Abstract
Lopez S, Decastro G, Van Ostrop KM, et al. “Palliative pandemic plan,” triage and symptoms algorithm as a strategy to decrease providers' exposure, while trying to increase teams availability and guidance for goals of care (GOC) and symptoms control. Am J Hospice Palliat Med 2020. [E-pub ahead of print]; doi.org/10.1177/1049909120942494
As the spread of the novel coronavirus disease 2019 (COVID-19) continues worldwide, health care systems are facing increased demand with concurrent health care provider shortages. This increase in patient demand and potential for provider shortages are particularly apparent for palliative medicine, where there are already shortages in the provision of this care. In response to the developing pandemic, the North Shore University Hospital Geriatrics and Palliative (GAP) Medicine team formulated a two-team approach that includes triage algorithms for palliative consults as well as acute symptomatic management for both patients diagnosed with and under investigation for COVID-19. These algorithms provided a delineated set of guidelines to triage patients in need of palliative services and included provisions for acute symptoms management and the protection of both the patient care team and the families of patients with COVID-19. These guidelines helped with streamlining care in times of crisis, providing care to those in need, supporting frontline staff with primary-level palliative care, and minimizing the GAP team's risk of infection and burnout during the rapidly changing pandemic response.
Soosaipillai G, Archer S, Ashrafian H, Darzi A. Breaking bad news training in the COVID-19 era and beyond. J Med Educ Curricular Dev 2020. [E-pub ahead of print]; doi.org/10/1177/238212050938706
COVID-19 has disrupted the status quo for health care education. As a result, redeployed doctors and nurses are caring for patients at the end of their lives and breaking bad news with little experience or training. This article aims to understand why redeployed doctors and nurses feel unprepared to break bad news through a content analysis of their training curricula. As digital learning has come to the forefront in health care education during this time, relevant digital resources for breaking bad news training are suggested.
Bui N, Halifax E, David D, et al. Understanding nursing home staff attitudes toward death and dying: A survey. Am J Nurs 2020;120:24–31
Nearly 70% of nursing home residents are eligible for palliative care, yet few receive formal palliative care outside of hospice. Little is known about nursing home staff attitudes, knowledge, skills, and behaviors related to palliative care. In this study, the authors administered a modified survey measuring attitudes toward death to 146 nursing home staff members, including both clinical and nonclinical staff, from 14 nursing homes. Results demonstrated that nursing home staff generally reported feeling comfortable caring for the dying, but half believed the end of life is a time of great suffering. Pain control (63%), loneliness (52%), and depression (48%) were the most important issues identified with regard to these patients, and there was ambivalence about the use of strong pain medications and the utility of feeding tubes at the end of life. Top priorities identified for improving palliative care included greater family involvement (43%), education, and training in pain control (50%) and in management of other symptoms (37%), and use of a palliative care team (35%) at their facility. The authors conclude that there is a need for more palliative care training and education, which should be built on current staff knowledge, skills, and attitudes toward palliative care.
Fox BM. Looking behind the fear of becoming a burden. HEC Forum 2020. [E-pub ahead of print]; doi.org/10.1007/s10730-020-09420-w
As they age, many people are afraid that they might become a burden to their families and friends. In fact, fear of being a burden is one of the most frequently cited reasons for individuals who request physician aid in dying. Why is this fear so prevalent, and what are the issues underlying this concern? The author argues that perceptions of individual autonomy, dependency, and dignity all contribute to the fear of becoming a burden. However, this fear is misplaced; common conceptions of these values should be reframed and re-examined. Practices that support a more community-centered type of autonomy can be found in dependency and dignity. This article offers some practical examples of how to address common end-of-life situations that may cause anxiety to patients who are worried about being a burden. These practices include discussing expectations, both for care and how the relationship among the participants might change, and modeling respectful caregiving behaviors. Most difficult of all, though, includes cultural and societal attitude changes so that people recognize the good in receiving care and get used to the idea that they do not need to do anything to be valuable.
Malhotra C, Bundoc FG, Sim D, et al. Instability in preference for place of death among patients with symptom of advanced heart failure. J Am Med Directors Assoc 2020. [E-pub ahead of time]; doi.org/10.1016/j.jamda.2020.05.030
Patient preference for place of death is an important component of advance care planning (ACP). If patients' preference for place of death changes over time, this questions the value of their documented preference. The authors aimed to assess the extent and correlates of change in preference for place of death over time among patients with symptoms of advanced heart failure. The authors interviewed 282 patients aged 21 years old and above with heart failure and New York Heart Association Classification III and IV symptoms in Singapore. Analytic sample included 200 patients interviewed at least twice. The authors assessed factors associated with patients' preference for place of death (home/institution/no preference) and change in their preference for place of death from previous time point (change toward home death/toward an institutional death/toward no preference/no change). These included patient demographics, quality of life (Kansas City Cardiomyopathy Questionnaire), and prognostic understanding. Results demonstrated that 66% of patients with heart failure changed their preference for place of death at least once during the study period with no consistent pattern of change. Correct prognostic understanding at the time of survey reduced the relative risk of change in preference for place of death to home, whereas a higher quality-of-life score was associated with a lower relative risk of patients changing their preferred place of death to an institution relative to no change in preference. The authors conclude that they provide evidence of instability in patients with heart failure preference for place of death, which suggests that ACP documents should be regularly re-evaluated.