Literature Review

National Healthcare Decisions Week highlights the importance of Advance Care Planning JAX Chamber - Jacksonville News, Jacksonville, FL; 4/1/25 National Healthcare Decisions Week kicks off on April 14, 2025, with a nationwide effort to raise awareness about the importance of advance healthcare decision-making. This initiative encourages individuals to take proactive steps in planning for their future healthcare needs. Through various events and resources, the week aims to promote thoughtful conversations about healthcare decisions and the completion of advance directives to ensure patients' wishes are known and respected. ... For more information about National Healthcare Decision Day, please visit http://nhdd.org.

Home care aides largest occupation in US as of last May, BLS reports McKnights Home Care; by Adam Healy; 4/7/25 As of May 2024, home health and personal care aides made up the largest single occupation in the US with 4 million workers, according to the Bureau of Labor Statistics’ Occupational Employment and Wages Summary report released Wednesday. The next highest groups were retail salespeople and fast food counter workers, which each had 3.8 million. Registered nurses also were among the top 10 largest US occupations, and they were one of only two top 10 workforces that earned above-average wages. RNs’ average salary in May 2024 was just over $98,000. Meanwhile, home health and personal care aides earned an average yearly salary of $35,000, or about $17 per hour.

Interprofessional advance care planning to enhance end-of-life care: A community assessmentCreighton Journal of Collaborative Practice and Education; Meghan Potthoff, Amanda Kirkpatrick, Jenny Jessen, Cathy Fox, Victoria Haneman, Megan Piotrowski, Beatriz Rodriguez, Sydney Langlois; 3/25Lawyers and financial planners are more often sought for estate directives than primary care providers for end-of life planning. Lack of role clarity and divergent views about advance care planning (ACP) responsibility among healthcare providers lead to further delay of these important discussions. A qualitative, exploratory design was employed to investigate ACP understanding, barriers, and needs among aging Nebraskans and Omaha-metro community agencies that serve these consumers. Conclusions: Improved ACP discussions are needed for supporting value-aligned end-of-life care by educating aging adults about, and documenting their wishes for, life-sustaining treatments and other decisions surrounding death. Enhanced role clarity, increased competence, and a collaborative approach are needed among interprofessional team members involved to improve these end-of-life discussions. 

"Be a yardstick of quality. Some people aren't used to an environment where excellence is expected." ~ Steve Jobs

The true test of character is not how much we know how to do, but how we behave when we don’t know what to do. ~ John Holt

Hiding in plain sight: A narrative review of non-parental relatives' perinatal griefJournal of Social Work in End-of-Life and Palliative Care; Rennie Bimman, Nancy Graham; 3/25Perinatal loss frequently leads to disenfranchised grief, and members of family systems less proximate to the loss are at risk for additional disenfranchisement. Grandparents and siblings are especially vulnerable to complications in perinatal grief due to intersecting and disenfranchising factors of identity, including age, role within family, and type of loss. Evidence found attested to the uniquely complex grief experiences these populations face as a result of their confluent disenfranchisement, and their overwhelming lack of support and recognition. New insights uncovered may inform clinicians as they assess needs and provide support to these oft-ignored grievers. Significant research gaps remain in this subtopic, such as firsthand perspectives of nonparental grievers, data on other extended family members, and the effect of additional psychosocial stressors on nonparental perinatal grief.

Interventions for prolonged grief disorder in children and adolescents: A systematic reviewJournal of Child & Adolescent Trauma; Sarah Bondy, Haleigh Scott; 3/25 Prolonged Grief Disorder (PGD) was added as a new diagnosis to the Diagnostic and Statistical Manual of Mental Disorders 5 Text Revision (DSM-5-TR). There is a need to tailor interventions to children and adolescent populations, but there is a lack of consensus on best practices for treating PGD in these populations. Interventions were grouped by modality including group treatments, hybrid treatments (combined group or individual therapy with family therapy), family treatment, and individual treatment. Cognitive Behavior Therapy (CBT), Attachment Theory and Multidimensional Grief Theory were common theoretical bases for interventions and all shared elements of psychoeducation and integrating knowledge about the loss with existing knowledge. Results for each intervention were found to be generally positive in reducing PGD symptoms.

