Literature Review

More COVID-19 patients died in understaffed hospitals, new data showUniversity of Minnesota [reported by KFF Health News]; by Stephanie Soucheray, MA; 6/13/24A new study in the International Journal of Nursing Studies suggests chronically understaffed US hospitals had higher rates of COVID-19 patient deaths early in the pandemic. "Our study found that individuals' likelihood of surviving was related to hospitals' investments in nursing services prior to the pandemic—in terms of hiring sufficient numbers of RNs, employing nurses with bachelor's educational preparation, and sustaining favorable work environments," said Karen Lasater, PhD, RN, the lead author of the study, in a press release from the University of Pennsylvania School of Nursing. The study was based on outcomes seen among 87,000 Medicare enrollees (ages 65 to 99) hospitalized with COVID-19 from April through December 2020 in 237 general acute-care hospitals in New York and Illinois. ... Overall, the average age of patients was 78 years, and 31.5 % died within 30 days of admission, with 23% of those patients dying during the hospitalization.

Geriatric conditions and healthcare utilization among older adults living in subsidized housingJournal of the Americal Geriatric Society; by Sarah E Kler, L Grisell Diaz-Ramirez, Kira L Ryskina, Sun Young Jeon, Kanan Patel, Thomas K M Cudjoe, Christine S Ritchie, Krista L Harrison, W John Boscardin, Rebecca T Brown; 6/24Older adults living in subsidized housing have higher hazards of hospitalization and nursing facility utilization compared to those in the general community. Housing-based interventions to optimize aging in place and mitigate risk of nursing facility utilization should consider risk factors including functional impairment and dementia.

Loneliness, psychological distress, and the moderating effect of positive aspects of caregiving among cancer caregiversSupportive Care in Cancer; by JoAnn Jabbari, Kyle A Pitzer, Keisha White Makinde, Jacquelyn J Benson, George Demiris, Debra Parker Oliver, Karla T WashingtonThe results of this study shed new light on the relationship between loneliness and symptoms of psychological distress experienced by family caregivers of cancer patients, providing a better understanding of the impact that recognition of positive aspects of caregiving has on the association between loneliness and psychological distress symptoms. Our findings emphasize the importance of targeting family caregiver loneliness in order to reduce psychological distress among family caregivers of cancer patients.

Training Senior Companion Volunteers to identify and report adult abuse, neglect, and exploitationJournal of Applied Gerontology; by Jessica Bibbo, Courtney Reynolds, Farida Kassim; 6/24Elder abuse is a national public health challenge that can have dire consequences for the older adults who experience it in any form. The Senior Companion Program presents a unique opportunity to address this public health challenge. An in-person training for Senior Companion volunteers across Ohio on how to recognize and report elder abuse was developed, implemented, and evaluated prior to the COVID-19 pandemic. ... Training older adult volunteers working with other community-dwelling adults is likely a valuable strategy to educate and protect against elder abuse.Publisher's Note: I wonder if similar training could be incorporated into hospice voluteer, social worker, etc., training?

Patterns of national emergency department utilization by fee-for-service Medicare beneficiaries with dementiaJournal of the American Geriatrics Society; by Jason K Bowman, Christine S Ritchie, Kei Ouchi, James A Tulsky, Joan M Teno; 6/24Persons with ADRD frequently use the ED-particularly those with recent hospitalizations, rehab/SNF stays, or home health use-and may benefit from targeted interventions during or before the ED encounters to reduce avoidable utilization and ensure goal-concordant care.

National Nurses Honor Guard CoalitionJournal of Hospice and Palliative Nursing; by Betty Ferrell; 6/24As hospice and palliative care nurses, we are very familiar with the importance of rituals at the end of life or after death, which helps us to honor this sacred time. We know that funeral or memorial services offer a time to honor lives and to provide comfort to families. But how often do we pause to honor our own nursing colleagues for their lives of service?I recently learned of an incredible organization, the National Nurses Honor Guard Coalition, which is doing just this—honoring nurses through participation in their funeral services to celebrate these lives well lived and lives dedicated to our profession. ... Hearing about the Honor Guard Coalition brought tears to my eyes to think about this incredible tribute to nurses.Publisher's Note: Thanks for writing about this important group Betty! I also recently learned about the National (and state-specific) Nurses Honor Guard Coalition at the Nebraska Hospice & Palliative Care Association annual conference. A great group with a fantastic mission. 

Stepped palliative care for patients with advanced lung cancer: A randomized clinical trialJAMA; by Jennifer S. Temel, MD, Vicki A. Jackson, MPH, MD, Areej El-Jawahri, MD, Simone P. Rinaldi, MSN, ANP-BC, ACHPN, Laura A. Petrillo, MD, Pallavi Kumar, MD, Kathryn A. McGrath, MD, Thomas W. LeBlanc, MD, Arif H. Kamal, MD, Christopher A. Jones, MD, Dustin J. Rabideau, PhD, Nora Horick, MS, Kedie Pintro, MS, Emily R. Gallagher Medeiros, RN, Kathryn E. Post, PhD, RN, ANP-BC, Joseph A. Greer, PhD; 6/24A stepped-care model, with palliative care visits occurring only at key points in patients’ cancer trajectories and using a decrement in QOL to trigger more intensive palliative care exposure, resulted in fewer palliative care visits without diminishing the benefits for patients’ QOL. While stepped palliative care was associated with fewer days in hospice, it is a more scalable way to deliver early palliative care to enhance patient-reported outcomes.Publisher's note: This article was reference earlier this week in Palliative care for cancer patients is found to be as effective given virtually as in person.

