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The future of palliative care - Issue #11

Thank your favorite nurse--it's National Nurses' Week! [If you received this newsletter as a forward,

The future of palliative care

May 6 · Issue #11 · View online
In many respects, we've arrived. Yet what we know now won't get us to the next level. So I'm looking for signals from the future, & I'm curating them here.

Thank your favorite nurse–it’s National Nurses’ Week! [If you received this newsletter as a forward, and you like it, you can subscribe here.]

1. A nurse-poet examines her own grief.
Although I was surrounded by death I was oddly comforted by the boys whose bodies took on the shape of my brother’s body. They all had the same cancer starvation, they all had delicate bones. And when they died, I washed their bodies and wrapped them in plastic, then cloth. Each tragedy reminded me that I was not alone in my tragedy.” Mary Jane Nealon’s brother died of cancer, she nursed young men through AIDS in NYC in the 80s, and wrote an amazing memoir that never got the attention it deserved. Utterly remarkable.
Beautiful Unbroken: One Nurse's Life: Mary Jane Nealon: 9781555975906: Books
2. Why our big world needs palliative care.
Sylvia Nam’s grandfather went to North Korea from South Korea during the war, and never returned. But the reason i’m including her story here is not because of the politics. It’s one of the truest accounts of grief i’ve heard. Sylvia eventually traveled to North Korea, against her mother’s advice, to search–and what narrative reveals, something i’ve never seen in a textbook, is how grief is transmitted across generations. Could grief, like trauma, be intergenerational? I couldn’t turn this one off.
Listen to ‘The Daily’: A Family Divided by the Korean War - The New York Times
3. A new taxonomy for high-need patients.
A concise report of a consensus process following a National Academy workgroup, this paper lays down a road map for the next generation of palliative care services by defining 6 high-need patient subpopulations, what drives spending for each, and 4 characteristics of successful care models. If you’re looking for signals from the future, consider this a billboard. [If you need access, look here.]
Approach for Achieving Effective Care for High-Need Patients | Geriatrics | JAMA Internal Medicine | JAMA Network
4. The latest meta-analysis of PC consultation & cost.
The punch line: PC consultation still saves money. In 6 studies comparing hospitalized inpatients (with cancer; heart, liver, or kidney failure; chronic obstructive pulmonary disease; AIDS/HIV; or selected neurodegenerative conditions) who had PC consultation vs usual care, 133,118 patients in total. More comorbidities, more cost reduction. A deep bow to Sean Morrison. You can talk this up with your C-suite tomorrow. No paywall.
Economics of Palliative Care for Hospitalized Adults With Serious Illness: A Meta-analysis | End of Life | JAMA Internal Medicine | JAMA Network
5. For cancer, EOL quality is inversely related to cost.
A fascinating cost analysis from Scott Ramsey’s group analyzed costs for 36,000 patients with cancer in the region from 2014-6, and includes the total $ amount paid to all care providers by the 4 biggest insurers (Medicare, Blue Cross, Blue Shield, Uniform state plan). The cost scores are driven by ICU use (resulting in high cost) and hospice use (resulting in lower cost). The quality scores are driven by chemo in the last 14 days of life, multiple ER visits in the last 30 days of life, and ICU use in the last 30 days. What this shows clearly is that good EOL care isn’t something money (in our current system) can buy. We need to change the systems. But if the key determinant isn’t money, what is it? It’s not simply volume. Knowing some of these systems, i’ve got some hunches, but there is ground-breaking work to be done here. Get the entire report.
6. The economic stress is surfacing.
Starting tomorrow May 7, patient care service workers and technical workers–the people who do the thankless, basic, essential jobs–are going on strike at UCSF. And the nurses union is planning a sympathy strike starting on May 8. “The striking employees include nurses, operating room specialists, patient care assistants, pharmacy technicians and pharmacists, phlebotomists, psychologists, research coordinators and social workers, as well as custodians, food service workers and shuttle drivers.” I hear that UCSF has reduced its census by 60% to prepare. A signal of tensions in academic medical centers to come?–California is ‘roughly 15 years ahead’ in confronting the realities of our changing political and economic landscape. Sobering.
This newsletter is made possible by the John A. Hartford Foundation. The views, opinions, and recommendations, however, are mine alone. Next week, the newsletter is on retreat–see you in 2 weeks!
Could more public-facing messaging be like this? From The Conversation Project
What's the last sound you'd want to hear? Made me think. From EndWell
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