Literature Review

Recommendations to ensure safety of AI in real-world clinical careJAMA; Dean F. Sittig, PhD; Hardeep Singh, MD, MPH; 11/24As HCOs [health care organizations] adapt their clinical and administrative workflows to new AI [artificial intelligence]-driven technologies, unintended adverse consequences will inevitably occur, particularly during transitions. To address these risks, HCOs and AI/EHR [electronic health record] developers must collaborate to ensure that AI systems are robust, reliable, and transparent. HCOs must proactively develop AI safety assurance programs that leverage shared responsibility principles, implement a multifaceted approach to address AI implementation, monitor AI use, and engage clinicians and patients. Monitoring risks is crucial to maintaining system integrity, prioritizing patient safety, and ensuring data security. 

Evolution in documented goals of care at end of life for adolescents and younger adults with cancerJAMA Network Open; Rosemarie Mastropolo, Colin Cernik, Hajime Uno, Lauren Fisher, Lanfang Xu, Cecile A Laurent, Nancy Cannizzaro, Julie Munneke, Robert M Cooper, Joshua R Lakin, Corey M Schwartz, Mallory Casperson, Andrea Altschuler, Lawrence Kushi, Chun R Chao, Lori Wiener, Jennifer W Mack; 12/24Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions. In this cross-sectional study of AYA patients who died of cancer, palliative goals were rarely documented before the last month of life, highlighting the need for timely and ongoing GOC discussions.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectivesJournal of the American Geriatrics Society; Karolina Sadowska BA; Molly Turnwald BA; Thomas O'Neil MD; Donovan T. Maust MD, MS; Lauren B. Gerlach DO, MS; 12/24Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden. Behavioral symptoms of dementia are highly prevalent among the US hospice population and are often managed with psychotropic medications prescribed off-label. There are limited treatment guidelines in this population, so the appropriate risk and benefit balance may be highly individual. This qualitative study can help to inform the decision-making of hospice clinicians and caregivers regarding anticipated behavioral changes and limitations of treatment options in dementia end-of-life care. 

Estimation of cancer deaths averted from prevention, screening, and treatment efforts, 1975-2020JAMA Oncology; Katrina A. B. Goddard, PhD; Eric J. Feuer, PhD; Jeanne S. Mandelblatt, MD, MPH; Rafael Meza, PhD; Theodore R. Holford, PhD; Jihyoun Jeon, PhD; Iris Lansdorp-Vogelaar, PhD; Roman Gulati, MS; Natasha K. Stout, PhD; Nadia Howlader, PhD; Amy B. Knudsen, PhD; Daniel Miller, BA; Jennifer L. Caswell-Jin, MD; Clyde B. Schechter, MD; Ruth Etzioni, PhD; Amy Trentham-Dietz, PhD; Allison W. Kurian, MD, MSc; Sylvia K. Plevritis, PhD; John M. Hampton, MS; Sarah Stein, PhD; Liyang P. Sun, MS; Asad Umar, DVM, PhD; Philip E. Castle, PhD; 12/24Overall US mortality has declined over time for most major cancer sites because of progress in prevention, screening, and treatment. Nevertheless, the reignited Cancer Moonshot goal to reduce the age-adjusted cancer mortality rate by 50% in the next 25 years will not be achieved without accelerating progress. In this model-based study using population-level cancer mortality data, an estimated 5.94 million deaths were averted from these 5 cancers [breast, cervical, colorectal, lung, and prostate] combined. Prevention and screening accounted for 8 of every 10 averted deaths, and the contribution varied by cancer site. A comprehensive plan to reduce cancer mortality includes interventions in cancer prevention, detection, diagnosis, treatment, and survivorship care.

High-risk opioid prescribing and nurse practitioner independenceJAMA Health Forum; Lucas D. Cusimano, BS; Nicole Maestas, MPP, PhD; 12/24In 2021, more than 1 in 5 opioid overdose deaths were attributed to prescription opioids in the US, and the rate of such deaths has increased 5-fold since 1999. Concerns around excessive opioid prescribing have been used to argue against the expansion of the scope of practice of nurse practitioners (NPs) ... In this difference-in-differences analysis of opioid prescribing in 16 states, there was no change in the rates of high-risk opioid prescribing in the 6 states that adopted nurse practitioner independence compared with 10 nonadopting neighboring states during the 24 months following adoption. The study found no association between legislation that granted independence to nurse practitioners and rates of risky opioid prescribing. 

Saturday newsletters focus on headlines and research - enjoy!