A moratorium on the euphemism MAIDJournal of the American Medical Directors Association; by Richard W. Sams II MD, MA (Ethics), CMD, Peter Jaggard MD, CMD; 6/24It is essential for high-quality health care for providers to adhere to the principle of truth telling, speaking with clarity and honesty. The euphemism medical aid in dying, MAID, is being mainstreamed in the medical literature by proponents of physician-assisted suicide and euthanasia. ... We recommend standardized language that accurately denotes the context and process. Provider Assisted Death by Prescription (PAD-P) and Provider Assisted Death by Administration (PAD-A) are terms that most accurately describe the process, taking into account who is prescribing or administering a lethal substance and the outcome of the actions. ... The standardized language needs to be used on death certificates so we can most accurately assess the impact that provider-assisted death is having on society. Emphasizing truth telling in morally controversial practices will foster trust among health care providers and with patients.

Lessons learned establishing the Palliative Care Research Cooperative's Qualitative Data Repository Journal of Pain and Symptom Management; Salimah H Meghani, Kim Mooney-Doyle, Amber Barnato, Kathryn Colborn, Riley Gillette, Krista L Harrison, Pamela S Hinds, Dessi Kirilova, Kathleen Knafl, Dena Schulman-Green, Kathryn I Pollak, Christine S Ritchie, Jean S Kutner, Sebastian Karcher; 5/31/24 ... The [Palliative Care Research Cooperative Group] PCRC Data Informatics and Statistics Core leadership partnered with the Qualitative Data Repository (QDR) to establish the first serious illness and palliative care qualitative data repository in the U.S. ... Specifically, we discuss how we co-designed the PCRC-QDR and created tailored guidelines for depositing and sharing qualitative data depending on the original research context, establishing uniform expectations for key components of relevant documentation, and the use of suitable access controls for sensitive data. ... This work advances the establishment of best practices in qualitative data sharing.

A joint frailty model for recurrent and competing terminal events: Application to delirium in the ICUStatistics in Medicine; by Lacey H. Etzkorn, Quentin Le Coënt, Mark van den Boogaard, Virginie Rondeau, Elizabeth Colantuoni; 5/24Motivated by studies of recurrent delirium events in patients receiving care in an intensive care unit (ICU), we devise a joint model for a recurrent event process and multiple terminal events. ... We propose a competing joint model that uses a latent frailty to link a patient’s recurrent and competing terminal event processes. ... Lastly, we discuss limitations and possible extensions for the competing joint model.Publisher's Note: While complicated, some readers might find this methodological model of interest.

The balance between honesty and hopeJAMA Cardiology; by Sarah Godfrey; 5/24I am training to be a palliative cardiologist, often delivering heartbreaking news, but I was not prepared to receive it as a mother. Before [her new baby boy] N’s diagnosis, I would have said that our responsibility as physicians is to prepare families for the worst possible outcome. But how can we balance honesty and hope? Could that neurologist have prepared us for the potentially devastating outcome while also allowing us to believe more was possible? When I enter critical illness conversations now, I remember my desperate need for hope when I faced a parent’s worst nightmare. N has made me a better mother and physician, and he has taught me that we must allow hope to flourish even in the darkest of situations.

Beyond the diagnosis: A deep dive into the end stage liver disease experience from the patient perspectiveAmerican Journal of Hospice and Palliative Medicine; Sheza Malik, MD, Venkat Arutla, MD, Tariq Alamin, MD, Fatima Warraich, MD, Tausif A. Syed, MD, Mahesh Nepal, MD, Muhammad Farhan Ashraf, MD, and Karin J. Dunnigan, MD; 5/24The study identified six primary themes: the significance of communication style in diagnosis delivery, the crucial role of family and social support, varied understanding and preferences for palliative care, diverse attitudes towards advanced care planning, preferences for coordinated healthcare experiences, and the emotional and psychological impact of ESLD. ... Our study underscores the complexity of ESLD patient care beyond medical treatment, highlighting the importance of clear communication, empathetic care, and the integration of family and palliative care services.

Challenges and solutions of conducting dementia clinical trials: A palliative care at home pilot for persons with dementiaJournal of the American Geriatrics Society; by Leah V. Estrada, PhD, Laura Gelfman, MD, Meng Zhang, MD, Christian Espino, BA, Nathan Goldstein, MD; 4/24We enrolled 30 patients and their 30 caregivers in our pilot trial of home-based palliative care. We found two significant barriers to enrollment: (1) the electronic health record was insufficient to determine the severity ofpatients' dementia; and (2) rates of follow-up survey completion were low, with completion rates at 6 months between 14 and 44%. We created an iterative training process to determine dementia severity from electronic health records and applied person-centered approaches to improve survey completion. ... Electronic health records are not set up to include discrete fields for dementia severity, which makes enrollment of older adults with dementia in a clinical trial challenging. The strain of caring for a loved one with advanced dementia may also make participation in health-services research difficult for patients and their families. Novel approaches have the potential to counteract these challenges, improve recruitment and retention, and ultimately improve care for people with dementia and their caregivers.