Literature Review

Anxiety in late life and serious illness: A podcast with Alex Gamble and Brianna WilliamsonGeriPal [podcast]; by Eric Widera, Alex Smith, Alex Gamble, Brianna Williamson; 6/27/24“Anxiety is a lot like a toddler. It never stops talking, tells you you’re wrong about everything, and wakes you up at 3 a.m.” I’m not sure who wrote this quote, but it feels right to me. We’ve all had anxiety, and probably all recognize that anxiety can be a force of action or growth but can also spiral to quickly take over our lives and our sleep. How, though, do we navigate anxiety and help our patients who may end up in the anxiety spiral that becomes so hard to get out of? On today’s podcast, we’ve invited Alex Gamble and Brianna Williamson to talk to us about anxiety. Alex is a triple-boarded (palliative care, internal medicine, and psychiatry) assistant professor of medicine at Stanford. Brianna is one of UCSF’s palliative care fellows who just completed her psychiatry residency.

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences BMC Palliative Care; by Mario López-Salas, Antonio Yanes-Roldán, Ana Fernández, Ainhoa Marín, Ana I Martínez, Ana Monroy, José M Navarro, Marta Pino, Raquel Gómez, Saray Rodríguez, Sergio Garrido, Sonia Cousillas, Tatiana Navas, Víctor Lapeña, Belén Fernández; 6/21/24  Results: Four major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4) needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.

Chronic loneliness can raise stroke risk in older adults, findings show McKnights Long-Term Care News; by Kristen Fischer; 6/24/24 A new study links loneliness to stroke risk, showing that those who are regularly lonesome have a 56% higher risk for stroke than those who are more socially connected. Situational loneliness wasn’t linked to a higher risk for stroke, which indicates that the stroke risk stems from chronic loneliness. Investigators led by a team from Harvard T.H. Chan School of Public Health published their report Monday in eClinicalMedicine. Research has already linked loneliness to an increased risk for cardiovascular disease. The new report is one of the first to evaluate the association between loneliness and stroke risk.

Unity launches Guide that enhances quality of life for dementia patients and their caregivers The Chamber - Manitowoc County, De Pere, Wisconsin; Press Release; 6/20/24 In honor of The Longest Day Of The Year which is celebrated on June 20th to raise awareness and outshine the darkness of Alzheimer's disease, Unity, in partnership with National Partnership for Healthcare and Hospice Innovation (NPHI), announces the release of a new dementia care resources guide that will improve quality of life for dementia and Alzheimer’s patients, reduce hospitalizations, and ease the burden for families and caregivers. ... The new guide represents the best standards of care for mid-, advanced-, to end-stage dementia and was put together with the collective input of 100+ not-for-profit hospice, palliative care, and advanced illness care organizations. [Click on the title's link for more information, and to download the free guide.]

Bidirectional associations of depressive symptoms and cognitive function over timeJAMA Network Open; by Jiamin Yin, Amber John, Dorina CadarIn this longitudinal analysis of 8268 eligible participants, greater levels of depressive symptoms at study baseline and an accelerated change in depressive symptoms over time were associated with faster memory decline. In reverse, a steeper change in memory was also reciprocally associated with a more rapid change in depressive symptoms over time.Publisher's Note: Also see McKnight's Long-Term Care News story Depression, memory decline trigger each other in older adults, study finds.

Cancer therapy at end of life may not boost survival Cure; by Brielle Benyon; 6/17/24 Patients with advanced solid cancers who received systemic therapy toward the end of life typically did not live any longer than patients who did not receive treatment, according to research published in JAMA Oncology. Because cancer treatments can damper quality of life, it is crucial that patients and their loved ones discuss goals of care and prognosis with their oncology team, two experts emphasized. “I think once we progress to advanced and metastatic cancer when cure is no longer feasible, it’s important to consider goals-of-care conversations,” said study author Maureen Canavan, associate research scientist at Yale School of Medicine.

Cachexia and anorexia in serious illness: A podcast with Eduardo BrueraGeriPal [podcast]; by Eric Widera, Alex Smith, Eduardo Bruera; 6/13/24I always find cachexia in serious illness puzzling. I feel like I recognize it when I see it, but I struggle to give a clear definition or provide effective ways to address it. In today’s podcast, we had the opportunity to learn from a renowned expert in palliative care, Eduardo Bruera, about cachexia and anorexia in serious illness. Eduardo established one of the first palliative care programs in 1984, created the Edmonton Symptom Assessment Scale (ESAS), and significantly contributed to the evidence base for palliative care symptoms that many of us rely on daily. During our discussion with Eduardo, we delved into how we can define cachexia and anorexia, why they occur in conditions like cancer, how to assess for them, and explored the interventions that are helpful and those that are not in the treatment of these conditions.

