Literature Review

Mayo Clinic Minute: Creating an advance directive for your future well-being

Alleged DNR mix-up death highlights concerns for nursing homes McKnights Long-Term Care News, by Josh Henreckson; 4/11/24 The untimely death of a Connecticut nursing home resident in September was the result of mistakenly applying a roommate’s do-not-resuscitate order, alleges a lawsuit filed by that resident’s daughter last week. The potential mix-up illuminates struggles faced by nursing homes across the country when it comes to managing the increasingly complex needs of their patients. 

Qualitative analysis of initial palliative care consultations in amyotrophic lateral sclerosis Journal of Pain and Symptom Management; by Christine L Watt, Ian C Smith, Jill Rice, Rebekah Murphy, Ari Breiner, Maria Duff, Danica Nogo, Shirley H Bush, Susan McNeely, Usha Buenger, Belinda Zehrt, Jocelyn Zwicker; 4/2/24, online ahead of print Background: Palliative care (PC) benefits patients with amyotrophic lateral sclerosis (ALS), however the needs of patients and caregivers and the optimal timing of PC discussions remains unclear. This study reports the analysis of PC consult notes from a larger feasibility trial. The specific aims of this analysis were to i) identify the PC needs of patients with ALS via qualitative analysis and ii) identify characteristics of patients and caregivers that could predict specific PC needs.

Cancer patients often want ‘one more round.’ Should doctors say no? The Washington Post, by Mikkael A. Sekeres, MD; 3/31/24 My patient was in his early 30s and his leukemia had returned again following yet another round of treatment. He was a poster child for the recently reported rise in cancer rates in the young, and had just asked me what chemotherapy cocktail I could devise for him next, to try to rid him of his cancer. I hesitated before answering. Oncologists are notorious for always being willing to recommend to our patients one more course of treatment, even when the chances of success are negligible.  

Death is inevitable. Doctors should be prepared to manage it appropriately. MedPageToday, by Gabrielle Kis Bromberg, MD; 3/28/24In preparation for my clinical year, my medical school instructors taught me about the importance of assessing the goals and wishes of patients at the end of life. ... [My Aunt] Daniella shared with my mom and me that she was tired of being so sick and tired of feeling stuck in the hospital's revolving door. So, I asked my aunt the questions I'd just learned in class. "What is most important to you?" "If you were sicker and could not share your own medical wishes, what would you want us to tell your doctors about your goals?" "Would you accept another ICU stay, CPR, a breathing tube?" My mom and I drove home with crystal clear instructions from Daniella. If she got sicker, she wanted to die without prolonged suffering. ... [Months later] Despite many doctors, hospitalizations, a years-long decline, and countless healthcare touch points, no one had asked Daniella how she was faring as her body failed. Why did it require a medical student -- me -- just 4 months into training, to achieve an end of life consistent with her wishes?

The process of dealing with death is experiencing rebirth in a less-religious Pittsburgh Digital Daily; by Med St-Esprit, PublicSource; 3/24/24 Tanisha Bowman, of the North Side, a palliative care social worker for Butler Health System and a “death walker,” walks amongst the old graves in St. Mary’s Cemetery. ... From green burial to glass orbs containing ashes, the norms of funerals and burials are broadening as religious affiliation declines. ... According to a 2021 survey by Pew Research, 3 in 10 American adults are religiously unaffiliated. Data compiled by Pew Research about the Pittsburgh metro region found that 50% of adults in the region describe religion as “very important” and nearly 20% consider themselves not religious. Shifts in faith and worship mean families as well as businesses related to death and dying have had to alter their approaches.

Legendary healthcare researcher John E. Wennberg, who shaped efforts to reform the nation’s healthcare system, dies at 89Dartmouth Geisel School of Medicine, by Susan Green; 3/18/24John E. (Jack) Wennberg, MD, MPH, founder and director emeritus of The Dartmouth Institute for Health Policy and Clinical Practice, the Peggy Y. Thomson Professor in the Evaluative Clinical Sciences Emeritus at the Geisel School of Medicine, and founding editor of the Dartmouth Atlas of Health Care, died March 10, 2024. He was 89 years old. “His work pioneered a field that has grown into an entirely new academic discipline in medicine,” Duane Compton, PhD, Geisel School of Medicine dean, says. ... Wennberg focused on improving decision quality by combining better clinical evidence with informed patient preferences. The introduction of shared decision-making between clinicians and patients to preserve warranted variation due to patient preferences is now embedded in health policies across the globe.