“I Don’t Know What to Say”-A multimodal educational and environmental intervention to improve bedside nursing communication at end of lifeJournal of Hospice & Palliative Nursing; Wolownik, Gregory DNP, AGPCNP-BC, ACHPN; Wholihan, Dorothy DNP, AGPCNP-BC, ACHPN, FPCN, FAAN; 4/25... research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed ...[including] environmental cues, engaging pocket cards, and an education module on communication techniques. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.

Antimicrobials in serious illness and end-of-life care: Lifting the veil of silenceThe Lancet. Infectious Diseases; William E Rosa, Shila Pandey, Renee Wisniewski, Craig Blinderman, Mark Wing Loong Cheong, Juan Esteban Correa-Morales, Diego Alejandro Cubides-Diaz, Sharif Folorunso, Nahla Gafer, Mohja Marhoom, Tiffanny Newman, Christian Ntizimira, Temitope Oyewole Obadare, Cihan Papan, Pedro Emilio Pérez-Cruz, Lukas Radbruch, Giri Shan Rajahram, Tomás Alejandro Reyes-Barros, Naveen Salins, Kavitha Saravu, Donald R Sullivan, Edward Christopher Dee; 3/25Global rates of antimicrobial consumption increased by 65% between 2000 and 2015, by 16% between 2016 and 2023, and are estimated to increase by an additional 52% by 2030. Antimicrobial use and misuse remains high among people with serious illness and at end of life, despite scarce evidence of benefit. In addition, the overuse and misuse of antimicrobials at end of life further exacerbate antimicrobial resistance, which is a substantial public and global health concern. These examples are combined with a case of non-beneficial end-of-life antimicrobial use and clinical guidance for patient and family communication regarding antimicrobial treatment. This Personal View also provides recommendations to improve antimicrobial stewardship with the goal of engaging multidisciplinary stakeholders and decreasing inappropriate antimicrobial use at end of life.

[Canada] Care utilization patterns among patients dying with advanced chronic obstructive pulmonary diseaseCanadian Journal of Respiratory, Critical Care, and Sleep Medicine; Aleisha Fernandes, Shuaib Hafid, Anastasia Gayowsky, Tetyana Kendzerska, Aaron Jones, Erin Gallagher, Colleen Webber, James Downar, Sophie Corriveau, Douglas G. Manuel, Sunita Mulpuru, David Da Silva-Krul, Amy Hsu, Peter Tanuseputro, Sarina R. Isenberg, Michelle Howard; 3/25Despite primary care providing majority of outpatient care, inpatient utilization is higher amongst patients who are notaccessing PC [palliative care]. These patients are also more likely to die in an acute setting. This study provides insight into the proportion of care patients are being provided from different specialties as well as the distribution of end-of-life outcomes amongst these patterns of care. Future research will benefit from exploring the association between these different patterns and end-of-life outcomes to identify the most optimal care pattern for improving end-of-life outcomes for patients with ACOPD [advanced chronic obstructive pulmonary disease].

Saturday newsletters focus on headlines and research - enjoy!

RCT of PC in EDGeriPal podcast; by Eric Widera, Alex Smith, Corita Grudzen, Fernanda Bellolio, Tammie Quest; 4/10/25Today we focus on an intervention, published in JAMA, that gave emergency clinicians basic palliative care knowledge, training, and skills. We talk with Corita Grudzen and Fernanda Bellolio about their cluster stepped wedge randomized trial of a palliative care intervention directed at emergency clinicians... We are fortunate to have Tammie Quest, emergency and palliative trained and long a leader in this space, to help us unpack and contextualize these findings.

Rural US loses 43% of independent physicians: 5 things to know Becker's Hospital Review; by Kelly Gooch; 4/7/25 The number of independent physicians in U.S. rural areas declined 43% over five years — from 21,956 in January 2019 to 12,467 in January 2024 — according to an Avalere study sponsored by the Physicians Advocacy Institute. ... Five things to know: