Literature Review

Well-being and choosing the best job for youJAMA Internal Medicine; Jamile A. Ashmore, PhD; J. Michael DiMaio, MD; 1/25Well-being is emerging as the catch-all term describing the field dedicated to understanding and addressing the way in which the health care system, work environment, and individual interact to influence the fulfillment and meaning that health care workers derive from their work. Clinician well-being is often led by a chief wellness officer (CWO) or other executive leader who is compensated to focus on well-being. In addition to strategic planning and oversight, the CWO’s role is to ensure that well-being is considered in administrative and operational decisions including in those related to governance, rewards systems, and culture. Health care systems’ moving from the triple to the quadruple aim are signaling that they are committed to taking care of those that care for the patients. Indeed, health care systems cannot have optimal patient care without a healthy and fulfilled workforce. 

What can we learn from the dying? Newscastle's News Letter Journal (NLJ), Newcastle, WY; by Kelly Evans-Hullinger, MD; 1/26/25 For the last five years, I have had the great privilege of serving my local health system as Medical Director for Home Hospice. Every week I sit in a meeting with the multidisciplinary caretakers on this team ... Patients facing their own deaths want to talk about their lives. Our staff frequently tries to facilitate what they call a “life review” in which a patient can openly talk about their childhood, family, career, service, and sometimes their regrets. This is therapeutic for the dying patient and their loved ones.  ... I have recently thought about this particular human need – to reflect and remember one’s life. I take this as a reminder to both seek those stories from my own loved ones (I wish I had asked my grandmother more questions about her life) and, perhaps, to tell and write about the things in my own life I would want to be remembered after I am gone. For if there is another thing I’ve learned serving patients on hospice, it is that my death is also inevitable; but, I think, life’s finality is what gives it beauty and meaning. 

Palliative care is essential for seriously ill patients—at any ageAMA (American Medical Association); by Kevin B. O'Reilly; 1/27/25 The AMA House of Delegates has adopted new policies outlining physicians’ ethical obligation to provide or seek optimal palliative care for patients with serious illnesses who can benefit from comprehensive management of pain and other distressing symptoms—not only those with terminal illnesses or on the precipice of death. “Physicians have clinical ethical responsibilities to address the pain and suffering occasioned by illness and injury and to respect their patients as whole persons,” says one of the new policies adopted at the latest AMA Interim Meeting, held in Lake Buena Vista, Florida. “These duties require physicians to assure the provision of effective palliative care whenever a patient is experiencing serious, chronic, complex or critical illness, regardless of prognosis.” 

Some wary of Providence home health joint venture with for-profit company Herald Net, Everett, WA; by Jenna Peterson; 1/23/25 Some nurses in the state say an upcoming joint venture between Providence Home and Community Care and Compassus, a for-profit company with private equity ownership, could have an adverse effect on health care. The deal, expected to be finalized in Washington early this year, ... impacts locations in five U.S. states. ... Boyle and Compassus spokesperson Dana Coleman said there will be no changes in care or staffing under the joint venture. But some nursing advocates, like Ian Mikusko, worry that a for-profit, private equity influence could be harmful for health care.“Private equity is somewhat more extractive because there’s a pressure to provide large dividend payments to investors,” said Mikusko, strategic researcher with the Washington State Nurses Association. Mikusko cited research that shows quality of care diminishes when private equity companies become involved in health care, such as a 2023 study from the Center for Economic and Policy Research.

Spread some love to seniors this Valentines Day WKBN Youngstown, OH; by Dave Sess; 1/21/25 As you’re making Valentine’s Day plans, consider spreading some love to local seniors. You can make special cards or buy a thoughtful card and share the love. Home Instead is organizing the collection again this year. It has three schools already committed to making cards as it hopes to double last year’s total of 1,000. Each of the Valentine’s Day cards will carry a heartfelt message to seniors in nursing homes and assisted living communities that they’re loved, appreciated and remembered. ... The seniors will also receive flowers from Harmony Hospice. “These seniors appreciate anything from a simple smile to a card or a flower and just a simple hello,” said Sara Stevens with Harmony Hospice.Editor's note: Calling community outreach professionals--what a simple, meaningful way to engage your community for meaningful, intergenerational engagement and support. Now's the time! What can you do?

New data reveals the hidden costs of workplace violence in healthcare Perceptyx; by Ellen Lovell, PhD and Stephanie Schloemer, PhD; 1/17/25 Workplace violence has become an impossible-to-ignore crisis in healthcare, threatening the safety of medical professionals, patients, and institutions. The severity and frequency of these incidents have reached alarming levels, demanding immediate attention and action. ... The human cost is staggering.  ... While our research confirms the widespread nature of safety concerns in healthcare, a deeper analysis reveals significant variations across different healthcare environments and roles. This granular view helps us understand where intervention is most urgently needed. Editor's note: Although "hospice settings reported the lowest agreement at 54%," this statistic should be considered too high for comfort. Actions need to be taken to reduce it. From your professional leadership role, examine the importance of protecting hospice professionals' safety--typically in home settings--and through moments such vulnerable, emotional, conflicted times within families. What can your agency improve?

