Literature Review
Mortality and function after widowhood among older adults with dementia, cancer, or organ failure
11/03/24 at 03:55 AMMortality and function after widowhood among older adults with dementia, cancer, or organ failureJAMA Network Open; Rebecca Rodin, MD, MSc; Alexander K. Smith, MD, MS, MPH; Edie Espejo, MPH; Siqi Gan, MPH; W. John Boscardin, PhD; Lauren J. Hunt, PhD, RN; Katherine A. Ornstein, PhD, MPH; R. Sean Morrison, MD; 9/24In this cohort study including 13,824 participants in the Health and Retirement Study, widowhood was associated with functional decline and increased 1-year mortality in functionally impaired older adults with dementia and cancer. The study findings suggest that older adults with functional impairment and cancer or dementia are at risk of adverse outcomes following widowhood, including functional decline and a marked elevation in the risk of death, in the year after widowhood.
Perspectives on artificial intelligence–generated responses to patient messages
11/03/24 at 03:50 AMPerspectives on artificial intelligence–generated responses to patient messagesJAMA Network Open; Jiyeong Kim, PhD, MPH; Michael L. Chen, BA; Shawheen J. Rezaei, MPhil; April S. Liang, MD; Susan M. Seav, MD; Sonia Onyeka, MD; Julie J. Lee, MD, MPH; Shivam C. Vedak, MD, MBA; David Mui, MD, MBA; Rayhan A. Lal, MD; Michael A. Pfeffer, MD; Christopher Sharp, MD; Natalie M. Pageler, MD, MEd; Steven M. Asch, MD, MPH; Eleni Linos, MD, DrPH; 10/24Generative artificial intelligence (AI) has the potential to assist clinicians in responding to patients’ messages. Satisfaction was consistently higher with AI-generated responses than with clinicians overall and by specialty. However, satisfaction was not necessarily concordant with the clinician-determined information quality and empathy. For example, satisfaction was highest with AI responses to cardiology questions while information quality and empathy were highest in endocrinology questions. Interestingly, clinicians’ response length was associated with satisfaction while AI’s response length was not. The findings suggest that the extreme brevity of responses could be a factor that lowers satisfaction in patient-clinician communication in EHR.
Patient, staff satisfaction biggest ROIs of trauma-informed hospice care
11/03/24 at 03:45 AMPatient, staff satisfaction biggest ROIs of trauma-informed hospice care Hospice News; by Holly Vossel; 10/23/24 Improved patient and staff satisfaction are among the most significant returns on investment for hospices that are pouring greater resources into trauma-informed training. The ability to build a trusting relationship with patients and their families is a key skill set for any hospice professional to possess, but one that takes on a profoundly different meaning when caring for survivors of abuse, violence and trauma. This is according to Amber Ash, pediatric hospice and palliative care social worker at Ohio-based Hospice of the Western Reserve. Trauma-informed education should be a normalized part of hospice’s interdisciplinary training to help staff recognize and respond to a range of experiences, Ash indicated. This type of training can help provide opportunities for improved goal-concordant care while also aligning with staff’s professional goals and personal values, she stated.
Patterns of migration following dementia diagnosis
11/03/24 at 03:40 AMPatterns of migration following dementia diagnosisJAMA Network Open; Momotazur Rahman, PhD; Bishnu Bahadur Thapa, PhD; Christopher Santostefano, MPH, RN; Pedro Gozalo, PhD; Ulrike Muench, RN, PhD; Cyrus M. Kosar, PhD; Hyesung Oh, PhD; Elizabeth White, APRN, PhD; Vincent Mor, PhD; 10/24In this cohort study of more than 1 million Medicare fee-for-service beneficiaries, individuals with a diagnosis of dementia were almost twice as likely to migrate to another county or state compared with those with diagnoses of myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings. The marked increase in migration among patients following a dementia diagnosis highlights a distinctive need for policy and support interventions tailored to their unique migration patterns and care requirements.
Family caregiver experience at heart of new project
11/03/24 at 03:35 AMFamily caregiver experience at heart of new project McKnights Home Care; by Foster Stubbs; 10/27/24 In healthcare, the needs of the patient are paramount. But for every patient there is at least one caregiver with needs of their own. Former first lady of the United States Rosalynn Carter understood this and established The Rosalynn Carter Insitute for Caregivers (RCI) to serve this underserved population. ... More than 40 years later, RCI continues Carter’s mission through its newest caregiver support resource. Using over two decades of research on caregiving combined with feedback from actual caregivers, RCI composed a series of 10 different Caregiver Profiles that reflect the unique and diverse experiences of family caregivers. These profiles revolve around the following:
Advance Directives: How to make sure your end-of-life decisions are followed
11/03/24 at 03:30 AMAdvance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated. Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.
