Literature Review

Palliative and hospice care in hospitals and clinics: the good, the bad, and the ugly MedPageToday's KevinMD.com; by Earl Stewart, Jr., MD and Miguel Villagra, MD; 4/1/24 I walk into the patient’s hospital room during evening rounds. He looks pale and tired, having recently completed a round of chemotherapy for his stage IV pancreatic cancer. His wife is at the bedside, scared and concerned about her husband’s rapid decline. I sit down to discuss goals of care when the patient immediately says, “I can’t do this anymore.” His wife responds immediately to the patient: “Of course you can.” ...

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.  

UT Tyler School of Medicine receives $400k gift from anonymous donor [for hospice and palliative medicine fellowship] The Gilmer Mirror; 4/1/24The University of Texas at Tyler School of Medicine received a  $400,000 gift from an anonymous donor to support the hospice and palliative medicine  fellowship. The purpose of the gift is to retain physicians in the East Texas region. 

Integrating palliative care screening in the intensive care unit: A quality improvement projectCritical Care Nurse; by Traci N. Phillips, DNP, APRN, ACNP-BC, CCRN; Denise K. Gormley, PhD, RN; Sherry Donaworth, DNP, APRN, ACNP-BC, FNP-BC; 4/1/24Background: Patients admitted to the intensive care unit have complex medical problems and increased rates of mortality and recurrent hospitalization for the following 10 years ...  Delayed access to palliative care can result in untreated symptoms, lack of understanding of care preferences, and preventable admissions. Conclusion: The screening process can maximize the benefit of palliative care services with early patient identification, improved consultation efficiency, decreased critical care resource use, and reduced readmission rates.

How’s Your Soul? JAMA Network, by Daivd Vermette, MD, MBA, MHS; 3/28/24 "Brother David, how’s your soul?” The question took me by surprise. It was time for my first advisement meeting with my residency program director. In medicine, the machine runs on competence and achievement of “milestones.” Yet, as I braced for a meeting to trudge through performance evaluations and in-training exam scores, I awoke to humanity. ... Medical education has numerous models for coaching, advising, and mentoring. While these models helped develop my professional life, they missed the fundamental core of who I am: a human being. Perhaps instead we could embrace a model in medical education built on the tenets of pastoral care. ...

Why a Texas system hasn't hired a travel nurse in 30 years Becker's Hospital Review, by Kelly Gooch; 3/28/24 Beth Schmidt remembers the last time Fort Worth, Texas-based Cook Children's Health Care System hired a travel nurse, and it was not recently. ... Many hospitals and health systems increased their reliance on travel nurses during the pandemic to fill vacancies. However, a number of organizations are now making efforts to decrease their dependence for financial reasons. ... [This organization has had 15-20 years success with] the Winter Plan, a program ... [that] allows workers to temporarily become Cook Children's employees for four to six months to help augment the health system's nursing staff. 

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?

Fall prevention for the elderly: 13 strategies to keep them safe U.S. News & World Report, by Claire Wolters, ed. by Christine Comizion, MPH; 3/26/24Falls are the leading cause of injury in adults 65 and older – with reports showing about 14 million adults fall each year, according to the Centers for Disease Control and Prevention. ... According to the CDC, falls are also the leading cause of injury-related death in the 65-and-older population – and the fall death rate is growing.Here's what to know about what increases risk for falls in older adults, and get familiar with fall prevention tips and safety measures that can help reduce the risk.Editor's Note: This U.S. News article primes the pump. Preventing falls matters especially for vulnerable hospice patients as their disease progresses, and as they and/or family want the person to be as mobile as possible. What do your Incident Reports tell you about falls? What falls-specific education do you provide for your interdisciplinary teams? On-call staff? Family caregivers? Volunteers? What QAPI programs have addressed falls? 

Home care unionization efforts beginning to tick back up Home Health Care News, by Andrew Donlan; 3/25/24 The home care workforce has traditionally been a tough one to organize. But efforts have ramped up over recent years, leading to more workers opting into unions across the country. Recently, University of Rochester Medicine Home Care (URMHC) workers “overwhelmingly” chose to join a labor union. They aligned themselves with 1199SEIU United Healthcare Workers East, which is one of the largest health care worker unions in the country. 

20 states facing acute nursing shortages Becker's Hospital Review, by Kelly Gooch; 3/25/24 ... On March 1, Medical Solutions, a healthcare staffing company, released the 20 states where nurses are needed the most based on the most current nurse-to-state population ratios and projected need by 2030. Ratios in the report were from Census and Bureau of Labor Statistics data published in NurseJournal. Projected need by 2030 is from Projections Central, a site sponsored by the Labor Department. Here are the 20 states where nurses are needed the most, per the Medical Solutions article: ... 

Antibiotics in end-of-life care NEJM Journal Watch, by Abigail Zuger, MD; 3/27/24Antibiotics often are considered to be among the gentler and more comfort-oriented interventions in end-of-life care, certainly far less aggressive than intubation or last-ditch surgery. ... Still, antibiotics do entail their own costs in the form of toxicities and need for intravenous access, and liberal antibiotic use reliably worsens institutional and community drug-resistance profiles. ... A new review was written for infectious disease consultants but contains specific suggestions that should interest both generalists and other subspecialists caring for dying patients. 

Meaningful conversations to have with your loved oneMediaFeed.org, by Merritt Whitley; 3/27/24“One of the most important concepts in the field of grief and loss is that people drift in and out of the awareness of dying,” says Kenneth Doka, a senior consultant to the Hospice Foundation of America, and professor emeritus of gerontology at the graduate school of The College of New Rochelle. “Sometimes they do talk about it, sometimes not. The dying one should control the agenda. Don’t force conversations on them.” When your loved one feels ready to talk, the following suggestions can be comforting ways to begin a conversation: ...