Literature Review

[Australia] Why mental health clinicians are not engaging in advance care planning with older people with schizophrenia and other psychotic illnessesPsychology Research and Behavior Management; Anne P F Wand, Aspasia Karageorge, Yucheng Zeng, Roisin Browne, Megan B Sands, Daniella Kanareck, Vasi Naganathan, Anne Meller, Carolyn M Smith, Carmelle Peisah; 12/24These clinician-identified attitudes, experiences, and barriers to engagement in ACP [advance care planning] with older people with psychotic illnesses highlight avenues of potential intervention to facilitate ACP in this cohort. Given the complexity of issues, clinicians need education and training in ACP combined with clear processes and policies to support practice. Clinician insights should be combined with the perspectives of older consumers with psychotic illnesses and their families to inform implementation of ACP. 

US FDA approval of pediatric artificial intelligence and machine learning–enabled medical devicesJAMA Pediatrics; Ryan C. L. Brewster, MD; Matthew Nagy, MD, MPH; Susmitha Wunnava, PhD; Florence T. Bourgeois, MD, MPH; 12/24Despite rapid growth in the availability of AI/ML [artificial intelligence and machine learning]-enabled devices in recent years, only a small number have been authorized for pediatric use. The current regulatory framework may expose children to off-label use, differential performance of algorithms, and safety risks. Additionally, the lack of standardized reporting of pediatric device characteristics precludes informed decision-making by health care clinicians on appropriate device use. Pediatric AI/ML-enabled devices should be validated using representative datasets and should include complete and standard documentation on pediatric testing and authorization. Such changes will require cooperation across regulatory and industry stakeholders with a commitment to safe, equitable, and effective AI/ML development for children. 

Loneliness and social and emotional support among sexual and gender minority caregiversJAMA Network Open; Zhigang Xie, PhD; Hanadi Hamadi, PhD; Kassie Terrell, PhD; Laggy George, MPH; Jennifer Wells, BA; Jiaming Liang, PhD; 12/24In the current landscape of US health care, informal unpaid caregiving provided by family members and friends is indispensable for managing diseases and ensuring long-term care in residential settings. Sexual and gender minority (SGM) adults in the US are more likely than their non-SGM counterparts to provide informal care to their family members and/or friends. Caregiving can impose substantial physical, mental, and social connection issues on caregivers.Conclusions and Relevance In this cross-sectional study of social connections, SGM adults experienced significantly higher levels of loneliness compared with straight adults, irrespective of caregiving status. 

Mobile app–facilitated collaborative palliative care intervention for critically ill older adults-A randomized clinical trialJAMA Internal Medicine; Christopher E. Cox, MD, MPH; Deepshikha C. Ashana, MD, MBA, MS; Katelyn Dempsey, MPH; Maren K. Olsen, PhD; Alice Parish, MSPH; David Casarett, MD; Kimberly S. Johnson, MD; Krista L. Haines, DO; Colleen Naglee, MD; Jason N. Katz, MD, MHS; Mashael Al-Hegelan, MD, MBA; Isaretta L. Riley, MD, MPH; Sharron L. Docherty, RN, PNP, PhD; 12/24An automated electronic health record–integrated, mobile application–based communication platform that displayed family-reported needs over 7 days, coached ICU attending physicians on addressing needs, and prompted palliative care consultation if needs were not reduced within 3 study days. In this randomized clinical trial, a collaborative, person-centered, ICU-based palliative care intervention had no effect on palliative care needs or psychological distress compared to usual care despite a higher frequency of palliative care consultations and family meetings among intervention participants.

A scoping review of end-of-life discussions and palliative care: Implications for neurological intensive care in Latin America and the CaribbeanJournal of Palliative Medicine; Monica M Diaz, Lesley A Guareña, Bettsie Garcia, Christoper A Alarcon-Ruiz, Stella M Seal, Clio Rubinos, Dulce Cruz-Oliver, J Ricardo Carhuapoma; 12/24Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC. 

Quality of hospices used by Medicare Advantage and traditional fee-for-service beneficiariesJAMA Network Open; Lindsay L. Y. White, PhD, MPH; Chuxuan Sun, MPA; Norma B. Coe, PhD; 12/24In this cross-sectional study including 4 215 648 decedents and 2 211 826 hospice enrollees, regular Medicare Advantage and fee-for-service beneficiaries enrolled in hospices of similar quality. However, beneficiaries in Medicare Advantage special needs plans were significantly more likely than fee-for-service beneficiaries to use hospices of inferior quality, with referral networks playing an important role in hospice quality choice. These results suggest that policymakers should consider incentivizing referrals to high-quality hospices and approaches to educating beneficiaries on identifying high-quality hospice care. 