LeadingAge: Diverting patients from SNF to home health does more harm than good
11/03/24 at 03:25 AMLeadingAge: Diverting patients from SNF to home health does more harm than good McKnights Home Care; by Adam Healy; 10/28/24 Mounting evidence suggests that Medicare Advantage plans are directing beneficiaries to home health when they should receive skilled nursing facility care, which is negatively affecting providers’ care quality, according to LeadingAge. The Senate Committee Permanent Subcommittee on Investigations recently reported that MA plans may be diverting patients in need of SNF care to home health as a means of saving money. In an Oct. 25 letter, LeadingAge said this practice damages care quality and patient health outcomes, and asked the Medicare Payment Advisory Commission (MedPAC) to investigate the issue further.
New FTC regulations could create obstacles for hospice M&A
11/03/24 at 03:20 AMNew FTC regulations could create obstacles for hospice M&A Hospice News; by Jim Parker; 10/24/24 Changes to federal rules governing mergers and acquisitions could have sweeping effects on hospice and other health care transactions. The Federal Trade Commission (FTC) recently finalized a rule that will implement changes to required pre-merger notification forms. Pursuant to the Hart-Scott-Rodino Act, parties to certain transactions must submit these documents to the FTC and other regulatory agencies to help identify and address potential antitrust concerns. The law requires that transactions exceeding $120 million must submit the form, which agencies will use to conduct a 30-day premerger assessment, according to Luke Smith, member at the law firm Bass, Berry and Sims. The final rule will likely complicate the closing of some hospice acquisitions.
The ever-rising importance of hospital chaplains
11/03/24 at 03:15 AMThe ever-rising importance of hospital chaplains Religion News Service (RNS); by Robert L. Klitzman; 10/24/24 Frequently, chaplains are the only hospital staff member who has time to sit and speak with patients and families. ... “My religion is watching CNN,” a feisty elderly woman with cancer recently told a hospital chaplain who had knocked on the patient’s door to introduce himself. ... [After initial resistance, they] developed a rapport, and she described her deep loneliness and terror of dying. At the end of their conversation, she felt better, grasped the chaplain’s hand firmly and said, “Thank you!” ... In recent decades, the proportion of Americans who are “religiously unaffiliated” has risen sixfold, and the percentage of “Christian” individuals has dropped about a third. Partly as a result, chaplains have, at the same time, increasingly gained training in interfaith and nondenominational approaches, and frequently see their profession as “post-religious” — extending beyond the boundaries of any one particular faith; taking nondenominational, multifaith and humanistic approaches; and commonly receiving training in counseling. With these skills they aid patients, from evangelical to agnostic, atheist and “nothing in particular,” in resetting priorities and finding sources of connection, meaning, purpose and hope. Strongly committed to aiding vulnerable and underserved populations, chaplains remind doctors to uphold the dignity of every patient.Editor's note: Call all executive leaders--whatever your faith background--click here to continue reading this excellent article with data, descriptions, and applications about the importance of your patients spiritual care needs and the unique training and skills for hospital/hospice/palliative care chaplains. For a recent, related post, see Research synthesis related to oncology family caregiver spirituality in palliative care.
Saint Francis Hospital’s Healthy Village creates national social-services healthcare model
11/03/24 at 03:10 AMSaint Francis Hospital’s Healthy Village creates national social-services healthcare model DelawareLive, Wilmington, DE; by Jarek Rutz; 10/23/24 Saint Francis Hospital hopes a new, unique initiative will be a national model for healthcare. As it celebrates 100 years of service, the hospital is expanding its community outreach to the Wilmington community by launching the Healthy Village at Saint Francis Hospital, which aims to deliver essential social services to those in need. Located in economically challenged neighborhoods, Healthy Villages are designed to enhance the traditional safety net hospital model. “The goal is to create the ultimate one-stop care setting that promotes synergy, diversity, and equity,” said Lillian Schonewolf, executive director of the Healthy Village at Saint Francis, in a YouTube video. Editor's note: See the article we posted yesterday about the importance of community, "Who gets access to a good death?"
