Literature Review

The Road Not Taken by Robert Frost

The Alliance celebrates the Dole Act becoming law, expanding access to care and benefits for veteransNational Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 1/7/25 The National Alliance for Care at Home (the Alliance) issued the following statement in response to President Biden signing S. 141, the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, into law on Thursday, January 2. This landmark legislation includes several key provisions to enhance care and benefits for Veterans and their families, including Section 301, Gerald’s Law. Gerald’s Law addresses a critical gap in benefits for Veterans by ensuring that families of terminally-ill Veterans receiving Veterans Affairs (VA)-furnished hospice care—whether at home, in a nursing home, or in another non-VA setting—retain access to their full VA burial allowance. ... “We are deeply grateful for the bipartisan support that made these critical reforms possible,” said Dr. Steve Landers, CEO for the Alliance. “This legislation ensures that Veterans and their families have greater flexibility and support when accessing the care they need, whether through hospice services, home care, or other settings. ...”

Global healthspan-Lifespan gaps among 183 World Health Organization member statesJAMA Network Open; Armin Garmany, BS; Andre Terzic, MD, PhD; 12/24Gains in life expectancy across global populations are recognized as a societal achievement, ... but increased lifespan, ...  does not necessarily mean a longer healthy life. An estimate of healthspan is the health-adjusted life expectancy whereby years of life are weighted by health status. Notably, gains in life expectancy have not been matched by an equivalent rise in health-adjusted life expectancy. The resulting healthspan-lifespan gap reflects the extent of lifespan burdened by disease. Against the backdrop of the greatest noncommunicable disease burden, the US recorded the largest healthspan-lifespan gap ... , with a gap 24% larger than projected from the country’s life expectancy. Specifically, in the US the mean healthspan-lifespan gap increased from 10.9 to 12.4 years over the past 2 decades ... , resulting in a 29% higher gap than the global mean. Women exhibited a 2.6-year higher healthspan-lifespan gap than men, increasing from 12.2 to 13.7 years or 32% beyond the global mean for women.

A call to action for revisiting goals of care discussions with adolescents and young adults with cancerJAMA Network Open; Erica C. Kaye, MD, MPH; 12/24In “Evolution in Documented Goals of Care at End of Life for Adolescents and Young Adults With Cancer,” Mastropolo et al addresses an important and understudied question regarding whether and how goals of care (GOC) change for adolescents and young adults (AYAs) with cancer as death approaches. Intuitively, the study findings showed that AYAs with cancer had increased documentation of palliative GOC as they approached end of life. More specifically, 1 in 5 AYAs had GOC documentation that transitioned from nonpalliative goals in the early or middle periods to palliative in the final 30 days before death. While perhaps unsurprising, the clinical relevance of this finding is significant: a sizeable minority of AYAs may change their GOC during the final weeks of life, underscoring the importance of revisiting GOC conversations as death approaches to align medical interventions with a patient’s wishes. 

What should health professions students learn about data bias?AMA Journal of Ethics; by Douglas Shenson; 1/25In epidemiology, bias is defined as systematic deviation from the truth, and it can arise at different stages of scientific investigation (eg, data collection, methodological application, and outcomes analysis). Epidemiological bias can appear as a consequence of data bias (usually categorized as selection bias or information bias) or social bias (prejudice). Such forms of bias may occur separately or together. This article explores what health professions students should learn about the relationship between data bias and social bias—generated by racial, ethnic, gender, or other kinds of prejudice, singly or in combination—as a source of ethical and clinical concern in health care practices and policies that influence patient care and community health.Publisher's note: A thoughtful article regarding data bias - particularly as we examine CMS' Special Focus Program methodology (and others).

Researchers compared hospital early warning scores for clinical deterioration—Here’s what they learnedJAMA Network; Roy Perlis, MD, MSc; Jennifer Abbasi; 1/24This conversation is part of a series of interviews in which JAMA Network editors and expert guests explore issues surrounding the rapidly evolving intersection of artificial intelligence (AI) and medicine. Arecent head-to-head study at Yale New Haven Health System compared 6 different early warning scores designed to recognize clinical deterioration in hospitalized patients, including 3 proprietary AI tools. Among the best was the National Early Warning Score (NEWS), a publicly available non-AI tool, while the Epic Deterioration Index “was one of the worst” of the batch, the authors reported in October in JAMA Network Open.