At United Hospice good leadership makes all the difference Mid Hudson News, Goshen, NY; by Mid-Hudson News Staff; 1/19/25 In the world of healthcare, there are few environments as emotionally charged and delicate as hospice care.  Here, patients face the final chapter of their lives, and their families must grapple with the profound weight of grief and impending loss. It’s a space that requires not only clinical expertise but also an extraordinary level of compassion, empathy, and resilience. At the heart of it all is leadership—a factor that can profoundly shape the quality of care, support, and comfort patients and families receive during this challenging time. [Cara Pace, United Hospice CEO] noted that leadership in hospice care is not about wielding authority or simply managing logistics. It’s about embodying a vision of compassionate, patient-centered care that resonates throughout the organization. A good hospice leader knows how to create a culture of empathy, where every member of the team understands the profound impact their work has on the lives of patients and families.

Guidelines for evaluating, diagnosing, and disclosing dementia published by Alzheimer’s Association Practical Neurology; 1/14/25 The Diagnostic Evaluation, Testing, Counseling, and Disclosure Clinical Practice Guideline (DETeCD-ADRD CPG) Workgroup, convened and funded by the Alzheimer’s Association, has developed new recommendations for clinicians to use when evaluating patients with possible Alzheimer disease (AD) or AD and related dementias (ADRD). An executive summary of the recommendations for use in primary care and other practice settings was published in Alzheimer’s & Dementia, along with a companion article summarizing specific guidance for specialists. The Workgroup included representatives from  primary, specialty, subspecialty, long-term, and palliative care disciplines as well as the fields of health economics and bioethics.  Editor's note: Click for open access to the Alzheimer's Association clinical practice guideline ..., executive summary of recommendations for primary care. 

End-of-life care can be more aggressive for cancer patients with defibrillators Medical Xpress; by UT Southwestern Medical Center; 1/8/25 Patients with advanced cancer who also had cardiac defibrillators were more likely than those without these implants to receive aggressive end-of-life care, a team led by UT Southwestern Medical Center researchers found in a new study. The findings, published in Cancer, could help physicians guide patients in this growing population toward care that better matches their goals. ... The findings showed that about 6% of patients with advanced cancer also had [implantable cardioverter defibrillators] ICDs. However, significantly more of the ICD patients received aggressive care during the last month of their lives compared to those without these devices.

[Cure] Top palliative care stories from 2024 Cure; by Alex Biese; 12/28/24 This year, CURE® worked to provide education and insight that underscored the importance of palliative care in cancer treatment. Early integration of palliative care, whether through in-person visits, telehealth or ongoing emotional support, can make a significant difference in a patient's quality of life. Here are some of the top articles on the topic of palliative care from 2024.

'We do more than just pray': Chaplains take active role at Milwaukee VA and in community U.S. Government Veterans Administration; by David Walter; 12/23/24 If you think hospital chaplains just pray at bedsides, think again. At the Milwaukee VA Medical Center, chaplains are much more than comfort providers. They are fully integrated into the everyday workings of the hospital, serving on committees, participating in numerous events and consulting with other subject matter experts. Their work also goes beyond the walls of the hospital, interfacing with the community to help better reach those Veterans who may not venture into the hospital. And while they continue to meet one-on-one with patients on a daily basis, they also extend their services to hospital staff, providing solace and support for those dealing with the emotional toll that caregiving can sometimes take on health care professionals. “There’s been a really big shift here,” said Chaplain Robert Allen, chief of the Milwaukee VA’s Chaplain Services, adding that for too long chaplains were “put in this corner, thinking that we only just pray.” Editor's note: To strengthen your understanding of chaplaincy roles, standards, training, and certification, examine the national Association of Professional Chaplains.

Hospice study reveals contrasting views on managing dementia behaviors McKnights Long-Term Care News; by Donna Shryer; 12/20/24 A new study finds that healthcare providers and family caregivers often disagree on how best to manage dementia behaviors during end-of-life care. The research, published in the Journal of the American Geriatrics Society, involved interviews with 23 hospice clinicians and 20 family caregivers. With dementia affecting 33% of adults over age 85 and now ranking as the primary diagnosis for Medicare hospice services, understanding these differing perspectives about managing dementia behaviors has become increasingly important. The study found that while both groups identified agitation as the most concerning behavioral symptom, they approached it from different angles. Clinicians primarily worried about physical safety risks, while family caregivers were more distressed by personality changes in their loved ones.

Delaware Hospice to move to scattered bed model at Saint Francis in Jan. Delaware Live; by Jarek Rutz; 12/19/24 Just two months after celebrating its 100-year anniversary, Wilmington’s Saint Francis Hospital is making a logistical shift for its hospice patients. This week, Delaware Hospice announced it will shift its Saint Francis-based operations from a centralized In-Patient Unit (IPU) to a scattered bed model.  The move is to increase both patient and hospital flexibility as well as create more financial and operational efficiency. A scattered bed model involves distributing General Inpatient (GIP) Hospice Care across various rooms within the hospital rather than maintaining a centralized unit. Closing the IPU means Delaware Hospice continues to live its mission of providing compassionate, expert care without the costs of maintaining a centralized unit.