"A wholeness that grows out of that which is lacking": Providing palliative care to patients with anorexia nervosaPsychiatric Times; by Rabbanit Allissa Thomas-Newborn, BCC; 6/13/24Sitting with the patient, I brought in a nesting doll, separating each doll and lifting the layers of self that surrounded the smallest version of herself within. We spoke about layers. Layers and walls we put up to protect ourselves. Layers that hide the things we are afraid for anyone—worst of all, ourselves—to see. Layers that embrace and comfort and hold us together. ... With the fullness of the nesting doll displayed, we gave witness to her story together. ... To see ourselves as stories of wholeness growing out of that which is lacking requires that we accept what is lacking without judgment. We do not need to fix or fill whatever is lacking, or to pretend it is not there. It is there and may always be there. And there is a wholeness that can still grow. Editor's Note: Rabbanit Thomas-Newborn is a board-certified chaplain at New York-Presbyterian Columbia University Irving Medical Center and Morgan Stanley Children’s Hospital. She specializes in Behavioral Health, Palliative Care, and Critical Care chaplaincy. She is the president of Neshama: Association of Jewish Chaplains. 

Navigating Aging: New help for dealing with aggression in people with dementia Northern Kentucky Tribune; by Judith Graham, KFF Health News; 6/9/24Caring for older adults with dementia is stressful, especially when they become physically or verbally aggressive, wander away from home, develop paranoia or hallucinations, engage in inappropriate or repetitive behaviors, or refuse to let caregivers help them. Upward of 95% of patients experience these neuropsychiatric symptoms of dementia, which tend to fluctuate over time and vary in intensity. They’re the primary reasons people with dementia end up in assisted living facilities or nursing homes. At some point, families and friends trying to help at home simply can’t manage. “When people think about dementia, they usually think about forgetfulness and memory impairment,” said Mary Blazek, director of the geriatric psychiatry clinic at the University of Michigan. “But it’s behavioral and psychological disturbances that are most disruptive to patients’ and caregivers’ lives.”

Design, creation, and 13-month performance of a novel, web-based activity for education in primary cardiology palliative care Journal of Pain and Symptom Management; by Jill M Steiner, Caroline L Doherty, Jill A Patton, Jadry Gruen, Sarah Godfrey, John Mulrow, Richard A Josephson, Sarah J Goodlin; 6/5/24 online ahead of print Cardiovascular disease (CVD) clinicians who care for seriously ill patients frequently report that they do not feel confident nor adequately prepared to manage patients' palliative care (PC) needs. With the goal, therefore, of increasing PC knowledge and skills amongst interprofessional clinicians providing CVD care, the ACC's PC Workgroup designed, developed, and implemented a comprehensive PC online educational activity. This paper describes the process and 13-month performance of this free, online activity for clinicians across disciplines and levels of training, "Palliative Care for the Cardiovascular Clinician" (PCCVC).Editor's Note: Reiterating, this "free, online activity [is] for clinicians across disciplines and levels of training." The trajectories for cardiovascular diseases can elicit enormous anxiety--due to their roller-coaster changes that can result in sudden death--in contrast to the more predictable trajectories for cancer. Whether you use this resource or another, educate your interdisciplinary clinical managers and team members to the all-important disease and care factors for cardiology palliative care, relevant to the scope of professionals' different roles. 

Telehealth delivers early palliative care as effectively as in-person careAJMC, American Society of Clinical Oncology; by Laura Joszt, MA; 6/2/24 Early palliative care can be delivered via telehealth with equivalent quality-of-life effects as palliative care delivered in person to patients with advanced non–small cell lung cancer (NSCLC), according to late-breaking results presented during [a] plenary session at the 2024 American Society of Clinical Oncology (ASCO) annual meeting. Whether the palliative care was delivered in person or via telehealth, the most common topics discussed during the visit were similar and included building and establishing rapport to create a relationship with the patient and their family, identifying symptoms and grading symptom management, and coping with serious illness, explained Joseph Greer, PhD, codirector of the Cancer Outcomes Research & Education Program at Massachusetts General Hospital Cancer Center and associate professor of psychology in the Department of Psychiatry at Harvard Medical School ...

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

How palliative care is changing in today’s health care environment Hospice News; by Molly Bookner; 5/29/24 As the palliative care field continues to grow and transform, understanding the current trends, outlook, relevant challenges and necessary skills for future leaders is critical. Two significant trends impacting the field of palliative care currently, according to experts, are the expansion of services and the integration of technology, particularly artificial intelligence (AI). Dr. Vicki Jackson, board president of the American Academy of Hospice and Palliative Medicine (AAHPM), noted that palliative care has demonstrated a positive impact on patient-reported outcomes across various illnesses, including cancer, heart, liver, kidney disease and dementia.