Healthy days at home and prognosis of older adults with cancer and non-cancer serious life-limiting illnesses
BMC Geriatrics; by Oluwaseun J. Adeyemi, Nina Siman, Allison M. Cuthel, Keith S. Goldfeld, Corita R. Grudzen; 7/25
Approximately 75% of U.S. older adults with serious life limiting illnesses visit the emergency department (ED) in the last six months of life, with three quarters of these individuals being admitted to the hospital. In this context, Healthy Days at Home (HDaH) and prognosis have emerged as important concepts for assessing and guiding care among older adults with serious life-limiting illnesses. HDaH is a patient-centered outcome measure that captures the number of days individuals spend at home without hospitalizations or ED visits. Among US older adults with serious life-limiting illnesses, worse prognosis is associated with fewer HDaH. Increasing age is associated with fewer HDaH, with substantial variability by race/ethnicity. In contrast, cancer is associated with more HDaH.
Assistant Editor's note: "Healthy Days at Home (HDaH)" is such a fabulous concept, and so in keeping with the intent and goals of palliative care. Perhaps HDaH is a quality measure that palliative care providers might consider implementing. 

Systemic strategies to prevent nonbeneficial treatments near the end of life
JAMA Network Open; by Sofia Weiss Goitiandia, Amy Z. Sun, Amy Rosenwohl-Mack, Catthi Ly, Katherine E. Sleeman, Daniel Dohan, Elizabeth Dzeng; 7/25
There exists a default toward high-intensity treatments near the end of life in the United States, including for people living with advanced dementia (PLWD). Clinical momentum, a cascade of increasingly intensive treatments facilitated by systemic factors, contributes to this default. The intensity of treatments provided to PLWD near the end of life is lower in Great Britain. Using Great Britain as a counterexample to the United States, this study examines factors that may contribute to lower-intensity treatment patterns.

Benefits of emergency department-initiated goals of care conversations and palliative care consultations among older adults with chronic or serious life-limiting illnesses
Journal of the American College of Emergency Physicians Open; by Jennifer Johnson, Timmy Li, Megan Mandile, Santiago Lopez, Molly McCann-Pineo, Landon Witz, Payal Sud; 8/25
Initiating goals of care (GOC) conversations and palliative care consultations in emergency departments (EDs), compared with inpatient settings, may be associated with improved outcomes among older adults with chronic or serious life-limiting illnesses. ED-initiated GOC conversations were associated with approximately 3-day shorter hospitalizations and a $2689 contribution margin increase, suggesting increased health care cost savings. ED-initiated palliative care consultations were associated with approximately 7-day shorter hospitalizations, 6 fewer excess days in acute care, 1 fewer intensive care day, and higher odds of hospice discharge. Starting these discussions earlier in the ED may help hospitals optimize resources while ensuring treatment aligns with patients’ palliative needs and care preferences.

Certified Child Life Specialists in hospice and palliative care organizations: A state of the profession
American Journal of Hospice and Palliative Medicine; by Jennifer Mangers-Deans, Alyssa Friedberg, Kimberly Downing, Lisa C. Lindley; 8/25
Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

Parental goals of care for children with rare diseases: A content analysis of pediatric advance care planning conversations
American Journal of Hospice and Palliative Medicine; by Tamiko Younge, Hailey Moore, Jessica D. Thompkins, Maureen E. Lyon; 7/25
Caregivers and surrogate decision makers for children with rare diseases often make complex medical decisions with limited prognostic information specific to their child’s disease. Our objective was to describe goals of care as explored through advance care planning conversations among the high-risk and high-need community of families with children with rare diseases. We identified 13 goals of care themes: maintaining stability, being happy, moving the body, thriving along their own path, reducing interventions, living a long life, curing disease, avoiding complications, connecting with others, having a village, an understanding world, knowing our child, and partnering with our medical team. Conclusions:Parents of children with rare diseases have a multitude of holistic goals related to their child’s care. High-quality advance care planning conversations may help families articulate these goals.

Simulating the overall hospital quality Star ratings with random measure weights
JAMA Network Open; by Benjamin D. Pollock, Daniel S. Ubl, Subashnie Devkaran, Sean C. Dowdy; 7/25
We found that only 244 US hospitals achieved reliable excellence in hospital quality in 2024 when defined as 90th percentile performance or better in at least 50.0% of 100,000 simulations using random weights for each measure in the CMS Overall Star Ratings. Our analysis highlights that there is meaningful variation in hospital quality performance across the spectrum of quality measures, even among 5-star hospitals. Future efforts to assess this variation may allow for better identification of reliably excellent hospitals, which could in turn lead to solicitation of evidence regarding the processes or cultures that separate reliable excellence from inconsistent greatness in hospital quality.  

