Literature Review

“Rehabbed to Death” in oncology: Where do we go from here?JCO Oncology Practice; by Daniel E. Lage, Craig D. Blinderman, Corita R. Grudzen; 9/3/24You can go to rehab to see if you get stronger for chemo. These are words that every clinician caring for hospitalized patients with cancer has heard or said countless times. And yet, especially when it comes to older adults with advanced solid tumors, less than a third of these patients will ever receive systemic therapy again. Furthermore, their symptom profile is more similar to those discharged to hospice than to those discharged home, and they face debilitating functional decline and early mortality—leading some to coin the term “rehabbed to death” to describe this phenomenon. We suggest a few keys area of focus: (1) reframing hospital discharge conversations, including incorporating practices of disclosing prognoses using validated tools or other algorithms; (2) empowering team-based care and inclusion of palliative care clinicians in the SNF setting; and (3) identifying patients failing to make functional progress early. [Also see accompanying article: Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facility by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer.]

Hospice leaders: Culture the key to sustaining the workforceHospice News; by Jim Parker; 8/30/24In a time of workforce shortages, hospices are seeking the “secret sauce” that will help keep employees on board and bring new people into their fold. To find the right mix, hospice providers that have achieved national recognition for employer best practices point to a particular secret ingredient — a supportive culture with open lines of communication, a career path with room to grow and competitive compensation. For the California-based YoloCares, culture is critical, according to the nonprofit’s CEO Craig Dresang.Notable mentions: YoloCares, Vitas, Jennifer Blades of Haven Hospice.

Nothing can be loved or hated unless it is first understood. ~Leonardo da Vinci

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunitiesPublic Library of Science (PLOS) Digital Health; Amy Bucher, Beenish M Chaudhry, Jean W Davis, Katharine Lawrence, Emily Panza, Manal Baqer, Rebecca T Feinstein, Sherecce A Fields, Jennifer Huberty, Deanna M Kaplan, Isabelle S Kusters, Frank T Materia, Susanna Y Park, Maura Kepper; 8/24With a renewed focus on health equity in the United States ... there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. Specifically, the Double Diamond Model, the IDEAS framework and toolkit, and community collaboration techniques such as participatory design are explored as mechanisms for practitioners to solicit input from members of underserved groups and better design digital health tools that serve their needs. A series of case studies that use different methods to build in equity considerations are offered to provide examples of how this can be accomplished and demonstrate the range of applications available depending on resources, budget, product maturity, and other factors.

The sowers of seeds: A qualitative analysis of the role of palliative care educators in facilitating goals-of-care conversations and palliative care referrals American Journal of Hospice & Palliative Care; by Seth N Zupanc, Lisa M. Quintiliani, Amy M. LeClair, Michael K. Paasche-Orlow, Angelo Volandes, Akhila Penumarthy, Lori Henault, Jennifer E. Itty, Aretha D. Davis, Joshua R. Lakin; 8/28/24 online ahead of print Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role.

Saturday newsletters focus on headlines and research - enjoy!

Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application-a reviewAnnals of Palliative Medicine; Arum Kim, Barley Halton, Akash Shah, Olivia M Seecof, Stephen Ross; 8/24Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings.

Creating a palliative care clinic for patients with cancer pain and substance use disorderJournal of Pain and Symptom Management; Sachin S Kale, Gennaro Di Tosto, Laura J Rush, Justin Kullgren, Deborah Russell, Martin Fried, Blessing Igboeli, Julie Teater, Katie Fitzgerald Jones, Devon K Check, Jessica Merlin, Ann Scheck McAlearney; 8/24Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use. We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry. The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.

Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facilityJCO Oncology Practice; by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer; 6/24There is a need to increase palliative care access for hospitalized older adults with cancer discharged to a skilled nursing facility (SNF) at risk of poor outcomes. Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care intervention developed to address this gap. This study gathered perspectives from clinicians across care settings to describe perceptions on serious illness communication and care coordination for patients with cancer after discharge to a SNF to guide ALIGN refinements... These findings suggest that acute and postacute care clinicians defer serious illness conversations to the oncologist when patients are on a steep trajectory of decline, experiencing multiple care transitions, and may have limited contact with their oncologist. There is a need to clarify roles among nononcology and oncology clinicians in discussing prognosis and recommending hospice for older adults discharged to SNF.

Private equity acquisitions of hospices are increasing; Ownership remains opaqueHealth Affairs; by Melissa D. Aldridge, Lauren J. Hunt, Zelle Halloran, Krista L. Harrison; 9/24Private equity ownership across the US health care system is rapidly increasing, yet ownership structures are complex and opaque. We used an economic data set tracking mergers and acquisitions linked to Medicare data to identify private equity hospice acquisitions. Given the influence of for-profit ownership on hospice quality, transparent data on private equity investment are fundamental to ensuring high-quality end-of-life care.

Grief redoubled by a death certificate delayed: A seven-week odyssey in search of a vital record The Provincetown Independent; by Aden Choate; 9/4/24 Richard Pask, 72, came to the select board on Aug. 27 distraught. His wife, Carol Harris, 69, who had ALS, had died at home in hospice care on July 18, he said, and the town had still not issued a death certificate. Without the certificate, Pask could not access his late wife’s pension payments, manage their mutual assets, update annuity contracts, or cancel service accounts in her name. The Social Security Administration, which has continued to issue payments to Harris — a death certificate is required to stop them — had launched an investigation into possible fraud, ...Editor's note: Root causes from this complex case study relate to the family having used a "green burial" which is becoming more common, where permitted. This case study represents a gap in collaboration between typical systems. Hospice personnel who have any 'touch-points" with the death certificate process must know and adhere to federal, state, and local policies and procedures, especially when variables occur (such as green burials).