Literature Review

Inpatient palliative care and healthcare utilization among older patients with Alzheimer's Disease and Related Dementia (ADRD) and high risk of mortality in U.S. hospitalsAmerican Journal of Hospice and Palliative Care; by Zhigang Xie, Guanming Chen, Oluwadamilola T Oladeru, Hanadi Y Hamadi, Lucinda Montgomery, Maisha T Robinson, Young-Rock Hong; 5/24PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.

End-of-life ethics content in the ten residencies offering Hospice and Palliative Medicine FellowshipJournal of Pain and Symptom Management; by Sara W. Youssef, Lauren E. Berninger, Danielle J. Doberman; 5/24Ethics training is essential to hospice and palliative medicine (HPM) training. Ten residencies feed into HPM fellowship, but clinical ethics tested on board certification exams vary in content and weight across specialties. Given this variance, standardizing end of life ethics training for HPM fellowship programs presents an opportunity for educational improvement.

Does assisted living provide assistance and promote living?Health Affairs; by Sheryl Zimmerman, Robyn Stone, Paula Carder, Kali Thomas; 5/24Assisted living has promised assistance and quality of living to older adults for more than eighty years. ... As assisted living has evolved, the needs of residents have become more challenging; staffing shortages have worsened; regulations have become complex; the need for consumer support, education, and advocacy has grown; and financing and accessibility have become insufficient. Together, these factors have limited the extent to which today’s assisted living adequately provides assistance and promotes living, with negative consequences for aging in place and well-being. This Commentary provides recommendations in four areas to help assisted living meet its promise: workforce; regulations and government; consumer needs and roles; and financing and accessibility. Policies that may be helpful include those that would increase staffing and boost wages and training; establish staffing standards with appropriate skill mix; promulgate state regulations that enable greater use of third-party services; encourage uniform data reporting; provide funds supporting family involvement; make community disclosure statements more accessible; and offer owners and operators incentives to facilitate access for consumers with fewer resources. Attention to these and other recommendations may help assisted living live up to its name.Publisher's note: Many of these ALF recommendations may be helpful in hospice, too...

Retraumatization when an adult child cares for the parent who harmed them through serious illness or the end of lifeJournal of Pain and Symptom Management; by Jaime Goldberg, Jooyoung Kong; 5/24Adult children caring for a parent who harmed them through the parent's serious illness or the end of life are at high risk for experiencing retraumatization. This session will offer trauma-informed, culturally responsive, person-centered tools and techniques hospice and palliative care professionals can use to effectively identify, assess, and intervene with this often-overlooked population of caregivers.Publisher's note: This current article summary is for an upcoming AAHPM conference workshop. The study was previously published in JPSM 5/24 here.

The role of mindfulness and resilience in Navy SEAL trainingMilitary Psychology; by Andrew Ledford, Celeste Raver Luning, Deirdre P. Dixon, Patti Miles, Scott M. Lynch; 5/24Mindfulness and resilience are thought to be essential qualities of the military’s special operations community. Both are tested daily in Special Operations Forces (SOF) assessment and selection efforts to prepare candidates to persist through grueling training and complex combat situations; but these qualities are rarely measured. While military leadership places value on the concepts of mindfulness and resilience, there is minimal empirical research examining the role that they play in the completion of training. This longitudinal study followed three classes of SEAL candidates at Basic Underwater Demolition/SEAL (BUD/S) training over their six-month selection program. We estimated logit models predicting successful completion of BUD/S and specific types of failure in that training environment with indexes of mindfulness and resilience at the start of the program as predictors of completion. The results indicate that mindfulness is generally unrelated to completion, while resilience generally predicts completion.Publisher's note: A leadership-oriented article from another field (the military) that can be applied to healthcare.

Hospice satisfaction among patients, family, and caregivers: A systematic review of the literatureAmerican Journal of Hospice and Palliative Medicine; Timothy Hoff, PhD, Kathryn Trovato, MPH, Aliya Kitsakos, BA; 6/24Thirty-eight studies were included in the review. Key findings were: (a) higher levels of hospice care satisfaction among patients, families, and other caregivers; and (b) correlates of hospice care satisfaction falling into the categories of communication, comfort, and support. The published literature had fewer findings related to demographic correlates of satisfaction such as age or race/ethnicity and was lacking in comparative research examining satisfaction across different types of hospice care settings.

Making end-of-life health disparities in the U.S. visible through family bereavement narrativesPEC Innovation; by Cassidy Taladay-Carter; 4/24End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care. ... Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond.

Textures of Black sound and affect: Life and death in New OrleansAmerican Anthropologist; by Matt Sakakeeny; 6/24In a traditional New Orleans jazz funeral, the characteristic shift from mourning to joy is propelled by brass band musicians weaving melodies and rhythms together. This article is about how these thickly layered textures of sound elicit shared sentiments of lament and of joy.

"It's a heavy thing to carry": Internal medicine and pediatric resident experiences caring for dying patientsAmerican Journal of Hospice and Palliative Medicine; by Lindsay M Gibbon, Laura Buck, Lauren Schmidt, Jori F Bogetz, Amy Trowbridge; 5/24Our data suggests a model for the process by which residents learn affective skills critical to EOL care: residents (1) notice strong emotion, (2) reflect on the meaning of the emotion, and (3) crystallize this reflection into a new perspective or skill. Educators can use this model to develop educational methods that emphasize normalization of physician emotions and space for processing and professional identity formation.

Time to rethink assisted dying?Bioethics; by Udo Schuklenk; 5/24... But who should be tasked with the provision of such services [assisted suicide and / or voluntary euthanasia], given that it would no longer be the case that only people defined as patients would be eligible for an assisted death. Healthcare professionals might object to providing such services to people who aren't patients. Different societies could decide to introduce permissive assisted dying regimes tasking different professionals with the provision of such services. If doctors are the profession tasked with the provision of such services in a particular jurisdiction, they ought to provide it to those eligible in that society. However, it is worth considering whether a newly created assisted dying profession, that is equally tightly regulated, may be a preferable way forward.

Dana-Farber retracts string of studies in systematic review of data integritySTAT+, by Angus Chen; 4/18/24An ongoing investigation into data integrity at Dana-Farber Cancer Institute has resulted in a string of retractions, the latest of which is a 2006 Science paper co-authored by institute president and CEO Laurie Glimcher. The retraction notice, published in Science on Thursday, noted that the authors had become aware of discrepancies in key scientific images that led them to lose confidence in key figures in the study, although the study’s lead author opposed the retraction. The issues with this paper, along with concerns with more than 50 other articles co-authored by four of Dana-Farber's top researchers, were highlighted in a January blog post by the scientific sleuth Sholto David.

How do people in prison access palliative care? A scoping review of models of palliative care delivery for people in prison in high-income countriesPalliative Medicine, by Emma Gilbert, Nick De Viggiani, Joana de Sousa Martins, Tanuka Palit, Jessica Sears, Daniel Knights, Audrey Roulston, Mary Turner, Lucy E Selman; 4/24We identified a typology of three models of care delivery for people in prison in high-income countries: (1) Embedded hospice model, typified by an interdisciplinary team and volunteer caregivers providing care on-site; (2) Outsourcing Care model, in which end-of-life care is provided outside the prison; (3) Collaborative community model, which involves prisons engagement with other healthcare facilities or practitioners. ... Embedded hospice models in the USA are prevalent and demonstrate promising evidence for enhancing the care experience for recipients and peer caregivers. Chaplains, social workers and peer caregivers provide psychosocial support, yet documented assessment and strategies for managing the distinctive needs of this group and their families are lacking, despite their acknowledged complexity.