Literature Review

Dr. Oswalt on the effects of palliative care timing on end-of-life care in mNSCLC OncLive, Oncology Specialty Group; by Cameron James Oswalt, MD; 8/15/24 Cameron James Oswalt MD, fellow, Hematology-Oncology, assistant professor, medicine, Department of Medicine, Duke University School of Medicine, discusses findings from a study evaluating the timing of palliative care referral and its effect on end-of-life care outcomes in patients with metastatic non–small cell lung cancer (mNSCLC). ...  Investigators found that fewer than half of patients received palliative care during their treatment course, and fewer than one-third of the patients who received palliative care accessed this care within 2 months of diagnosis, ... The low referral rate in this cohort could be attributed to several factors, including patient preferences, preconceived notions, barriers to referral, and overall disease burden, he says. Among patients who died, 59.1% were enrolled in hospice. 

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

Center for Hospice Care Heartwize Program brings an individualized approach to cardiac care Great News Life; by Lauren Grasham; 8/12/24 To help patients live peacefully and at ease during one of life’s most vulnerable moments, Center for Hospice Care (CHC) welcomes all with open arms to its HeartWize program. Through the program, the CHC staff develops individualized plans with each patient and their loved ones to help them manage heart failure and other heart diseases, allowing patients to receive quality care in the comfort of their own homes without the worry of a hospital visit. “When their symptoms are not managed promptly, it gets to the point that patients can't breathe. When a patient can't breathe, the very first thing they're going to want to do is go to the hospital,” said Director of Nursing Chrissy Madlem. “It's important that we teach them the techniques to manage these end-of-life care symptoms that they're dealing with so they can stay home and be comfortable with their families.”Editor's Note: The Center for Hospice Care is in Mishawaka, IN.

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients. 

Dr. El-Jawahri on the impact of palliative care on end-of-life care for AML and MDS OncLive; by Areej R. El-Jawahri, MD; 8/12/24 Areej El-Jawahri, MD, associate director, Cancer Outcomes Research and Education Program, director, Bone Marrow Transplant Survivorship Program, associate professor, medicine, Massachusetts General Hospital, discusses findings from a multi-site, randomized trial (NCT03310918) investigating a collaborative palliative oncology care model for patients with acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) receiving nonintensive therapy at 2 tertiary care academic hospitals. Patients in the study who received the palliative care interventions had a median of 41 days from end-of-life care discussions to death, compared with 1.5 days in the standard care group (P < .001). Additionally, patients who received the palliative care interventions were more likely to articulate their end-of-life care preferences and have these preferences documented in electronic health records, El-Jawahri begins. This documentation correlated with fewer hospitalizations in the final 30 days of life, she notes. Furthermore, palliative care recipients experienced QOL improvements and a trend toward reduced anxiety symptoms vs the patients who received usual care, El-Jawahri says. These findings underscore the necessity of integrating palliative care as a standard of care for patients with AML and high-risk MDS, El-Jawahri emphasizes.

Psychiatric manifestations of neurological diseases: a narrative reviewCureus Journal of Medical Science; Anthony J. Maristany, Brianna C. Sa, Cameron Murray, Ashwin B. Subramaniam, Sean E. Oldak; 7/24Neurological diseases like Alzheimer's, FTD [frontotemporal dementia], Parkinson's, MS [multiple sclerosis], stroke, epilepsy, Huntington's, ALS [amyotrophic lateral sclerosis], TBI [traumatic brain injury], andMSA [multiple system atrophy] are not only characterized by neurological symptoms but also by various psychiatric manifestations, complicating diagnosis and treatment. For instance, Alzheimer's induces cognitive decline and emotionaldistress, Parkinson's leads to motor impairments and mood disorders, and MS intertwines physicalsymptoms with emotional disturbances. Understanding these complex relationships is crucial forcomprehensive care. Collaboration, innovation, and ethical commitment are essential for improvingoutcomes.

