SOS: What does Google and ChatGPT say about SSVI and quality?
Substack; by Joan Teno; 8/26
Medicare recently finalized a new hospice scorecard called the Service and Spending Variation Index (SSVI). It gives each Medicare-certified hospice a number from 0 to 16, built from nine billing-based measures, where a higher score flags a hospice whose spending and service patterns look unusual compared with its peers. A high score is not proof of bad care or fraud — it mainly signals to Medicare which hospices may be worth a closer look. In this post I asked Google Gemini and ChatGPT to interpret a sample hospice’s score, and I compare how well each explained what the number does, and does not, mean for a family choosing a hospice.
Publisher's note: Even though Substack is a blog site rather than a journal, Joan's content is outstanding and also fits here in a Saturday research issue!

Palliative care physicians' perceptions about using artificial intelligence for prognostication
Journal of Pain & Symptom Management; by Stacy M Fischer, Regina M Fink, Ahmed Y Alasmar, Eric G Campbell, Matthew DeCamp; 7/26
Statistical and artificial intelligence (AI)-based methods have informed clinical prognostication for decades, evolving into machine learning models integrated into electronic health records. We conducted a national survey of n=2,500 Hospice and Palliative Medicine physicians in the United States (January 2024-March 2025) to assess current prognostic practices, AI knowledge, and perceived benefits and risks of AI-based prognostication. Conclusions: Palliative care physicians report limited current use of AI-based prognostic tools but generally favorable attitudes toward potential benefits, especially among current AI tool users.

Goal-concordant care for older adults with advanced heart failure: A retrospective cohort study
Palliative Medicine; by Sarah Godfrey, Maryjane Farr; 7/26
Older adults with advanced heart failure experience significant morbidity and mortality and face higher complication rates from advanced therapies. Of 212 patients, 91 (42.9%) underwent evaluation for advanced therapies, though few received a heart transplant (16, 7.5%) or left ventricular assist device (32, 15.1%). Most (148, 69.8%) had only one palliative physician visit. One hundred thirty-nine (65.6%) died, often in the hospital (55, 40%) and with life-sustaining therapy in the last 24 h (73, 52.5%). Most (167, 78.8%) received goal-concordant care, with the main reasons for discordance being the desire for advanced therapy (33, 15.6%) and complications post-implantation affecting quality of life (9, 4.2%). Conclusions: Few older adults received advanced therapies, and palliative care was underutilized, with many patients seeing palliative care only once. Most received goal-concordant care, but decisions were often made late, highlighting the need for earlier, longitudinal palliative care for these vulnerable patients.

Advance care planning in sickle cell disease: A scoping review
Journal of Palliative Medicine; by Megan R Marshall, Miranda Ravicz Adelmann, Miriam A Osei, Sharl S Azar, Stephanie Kiser, Richard Newcomb; 7/26
Sickle cell disease (SCD) is an inherited hemoglobinopathy characterized by abnormal red blood cell sickling, leading to pain, organ dysfunction, and early mortality. Its severe, unpredictable course and the emergence of complex decisions surrounding transformative therapies have prompted recommendations to integrate palliative care (PC) to support patients and families. The limited available evidence suggests that patients are open to ACP [advance care planning] discussions with trusted clinicians, but few patients had participated in formal or informal ACP. Personal and environmental factors may influence ACP engagement, including patient-clinician trust, patient and clinician understanding of ACP in SCD, timing of ACP conversations, and previous experiences with critical illness or end-of-life care. Proposed steps for advancing ACP in SCD include education, early PC integration, and strengthened patient-clinician communication and relationships.

Empowering elderly Chinese Americans: Advance care planning educational workshop
Geriatric Nursing; by Mengyao Zhao, Tammy Tyree; 7/26
Advance care planning (ACP) is important to ensure an individual's values and preferences are followed at the end-of-life (EOL). However, elderly Chinese Americans have a much lower advance directive (AD) completion rate than the national average. This quality improvement project aimed to improve ACP engagement and AD completion rates among elderly Chinese Americans at a local senior center in Arizona. Three monthly culturally tailored educational workshops were conducted, and ... data analysis showed a significant increase in ACP engagement scores over time ...  Additionally, AD completion rates rose by 220% after the intervention. These findings indicate that culturally tailored educational workshops can effectively improve ACP engagement and AD completion rates in elderly Chinese Americans.

[Israel] Existential suffering at the end of life in long-term care: A critical essay on recognition, dignity, and witness
Palliative Care & Social Practice; by Anat Romem, Rachel Bardach; 7/26
Existential suffering is widely acknowledged in palliative care, but it remains inconsistently recognized and unevenly addressed in long-term care. This critical essay argues that the gap is not caused by clinician indifference, but by a persistent mismatch between whole-person ideals and care systems organized around measurable symptoms, risk management, task completion, and professional uncertainty. [This] ... essay identifies three interrelated shortcomings: the reduction of suffering to medically actionable symptoms; the depersonalizing effects of institutional routines on frail older adults; and the absence of shared existential literacy across interdisciplinary teams. The essay also cautions against romanticizing suffering or treating meaning-making as a clinical expectation. It proposes a practical framework of recognition, dignity, and witness: recognizing biography and identity as clinically relevant; protecting dignity in the ordinary details of care; and enacting witness ... Long-term care cannot resolve every existential wound, but it can reduce existential neglect by treating personhood as a core quality indicator of palliative care.

One must pay dearly for immortality; one has to die several times while still alive.  ~Friedrich Nietzsche