Literature Review

[UK] Identifying challenges related to the management of comorbidities in people with dementia in residential care: Expert delphi consensus exerciseJournal of Applied Gerontology; Serena Sabatini, Frances Hawes, Kelechi Eluigwe, Eugene Y. H. Tang; 1/25Improving early detection, management, and treatment of comorbid conditions to dementia in residential care could slow down cognitive and functional decline, and increase residents’ quality of life. ... Mental illnesses, delirium, and sensory impairments were identified as the most difficult comorbidities to dementia to deal with. Medication management, symptom management, shortage of staff, lack of training among staff, and limited resources from the broader healthcare system were identified as the most difficult issues when dealing with dementia comorbidities. To address disparities between different residential care homes there is the need of mandatory standards of care across UK residential care homes, and of clear guidelines on topics such as pathways of care for residents’ medical problems, staff to resident ratios, and minimum wages.

Truth-telling, and ethical considerations in terminal care: an Eastern perspectiveNursing Ethics; Qing Ma; Yi Wu; Ronghua Fang; 1/25 Truth-telling for terminally ill patients is a challenging ethical and social issue for Chinese health care professionals. However, despite the existence of ethical and moral standards for nurses, they frequently encounter moral dilemmas when making decisions about truth-telling to patients with end-stage diseases in China. This article focuses on nursing morality, ethics, norms, and philosophy in health care and discusses countermeasures taken by nurses in truth-telling decision-making in combination with Chinese Confucian culture. The analysis identifies key ethical strategies tailored to Chinese nurses’ practices, emphasizing individual autonomy, cultural sensitivity, and family dynamics in truth-telling decisions.

Use of digital health technologies by older US adultsJAMA Network Open; Cornelius A. James, MD; Tanima Basu, MS, MA; Brahmajee K. Nallamothu, MD, MPH; Jeffery T. Kullgren, MD, MPH, MS; 1/25Older adults use various types of DHT [digital health technologies], and they use patient portals most often. Although some older adults have unique physical and cognitive needs that can affect the utility and usability of DHTs, in aggregate they share some predictors of DHT use with younger adults. Additionally, our study showed a statistically significant association between non-Hispanic Black race and ethnicity and DHT use. Various factors may contribute to this finding, including medical mistrust among Black patients leading to decreased engagement with the health system and increased reliance on DHTs. This study highlights the need to carefully consider the unique characteristics of older adults when developing and deploying DHTs to avoid worsening the digital divide. 

Hospice care in the Emergency Department: An evolving landscapeJournal of Palliative Medicine; by Eliot Hill, Ky Stoltzfus, Joanna Brooks; 1/25Despite the increasing focus on goal-concordant care in the emergency department (ED), there is limited data about patients who receive a new hospice referral and the care paths of patients on hospice who present there. [In this study,] six patients received a new hospice referral. Of these, four had a primary diagnosis of cancer, three received a palliative care consult, and three were discharged to an inpatient hospice facility (hospice house). No patients had repeat health care encounters at our hospital. 42% (31/74) of patients enrolled in hospice required admission. Conclusion: New hospice referrals in the ED are possible but rare. Further research should investigate possible missed opportunities to provide goal-concordant care.

Experts are debating whether some cancers shouldn’t be called thatJAMA; Rita Rubin, MA; 1/25Back in 2012, the National Cancer Institute (NCI) convened a conference to discuss the overdiagnosis and overtreatment of indolent tumors—asymptomatic lesions unlikely to progress for years—that are detected by mammography, prostate-specific antigen (PSA) testing, and other screening tools. “I don’t think the name is that important,” acknowledged Hwang, who participated in the 2012 NCI conference about overdiagnosis and overtreatment. “It’s how we react to the diagnosis and how we convey risk to the patients.” In other words, stop calling low-risk tumors cancer, but make sure patients understand that such lesions are risk factors for cancer and, therefore, require diligent monitoring. Or keep calling the tumors cancer, but make sure patients understand that these lesions are unlikely to cause problems, so active surveillance, not immediate treatment, is appropriate.

