Literature Review

Key differences between palliative and hospice care in California Psychology Today; by Bob Uslander, MD; 12/3/24 ... Key Difference Between Palliative and Hospice Care in California: Whether you’re looking for support early in an illness or need end-of-life care, Californians have resources available to help. California also has some unique programs and resources, such as palliative care programs for people covered by Medi-Cal, California’s Medicaid program. Additionally, California has strict laws to protect patients’ rights, ensuring that people are fully informed about your care options and can make choices that align with your personal values and cultural beliefs. Below are some of the key differences highlighted to help you make the best choice possible for you and your family when the time comes. [Click on the title's link for more information.]Editor's note: Through recent years, too many hospice agencies have eliminated references to end-of-life care, a life-expectancy of six months or less, and references to dying, death, or grief. Various fraud and abuse cases have described that persons/caregivers did not even realize they had signed up for "hospice" care. Ethically, this is untenable. Key differences between palliative and hospice care--with applications to the person--are significant.

Nurse diagnosed with blood cancer fulfills dying wish to see new ‘Wicked’ movie Fox 13 Tampa Bay, FL: by Jennifer Kveglis; 11/26/24 A Tampa Bay area nurse who was diagnosed with blood cancer had one dying wish – to see the new movie "Wicked" in theaters. With the help of friends and family, that wish was fulfilled on Monday. Misty Steffen is a wife and mother, and she was also HCA Florida South Shore's chief of nursing. "I've loved every day of my life being a nurse," she said. "Twenty-six years that I got to be one and serve and love and decrease anxiety and increase trust and explain." ... [Description of her serious illness trajectory ...] "It's not what I thought would be the end of my story, but I'm at peace knowing whether I live or whether I die," she said. Steffen said she, her daughter and her husband always sang songs from "Wicked" in the car. Together, they've seen the musical on Broadway twice. Her last wish was to see the new movie in theaters. "The next thing I know he's [her husband] rented out the whole room in the theater," she said. HCA Florida Brandon paramedics, where Steffen worked too, as the assistant chief of nursing, transported her in their ambulance at no charge. "He's like we've got people who are going to come take you in an ambulance to ‘Wicked,’" she said. "I just started balling and I go...'what? Why am I so deserving of that?'" Steffen will spend the coming days surrounded by loved ones, many of whom flew in from all over the country. Editor's note: While this story appears to be focused on the movie "Wicked," it's more about relationships, meaning-making, quality of life, and ... her husband rented out the "whole room in the theater"! If you--like I--enjoy this movie weekend, Misty Steffen's story gives a new meaning to giving thanks, creating new memories from old for now and ahead. From Part 2 of Wicked, "... because I knew you, I have been changed for good."

If my dying daughter could face her mortality, why couldn’t the rest of us? DNYUZ, appearing first in The New York Times; Ms. Wildman; 11/25/24 The first week of March 2022, I flew to Miami with my 13-year-old daughter, Orli; her 8-year-old sister, Hana; and my partner, Ian. We were, by all appearances, healthy. Robust, even. In reality, we were at the end of a reprieve. Orli’s liver cancer had by then been assaulted by two years of treatments — chemotherapy, a liver transplant, more chemotherapy, seven surgeries. Now new metastases lit up a corner of one lung on scans, asymptomatic but foreboding. We asked her medical team if we might show her a bit of the world before more procedures. Our oncologist balked. Hence, this brief weekend away. When we arrived at the beach Orli ran directly to the water, then came back and stretched out on a lounge chair. She turned to me and asked, “What if this is the best I ever feel again?” Three hundred and seventy-six days later, she was dead. In the time since she left us, I have thought often of Orli’s question. All that spring, Orli asked, pointedly, why did we think a cure was still possible, that cancer would not continue to return? Left unspoken: Was she going to die from her disease? It was a conversation she wanted to have. And yet what we found over the wild course of her illness was that such conversations are often discouraged, in the doctor’s office and outside it. ... [Click on the title's link to continue reading this profound story.]Editor's note: While families are gathered for Thanksgiving, many health changes will be observed since this time last Thanksgiving, with countless unknowns to unfold until Thanksgiving next year. Tune into the wide scope of conversations that people do want to have, don't want to have, and--perhaps--that your own family needs to have, with grace and care for all.

How to start the most difficult conversation in the world this holiday season EIN Presswire, Philadelphia, PA; by Cremstar; 11/25/24 According to a Caring.com Survey only 32% of Americans have a will. This Thanksgiving take advantage of this year’s holiday gatherings to plan for the inevitable. ... “There isn’t one right way to approach this topic. It really depends on the person you’re talking with,” says J.G. Sandom, CEO of Cremstar, a leading online cremation service. For example, if you know your person doesn’t like to be taken by surprise, give them a heads up, says Kate DeBartolo of the Conversation Project, an initiative of the Institute for Healthcare Improvement. Planning a visit with your parent(s)? Let them know beforehand that this topic is on your mind and that you’d like to talk about it with them. This gives them the opportunity to think about what they want, if they haven’t already. Here are Four Tips to ensure a successful dialogue:

Nursing homes with more black residents lag in care goal discussions Medical Xpress; by Columbia University Irving Medical Center; 11/20/24 New research from Columbia University School of Nursing published in the American Journal of Hospice and Palliative Medicine shows that timely goals of care discussions are less likely to take place in nursing homes with a higher percentage of Black residents. These discussions are crucial to ensuring that nursing home residents receive care that aligns with their wishes, postdoctoral research fellow Jung A. "Chloe" Kang, Ph.D. '24, Professor Patricia Stone, Ph.D., and their colleagues note in the report, published online September 15, 2024. But these conversations are often delayed until patients experience life-threatening events, the authors add, which can lead to unwanted therapies and unnecessary hospitalizations. ... 

