Literature Review

Can default palliative care referrals increase consults? Medscape; edited by Gargi Mukherjee; 3/4/25 A default palliative care referral intervention increased palliative care consultations by more than fivefold and decreased end-of-life systemic therapy by more than half among patients with advanced cancer being treated in the community oncology setting. ...

Challenges to video visits for patients with non–English language preference-A qualitative studyJAMA Network Open; Marianna Kong, MD; Francine Rios-Fetchko, BA; Madelyn Olmos-Rodriguez, BA; Linda Branagan, PhD; Bradley Iott, MPH, MS, PhD; Therese Chan Tack, DO, MPH; Carol Yarbrough, MBA; Kevin Grumbach, MD; Alicia Fernandez, MD; 2/25Telemedicine, or synchronous video or audio-only visits, has made clinical encounters more convenient and accessible for many patients. Prior to the COVID-19 pandemic, video and telephone visits comprised a small minority of primary care visits, but by April 2020, approximately one-half of US physicians were treating patients virtually and nonurgent telemedicine video visits increased by more than 600%. In this qualitative study, participants with NELP [non-English language preference] perceived multiple barriers to video visits, including greater communication difficulties, lower medical evaluation quality, and technical issues. These findings suggest that addressable technical challenges associated with language barriers hamper access to video visits and decrease motivation for use and that interventions are needed to increase telehealth equity. 

Armed 60-year-old man arrested, accused of shooting at hospice nurse in Orange County ABC News 12, Vidor, TX; by Scott Eslinger; 2/28/25 A 60-year-old Vidor man was arrested after a hospice nurse accused of him of shooting at her outside a patient's home. Gordon Billy Ward, 60, of Vidor, was arrested on Thursday by Orange County [California] deputies and booked into the Orange County jail. He is currently being held there on a charge of aggravated assault with a deadly weapon, according to jail records. [Click here for the related California post.]

The Alliance commends introduction of legislation to extend hospice telehealth flexibilities  National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 2/28/25 The National Alliance for Care at Home (the Alliance) is pleased to support the reintroduction of the Hospice Recertification Flexibility Act in the House of Representatives. This bipartisan legislation, H.R.1720, would extend telehealth flexibilities for hospice face-to-face (F2F) recertification. The F2F encounter is performed by a physician or nurse practitioner to evaluate the patient and collect clinical information used in determining continued eligibility for hospice. Introduced by Representatives Carol Miller (R-WV) and Jared Golden (D-ME), the bill would extend the F2F recertification flexibility for providers until December 31, 2027. Beginning January 1, 2026, the legislation also includes important guardrails to ensure appropriate use and requires the Centers for Medicare & Medicaid Services (CMS) to create a modifier to collect data on when the F2F encounter is conducted via telehealth. The Alliance, then through its legacy organizations, worked with lawmakers to ensure continued care transformation and access to care for high-quality providers. [Click on the title's link to continue reading.]

Contemporary patterns of end-of-life care among Medicare beneficiaries with advanced cancer JAMA Network - JAMA Health Forum; by Youngmin Kwon, PhD; Xin Hu, PhD, MPSH; Kewei Sylvia Shi, MPH; Jingxuan Zhao, MPH, PhD; Changchuan Jiang, MD, MPH; Qinjin Fan, MS, PhD; Xuesong Han, PhD; Zhiyuan Zheng, PhD; Joan L. Warren, PhD; K. Robin Yabroff, PhD, MBA; 2/21/25Conclusions: In a contemporary cohort of older Medicare decedents originally diagnosed with advanced breast, prostate, pancreatic, or lung cancer, we found that many patients continue to receive potentially aggressive interventions at EOL at the expense of supportive care services. To make meaningful improvements in the quality of EOL care, a multifaceted approach that addresses patient, physician, and system-level factors associated with persistent patterns of potentially aggressive care will be required. Editor's note: Though published just one week ago--February 21--this journal article is already being used extensively, as demonstrated in our posts on 2/24 and 2/25.

Palliative care advocates at the World Health Organization executive board meeting ehospice; by Stephen Connor, Executive Director, Worldwide Hospice Palliative Care Alliance (WHPCA); 2/19/25 The World Health Organization (WHO) is in turmoil with the planned withdrawal of funding and membership from the USA. About 20% of the WHO budget is from the US and withdrawal of all USAID funding is causing serious problems worldwide. Many member states are increasing their dues to WHO to help offset this loss, but these are difficult times for public health. These issues were front and center at the meeting of the WHO Executive Board 3-11 February. .. The Worldwide Hospice Palliative Care Alliance (WHPCA) and the International Association for Hospice and Palliative Care (IAHPC) are the two organizations presently in official relations with WHO and we work together to cover the many health issues. Editor's note: For current information from USAID, visit www.usaid.gov. 

