Literature Review

The way I see it, if you want the rainbow, you gotta put up with the rain. ~Dolly Parton

Incorporating patient values in large language model recommendations for surrogate and proxy decisionsCritical Care Explorations; Victoria J Nolan, Jeremy A Balch, Naveen P Baskaran, Benjamin Shickel, Philip A Efron, Gilbert R Upchurch Jr, Azra Bihorac, Christopher J Tignanelli, Ray E Moseley, Tyler J Loftus; 8/24Surrogates, proxies, and clinicians making shared treatment decisions for patients who have lost decision-making capacity often fail to honor patients' wishes, due to stress, time pressures, misunderstanding patient values, and projecting personal biases. Advance directives intend to align care with patient values but are limited by low completion rates and application to only a subset of medical decisions. [Likert] scores were highest when patient values were captured as short, unstructured, and free-text narratives based on simulated patient profiles. This proof-of-concept study demonstrates the potential for LLMs [large language models] to function as support tools for surrogates, proxies, and clinicians aiming to honor the wishes and values of decisionally incapacitated patients.

Palliative care for dialysis-dependent pediatric patients: A survey of providers, nurses, and caregiversKidney360; Joshua Lipsitz, Mark Stockton Beveridge, Katherine Maddox; 8/24Dialysis-dependent pediatric patients and their families face significant biopsychosocial burdens and low health-related quality of life. Palliative care consultations can alleviate some degree of suffering for patients and families but remain underutilized within pediatric nephrology. 90% of providers and all nurses desired more palliative care education. Of the 22% of caregivers whose child had already received palliative care services, all found the consultation to be helpful. These data support further palliative care education for pediatric nephrology providers and nurses and more robust and systematic involvement of subspecialty palliative care for dialysis-dependent pediatric patients.

"At least I can push this morphine": PICU nurses' approaches to suffering among dying childrenJournal of Pain and Symptom Management; Elizabeth G Broden, Ijeoma Julie Eche-Ugwu, Danielle D DeCourcey, Joanne Wolfe, Pamela S Hinds, Jennifer Snaman; 8/24Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families. 

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

Cancer research provides a model for advancing clinical trials in dementia in the era of disease-modifying Alzheimer's-type dementia therapiesAlzheimer's Research and Therapy; Gregory A Jicha, Thomas C Tucker, Susanne M Arnold, Peter T Nelson; 8/24Dementia and cancer are multifactorial, widely-feared, age-associated clinical syndromes that are increasing in prevalence. There have been major breakthroughs in clinical cancer research leading to some effective treatments, whereas the field of dementia has achieved comparatively limited success in clinical research. The lessons of cancer research may help those in the dementia research field in confronting some of the dilemmas faced when the clinical care regimen is not entirely safe or efficacious. There is also evidence from both cancer and dementia research that individuals enrolled in the placebo arms of clinical trials have unexpectedly good outcomes, indicating that participation in clinical trial can have medical benefits to enrollees.

Nursing Home Compare star ratings before versus after a change in nursing home ownershipJournal of the American Geriatrics Society; by Kira L Ryskina, Emily Tu, Junning Liang, Seiyoun Kim, Rachel M Werner; 7/24Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.Publisher's note: This article might have interesting implications in the hospice field.

Begin, be bold and venture to be wise. ~ Horace

Humana to depart 13 Medicare Advantage markets Modern Healthcare; by Lauren Berryman; 9/4/24 Humana previewed its Medicare Advantage strategy for the coming plan year, including a decision to quit 13 counties where performance has been unsatisfactory, at the Wells Fargo Healthcare Conference on Wednesday. The Medicare Advantage heavyweight, which had 6.2 million members in those plans as of the second quarter, expects to lose a few hundred thousand enrollees in 2025 as it prioritizes profitable markets, Chief Financial Officer Susan Diamond told investors at the event in Everett, Massachusetts. In addition to leaving those 13 counties, Humana will offer fewer plans in some other areas, Diamond said. About 560,000 members will have to choose new policies for 2025, most of whom will have other Humana plans available to them, she said. ... Diamond did not specify what markets will be affected, but Humana will continue selling Medicare Advantage plans in every state. The company is committed to a presence in certain favorable regions, including south Florida, she said. 

