Literature Review

Exploding physician union membership signals a significant labor market shift NJToday.net; 10/16/24 As of 2022, about 70,000 medical doctors in the United States, or about 8% of the physician workforce, belonged to a union—a notable increase of 26.8% since 2014. This shift reflects significant changes in the employment landscape for doctors, with nearly half of all physicians now working for health systems or large medical groups. The rise in union membership comes amidst broader labor movements in healthcare, highlighted by the 2023 Kaiser Permanente strike, recognized as the largest healthcare worker strike in U.S. history. While nurses have typically led these efforts, physicians and residents are increasingly exploring unionization as a means to advocate for improved pay, benefits, and working conditions. 

Dozens of CarePartners patients in Asheville transferred to other facilities after HCA temporarily shuts down rehab, hospice center Asheville Watchdog; by Andrew R. Jones; 10/14/24 Hundreds of employees uncertain about their jobs after facility is closed to ease pressure on Mission Hospital. Mission Health’s CarePartners Health Services is temporarily closed following the pressures Hurricane Helene put on Asheville’s health care system, disrupting rehabilitative care for more than 50 patients and forcing more than 250 employees to take temporary jobs elsewhere in the system, according to employees and internal emails obtained by Asheville Watchdog.  ... The closing affected nearly 50 inpatient rehab patients, several long-term acute care patients, and eight hospice patients, all of whom were sent to home caregivers, skilled nursing facilities, other inpatient rehab programs, and UNC Health Caldwell in Lenoir, more than an hour’s drive to the east, according to one employee.

Patient considerations of social media account management after deathSupportive Care in Cancer; Rida Khan, Jacqueline Tschanz, Maxine De La Cruz, David Hui, Diana Urbauer, Astrid Grouls, Eduardo Bruera; 10/24Social media is widely used but few studies have examined how patients with advanced cancer want their accounts managed after death. The objective of this study was to determine the proportion of our patients with advanced cancer who have discussed the post-mortem management of their social media accounts with their family or friends. Conclusion: Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of social media as a digital legacy and a coping tool for patients with advanced cancer. 

Hospice care home provides peaceful place for low-income or homeless to die Indiana Capital Chronicle; by Elise Shrock; 10/10/24 My neighborhood is full of wonderful places. Lovely places where people go to worship, to meet for meals, to do their errands, and, a lovely place to die. Let me explain. Tucked behind the busy near-north Keystone corridor is the Abbie Hunt Bryce Home, a no-cost home for terminally ill individuals who are low-income or homeless and would have no other home to go to during their last days or months of life. Operated by Morning Light, LLC, Abbie Hunt Bryce Home offers critical and compassionate services to Hoosiers in their final days. As the second largest residential hospice in the nation, our state is positioned to be a leader in providing compassionate end-of-life care. Not only is the Home a leader in size and scope, but all hospice residents stay free of charge, with no payment or insurance required. The Home is supported solely by community support and qualifies for Medicaid Waiver. ... [A case study follows with "Systemic challenges in Indiana." ...]

Researchers raise concerns about the financial sector's rising role in US illness care Medical Xpress; by Mary Ann Liebert, Inc; 10/16/24 The authors of a new article in Journal of Palliative Medicine state that the "growing role of the financial sector in home health and hospice, a reflection of larger trends in U.S. health care, is concerning and has major implications for care quality unless reforms are undertaken." Co-authors Lauren Hunt, Ph.D., RN, FN, with the University of California, San Francisco, and R. Sean Morrison, MD, with the Icahn School of Medicine at Mount Sinai in New York, observe that home health and hospice began as nonprofit organizations with close ties to their communities. However, the overwhelming majority are now for-profit entities, many of which have become targets for private equity buyouts. The authors note that "big business's emphasis on maximizing profit can be at odds with patient welfare. Indeed, a substantial body of evidence now demonstrates that care quality is consistently worse in for-profits as compared to nonprofits," they state. The authors further express concern that "pressure to achieve high returns on very short-term time horizons may conflict with the need for longer-term investments in quality, training, and staffing, thus reducing care quality.Publisher's note: I suspect this will be the next "big" article summarizing the role of private equity in hospice.