How health care systems shape end-of-life care—A step toward transparency
JAMA Network Open; by Jacqueline M. Kruser, Gordon D. Rubenfeld; 7/25
Our health care systems, in all their multifaceted complexities, are more influential in shaping the delivery of care than individual human effort or error. Influential system-level factors span many different domains: how we are paid, the buildings we work in, the technology around us, who and how many we have on the team caring for patients, our workload, and our local social networks of influence. One pragmatic first step in addressing the problem of invisible, inaccessible, and/or inflexible patterns of end-of-life care is to build awareness of and foster transparency about the current patterns and their default orientation. Building from this deeper understanding of how our everyday routines and practice patterns influence care, we can then take the bigger step of intentionally designing our routine clinical practice patterns to be systematic yet flexible in their support of patients with serious illnesses.

Hospital decision-making and adoption of health-related social needs programs in US hospitals
JAMA Network Open; by Dina Zein, Cory E. Cronin, Neeraj Puro, Berkeley Franz, Elizabeth McNeill, Ji E. Chang; 6/25
In response to health disparities in the US, the Centers for Medicare & Medicaid Services (CMS) released a Framework for Health Equity recommending increased hospital commitment and leadership engagement around screening for health-related social needs (HRSNs). This cross-sectional study found that hospitals with multiple layers of management engagement tended to adopt multifaceted strategies that address patients’ social needs, which are critical components of health equity frameworks. Interestingly, hospitals where only senior management was involved were more likely to offer specific programs like food insecurity and transportation services, although these associations were generally smaller compared with when both senior and other management were engaged.

Evaluating a large language model in translating patient instructions to Spanish using a standardized framework
JAMA Pediatrics; by Mondira Ray, Daniel J. Kats, Joss Moorkens, Dinesh Rai, Nate Shaar, Diane Quinones, Alejandro Vermeulen, Camila M. Mateo, Ryan C. L. Brewster, Alisa Khan, Benjamin Rader, John S. Brownstein, Jonathan D. Hron; 7/25
Patients and caregivers who use languages other than English in the US encounter barriers to accessing language-concordant written instructions after clinical visits. Large language models (LLMs), such as OpenAI’s GPT-4o ... can translate Spanish translations of real-world personalized written patient instructions that are comparable in quality to those generated by professional human translators. Independent professional medical translators preferred the GPT-4o–generated translations over the human translations, and error analysis revealed a higher rate of mistranslation errors in the human translations. These findings demonstrate GPT-4o’s ability to produce quality translations in Spanish ...

Regional anesthesia for hip fracture surgery in older adults: A retrospective comparison of outcomes using ACS NSQIP data
Geriatric Orthopaedic Surgery & Rehabilitation; by Arissa M. Torrie, Gerard P. Slobogean, Rachel Johnson, Ron E. Samet, Samuel M. Galvagno, Robert V. O’Toole, Nathan N. O’Hara; 6/25
Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. This study found that regional anesthesia, presumably using peripheral nerve block techniques, may offer advantages beyond pain control, with potential protective benefits in high-risk hip fracture patients. Future clinical trials should examine peripheral nerve block benefits beyond pain management, identify mechanisms of action, determine optimal techniques for different risk profiles, and assess long-term outcomes. By combining the insights from this study with carefully designed future research, researchers can work towards developing more effective, patient-centered approaches to anesthesia for older adults undergoing surgical fixation of hip fractures.

[Finland] Moral psychological exploration of the asymmetry effect in AI-assisted euthanasia decisions
Cognition; by Michael Laakasuo, Anton Kunnari, Kathryn Francis, Michaela Jirout Košová, Robin Kopecký, Paolo Buttazzoni, Mika Koverola, Jussi Palomäki, Marianna Drosinou, Ivar Hannikainen; 9/25
A recurring discrepancy in attitudes toward decisions made by human versus artificial agents, termed the Human-Robot moral judgment asymmetry, has been documented in moral psychology of AI. Our studies documented reduced approval of an AI doctor's decision to withdraw life support relative to a human doctor. This effect persisted regardless of whether the AI assumed a recommender role or made the final medical decision, but, importantly, disappeared under two conditions: when doctors kept on rather than withdraw life support, and when they carried out active euthanasia (e.g., providing a lethal injection or removing a respirator on the patient's demand) rather than passive euthanasia. These findings highlight two contextual factors–the level of automation and the patient's autonomy–that influence the presence of the asymmetry effect, neither of which is not predicted by existing theories. Finally, we found that the asymmetry effect was partly explained by perceptions of AI incompetence and limited explainability. As the role of AI in medicine continues to expand, our findings help to outline the conditions under which stakeholders disfavor AI over human doctors in clinical settings.
Publisher's note: I find this study simultaneously interesting and unsettling...

[China] Machine learning models to predict 6-month mortality risk in home-based hospice patients with advanced cancer
Asia-Pacific Journal of Oncology Nursing; by Wan Cheng, Jianwei Zheng,Yuanfeng Lu, Guojuan Chen, Zheng Zhu, Hong Wu, Yitao Wei, Huimin Xiao; 12/25
This study aimed to construct predictive models using five different machine learning algorithms for predicting 6-month mortality risk among home-based hospice patients with advanced cancer. Our study demonstrated that routinely collected healthcare data on the first home visit have the potential to help screen high-risk patients, which may provide evidence for targeted hospice care.

True terror is to wake up one morning and discover that your high school class is running the country. ~Kurt Vonnegut