Literature Review

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!

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

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.

‘His Three Daughters’: A sister act that’s among the year’s best movies The Washington Post - Arts & Entertainment; by Ty Burr; 9/5/24 Carrie Coon, Elizabeth Olsen and Natasha Lyonne give career-peak performances in Azazel Jacobs's relatable family drama. ... “His Three Daughters” is in all its simplicity and complexity the story of how these women get along over the course of their dad’s final week. Spoiler alert: They don’t. If that sounds like a downer, the movie’s kept from terminal morbidity by writer-director Jacobs’s uncanny ear for dialogue and by the empathy of the three central performances. There’s humor here, gallows and otherwise. But there’s also an overflowing heartful of feeling, approached from three different angles by three different people who all happen to love the same parent. Other people come and go: a hospice worker (Rudy Galvan) whose smooth bromides eventually grate on the sisters’ nerves and ours; a night nurse (Jasmine Bracey) with patience and kindness and a full, unseen life outside the apartment; ... In its final moments, the movie takes a risk — a huge gamble, really — that for my money pays off on any number of levels, and in doing so finally confirms its writer-director’s talent. ... Available Sept. 20 on Netflix. [Netflix trailor and reminder available now.]

Bay Bluffs opens hospice wing as end-of-life care models change Interlochen Public Radio; by Michael Livingston; 9/4/24 Three new beds for hospice care opened in Harbor Springs today marking the end of a year-long pivot for an end-of-life care organization in the region. Last year, McLaren Health System closed hospice facilities in Petoskey and Cheboygan. Combined, the facilities provided more than a dozen beds for hospice in the region. At the time, McLaren called the decision to close "difficult" but necessary due to staffing constraints and said it would move to prioritizing outpatient hospice care - when a nurse visits patients in the home rather than a facility. But a group of advocates in Petoskey said residential hospice is needed in the region - especially for people with serious terminal illnesses. David McBride leads the newly renamed group, Friends of Hospice of Little Traverse Bay. It used to be called the Friends of Hiland Cottage for the facility in Petoskey. ... That’s what led to a partnership with skilled nursing facility Bay Bluffs in Harbor Springs. It’s the Emmet County Medical Care Facility and owned by the county health department. Bay Bluffs is not a licensed hospice provider but it is able to outsource hospice from other companies while providing rooms for families to gather with their loved ones and trained nursing. This newer model of end-of-life care is a growing trend and has been tried in other places such as Arbor Hospice in Ann Arbor which closed its residential facility in 2022.