Closing the hospice gap: the value of home-based medical care
Health Affairs Scholar; by Katherine Ornstein, Bruce Leff, Maggie Salinger, Jennifer M Reckrey, Bian Liu, Zainab Toteh Osakwe, Martha Abshire Saylor, Arushi Arora, Melissa Aldridge, Krista Harrison, Abraham A Brody, Christine S Ritchie; 10/26
Home-based medical care (HBMC), longitudinal medical care provided in a patient's home led by physicians or advanced practice providers, addresses complex medical and social needs of seriously ill older adults, particularly those with dementia. We examined whether HBMC use is associated with hospice enrollment and length of stay and whether this varies by dementia status... HBMC users had greater odds of hospice use (odds ratio: 1.34; 95% CI: 1.33-1.35) compared with nonusers, regardless of dementia status. For hospice enrollees, HBMC use minimized both ultra-short (<3 days) and prolonged (>180 days) stays, with a stronger reduction in short stays for patients with dementia. As more older adults age in the community and hospice services expand to support patients with complex illnesses such as dementia, HBMC may offer a valuable strategy for effectively navigating prognosis uncertainty and the complexities of hospice eligibility requirements and enrollment.

Surrogate decision-making for older adults with and without dementia
JAMA Network Open; by Lauren Hersch Nicholas, Scott D. Halpern, Kenneth M. Langa, Mario Macis; 10/7/26
In this survey study of 5965 adults, fewer respondents endorsed life-sustaining treatments (LSTs) when a hypothetical patient had dementia (22% vs 40%). LSTs were more likely to be recommended when the respondent preferred them for their own care, when patient advance directives requested them, and when physicians recommended them. The findings suggest that surrogates’ own values and assumptions about quality of life with dementia, along with documented patient wishes and clinical guidance, may contribute to their recommendations. These findings highlight the importance of preparing patients and surrogates for care decisions through explicit discussions of goals of care and decision-making roles.

Current challenges and future innovation in rural heart failure care: A qualitative analysis
Journal of Cardiovascular Nursing; by Alexander A. Walkon, Shoshana H. Bardach, Aricca D. Van Citters, Tamar Mosulishvili, Samuel L. Youkilis, Amanda N. Perry, Megan M. Holthoff, Olawale O. Akinola, Amelia M. Cullinan, Melissa Borrows, Katharine A. Manning; 9/26
Individuals living with heart failure experience challenges managing frequent hospital admissions and life-altering symptoms, including dyspnea, fatigue, and depression. These challenges are exacerbated by the unique obstacles associated with receiving healthcare in a rural community. Their care partners often do not receive sufficient support to care for someone with heart failure and experience fatigue, social isolation, and anxiety. Interviewees reported challenges related to symptom and care partner burden, fragmented healthcare communication, limited institutional support, and an unclear role for palliative care. Interviewees suggested that integrating personalized care strategies, improving communication and coordination, and expanding specialized support may help address these challenges.

Academic medical centers implementing new Medical Aid in Dying (MAiD) laws: Challenges and solutions
Academic Medicine; Robert Klitzman; 9/26
Institutions must decide what processes to establish if patients inquire about MAiD, which specific clinicians within an institution should evaluate patients for eligibility and capacity, and prescribe MAiD medications, how to communicate about the new law with patients and local communities, how to educate medical and other students and staff appropriately, and how to make these decisions ...  MAiD ...  use has been increasing and attitudes changing, and the contexts of different states and their relevant laws vary considerably. This paper provides suggestions for how institutions should address these challenges—by establishing as early as possible a multidisciplinary working group, including providers (e.g., from palliative care, psychiatry, nursing and social work), compliance, other administrative, legal, and ethics stakeholders. Institutions should also provide and organize structured “debriefs” after initial cases (to examine what went well or not) and/or periodic case conferences among clinicians performing MAiD, and mentorship in providing and prescribing MAiD, offering support, in part due to moral distress and other concerns that can emerge.

Urban and rural hospital closures in Georgia, 2022-2024
JAMA Network Open; by Sara D. Turbow, Kajal Patel, Young-Rock Hong, Jennifer Lom, Mohammed K. Ali; 9/26
Hospital closures are a growing concern with a marked increase in both urban and rural hospital closures seen in recent years. These closures, often due to financial strain, decline in patient volumes, and inequities in health care funding, can result in loss of access to critical medical services. The purpose of this study was to examine postclosure changes in discharge volume, charges, and length of stay at hospitals near urban vs rural hospital closures in the state of Georgia. Urban hospital closures are an emerging area that will only become more relevant as policy changes are expected to lead to more urban closures in the coming years.

Distress screening and pediatric palliative care referral: A retrospective case-control study in supportive cancer care delivery
Journal of Palliative Medicine; by Jonathan Ebelhar, Katherine Yeager, Jordan Gilleland-Marchak, Dio Kavalieratos, Zhulin He, Rebecca Williamson Lewis, Katharine E Brock; 9/26
Pediatric palliative care (PPC) reduces distressing symptoms and improves quality of life for children with cancer and their caregivers. This study assesses whether patient and caregiver distress is associated with PPC referral. Conclusion: Patients reporting high distress had higher odds of PPC referral. Caregiver DT [distress thermometer] scores were not associated with PPC referral. High patient distress scores could serve as a screening criterion for PPC referral.

[Greece] Early clinical mediation in end-of-life disputes: A procedural justice analysis
Health Care Analysis; by Olympia Lioupi; 9/26
Conflicts arise when surrogates request life-sustaining treatments that clinicians consider medically futile. This article proposes that early presumptive medical mediation with opt-out provisions should become the default initial offer for resolving such disputes. Mediation offers four procedural advantages: (a) protected and appropriately inclusive voice, (b) confidential caucus, (c) interest-based framing, and (d) outcome ownership. Embedding an early, structured offer of mediation in end-of-life policy may reduce escalation and strengthen the procedural legitimacy and acceptability of decision-making when voluntariness and appropriate clinical, ethical and legal safeguards are maintained. However, it cannot guarantee agreement, shorter ICU stays, reduced litigation, or substantively correct ethical outcomes.

... though we may come from different places, speak in different tongues, our hearts beat as one.  ~Albus Dumbledore in the movie, 'Harry Potter and the Goblet of Fire' (adapted from book by J.K. Rowling)