DAC) published Culturally Sensitive Communications to Enhance Care Delivery: A Resource Guide for Healthcare Professionals. ... It contains information from a multitude of NHPCO resources, such as the Hospice Through The DEI Lens report, Inclusion and Access Toolkit, Black and African American Outreach Guide, Chinese American Resource Guide, Latino Outreach Guide, and LGBTQ+ Resource Guide, as well as information from additional external research sources.

Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey studyJ Adv Nurse, by Alison Hession, Tim Luckett, David Currow, Michael Barbato; 1/31/24Results: Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care.Editor's Note: This research was in Australia, yet has global applications. For U.S. leaders, call on your chaplains, many of whom are trained pastoral counselors to sensitively support and explore patient's "dreams and visions," in non-manipulative ways.

Anorexia Nervosa: Evaluating disparities in places of death in the United States over 22 years using the CDC WONDER databaseCureus / NCBI, by Nirmal Patel, Rahul Tyagi, Deepanwita Biswas, Ayesha Birjees, Chetana Rajesh 6, Sadia Khan; posted via NCBI 1/30/24Conclusions:[This] study found that death in home and hospice was more common than in medical or hospital nursing facilities in all four analyzed groups. These findings highlight the critical need for significant advancements in end-of-life care, particularly in home and hospice settings.

Palliative telecare team aids QOL, health status for chronic conditionsHealthDay News, by Lori Solomon; 1/23/24Use of a nurse and social worker palliative telecare team is associated with clinically meaningful improvements in quality of life at six months for adults with chronic obstructive pulmonary disease (COPD), heart failure, or interstitial lung disease (ILD) versus usual care, according to a study published in the Jan. 16 issue of the Journal of the American Medical Association.

Hospice of the Valley launches living will campaignAhwatukee Foothills News, by Lin Sue Flood; 1/23/24National research shows that only about a third of Americans have created a living will or advance healthcare directive. ... Three nonprofit organizations — Mercy Care, Hospice of the Valley and Contexture — are launching a community education campaign to ensure that Arizonans’ wishes are honored. ... Choose Your Person is an awareness campaign urging all adults to choose someone to be their healthcare power of attorney.