The case for stronger caregiver vetting in home care
11/03/24 at 03:05 AMThe case for stronger caregiver vetting in home care Home Health Care News; by Audrie Martin; 10/24/24 Direct care workers are, in many ways, the collective face of home-based care organizations. They are who clients and patients interact with. Therefore, regulators and providers are increasingly taking a closer look at who they’re hiring in the first place. While it is shocking to see caregivers commit crimes against clients, it does happen. About one in six people aged 60 and older experienced some form of abuse during 2023, according to the World Health Organization. Rates of abuse against older people have increased since the COVID-19 pandemic and are predicted to continue rising as many countries experience rapidly aging populations. To combat this trend, increased vetting is essential when hiring individuals to care for seniors in their homes. Editor's note: Related, disturbing articles we posted recently include ...
Today's Encouragement
11/03/24 at 03:00 AMI love people that have no idea how wonderful they are and just wander around making the world a better place. ~Inspirivity; posted by Clergy Coaching Network.
Hurricane Helene: NC recovery update after one month
11/03/24 at 03:00 AMHurricane Helene: NC recovery update after one monthHospice & Palliative Care Today; Chris Comeaux with Cordt Kassner; 10/29/24This is an ongoing series of interviews with Chris Comeaux, President / CEO of Teleios Collaborative Network, who lives and works in Western North Carolina – the area most impacted by Hurricane Helene. Chris framed today’s discussion as the good, the bad, and the ugly:
Sunday newsletters
11/03/24 at 03:00 AMSunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!
Today's Encouragement
11/02/24 at 03:55 AMBe yourself; everyone else is already taken. ~Oscar Wilde
Asian American diversity and representation in the health care workforce, 2007 to 2022
11/02/24 at 03:55 AMAsian American diversity and representation in the health care workforce, 2007 to 2022JAMA Network Open; Michelle Ko, MD, PhD; Kevin Dinh, MS; Sarah Iv, BS; Monica Hahn, MD; 10/24In this serial cross-sectional study of American Community Survey 1-year estimates from 2007 to 2022, Filipinx Americans had consistently high representation among registered nurses and nursing assistants; Indian, Pakistani, and Chinese Americans predominated among physicians, whereas Hmong and Cambodian American representation in medicine remained substantially below general population representation. Bangladeshi and Chinese American representation grew among home health aides over the study period. These findings suggest that aggregation of Asian American subgroups into a single racialized group erases substantial inequities in health workforce diversity.
Morphomics, survival, and metabolites in patients with metastatic pancreatic cancer
11/02/24 at 03:50 AMMorphomics, survival, and metabolites in patients with metastatic pancreatic cancerJAMA Network Open; Valerie Gunchick, MS; Edward Brown, MS; Juan Liu, PhD; Jason W. Locasale, PhD; Philip A. Philip, MD, PhD; Stewart C. Wang, MD, PhD; Grace L. Su, MD; Vaibhav Sahai, MBBS, MS; 10/24In this large cohort study, we observed no association of BMI [body mass index] with survival for patients with metastatic PDA [pancreatic ductal adenocarcinoma]. However, longer survival was associated with more subcutaneous fat and a higher muscle-to-fascia ratio, whereas shorter survival was associated with more dense visceral fat. In addition, we observed large-magnitude associations of subcutaneous fat and muscle-to-fascia ratio with several metabolites, which provide key biological insight.
Emergency department visits among patients with dementia before and after diagnosis
11/02/24 at 03:45 AMEmergency department visits among patients with dementia before and after diagnosisJAMA Network Open; Cameron J. Gettel, MD, MHS; Yuxiao Song, MS; Craig Rothenberg, MPH; Courtney Kitchen, BA; Andrea Gilmore-Bykovskyi, PhD, RN; Terri R. Fried, MD; Abraham A. Brody, PhD, RN; Stephanie Nothelle, MD; Jennifer L. Wolff, PhD; Arjun K. Venkatesh, MD, MBA, MHS; 10/24Emergency department (ED) visits among persons living with dementia represent a substantial health care challenge, often necessitating targeted interventions to optimize care and support. We assessed changes in ED use before and after incident dementia diagnosis among Medicare beneficiaries aged 65 years and older. Within the entirety of the 12-month period assessed, having a diagnosis of dementia was associated with a 40% increase in the likelihood of having an ED visit.The observed changes in ED use, with peaks before and after dementia diagnosis, suggest that the diagnostic process may precipitate acute health care crises and increased health care–seeking behavior among individuals with dementia and their caregivers.
An authentic learning experience for medical students on conducting a family meeting
11/02/24 at 03:40 AMAn authentic learning experience for medical students on conducting a family meetingAmerican Journal of Hospice and Palliative Care; by Mariana Khawand-Azoulai, Elisse Kavensky, Julia Sanchez, Ileana M Leyva, Corinne Ferrari, Marcio Soares, Khin M Zaw, Maria H van Zuilen; 9/24Medical schools often lack training for serious illness conversations with patients and caregivers. We developed a curriculum in our elective Transitioning to Residency medical student course, focused on end-of-life discussions. This paper provides an overview of the curriculum and outcomes from an advanced preparation assignment and student evaluations.