New Health Equity Guide from Center to Advance Palliative Care provides a roadmap to transform care for black patients with serious illness Cision PRWeb; by Center to Advance Palliative Care; 11/13/24 Having medical concerns dismissed, not being believed when reporting pain, and facing multiple barriers to care are just three of the experiences reported to Center to Advance Palliative Care (CAPC) in a focus group of Black patients with serious illness. In fact, when Black people in the United States are living with a serious illness like cancer, heart failure, or dementia, they experience disproportionately high suffering compared to white patients—often due to poor pain management, low-quality communication from their care teams, and high family caregiver burden. To address these inequities, CAPC has released a new, comprehensive guide, Advancing Equity for Black Patients with Serious Illness, to equip palliative care leaders and health equity change agents with practical tools to implement meaningful change. Drawn from research, examples of health equity initiatives from across the country, and the wisdom of health equity leaders, the guide provides a practical roadmap for transforming care for Black patients, and their families and caregivers.

Perspectives of nursing home staff in advance care planning conversations: Experiences from the APPROACHES projectJournal of the American Medical Directors Association; by Kathleen T. Unroe, Hillary D. Lum, Susan E. Hickman; 9/24Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences e a Role offering Alzheimer’s patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP... Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.

Early palliative care may curb aggressive end-of-life care Medscape; by Marilynn Larkin; 11/6/24 Increasing the uptake of palliative care may decrease the aggressiveness of end-of-life care, an analysis of ovarian cancer decedents suggested. Palliative care initiated earlier than 3 months before death was associated with lower rates of emergency department (ED) visits, hospital admissions, and intensive care unit (ICU) admissions in the last 3 months of life. It was also associated with a lower rate of death in the hospital. “When patients with advanced or incurable cancers experience aggressive end-of-life care, spending their final weeks of life in and out of the ED or admitted to acute care hospital wards or the ICU, where they undergo invasive tests or procedures that may not meaningfully prolong life or address symptoms or suffering, this can be very distressing for patients and their caregivers,” lead author Sarah J. Mah, MD, of McMaster University in Hamilton, Ontario, Canada, told Medscape Medical News.

How to initiate goals of care discussions with familyExpertClick, Denver, CO; by Pamela D. Wilson; 10/30/24 ... While many adults set these conversations aside until a health diagnosis or other situation occurs, having goals of care discussions early in life allows more effective planning.

Palliative care in the ED reduces costs, improves patient outcomes Hospice News; by Jim Parker; 10/28/24 The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs. A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver. ... “When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

Ethics roundtable state-erected barriers to end-of-life careAmerican Journal of Hospice and Palliative Medicine; by Saima Rashid, Scott P Broyles, Andrew Wampler, Matthew Stolick, Steven J Baumrucker; 10/24[An interesting ethics case study discussed from physician, spiritual care, legal, and ethics perspectives. Discussion focused on conflicts between healthcare ethics and state law.]

Busting palliative care misconceptions in cancer care Cure; by Alex Biese; 10/22/24 Palliative care can serve a crucial function for patients living with serious illnesses such as cancer, as an expert explained in an interview with CURE®. “Palliative care is sub-specialized health care for patients living with serious illness, where we're really focused on alleviating the symptoms and the stress associated with illness, and our goal is to improve quality of life for patients and their families,” said Dr. Cari Low of the University of Utah Huntsman Cancer Institute. ... However, some misconceptions persist regarding palliative care — most prominently that it is synonymous with hospice care. ... "We [i.e., palliative care] follow patients from the time of diagnosis through their curative cancer treatment and throughout their journey and into survivorship. ... Hospice is really focused on end-of-life care and comfort when cancer treatments no longer make sense. So, I really think of palliative care as this great big umbrella of support throughout the entire journey, where hospice is just a tiny piece of that umbrella.”

The daily balancing act of value-based cancer care The American Journal of Managed Care (AJMC); by Laura Joszt, MA; 10/14/24 In value-based care, there’s a daily balancing act to achieve quality outcomes, cost reduction, and patient care improvements, explained Stuart Staggs, vice president of transformation, quality, and shared services for The US Oncology Network (Network). At the Institute for Value-Based Medicine event, cohosted by The American Journal of Managed Care (AJMC) and Minnesota Oncology, Staggs kicked it off with what he called a “practical look at value-based care.” He highlighted 4 main areas: quality, improvement, adoption, and cost. ... The area of improvement that the Network wanted to focus on was advanced care planning and better supporting and engaging patients and their families around hospice and life support. During the OCM, the Network better engaged patients and families around hospice care and encouraged practices to have difficult conversations. Not only does this improve patient experience by providing them the end-of-life care that they want, but there is also a cost factor. Patients who don’t receive hospice care spend significantly more in the last 30 to 60 days, Staggs said.