Caregiver-Reported Quality in Hospices Owned by Private Equity Firms and Publicly Traded CompaniesJAMA; by Alexander E. Soltoff, Mark Aaron Unruh, David G. Stevenson, Dio Kavalieratos, Robert Tyler Braun; 12/17/24The US hospice industry has shifted from not-for-profit to for-profit ownership models, producing concerns aboutcare quality... Hospices owned by private equity firms (PEFs) or publicly traded companies (PTCs) performed significantly worse across CAHPS measures relative to not-for-profit and non-PEF/PTC for-profit agencies... These findings raise questions as to how patients are affected when PEFs and PTCs own hospices and suggest the need for greater transparency and accountability of hospice ownership.Publisher's note: Also see related articles by these authors: Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations, JAMA Internal Medicine, 8/21; Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies; JAMA Network Open, 9/23.

An innovative take on transforming hospice spaces with Buildner for better well-being Arch Daily; 12/19/24 Buildner has announced the results of its Hospice - Home for the Terminally Ill competition, the third in a series of architectural idea challenges focused on creating compassionate spaces for individuals facing terminal illnesses. This competition encouraged architects to move beyond traditional medical models, designing environments that prioritize comfort, dignity, and community. Participants were tasked with envisioning a facility for up to 15 visitors and five staff members, incorporating essential spaces such as a library-equipped common area, gathering room, chapel, kitchen, dining area, nurse's station, and therapy room for psychological support. Designs were grounded in theoretical sites within participants' home countries, allowing for the integration of local cultural, social, and environmental contexts. The competition highlighted how innovative, thoughtful design can provide solace and strength during life's most difficult moments. ...

Vancouver non-profit offers hope for the bereaved during holidays [The Wishing Tree] KOIN, Portland, OR; by Anthony Kustura; 12/19/24 The holiday season is a wonderful time of year for many — but for those who recently lost a loved one, it can bring lots of heartache. In Portland, The Wishing Tree near Northeast 7th Avenue and Northeast Morris Street is a towering elm that carries hundreds of paper tags with people’s hopes and dreams all year long. ... With the tie of a bow, McCoy’s wish joins a long list of others, including ones that say “I wish to be loved” and “I wish for my kids to be happy and healthy. McCoy and her husband, Jordan Jackson, know what it’s like for the holiday season to be a solemn reminder of what’s missing. “Back home, my grandfather is in hospice care right now,” Jackson said. “You know, we miss family, so it’s always like… it would be nice to be around family, celebrate with family …,” added McCoy. [Click here to view photos of "The Wishing Tree" in Portland, OR.]

Executive Personnel Changes - 12/20/24

We studied 20 places around the world and found the most common diseases linked with voluntary assisted dying Medical Xpress; by Eliana Close and James Downar, The Conversation; 12/18/24 As of 2023, 282 million people lived in regions where voluntary assisted dying is legal. Jurisdictions such as the Netherlands, Belgium and Oregon have had these laws in place for decades. Other countries, including Canada, Spain, New Zealand and Australia, have passed reforms more recently. ... Debates about voluntary assisted dying are often highly polarized. Understanding the factors driving assisted dying is essential for evidence-based debates and for improving care for people with serious conditions. In a recent study, we examined data from people accessing voluntary assisted dying in 20 jurisdictions around the world. In particular we looked at what diseases they had. ...  With an international team of researchers, we looked at the role disease plays in voluntary assisted dying. We analyzed publicly available data from 20 jurisdictions in eight countries between 1999 and 2023. Overall, most people who accessed voluntary assisted dying had cancer (66.5% of cases). Neurological diseases were the second most common (8.1%), followed by heart (6.8%) and lung (4.9%) conditions. 

Palliative care, mental health services underutilized in pancreatic cancer Healio; by Jennifer Byrne; 12/19/24 Individuals with pancreatic cancer underutilized palliative care and mental health services, according to a retrospective analysis. ... Researchers from Saint Louis University used electronic health record data from Optum’s Integrated Claims-Clinical Data set to identify 4,029 patients with newly diagnosed pancreatic cancer. The investigators then used ICD-9/10 codes to identify subsequent diagnoses of anxiety and depression, as well as palliative care consultations. ... Results showed higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%) among patients who had palliative care consultations than those who did not have documented consultations. ... Healio: Did any of your findings surprise you? Divya S. Subramaniam, PhD, MPH: It was unexpected to see that palliative care consultations, despite identifying higher levels of anxiety and depression, did not increase treatment rates for these mental health conditions. This suggests mental health might not yet be a central focus in palliative consultations, which often concentrate on managing physical symptoms.

Providence’s joint venture with Compassus likely delayed amid concerns about patient care and rural access Home Health Care News; by Audri Martin; 12/19/24Oregon’s Health Care Market Oversight (HCMO) program is reviewing a proposal to spin off Providence’s home health and hospice services into a joint venture supported by private equity. ... OHA’s HCMO program evaluates health care business transactions to ensure they do not negatively impact citizens or communities. The program also empowers state regulators to impose conditions on acquisitions and mergers or reject deals they find anti-competitive. Critics of the deal argue that the joint venture will result in cost-cutting measures, increased staff workloads and reduced patient services. Providence is the fifth largest nonprofit health care provider in the United States, while Compassus is a private equity-backed provider of home-based care services operating in more than 30 states.