Music therapist helps patients navigate end-of-life journey on Long Island CBS New York / YouTube; by Jenna DeAngelis; 10/15/24 The healing power of music is being brought to hospice patients on Long Island, by Yuzuko DeGrottole, LCAT, MT-BC, a board-certified music therapist with MJHS Hospice.  “Everyone has a song that takes them to a special place. “Are you going to sing with me?” [Sings a beautiful Jewish song.] That's the power of music. It moves us. It connects us, and for Sarah Jacobowitz it just makes her feel good. “I like it.  It makes me happy.”  The 95-year-old Holocaust Survivor is proud of her Jewish Heritage which she celebrates in song since she's bedridden.  Yuzuko brings the music to her, even learning to sing in many languages for her patients. Music communicates with you directly to your heart. Music brings up a lot of emotion, with or without words. … Sarah's son who often sits bedside says music therapy hits all the right notes. Sarah is attentive instead of just sleeping all day or just doing nothing. Music brings back memories and it gives her pleasure just to be alive.Editor's note: Having a board-certified music therapist is significantly more valuable--therapeutically, clinically, meaning-making, mission-oriented--than simply having musicians play music. For more information visit "Facts for Music Therapy in Hospice Care" by American Music Therapy Association and the Certified Board for Music Therapists.

One of the most important things you can do on this Earth is to let people know they are not alone. ~ Shannon L. Adler

Ethical considerations in the design and conduct of clinical trials of artificial intelligenceJAMA Network Open; Alaa Youssef, PhD; Ariadne A. Nichol, BA; Nicole Martinez-Martin, JD, PhD; David B. Larson, MD, MBA; Michael Abramoff, MD, PhD; Risa M. Wolf, MD; Danton Char, MD, MS; 9/24In this qualitative study, interviews with 11 investigators involved in clinical trials of AI [artificial intelligence] for diabetic retinopathy screening confirmed the applicability of current ethical principles but also identified unique challenges, including assessing social value, ensuring scientific validity, fair participant selection, evaluation of risk-to-benefit ratio in underrepresented groups, and navigating complex consent processes. These results suggest ethical challenges unique to clinical trials of AI, which may provide important guidance for empirical and normative ethical efforts to enhance the conduct of AI clinical trials. These considerations call for further guidance on where to focus empirical and normative ethical efforts to best support conduct clinical trials of AI and minimize unintended harm to trial participants.

Physician altruism and spending, hospital admissions, and emergency department visitsJAMA Health Forum; Lawrence P. Casalino, MD, PhD; Shachar Kariv, PhD; Daniel Markovits, JD, DPhil; Raymond Fisman, PhD; 10/24This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

Applying a health equity lens to better understand end-of-life prognosticationAMA Journal of Ethics; by Newsha Nikzad, Joelle Robertson-Preidler, Faith E. Fletcher; 10/24Racial and ethnic inequity exists throughout the lifespan, including at the end of life (EOL). Although prognostication is inherently fraught with uncertainty, many underrepresented minorities get prognoses that are overly optimistic, which can exacerbate inequity by depriving patients of details needed to make informed decisions and plan for EOL care. This article applies a health equity lens to facilitate better ethical and clinical understandings of how to care for patients of color more equitably at the EOL.

Home health care and place of death in Medicare beneficiaries with and without dementiaGerontologist; Hyosin Dawn Kim , Paul R Duberstein, Anum Zafar, Bei Wu, Haiqun Lin , Olga F Jarrín; 11/24Home health care supports patient goals for aging in place. Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.

Socioeconomic trends in palliative care: A six-year studyCureus; by Andrej Sodoma, Muhammad Wahdan Naseeb,Samuel Greenberg, Nicholas J. Knott, Jonathan Arias, Argirios Skulikidis, Mary Makaryus; 10/24Our study investigates trends in PC utilization, focusing on socioeconomic characteristics. The National Inpatient Sample (NIS) from 2015 to 2020 was used to identify adults hospitalized in the United States (US). International Classification of Diseases, Tenth Revision (ICD-10), was used for PC encounters, code Z51.5. An equal number of random records, stratified by year and without this code, were selected to serve as controls [5.2M visits]. Men were more likely to receive PC consults. Medicare/Medicaid holders’ PC access was limited compared to private insurance holders. Racial minorities, particularly Hispanics and Blacks, were less likely to engage in PC. Compared to urban teaching hospitals, rural hospitals had a decreased rate of PC utilization. Smaller hospitals had significantly fewer PC referrals than large hospitals. A lower socioeconomic status was associated with a reduced propensity to utilize PC services compared to an upper socioeconomic status.