Literature Review

Concerning new data on female physician suicide Medscape Medical News; by Pauline Anderson; 2/28/25 Suicide rates for female physicians in the United States between 2017-2021 were 47% higher than for women in the general population, results of a retrospective cohort study showed. Unlike their female counterparts, male physicians had a lower rate for suicide relative to the general male population, investigators found. “The results indicate we need added multimodal and comprehensive suicide prevention specific for physicians,” lead study author Hirsh Makhija, MS, postgraduate researcher, Department of Psychiatry, University of California San Diego School of Medicine, told Medscape Medical News. ... The findings were published online on February 26 in JAMA Psychiatry. 

Nurse leaders can take the lead in promoting civility in the workplace Oncology Nurse Advisor; by Susan Rux, PhD, DNP, RN, FACHE; 2/28/25 Civility, the act of respecting others, especially in situations where disagreement or disparity may arise, occurs by intentionally displaying kindness and empathy. These behaviors help people to understand differences as well as uphold common ground across all social contexts. A stable foundation, afforded through civil actions, serves as a catalyst in achieving environments that promote diversity, equity, and inclusivity — the underpinnings of a culture of belonging. Nurse leaders can play a key role in creating this culture. Contrary to civility, in the healthcare setting, acts of incivility lead to increased levels of staff disengagement and turnover. Researchers have noted that a civil nursing workplace provides a safeguard against numerous professional issues, including but not limited to increased turnover rates, burnout, job dissatisfaction, and stress.

Exploring the role of AI in palliative care and decision-making Penn Today; by Erica Moser; 2/28/25 Oonjee Oh [nursing Ph.D studen] was the lead author on the paper “The ethical dimensions of utilizing Artificial Intelligence in palliative care,” which published in the journal Nursing Ethics in November. ... The paper applies the moral principles of beneficence, nonmaleficence, autonomy, justice, and explicability to examine the ethical dimensions of three hypothetical use cases: machine learning algorithms that predict patient mortality, natural language processing models that capture the signals of psychological distress from clinical notes, and chatbots that provide informational and emotional support to caregivers.

45% of end-of-life cancer patients potentially overtreated: 5 study notes Becker's Hospital Review; by Elizabeth Gregerson; 2/28/25 Almost half of all Medicare enrollees with cancer nearing end of life receive aggressive overtreatment as opposed to supportive palliative or hospice care, according to a study published Feb. 21 in JAMA Health Forum. Here are five things to know from the study:

'Shouldn't be something that's feared': She helps people face the end of life with dignity News Chief, part of the USA TODAY Network, Lakeland, FL; by Thomas R. Oldt; 3/2/25 Allow me to introduce a perfectly lovely person you may not wish to meet. She’s fostered rescue dogs, advocated for domestic violence victims, volunteered for foreign medical missions and worked emergency rooms throughout Central Florida. She is exceptionally empathetic, intensely focused and candid to a fault. She is also highly conversant in a subject most of us prefer to avoid. For the past seven years, Dr. Danielle Christiano has been staff physician at Good Shepherd Hospice in Auburndale where – in contrast to most other places – death is not a verboten subject. ... [Question:] What do you say or do to alleviate fears that accompany the end of life? [Answer:] It depends on your definition of hope. And it depends on what you want out of this. My general prescription is very different from most doctors because I embrace joy. I want people to seek out the things that bring them joy, ...

The Alliance commends introduction of legislation to extend hospice telehealth flexibilities  National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 2/28/25 The National Alliance for Care at Home (the Alliance) is pleased to support the reintroduction of the Hospice Recertification Flexibility Act in the House of Representatives. This bipartisan legislation, H.R.1720, would extend telehealth flexibilities for hospice face-to-face (F2F) recertification. The F2F encounter is performed by a physician or nurse practitioner to evaluate the patient and collect clinical information used in determining continued eligibility for hospice. Introduced by Representatives Carol Miller (R-WV) and Jared Golden (D-ME), the bill would extend the F2F recertification flexibility for providers until December 31, 2027. Beginning January 1, 2026, the legislation also includes important guardrails to ensure appropriate use and requires the Centers for Medicare & Medicaid Services (CMS) to create a modifier to collect data on when the F2F encounter is conducted via telehealth. The Alliance, then through its legacy organizations, worked with lawmakers to ensure continued care transformation and access to care for high-quality providers. [Click on the title's link to continue reading.]

WVU nursing faculty aim to enhance rural home care for chronically ill through NIH award WVU Today - West Virginia University, Morgantown, WC; Press Release; 2/26/25 Three West Virginia University nursing faculty know firsthand the difficulties faced by family caregivers and their chronically ill loved ones. With a $2.7 million award from the National Institutes of Health’s National Institute of Nursing Research that is one of the largest ever for the WVU School of Nursing, the faculty researchers aim to support these families while increasing access to care in the rural reaches of the Mountain State by testing an integrated, nurse-led intervention for family home care management of end-stage heart failure and palliative care. ... Through their lived experiences, as well as their previous studies using nursing science to develop and test nurse-led interventions, the three said they hope to improve family caregivers’ and their loved ones’ overall health and well-being, including reducing depression and anxiety, and monitoring and managing end-of-life symptoms.

