Literature Review

Voluntarily stopping eating and drinking (VSED) with hospice support in America: A case seriesJournal of Pain and Symptom Management; by Hope A Wechkin, Elizabeth T Loggers; 5/26Despite increasing public awareness of voluntary stopping of eating and drinking (VSED), there are no descriptions of the clinical course of US patients who pursue VSED, with or without hospice support... We employed retrospective chart review methodology to review a consecutive case series of 20 patients who requested and received hospice support for VSED... While this study has significant limitations, VSED was completed by all who initiated the process and death generally occurred within 10 days. Therefore, those initiating VSED should be considered eligible for hospice care, with care initiated quickly. Symptoms during VSED were typical of hospice patients and can be managed using common hospice techniques and medications.

Ketamine for depression in serious illness: Evidence, safety, and practical approachesJournal of Pain & Symptom Management; by Paul Noufi, Joshua B. Borris, Danielle Chammas, Cara L. McDermott, Nneka N. Ufere, Jason A. Webb, Daniel Shalev; 4/26Patients with serious illness and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. Ketamine and esketamine [nasal spray] offer the strongest evidence among rapid-acting antidepressants and may be preferred when urgent symptom relief is needed. However, rigorous psychiatric trials in serious illness are lacking. Clinicians should consider prognosis, access to Risk Evaluation and Mitigation Strategies-certified esketamine programs or equivalent regulatory frameworks outside the US, and the need for an appropriate maintenance regimen when integrating ketamine into palliative care depression management.

Rigorous assessment of leadership development programs in health careNEJM Catalyst; by Amanda Woods Herron, Katelyn J. Cavanaugh, Courtney L. Holladay; 4/26Effective leadership is increasingly recognized as a critical determinant of organizational performance within health care systems, but funding for such programs is frequently in jeopardy as revenues fail to keep up with other expenses. Therefore, the managers of such programs should adopt rigorous methods for evaluating the impact of their work. Despite the proliferation of leadership development programs, few institutions systematically evaluate these initiatives. This article presents a comprehensive framework for the evaluation of leadership development, grounded in implementation science and organizational research, as applied within a large academic health care institution. The framework emphasizes the necessity of clear eligibility criteria, integrated data sources, and alignment with institutional strategic priorities to assess program effectiveness and support continuous improvement. 

How to transform a health system’s organizational culture and hardwire it for the futureNEJM Catalyst; by Brian Carlson, Nancy M. Lorenzi, Paul Sternberg, Jr., Cassandra Hennessy, Dandan Liu; 4/26Organizational culture is a critical driver of workforce and patient experience, yet health care institutions often struggle to sustain their desired culture over time. In 2017, Vanderbilt Health identified inconsistencies in expected workforce behaviors through patient feedback, prompting the creation of a strategic cultural renewal initiative. The resulting program, Defining Personalized Care, had a 4-year road map of seven e-learning modules designed to reinforce core values and improve interpersonal behaviors across the workforce. This single-center pre–post study revealed statistically significant improvements in patient experience scores, particularly in the communication and courtesy domains. The initiative demonstrated that engaging, relevant content combined with visible support from leadership can drive voluntary participation and generate measurable outcomes. This case study offers a replicable framework for health care organizations seeking to hardwire their cultural expectations and align workforce behaviors with patient-centered care goals.

Potential adjunctive role of osteopathic manipulative medicine in the management of cancer-related bone pain: A narrative reviewCureus; by Ambrose Loc T. Ngo, Niki Gharavi Alkhansari, Chi Pham, Hong Nguyen, Monica Rubi, David Tanner; 4/26Osteopathic manipulative medicine (OMM) is known for its therapeutic potential on the musculoskeletal system, and its emerging role and potential benefits in oncology care are gaining attention. Patients with primary and metastatic bone cancer tend to experience pain, restricted movement, and lower quality of life due to the pathology and its treatment. This narrative review examines the mechanistic rationale and available clinical evidence supporting the use of OMM in the management of pain and functional impairment among patients with bone malignancies. Limited clinical studies suggest that select OMM techniques, including myofascial release (MFR), gentle soft tissue methods, and lymphatic approaches, may contribute to improvements in pain perception, mobility, and fatigue in oncology populations.

The state of hospice: Impacts on equity, quality, and nursing-An AAN consensus paperNursing Outlook; by Laura Fennimore, Kathleen O Lindell, Marjorie M Godfrey, Melissa Reider-Demer, Patrick J Coyne, Ronda G Hughes, Sharon Kozachik, Masako Mayahara, Patricia L Thomas, Nelson Tuazon, Polly Mazanec; 4/26Hospice care has been an integral component of the United States healthcare system for over fifty years. Hospice has transitioned from a volunteer activity supported by philanthropy to a highly sophisticated business funded by Medicare, increasingly offered by for-profit and private equity companies. This consensus paper examines the current state of hospice care in the US and the impact of changing hospice business models on health equity, healthcare quality, and nursing practice. Recommendations include updating policies to account for private equity involvement, evaluating current quality measures, addressing the existing Medicare Hospice Benefit, ensuring transparency and oversight for hospice agencies, and ensuring patient and caregiver education about hospice services. These recommendations aim to preserve the fundamental values of hospice, supporting compassion, dignity, and comfort while ensuring the quality of care to patients and families in need.

Palliative care intervention for patients with end-stage liver disease-A cluster randomized clinical trialJAMA Internal Medicine; by Manisha Verma, Victor Navarro, Andrzej Kosinski, Tamar Taddei, Richard Kalman, A. Sidney Barritt, Simona Jakab, Marina Serper, Eric Orman, Maya Balakrishnan, Mina Rakoski, Don Rockey, Kristel Hunt, Roniel Cabrera, Ayse Aytaman, Binu John, Gyorgy Baffy, Rohit Nathan, Elliot Tapper, Marina Roytman, Brendan McGuire, Nicholas Hoppmann, Christopher Woodrell, Marie Bakitas, Yang Yue, Bryce Reeve, Li Lin, Rebecca Tantala, Michael Volk; 4/26Palliative care improves quality of life (QoL) in advanced illnesses, but data in end-stage liver disease (ESLD) are limited. It is unknown whether palliative care delivered by hepatologists is effective when compared with palliative care specialists. This cluster trial found that palliative care delivered by trained hepatologists was comparable with palliative care delivered by palliative care specialists in improving QoL in patients with ESLD and was associated with greater improvement in patient satisfaction, demonstrating the effectiveness among enrolled patients.Assistant Editor's note: That's the beauty of palliative care. It can be layered upon many other specialties and sub-specialties and utilized by a variety of health care disciplines. The science of palliative care, the skill and knowledge base involved, is adaptable and valuable for almost anyone working in direct patient care in many different health care settings.