Literature Review

The meaning of life is to find your gift. The purpose of life is to give it away. ~Pablo Picasso 

Existential communication with patients and families: A qualitative exploration of multidisciplinary oncology clinicians’ experiencesAmerican Journal of Hospice & Palliative Medicine; by Megan Miller, William E. Rosa, Haley Buller, Meghan McDarby, Alix Youngblood, Betty R. Ferrell; 12/25Existential concerns are inherent in serious illness and at the end of life, yet communication to address such concerns can be challenging. Themes across clinicians’ experiences of existential communication with patients and families included existential questions, guilt/regret, fears about the future, grief, preparing for death, values and goals of care, spiritual concerns, and letting go. Meaningful experiences included bearing witness; providing emotional support and information; easing suffering; learning and growing; and the honor of accompanying patients and families through the end of life. Challenges included discomfort when talking about death; facing denial; being unable to “fix it”; resistance to palliative care among oncology team members, patients, and families; fear of saying the wrong thing; navigating conflicting values; responding to spiritual concerns; barriers to inclusive, high-quality care; and struggling with emotions.

All hands on deck: A case report of an interdisciplinary team preventing elder financial abuse at a skilled nursing facilityCureus; by Grace Yi, Nicholas S. Cho, Karen Galvez-Maquindang, Christine Sun, Navid Darouian; 12/25Elder financial abuse (EFA) is a common but under-reported form of maltreatment among elderly individuals. This case describes an 84-year-old woman with cognitive deficits residing in a skilled nursing facility (SNF), who was exploited by a purported friend who took funds, important documents, and attempted to designate herself as the patient’s power of attorney. The situation was quickly identified by the multidisciplinary care team at the SNF and mitigated through early action and collaboration. The case emphasizes the importance of multidisciplinary efforts to identify at-risk patients and the establishment of protocols surrounding abuse identification and reporting to protect elderly patients from financialexploitation and preserve their autonomy, dignity, and quality of life.

Caregivers’ positive emotional language predicts their depression trajectories after dementia caregiving ends  The Journals of Gerontology; by Jenna L Wells, Julian A Scheffer, Suzanne M Shdo, Claire I Yee, Kevin J Grimm, Alissa B Sideman, Bruce L Miller, Jennifer M Merrilees, Katherine L Possin, Robert W Levenson; 12/25There are striking differences among caregivers of people with dementia in their health and well-being during active caregiving and after caregiving has ended. A key factor influencing caregiver health is the emotional quality of the caregiver-care recipient relationship, which may be reflected in the emotional language caregivers use when describing this relationship. Caregivers who use more positive words when describing their connection with the care recipient may be more resilient, underscoring the potential role of positive emotional qualities of the caregiving relationship in preserving caregivers’ mental health after caregiving ends.

Prevalence rate of depression in palliative and hospice care: A narrative reviewJournal of Social Work in End-of-Life & Palliative Care; by Reid M. JacobsDepression is a common but not universal experience among individuals receiving hospice and palliative care. Though much research exists on depression in this population, there is little consensus on the actual prevalence rate, with estimates varying drastically. This is due, in part, to non-standardized definitions of what constitutes depression, variance based on assessment methods and tools, and the presence of somatic symptoms that may be due to physical illness and not depression, thus distorting the prevalence rate in this population. Depression can cause significant negative consequences for individuals and those who care for them, robbing them of precious time, increasing suffering, and decreasing overall quality of life. This narrative review seeks to understand depression’s prevalence among people living with severe and life limiting illness based on the existing literature.

Development of a mortality prediction model for incarcerated adults to identify palliative care needsJournal of General Internal Medicine; by W. James Deardorff, Alexandra K. Lee, Kaiwei Lu, Bocheng Jing, W. John Boscardin, Michele DiTomas, John Dunlap, Brie A. Williams, Sei J. Lee, Alexander K. Smith; 12/25The United States prison population has seen a rapid rise in the number of older adults, with roughly 14% of male prisoners and 9% of female prisoners aged 55 years or older in 2020.  Incarcerated adults experience accelerated aging, leading to reduced life expectancy and higher rates of chronic medical conditions, functional impairments, and mental health conditions compared with non-incarcerated persons. For individuals with advanced age, multimorbidity, and/or serious illness, advance care planning discussions, palliative care, and hospice services are crucial for improving quality of life and ensuring medical care that is consistent with an individual’s values and goals. As the number of incarcerated adults with limited life expectancy increases, there is a clear need for a systematic way to identify individuals who may most benefit from these services. Our 2-year mortality prediction model for adults within the California prison system performed well on measures of discrimination, calibration, and classification. The model can be used to flag individuals at higher risk for mortality for consideration of advance care planning interventions, palliative care and hospice referrals, and compassionate release.

Solomon Center’s groundbreaking palliative care law and policy initiative drives nationwide reforms Yale Law School; Press Release; 1/15/26 The Solomon Center for Health Law and Policy at Yale Law School has established the country’s first comprehensive interdisciplinary initiative dedicated to palliative medical care, law, and policy — a pathbreaking effort that is already shaping reforms for patients of all ages. ... The work is supported by a first-of-its kind open-access research platform for palliative care policy across the states, developed by the Center, and in collaboration with partners at Yale School of Medicine, Yale School of Public Health, Yale School of Nursing, and Mount Sinai’s nationally renowned Center to Advance Palliative Care.

US health expenditures rapidly accelerating Hospice News; by Jim Parker; 1/14/26 ... Rising health care utilization is the most significant driver of the spending increases, according to CMS. One key factor is that utilization is bouncing back from declines that occurred during the COVID-19 pandemic, according to Micah Hartman, a statistician in the National Health Statistics Group with the Office of the Actuary at CMS. Population growth was also a factor. ... By payer type, private health insurance saw the largest rate of spending growth at 8.8%, followed by Medicare at 7.8% and Medicaid at 6.6%. Out-of-pocket spending rose by 5.9%. ... Hospice care saves Medicare roughly $3.5 billion for patients in their last year of life, according to a joint report from the National Hospice and Palliative Care Organization (NHPCO), the National Association for Home Care & Hospice (NAHC) and NORC at the University of Chicago.

AMA ‘disappointed’ in MedPAC for backing off deeper Medicare pay reform Becker's Hospital Review; by Alan Condon; 1/15/26 The American Medical Association expressed disappointment after the Medicare Payment Advisory Commission voted Jan. 15 to recommend only a modest update to Medicare physician payments for 2027, backing away from more robust reforms it had previously supported. ... “The AMA appreciates that last year’s reconciliation bill provided a temporary 2.5 percent update for 2026; however, that increase expires in 2027,” David Aizuss, MD, chair of the AMA Board of Trustees,” said in a news release shared with Becker’s. Editor's Note: Pair this with today's post, Alliance responds to MedPAC vote on home health and hospice payment recommendations.

Executive Personnel Changes - 1/16/26