[Korea] A prospective, single-cohort, open, multi-center, observational study of sublingual fentanyl for breakthrough cancer pain: Effectiveness, safety, and tolerability in Korean cancer patientsCancer Research and treatment; Youn Seon Choi, Su-Jin Koh, Woo Kyun Bae, Se Hyung Kim, Seong Hoon Shin, So Yeon Oh, Sang Byung Bae, Yaewon Yang, Eun-Kee Song, Yoon Young Cho, Pyung Bok Lee, Ho-Suk Oh, MinYoung Lee, Jin Seok Ahn; 12/24Fentanyl, a highly lipophilic opioid, was developed as a sublingual fentanyl tablet (SFT) for the management of breakthrough cancer pain (BTcP), and its efficacy and safety were confirmed in a randomized, controlled study. In a real-world setting, SFT provides rapid and effective analgesia in BTcP, even at the lowest dose (100 μg), and the safety profile was acceptable.

[France] Requesting euthanasia or assisted suicide when it is illegal: A qualitative study about relatives' experiences of patients hospitalized in French palliative care unitsPalliative Care and Social Practice; Camille De Cock, Florence Mathieu-Nicot, Hélène Trimaille, Mathilde Giffard, Aline Chassagne; 12/24Requests for euthanasia and/or assisted suicide are generally understood by relatives. However, receiving and discussing such requests is a challenging and emotionally demanding task, generating significant suffering. All relatives seem to experience some degree of suffering, although its expression varies greatly between individuals. We encourage healthcare professionals to identify the nature of this suffering and to invite patients and their relatives to openly discuss these issues and to proactively address the request.

No place like home: Oscar the pug reunites with owner in hospice KOAT 7 Action News, Albuquerque, NM; by Cristiana Ramos; 1/8/25 It was all smiles and licks Wednesday at Veteran Affairs in Albuquerque. Bob Knevitt, a Marine veteran and his pup, Oscar, reunited after Knevitt suffered a brain bleed during Christmas. Knevitt has been in hospice ever since. He recently had to do the unimaginable and put Oscar up for adoption. "It's hard to lose a dog, but in my situation, I had no choice, and I'm glad he's going to a good family," he said. ... It was a friendship too strong to break. Although Oscar has a new family now, he still comes to visit his dad ...

Whether it is a tsunami, or whether it is a hurricane, whether it's an earthquake - when we see these great fatal and natural acts, men and women of every ethnic persuasion come together and they just want to help. ~ Martin Luther King IIIReposted from our newsletter, 10/11/24 in response to Hurricanes Helene and Milton

UnitedHealth, Amedisys ask judge to toss antitrust lawsuit Modern Healthcare; by Diane Eastabrook; 1/9/25UnitedHealth Group and Amedisys asked a federal judge Wednesday to either dismiss a government lawsuit over their planned merger or require the Justice Department to better define where the deal would stifle competition. The motion is the latest chapter in UnitedHealth Group’s 18-month effort to acquire home health and hospice company Amedisys for $3 billion. In November, the Justice Department filed a lawsuit to block the deal, claiming it would stifle competition. ... The request for a dismissal came days after UnitedHealth Group and Amedisys backed away from a deal to sell some home health and hospice locations to Dallas-based Vital Caring Group to alleviate antitrust concerns.

When drugstores disappear: Why nearly 15,000 Bostonians live in ‘pharmacy deserts’Boston Globe; by Diti Kohli, Tiana Woodard, Daigo Fujiwara-Smith, Thomas Lee; 7/25/24Many of these dead zones overlap with vulnerable communities — already poorer, sicker, and less well-resourced than the rest of the state. Where do patients go? ... Since 2017, at least 26 pharmacies have closed in Boston, and about 200 shuttered statewide, according to data from the Massachusetts Department of Public Health. State estimates show that a comparable number have since opened, though they rarely serve the same communities. Often left behind are so-called pharmacy deserts, pockets of the city where the majority of residents live at least a half-mile from the nearest drugstore, and lack cars to make the trip. A Globe analysis found that almost 15,000 people in Boston live in such deserts, without a reliable place to go for prescriptions, over-the-counter treatments, and medical advice. Many of these dead zones overlap with vulnerable communities — already poorer, sicker, and less well resourced than the rest of the state.Publisher's note: While a little dated, this article recently came across my desk and reinforced "new year's discussions" of pharmacy deserts - and hospice deserts. More to follow on this in 2025...