Overcoming barriers to make patient-reported outcome collection the standard of care in oncologyJAMA Oncology; James A. Colbert, MD, MBA; Louis Potters, MD; 1/25Multiple studies have demonstrated the clear benefits of collecting patient-reported outcomes (PROs) in oncology care. These benefits include measurable effects on patient symptom burden, toxicity, emergency department (ED) use, and even cancer survival. Despite these well-recorded advantages, adoption of PRO collection beyond research studies and clinical trials remains low. Barriers to more widespread adoption in oncology care include clinician skepticism, historical technological limitations, and the challenges related to change management. We owe it to patients to make PRO collection standard practice. Achieving this will require additional education, the embrace of new technologies, and a willingness among clinicians to follow the data and adopt new routines that will necessitate changing established patient care models.

Saturday newsletters focus on headlines and research - enjoy!

The Handbook of LGBTQIA-inclusive Hospice and Palliative Care, 2nd edition Review in Ageing & Society, published online by Cambridge University Press; book authored by Kimberly D. Acquavia, review authored by Luis Stoisser; 1/23/25 The Handbook of LGBTQIA-inclusive Hospice and Palliative Care is a comprehensive guide to providing inclusive palliative and hospice care to everyone, regardless of their self-identification. Following the author's belief that LGBTQIA+ hospice and palliative care requires change at three levels - individual, institutional and systemic - the book extends state-of-the-art palliative and hospice practices (US focused) by including LGBTQIA+ perspectives. Such a rethinking educates hospice and palliative care practitioners on how to provide person-centered care, how to be self-reflexive on a daily basis and how to handle their own stereotypes and stigmas. [This book is available via Columbia University Press and Amazon.]

Polsinelli attorney: Expand access to capital for hospice, health care providersHospice News - Executive Perspectives; by Jim Parker; 1/28/25 Private equity in health care has come under fire in recent years, but the regulatory environment leaves few other options for raising capital. This is according to Bobby Guy, an M&A attorney and shareholder in the law firm Polsinelli. Guy posits that regulation of publicly traded markets have pushed business owners towards private equity and reduced transparency when it comes to corporate funding. ... The question should not be whether PE is good or bad for health care. The question should be, “How are we going to fund health care?” That’s the real question.Editor's note: This is an "Executive Perspective." Adding another perspective, I invite you to apply this proposed "real question" across the board to all potential payment sources. Are fraud and abuse payments ok, as long as they pay the bills? When you are dying--whether in hospice or not--will the quality of health care you receive matter? If the hospice patient is your child, your spouse, your parent, does the "good or bad" of the health care provided matter? I do not determine the answers for you. I re-ask the question, inviting readers to examine (1) the core purposes and values of hospice care and (2) its expansive body of clinical research data. 

Strike-throughs in 1/29 issueGreetings Readers, we regret that the emailed version of our Wednesday, January 29th issue had numerous strike-throughs throughout, while our web version did not. Thank you for letting us know! We have fixed this and provide for you both (1) a link to the page and (2) a downloadable PDF for your files.  Ongoing, freely let us know any challenges or ways we can improve your newsletter experience.  Joy Berger, Editor in Chief

January: The month where "new year, new me" turned into "new year, new Netflix series to binge-watch." So long! ~ Anonymous

Executive Personnel Changes - 1/31/25

The human edge: How AI can assist but never replace JD Supra; by Ralph Losey; 1/29/25 The rise of artificial intelligence has evoked both awe and apprehension. he list of its potential contributions seems endless. Yet, whispers of fear persist in our conversations: What if AI surpasses us? What if it replaces us entirely? These fears, while understandable, stem from a fundamental misunderstanding of what AI is—and what it is not. While AI may outperform humans in specific analytical domains, .. it can never replicate the full spectrum of what it means to be human. Far from being a threat to humanity, AI—when governed responsibly—offers a transformative tool to amplify our potential, not a rival to our existence. [Click on the title's link to continue reading.]