What do the ashes symbolize in life, death, and cultural rituals? Brain Wise Mind - Symbolism; by Jodie Lawrence; 1/26/25In this article, you’ll explore the rich symbolism behind ashes, from themes of loss and renewal to connections with the cycle of life. By understanding these meanings, you can gain a deeper appreciation for how ashes play a role in various rituals and practices. Get ready to uncover the significance that lies within these seemingly simple remnants. ... Ashes symbolize a range of profound concepts, particularly in relation to life and death. You can find their meanings in various cultures and traditions, reflecting significant themes.

The most common way people give up their power is by thinking they don't have any. ~Alice Walker

[UK] Coming to terms with dying: Advance care planning as a conduit between clinicians, patients, and conversations about death and dying - A qualitative interview studyPalliative Medicine; Rowena Jane Eason, Lisa Jane Brighton, Jonathan Koffman, Katherine Bristowe; 2/25Advance care planning elicits multiple complex thoughts, emotions, and behaviours, with responses ranging from the procedural to the profound. Discussions empowered and instilled confidence, promoted openness with relatives, encouraged people to make the most of their time remaining, and sometimes contributed to coming to terms with their mortality. Factors influencing experiences of discussions reflected the complexity and diversity in participants' lives, personalities, and life experiences, with discussions exposing the realities of living with terminal illness. 

Tracking US health care spending by health condition and countyJAMA; Joseph L. Dieleman, PhD; Meera Beauchamp, BS; Sawyer W. Crosby, BA; Drew DeJarnatt, MS; Emily K. Johnson, MSc; Haley Lescinsky, MPH; Theresa McHugh, PhD; Ian Pollock, MLS; Maitreyi Sahu, MPH; Vivianne Swart, MPH; Kayla V. Taylor, MPH; Azalea Thomson, MPH; Golsum Tsakalos, MS; Maxwell Weil, MS; Lauren B. Wilner, MPH; Anthony L. Bui, MD, MPH; Herbert C. Duber, MD, MPH; Annie Haakenstad, ScD, MA; Bulat Idrisov, MD, MSc; Ali Mokdad, PhD; Mohsen Naghavi, MD, MPH, PhD; Gregory Roth, MD, MPH; John W. Scott, MD, MPH; Tara Templin, PhD, MS; Christopher J. L. Murray, DPhil, MD; 2/25Health care spending in the US totaled $3.8 trillion in 2019 and is projected to reach more than $7 trillion by 2031. Within the US, spending varies dramatically across states, although many key drivers of health care spending, such as access to care, service prices, disease and injury prevalence, and underlying need for health care, vary at more local levels. Broad variation in health care spending was observed across US counties. Understanding this variation by health condition, sex, age, type of care, and payer is valuable for identifying outliers, highlighting inequalities, and assessing health care gaps.

An opportunity to advance cannabis science—DEA reschedulingJAMA Psychiatry; Kevin P. Hill, MD, MHS; Anshul V. Puli, BS; 2/25In 1970, the US Congress enacted the Controlled Substances Act (CSA), establishing a scheduling system for drugs based on their medical use, abuse potential, and safety. The most restrictive classification is Schedule I; cannabis along with other drugs, such as heroin and lysergic acid diethylamide (LSD), have this classification. May 13, 2024, the Drug Enforcement Agency (DEA), the agency regulating substance scheduling, issued a Notice of Proposed Rulemaking to investigate rescheduling cannabis from Schedule I to Schedule III. This was due to a recommendation from the US Department of Health and Human Services (HHS) to reschedule based on its review of the medical and scientific cannabis research. Still, the FDA investigated HHS’ CAMU [cannabis’ current accepted medical use] claim and found some credible scientific support for treating “anorexia related to a medical condition, nausea and vomiting (eg, chemotherapy-induced), and pain.”

Algorithm-based palliative care in patients with cancer-A cluster randomized clinical trialJAMA Network Open; Ravi B. Parikh, MD, MPP; William J. Ferrell, MPH; Yang Li, MS; Jinbo Chen, PhD; Larry Bilbrey; Nicole Johnson, BSN; Jenna White, MSW; Ramy Sedhom, MD; Natalie R. Dickson, MD; Stephen Schleicher, MD; Justin E. Bekelman, MD; Sandhya Mudumbi, MD; 2/25In this randomized clinical trial conducted in a community oncology network between November 2022 and December 2023 among 562 patients with advanced cancer identified by an automated electronic health record algorithm, default orders increased palliative care consultation (44% vs 8%) and decreased end-of-life systemic therapy (6% vs 16%) compared with usual care but did not improve patient-reported or hospice outcomes. The findings suggest that default algorithm-based palliative care orders are a scalable implementation strategy to increase palliative care referrals and reduce intensive end-of-life care. 

Explaining racial and ethnic disparities in advance care planning: A decomposition analysisJournal of Pain and Symptom Management; Yifan Lou, Emma Zang, Qianqian Li; 2/25The ACP [advance care planning] disparities between White and Hispanic populations were nearly twice as large as the disparity between White and Black populations. Interventions targeting less educated older Black and Hispanic individuals should be prioritized to narrow the ACP disparity. Negative healthcare experiences in previous care and household dynamics should be addressed while working with Black and Hispanic older adults, respectively.