Wishing that your patient would die: Reasons and reactions Psychiatrist.com - Rounds in the General Hospital; by Yelizaveta Sher, MD; Filza Hussain, MD; Benjamin J. Hoover, MD; Matthew Gunther, MD, MA; Daniel O. Fishman, MD; Mira Zein, MD; Jose R. Maldonado, MD; Theodore A. Stern, MD; 2/25/25 Have you ever had a patient suffer so much that you wanted them to die? Have you wondered whether such thoughts and feelings are acceptable? Have you been uncertain about how you could manage your guilt over such thoughts? Have you been unsure about how to best advocate for a patient whose medical care is futile? If you have, the following case vignette and discussion should prove useful. ...

‘Global problem’: Numerous factors, biases contribute to overtreatment at end of life Healio; by Josh Friedman; 2/26/25 Nathan I. Cherny, MD, has worked all around the world. At every stop — from Australia to Israel, and Memorial Sloan Kettering Cancer Center in between — he has seen people with cancer receive overly aggressive treatment at the end of life. ... In a review published in ESMO Open, Cherny and a cohort of multinational colleagues highlighted numerous reasons why overtreatment occurs among patients approaching the end of life, ... They listed more than 20 contributing factors, including desire for control of the cancer, denial and anger, family pressure and hope preservation. The two factors that contribute most to overtreatment are optimism bias and the “counterphobic determination to treat,” which involves clinicians having a difficult time introducing the suggestion of palliative care revert to offering further treatments, Cherny said. ... Responsibility for decisions does not need to fall solely on oncologists, Cherny added. Palliative care physicians, social workers, chaplains and others can be part of a team to assist patients with their choices. ... The number of patients who are overtreated differs at each institution. “Each institution has its own culture of care,” Cherny said. Editor's note: This article puts forth significant insights for all palliative and hospice clinicians, interdisciplinary teams, and palliative/hospice executive leaders. Apply Cherny's to your referral sources: "Each institution has its own culture of care." Apply these findings to your own palliative and hospice services. 

Leading early conversations about ICD [implantable cardioverter defibrillator] use in end-of-life cancer care  Cancer Network; by Megan Mullins, PhD, MPH; 2/21/25 Earlier and more frequent talks about disabling ICDs with patients receiving end-of-life care and their families may help avoid excessive pain. ... Regarding implantable cardioverter defibrillators (ICDs) in those with fatal cancers, it is critical that patients know what having a device means and how it impacts end-of-life care, according to Megan Mullins, PhD, MPH. CancerNetwork® spoke with Mullins, assistant professor in the Peter O’Donnell Jr. School of Public Health, the Harold C. Simmons Comprehensive Cancer Center, and the Department of Internal Medicine at UT Southwestern Medical Center, about how ICD deactivation prior to end-of-life care could impact clinical practice in patients with advanced cancers. ... She emphasized that device deactivation would allow the body to undergo the natural dying process without unnecessary painful shocks associated with the use of the device.

5 tips to determine how tech can support your physicians American Medical Association (AMA); by Georgia Garvey; 2/25/25 ... Margaret Lozovatsky, MD, vice president of digital health innovations at the AMA, recently shared five important considerations—among them establishing a governance model and agreeing on shared priorities—in designing technology to support clinical practice. Dr. Lozovatsky’s presentation was part of a two-day AMA training event to help physicians eliminate unnecessary work and free up more time to focus on what matters most—patient care. ...

Hospice caregiver spends days with family during Arkansas winter storm NBC News KARK - Maumelle, AR; by Neal Zeringue; 2/20/25 In icy conditions, many would not risk going up and down the steepest hills, but in-home care workers have. One in Maumelle even stayed away from home for days to be with a family on top of a dangerous hill. ... [Nelda] Michael’s husband has dementia and has had in-home care for 15 months. He needs constant attention. Because of the ice, nurses with Arkansas Hospice could not see him Wednesday, but on Thursday they were determined to give him care. However, Morgan Bartley and Michelle Kelley’s cars slid down the hill on one side of the road the Michaels live on top of. KARK 4 News found them stuck and helped them up from the other end of the road. “We were prepared to park our vehicles at the bottom and hike a mile up. Anything to get to him and to her,” Bartley said. [Click on the title's link to continue reading.]

Patients without family or health care proxies face overtreatment or limbo in hospitals WHYY - PBS; by Maiken Scott; 2/24/25 A program matches unrepresented patients with volunteers who can make care decisions for them during health care crises. ... [Intensive care physician David] Oxman says unrepresented patients are a small, but growing group. Some have outlived their family members, or are estranged from them. Maybe they’ve moved a lot, sometimes substance use or homelessness plays a role. The situation is especially complicated with patients who have dementia, or who can’t communicate their wishes for other reasons. ... Most states have provisions where medical guardians and medical decision makers can be appointed by a court, but that takes a long time. In the meantime, a search for relatives begins. David Sontag, director of ethics for Beth Israel Lahey Health in Massachusetts, ... created a matching program where health care professionals volunteer to represent patients, not within their own hospital systems because that could cross ethical boundaries, but at other hospitals. “This is an opportunity for us to help some of the most vulnerable members of our communities, those who have nobody to speak for them when they can no longer speak for themselves. And that allows us to respect their autonomy throughout their lives,” he said.