MAiD in America: A rapid review of medical assistance in dying in the United States and its implications for practice for health care professionals
11/02/24 at 03:35 AMMAiD in America: A rapid review of medical assistance in dying in the United States and its implications for practice for health care professionalsJournal of Hospice and Palliative Nursing; by Kathy Howard Grubbs, Christiana M. Keinath, Sharon E. Bigger; 10/24The evolving legal landscape associated with medical assistance in dying (MAiD) may pose significant challenges for hospice and palliative care professionals. In the United States, 10 states and 1 jurisdiction have passed legislation allowing MAiD. National organizations, such as the Hospice and Palliative Nurses Association, have created position statements to serve as guides to care. Given the clinical and ethical challenges associated with MAiD, a rapid review was conducted to provide current evidence for policymakers, health care professionals, and researchers to use when considering care management and policy initiatives. Using a systematic approach, publications related to MAiD between 2019 and 2024were extracted and synthesized. The review provides definitions of terms that differentiate between MAiD, euthanasia, physician-assisted suicide, medically assisted death of the nonterminal patient, and death with dignity. A total of 23 articles were included in the review and categorized into 4 themes: (1) legal, regulatory, and policy concerns; (2) health care professional experience of MAiD; (3) patient and caregiver experience of and communication about MAiD; and (4) disparate access to MAiD.
Six basic rules of palliative care and their Buddhist counterparts
11/02/24 at 03:30 AMSix basic rules of palliative care and their Buddhist counterpartsAmerican Journal of Hospice and Palliative Medicine; by Jonathan D. Walker, Steven Radwany; 10/24As healthcare workers in palliative care, every day brings its share of awfulness and beauty, suffering and connection, meaning and cynicism. Without a way to support ourselves, we cannot help our patients, let alone one another. But how do we cope? Despite the unpredictability inherent in our work, we can discern certain patterns that offer an approach for dealing with these stressors. These patterns can be summarized into six simple rules of palliative care—rules that are coterminous with the teachings of Buddhism... The Six Rules of Palliative Care we propose are as follows:
Dying or lying? For-profit hospices and end of life care
11/02/24 at 03:25 AMDying or lying? For-profit hospices and end of life careAmerican Economic Review; by Jonathan Gruber, David H. Howard, Jetson Leder-Luis, Theodore L. Caputi; 10/24The Medicare hospice program is intended to provide palliative care to terminal patients, but patients with long stays in hospice are highly profitable, motivating concerns about overuse among the Alzheimer’s and Dementia (ADRD) population in the rapidly growing for-profit sector. We provide the first causal estimates of the effect of for-profit hospice on patient spending using the entry of for-profit hospices over twenty years. We find hospice has saved money for Medicare by offsetting other expensive care among ADRD patients. As a result, policies limiting hospice use including revenue caps and anti-fraud lawsuits are distortionary and deter potentially cost-saving admissions.
Healthcare utilization in pediatric cancer patients near the end-of-life
11/02/24 at 03:20 AMHealthcare utilization in pediatric cancer patients near the end-of-lifeAmerican Journal of Hospice and Palliative Medicine; by James P. Kelly, Daniel V. Runco, James E. Slaven, Jason Z. Niehaus; 10/24Describe the healthcare utilization in the last 60 days of life in pediatric patients with cancer who died at home under hospice care and those that died in the hospital. Patients dying under hospice care spent a median of 44 days at home. Patients dying in the hospital spent a median of 30.5 days in the hospital, 10.5 days in the intensive care unit, and underwent 3.5 procedures requiring anesthesia. 45% of those that died in the hospital were compassionately extubated. Conclusion: For those dying with a cancer diagnosis, hospice care can allow for significant time at home with minimal healthcare while those dying in the hospital do spend a significant time in the hospital.
Living for the moment – How important is it in the end of life?
11/02/24 at 03:15 AMLiving for the moment – How important is it in the end of life?American Journal of Hospice and Palliative Medicine; by Renuka Chintapalli; 10/24This essay investigates the role of present-moment living in end-of-life care, drawing on reflections from a personal patient encounter in a palliative care setting, Mrs. B, a 63-year-old patient with terminal squamous cell lung cancer, whose experience underscores the impact of living with a sense of fulfillment and joy despite a life-limiting diagnosis.
Person-centered care planning for people living with or at risk for multiple chronic conditions
11/02/24 at 03:10 AMPerson-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD3; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.