PBMs secretly profited from opioid crisis: New York Times Becker's Hospital Review; by Alexandra Murphy; 12/17/24 Pharmacy benefit managers were paid by drugmakers, including Purdue Pharma, to keep opioid prescriptions flowing even as overdose deaths soared across the U.S., according to an investigation by The New York Times. The Dec. 17 report highlighted how Express Scripts, CVS Caremark and Optum Rx, which control access to medications for millions of Americans, negotiated deals with opioid manufacturers to prevent restrictions on painkiller prescriptions in exchange for lucrative rebates. Between 2003 and 2012, Purdue Pharma paid PBMs roughly $400 million annually to avoid limits on opioid prescriptions, which included measures that could have curtailed overprescribing, such as requiring additional physician justifications or limiting the number of pills dispensed. Internal documents reviewed by the Times show how the PBMs repeatedly collaborated with opioid manufacturers to influence insurers' decisions and block restrictions.

Increasing awareness of hospice services among Latinos on the border YouTube - Borderzine Reporting across fronteras; features Hospice El Paso; 12/25/24 El Paso's Latino Community is seeing a rise in the use of hospice care ... Hospice in Mexico is a place and so a lot of Hispanics--true Mexicans--feel that you're going to take a loved one out of their home when it comes to hospice care. ... Latino families make up a growing portion of hospice users, reflecting national efforts in bilingual outreach and cultural sensitivity programs I had heard. The term "hospice"--I didn't know I didn't know what it meant. I didn't know what it involved but after my dad was enrolled in hospice ... I realized [that it] provided emotional and medical support ... [and] comfort that respects their cultural values. We were very fortunate that the individuals that came in that met with us beforehand and after were bilingual. I noticed that they spoke in English and in Spanish so that they would look between myself, my mom my sister to make sure we were nodding, agreeing, listening, hearing. I think that made a difference. It was very comforting. My dad at one point even said, "They gave me a bath but they didn't get the bed wet." That was our big joke and the fact that he was very comfortable. As more Hispanic families turn to hospice they're finding it offers not just medical care, but a way to honor their loved ones with dignity respect and familiar comforts in their final days.Editor's note: For data on the Hispanic population in the areas you serve, click here for the 

Look at how a single candle can both defy and define the darkness. ~ Anne Frank We honor Hanukkuh with this powerful quote from  Anne Frank when she was a young teenager. She died in the Bergen-Belsen concentration in February/March 1945. If she were still alive, she would be 95.

In Oregon and around the world, volunteer crafters are ready to finish your loved one’s projects The Oregonian - Homes & Garden; by Janet Eastman; 12/20/24, updated 12/24/24 Sue Heagy touches the colorful yarn circles her late daughter, Angie Kimmel, crocheted to relieve her pain and fear of dying. Kimmel was 39 and working in Corvallis eight years ago when she made her last stitch. ... Over the years, Heagy would take the pieces out to appreciate her daughter’s fine handwork. Late last year, Heagy decided it was time for the “complicated and unusual work” to be completed. She contacted the nonprofit Loose Ends Project and was matched to Bobbie Wallace, a volunteer “finisher” who lives in Arizona near Heagy. ... Heagy, who received the completed throw blanket this summer, said, “It’s so touching, so intimate” how finishers like Wallace work. “To have the sensitivity to delve into the creativity” of someone they never met. The place where Kimmel’s final stitch continued under Wallace’s hands is marked with a tiny heart-shape red button. “When I saw that, I burst out crying,” said Heagy, who has draped the throw blanket across her favorite reading chair. “Angie’s blanket hugs me,” said Heagy, “and it was a real comfort to talk to Bobbie, who has such an open heart, about my daughter.”

CMS scraps value-based Medicare Advantage model [VBID]Modern Healthcare; by Bridget Early; 12/20/24Citing overspending, the Centers for Medicare and Medicaid Services is calling an early end to an initiative that aimed to provide better, more efficient care to Medicare Advantage enrollees. The Value-Based Insurance Design model, or VBID, will sunset at the end of 2025, CMS announced, just 20 months after the agency extended it until 2030. The latest data show “substantial and unmitigable costs” totaling $4.5 billion in 2021 and 2022, an amount "unprecedented in CMS innovation center models," CMS said in a news release Monday.

Executive Personnel Changes - 12/27/24

The power of top 100 relationships in leadership success Forbes; by David Nour; 12/18/24 In today’s fast-paced, hyper-connected world, leadership success often hinges on one defining factor: the depth, health, and relevance of your most valuable relationships. Yet, many leaders mistakenly equate having an extensive network with having a meaningful or impactful one. ... However, authentic leadership thrives not in the breadth of relationships but in their depth, quality, and relevance. As leaders, we must embrace a critical shift: moving away from collecting contacts and toward cultivating authentic, intentional, and strategic relationships. These top-tier relationships—our Top 100—are not merely assets but the foundation of professional and personal success. This fundamental mindset shift must also cascade throughout our organizations ...