Palliative pharmacotherapy for cardiovascular disease: A scientific statement from the American Heart Association Circulation: Cardiovascular Quality and Outcomes - American Heart Association (AHA) / American Stroke Association (ASA); by Katherine E. Di Palo, PharmD, MBA, MS, FAHA, Shelli Feder, PhD, APRN, ACHPN, FPCN, FAHA, Yleana T. Baggenstos, PharmD, Cyrille K. Cornelio, PharmD, Daniel E. Forman, MD, Parag Goyal, MD, MSc, Min Ji Kwak, MD, MS, DrPH, and Colleen K. McIlvennan, PhD, DNP, FAHA on behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing; 7/24 ... Compared with other serious illnesses, medication management that incorporates a palliative approach is underused among individuals with cardiovascular disease. This scientific statement describes palliative pharmacotherapy inclusive of cardiovascular drugs and essential palliative medicines that work synergistically to control symptoms and enhance quality of life. We also summarize and clarify available evidence on the utility of guideline-directed and evidence-based medical therapies in individuals with end-stage heart failure, pulmonary arterial hypertension, coronary heart disease, and other cardiomyopathies while providing clinical considerations for de-escalating or deprescribing. Shared decision-making and goal-oriented care are emphasized and considered quintessential ... across the spectrum of cardiovascular disease.

Ethical challenges in the treatment of patients with severe anorexia nervosa Psychiatry Online; by Patricia Westmoreland, MD; Jole Yager, MD; Jonathan Treem, MD; and Philip S. Mehler, MD; 7/15/24 Ethical principles assist us in determining the best course of action with regard to patients with [anorexia nervosa] AN. The vast majority of patients with AN should be offered high-quality, restorative-informed care. But for a minority of patients (e.g., those with SE-AN) other treatment options need to be considered. Clinicians are obliged to realistically assess each patient’s potential for recovery or ability to engage in harm reduction and palliative care approaches, and be cognizant of the wishes of the patient, family, and treatment team. In addition, the burden on caregivers and stewardship in the expenditure of health care resources should also be considered when deciding whether involuntary treatment, harm reduction, palliative care, or end-of-life care be recommended for a particular patient.

Advanced practice providers have an important role in kidney supportive care Healio; by Christine Corbett, DNP, FNP-BC, CNN-NP, FNKF; 7/15/24For more than 2 decades, nephrologists and patients have recognized the key role nephrology advanced practice providers have played in the care of patients with chronic kidney disease. ... With its attention to the psychosocial and spiritual aspects of care in addition to the physical, it is expected that nephrology nurse practitioners would also play a major role in the palliative care for patients with kidney disease. ... As part of the kidney care team, APPs [advanced practice practitionsers] educate patients about kidney failure treatment options, including palliative dialysis and active medical management without dialysis. Also, nurse practitioners have been noted to play a significant role in the palliative care skills of goals-of-care conversations, advance care planning and Portable Orders for Life-Sustaining Treatment (POLST, or similar term depending on the state) completion.

Integrative oncology for patients with lung cancer: A prospective pragmatic controlled trial Lung Cancer; by Eran Ben-Arye, Orit Gressel, Shahar Lifshitz, Nir Peled, Shoshana Keren, Noah Samuels; 6/25/24 Complementary medicine and integrative oncology modalities (IOM) have been included in the clinical practice guidelines of the American College of Chest Physicians in the treatments of patients with lung cancer. The present study examined the impact of a patient-tailored IOM treatment program on quality of life (QoL)-related concerns among patients with non-small and small lung cancer undergoing active oncology treatment. ... High adherence to a 6-week IOM program within supportive/palliative care for patients with lung cancer was found to alleviate pain and emotional concerns, improving overall QoL. Further research is needed to confirm the findings in real-life IOM practice for patients with lung cancer.

Medicare Program: End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals with Acute Kidney Injury, etc. Federal Register; Proposed Rule by the Centers for Medicare & Medicaid Services; 7/5/24

Green Bay Packers Foundation awards $1.75 million in grants [$125k to Agrace Hospice Care Foundation] Philanthropy News Digest; 6/29/24 The Green Bay Packers Foundation has announced 10 grants totaling $1.75 million to support organizations serving Wisconsin’s Brown, Dane, and Milwaukee counties. Recipients include ... ; Agrace Hospice Care Foundation, which will receive $125,000 to expand dementia and Alzheimer’s services throughout Wisconsin; ... “The Packers Foundation is pleased to award a record amount in impact grants to 10 organizations doing critically important work in their communities,” said Packers president and CEO Mark Murphy. “From education, mentoring, and community building programs to providing care and support for our most vulnerable neighbors, the grant recipients will create direct and lasting impacts throughout the state of Wisconsin.”