Literature Review

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Trends in location of death for individuals with pediatric cancerJAMA Pediatrics; Urvish Jain, BSc; Angelin Tresa Mathew, BSc; Bhav Jain, BS; Erin Jay Garbes Feliciano, MD, MBA; Edward Christopher Dee, MD; Leonard H. Wexler, MD; Suzanne L. Wolden, MD; 9/24Children and adolescents with cancer face unique symptomatic, psychosocial, and existential challenges at the end of life (EOL). Premature death, severe pain, and complex symptoms can be distressing for patients and families. In contrast to prior literature regarding trends on adults with cancer, in this study, the pediatric population had lower rates of death at home, potentially because pediatric patients receive more aggressive EOL treatment than adult patients. Our study found differences among racial and ethnic minority groups, who were more likely to die in hospitals, outpatient settings, and ED facilities. As such, developing capacities for palliative care teams that can reach patients across many EOL settings may be valuable for helping patients and families achieve a death congruent with their wishes, particularly because of persistent differences by race over the past 20 years paralleling findings in adult populations.

Top ten tips palliative care clinicians should know about hospice live dischargeJournal of Palliative Medicine; Stephanie P Wladkowski, Lauren J Hunt, Elizabeth A Luth, Joan Teno, Krista L Harrison, Cara L Wallace; 9/24Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as disenrollment or a "live discharge." Live discharge from hospice is a common and often distressing issue for hospice patients, their caregivers, and also for hospice professionals and agencies. This paper discusses common issues surrounding live discharge that clinicians and other healthcare professionals should consider when dealing with live discharge in their own clinical practices. Where applicable, we provide practical steps for hospice and palliative care clinicians to better support patients and families through this critical care transition. Further, we offer strategic directions interprofessional clinicians can take to affect systemic change to improve live discharge experiences.

Saturday newsletters focus on headlines and research - enjoy!

Damage from Helene devastating for some veterans [including some on hospice]The VA health system is working to help veterans with medical needs after Helene left many in western North Carolina without power and water — and some without homes.

Asian-American communities face ‘digital divide’ in health equity, hospice care Hospice News; by Holly Vossel; 10/1/24 Recent research has dug into the barriers limiting greater telehealth utilization among Asian American, Native Hawaiian and Pacific Islander (AANHPI) communities. The data come at a time when hospices are striving to better understand how to improve those groups’ end-of-life trajectories. Technology utilization has gained momentum in health care, including in hospice care delivery. Though increased virtual health care access can help hospice providers reach patients upstream, the trend may be worsening disparities and outcomes among Asian American populations, according to Victoria Tsze, an outpatient hospice social worker at Tucson Medical Center (TMC) Hospice. 

Executive Personnel Changes - 10/4/24 

TCNtalks - Hurricane Helene

Hospice of Golden Isles returns to independent operations Savannah Tribune - Social and Community News; by Savannah Tribune; 10/2/24 Hospice of the Golden Isles (HGI) is pleased to announce it will resume independent operations in the coming months. This decision was made as HGI approaches the final year of its five-year agreement with Alivia Care, a Florida-based nonprofit hospice provider. Throughout the affiliation, HGI faced significant challenges, including the COVID-19 pandemic, increased for-profit competition, and Medicare reimbursement changes. Despite these challenges, HGI has continued to deliver high-quality care to all patients, regardless of their ability to pay. “We are incredibly grateful for the benefits this partnership has brought to Hospice of the Golden Isles,” said Paula DiLandro, Executive Director of HGI. “However, as the Board of Directors assessed the current landscape, they realized the factors that initially drove the affiliation are no longer as pressing. After careful consideration, the Board decided to return to independent operations, ensuring the future success of HGI.”

$1.6M grant to focus on nursing home units to reduce racial disparities in dementia care McKnights Long-Term Care News; by Jessica R. Towhey; 10/3/24 Emory University will use a $1.6 million, federal grant to investigate the role Alzheimer’s special care units play in reducing racial and ethnic disparities in dementia care within nursing homes. The research team will be led by Huiwen Xu, PhD, an associate professor in the university’s Nell Hodgson Woodruff School of Nursing, who specializes in gerontology and elder health. The four-year grant from the National Institute on Aging will analyze quality of life and improved health outcomes in the specialized care units, which the school’s press release said are available in only 14% of nursing homes nationwide. Xu’s team will examine the underlying causes of racial disparities for Black and Hispanic residents, who have limited access to the memory care units, the release said. 

Hospitalists use POLST to initiate patient conversations about care goals The Hospitalist; by Larry Beresford; 10/1/24 Physician orders for life-sustaining treatment (POLST) is a single-page medical order form, typically printed on bright pink paper, and signed by a physician, nurse practitioner, or physician assistant to spell out treatment preferences for a seriously ill or frail patient. It is also a process for exploring those preferences in conversation with patients and then communicating them to those who might need to know, such as EMS personnel, in some future medical emergency when the patients can no longer speak for themselves. And, said Steven Pantilat, MD, FAAHPM, MHM, a former clinical hospitalist and the inaugural chief of the division of palliative medicine at the University of California San Francisco, it is “solidly within what hospitalists can and should be doing.” That may involve meeting and talking with patients and their families about their values and treatment preferences, reviewing any existing POLST forms, and even filling out and signing a form.

SPECIAL EDITION: Helena & Hospice UpdatesOur "Headlines" overload today focuses on Helena and Hospices: current status, ways we can support affected hospices, resources, and more. With a prelude to our "Today's Encouragement" post: In unity, there is strength; when communities come together during a crisis, they can accomplish the impossible. ~ Amanda Ripley