American Heart Association affirms importance of palliative care in treating cardiac conditions Hospice News; by Jim Parker; 9/4/24 Multidisciplinary palliative care offers clear benefits to patients with cardiovascular disease, particularly when it comes to medication management and goals-of-care conversations. Palliative care with effective medication management, shared decision making and symptom management can help improve quality of life for heart disease patients, according to a scientific statement from the American Heart Association (AHA) — “Palliative Pharmacotherapy for Cardiovascular Disease.” The statement offers guidance for health care providers to integrate palliative methods as part of holistic medication management at all stages of a patient’s illness, the AHA indicated. This underscores the importance of collaboration between palliative care professionals and other clinical specialties, according to Dr. Andrew Esch, director of palliative care program development at the Center to Advance Palliative Care (CAPC). 

‘His Three Daughters’: A sister act that’s among the year’s best movies The Washington Post - Arts & Entertainment; by Ty Burr; 9/5/24 Carrie Coon, Elizabeth Olsen and Natasha Lyonne give career-peak performances in Azazel Jacobs's relatable family drama. ... “His Three Daughters” is in all its simplicity and complexity the story of how these women get along over the course of their dad’s final week. Spoiler alert: They don’t. If that sounds like a downer, the movie’s kept from terminal morbidity by writer-director Jacobs’s uncanny ear for dialogue and by the empathy of the three central performances. There’s humor here, gallows and otherwise. But there’s also an overflowing heartful of feeling, approached from three different angles by three different people who all happen to love the same parent. Other people come and go: a hospice worker (Rudy Galvan) whose smooth bromides eventually grate on the sisters’ nerves and ours; a night nurse (Jasmine Bracey) with patience and kindness and a full, unseen life outside the apartment; ... In its final moments, the movie takes a risk — a huge gamble, really — that for my money pays off on any number of levels, and in doing so finally confirms its writer-director’s talent. ... Available Sept. 20 on Netflix. [Netflix trailor and reminder available now.]

Ohio hospital closes amid financial challengesBecker's Hospital CFO Report; by Madeline Ashley; 9/4/24Hicksville, Ohio-based Community Memorial Hospital permanently closed its doors Aug. 31 after temporarily shutting down in May due to financial challenges, Bill Cherry, former CEO of Community Memorial Hospital, confirmed with Becker's. "The decision to close Community Memorial Hospital follows thorough efforts to find a viable path to continue operations," Mr. Cherry said in a Sept. 4 statement shared with Becker's. "Unfortunately, despite all our efforts made, CMH has not been able to identify a sustainable solution. We understand the profound impact this closure will have on the community and we extend our deepest gratitude to the residents of Northwest Ohio and Northeast Indiana for their unwavering support and trust over the years."

Urgency to adopt AI intensifies for health IT leaders Becker's Health IT; by Naomi Diaz; 9/4/24 A Sept. 4 survey from healthcare data platform Arcadia revealed that 96% of healthcare technology leaders view the effective use of AI as crucial for gaining a competitive edge. ... The findings show that while 33% of these decision-makers see AI as essential today, that number rises sharply to 73% who believe it will be indispensable within the next five years. Despite their confidence in AI adoption, 96% of health tech leaders report feeling an increasing urgency to act, driven by pressure from data and analytics teams (82%), IT and tech departments (78%) and executive leadership (73%). However, the survey also highlights a significant challenge: 40% of leaders cite a talent shortage as a major barrier to AI implementation. This has led CIOs to place greater emphasis on skills such as data-driven decision-making (71%), data analysis, machine learning and systems integration (66%), as well as the need for roles focused on training and support for healthcare staff (59%).