Literature Review

Hospice & Palliative Care Handbook: Quality, Compliance, and Reimbursement, 4th Edition McGraw Hill - Access APN; textbook by Tina M. Marrelli and Jennifer Kennedy; 3/28/24 “Hospice & Palliative Care Handbook, Fourth Edition, is an invaluable resource for timely hospice regulatory and compliance information, documentation, care planning, and case management. It provides clear guidance for hospice managers, clinicians, and interdisciplinary group members. I have utilized Tina Marrelli’s home health and hospice handbooks to support training new clinical staff and students for decades and consider these resources to be the gold standard.” – Kimberly Skehan, MSN, RN, HCS-D, COS-C, Vice President of Accreditation - Community Health Accreditation Partner

Fall prevention for the elderly: 13 strategies to keep them safe U.S. News & World Report, by Claire Wolters, ed. by Christine Comizion, MPH; 3/26/24Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. ... According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here's what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.Editor's Note: This U.S. News article primes the pump. Preventing falls matters especially for vulnerable hospice patients as their disease progresses, and as they and/or family want the person to be as mobile as possible. What do your Incident Reports tell you about falls? What falls-specific education do you provide for your interdisciplinary teams? On-call staff? Family caregivers? Volunteers? What QAPI programs have addressed falls? 

4 things nobody tells you about watching a loved one die of cancer The New York Post; by Jessica Ariel Wendroff; 3/23/24 ... “The surgery was successful. However, tests after the operation found cancer had been present,” the Princess of Wales, 42, revealed in a bombshell videotaped statement Friday. ... While the royal insisted she is “well and getting stronger every day,” other patients’ real pain begins when the cancer has spread too far and chemotherapy and radiation no longer work, so doctors stop treatment. As the daughter of a Stage 4 bladder cancer patient, I’ve empirically learned four realities that people usually don’t talk about ...

Health care utilization and opioid use in patients receiving an integrated palliative care intervention for treatment of head and neck cancer compared to a historical control Elsevier, International Journal of Radiation; by F. Rizwan. C. D'Avella, M. Albert, T. King, B. Egleston, T.J. Galloway, M. Chwistek, C. Fang, A. El-jawahri, J.R. Bauman; online access for 4/1/24 release Patients receiving chemoradiation therapy (CRT) for head and neck cancer (HNC) can develop significant symptomology (odynophagia, malnutrition) resulting in frequent hospitalizations and decreased quality of life (QOL) and continue to have chronic symptoms such as dysphagia and/or pain. The integration of a palliative care (PC) team during CRT has the potential to address the high symptom burden and improve QOL.

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).

Description and outcomes of a palliative care pharmacist-led Transitions of Care program J Palliat Med, by Connor McCormick, Mamta Bhatnagar, Robert M Arnold, Maria Felton Lowry; 3/6/24Background: Patients with palliative care needs are at high risk of medication errors during transitions of care (TOC). Palliative Care Pharmacist Interventions surrounding Medication Prescribing Across Care Transitions (IMPACT) program was developed to improve the TOC process from hospital to community setting for cancer patients followed by palliative care. Conclusion: Our pilot study demonstrates that integrating a pharmacist in TOC for seriously ill patients is feasible and valuable.

Subcutaneous patient-controlled analgesia in home-based palliative care: "It's as straightforward as pushing a button, right at my fingertips" J Pain Palliat Care Pharmacother, by Miguel Julião, Patrícia Calaveiras, Eduardo Bruera, Paulo Faria de Sousa; 2/26/24Subcutaneous patient-controlled analgesia (SCPCA) in home-based palliative care is a potentially valuable option for providing effective pain relief to some patients, particularly when conventional analgesic approaches prove ineffective or are refused.

Reimagining end-of-life care: Balancing polypharmacy, treatment modification, and quality of life in advanced cancer patientsBNN, by Mahnoor Jehangir; 2/15/24In a recent groundbreaking study, researchers have illuminated the complexities surrounding polypharmacy and the prescription of potentially inappropriate medications (PIMs) to patients at the end of their lives, particularly those battling advanced cancer. This investigation, involving a cohort of 265 older adults, sheds light on the nuanced challenges and critical decisions faced by healthcare providers in managing the delicate balance between treatment efficacy and quality of life for terminally ill patients. 

Study testing new strategy for spotting, managing pain in dementia patients McKnights Long-Term Care News, by Kimberly Marselas; 2/1/24Up to 80% of dementia patients living in nursing homes also experience pain, but many struggle to communicate their symptoms. A new, $2.1 million study aims to test recently revised guidelines for staff members tasked with detecting and managing that pain. ... Barbara Resnick, PhD, RN, professor and associate dean for research at the University of Maryland School of Nursing, will lead the project at 12 nursing homes over the next five years.

A pathophysiological approach for selecting medications to treat nociceptive and neuropathic pain in servicemembersMil Med, by Khan Thi Nguyen, Daniel W Beauchamp, Reginald B O'Hara; 1/31/24The prevalence of chronic pain of service members (SMs) in the U.S. is estimated to be higher (roughly 31-44%) compared to that of civilian population (26%). This higher prevalence is likely due to the high physical demands related combat and training injuries that are not immediately resolved and worsen over time. Mental Health America reports that chronic pain can lead to other mental health conditions such as severe anxiety, depression, bipolar disorder, and post-traumatic stress disorder.

Hospices struggle to balance costs, patient needs in medication deprescribingHospice News, by Jim Parker; 1/30/24When deprescribing medications for hospice patients, providers have to navigate a complex web of factors. But according to some clinicians, the prospect of cost savings often takes precedence over clinical outcomes. Medication costs are among hospices’ biggest expenses, and deprescribing some medications deemed “curative” or “unrelated” to the patient’s terminal diagnosis is a standard practice. However, even in the context of providing comfort care at the end of life, many patients do not receive medications that could benefit them, including those for pain management.

Ethical issues in pain and palliationCurr Opin Anaesthesiol, by Marco Cascella, Alessandro Laudani, Giuliana Scarpati, Ornella Piazza; 1/30/24Summary: Palliative care in the ICU should involve a multidisciplinary team, to mitigate patients suffering and futility. Providing spiritual support in the ICU is an important aspect of holistic patient care too. Increasingly sophisticated tools for diagnosing and treating pain, as those involving artificial intelligence, might favour disparities in access, cause informed consent problems, and surely, they need prudence and reproducibility. Pain clinicians worldwide continue to face the ethical dilemma of prescribing opioids for patients with chronic noncancer pain. Balancing the need for effective pain relief with the risk of opioid misuse, addiction, and overdose is a very controversial task.