Literature Review

The dozen phrases doctors warned never say to patients, including ‘everything is going to be fine’ What's New 2Day; by Alexander; 11/8/24 “Everything is going to be okay.” No doubt you or someone you know has heard those words from a doctor, but doctors are now being warned to stop doing so because it could raise false hope. A new report has identified 12 “never phrases” that doctors should never use with patients with serious illnesses, such as heart failure, cancer and lung disease. They explain that these “isolated words or phrases not only lack benefits but can also cause emotional harm and accentuate power differences.” If a patient is seriously ill, for example, a doctor should never mention the words “withdraw care,” as this implies that the medical team is “giving up.” While “everything will be okay” may seem like a comforting phrase, researchers say this could offer false hope when dealing with a serious illness and a better expression might be “I’m here to support you through this whole process.” [Click on the title's link for the dozen phrases they identify, with alternative language and rationale.]

Pennsylvania LPNs will now be able to make death pronouncements Tri-State Alert; 11/4/24 A bill sponsored by Sen. Lynda Schlegel Culver (R-27) was signed into law this week to enable licensed practical nurses (LPNs) working in a hospice setting to make death pronouncements. “I am grateful for the governor’s support of this important legislation,” Culver said. “LPNs are with patients and their families until the moment of death, providing essential care during emotional times. Allowing LPNs to make death pronouncements, which was previously only a function of doctors, RNs, physician assistants, and coroners, can alleviate wait times that grieving families often experience.” The bill was amended in the House of Representatives to also provide needed clarification on the waiver of birth and death certificate fees for members of the armed services, veterans, and their families. The law now outlines specifically whose documents qualify for the waiver, as well as applicants and scenarios for which the fee may be waived. 

Asian American diversity and representation in the health care workforce, 2007 to 2022JAMA Network Open; Michelle Ko, MD, PhD; Kevin Dinh, MS; Sarah Iv, BS; Monica Hahn, MD; 10/24In this serial cross-sectional study of American Community Survey 1-year estimates from 2007 to 2022, Filipinx Americans had consistently high representation among registered nurses and nursing assistants; Indian, Pakistani, and Chinese Americans predominated among physicians, whereas Hmong and Cambodian American representation in medicine remained substantially below general population representation. Bangladeshi and Chinese American representation grew among home health aides over the study period. These findings suggest that aggregation of Asian American subgroups into a single racialized group erases substantial inequities in health workforce diversity.

Morphomics, survival, and metabolites in patients with metastatic pancreatic cancerJAMA Network Open; Valerie Gunchick, MS; Edward Brown, MS; Juan Liu, PhD; Jason W. Locasale, PhD; Philip A. Philip, MD, PhD; Stewart C. Wang, MD, PhD; Grace L. Su, MD; Vaibhav Sahai, MBBS, MS; 10/24In this large cohort study, we observed no association of BMI [body mass index] with survival for patients with metastatic PDA [pancreatic ductal adenocarcinoma]. However, longer survival was associated with more subcutaneous fat and a higher muscle-to-fascia ratio, whereas shorter survival was associated with more dense visceral fat. In addition, we observed large-magnitude associations of subcutaneous fat and muscle-to-fascia ratio with several metabolites, which provide key biological insight.

Emergency department visits among patients with dementia before and after diagnosisJAMA Network Open; Cameron J. Gettel, MD, MHS; Yuxiao Song, MS; Craig Rothenberg, MPH; Courtney Kitchen, BA; Andrea Gilmore-Bykovskyi, PhD, RN; Terri R. Fried, MD; Abraham A. Brody, PhD, RN; Stephanie Nothelle, MD; Jennifer L. Wolff, PhD; Arjun K. Venkatesh, MD, MBA, MHS; 10/24Emergency department (ED) visits among persons living with dementia represent a substantial health care challenge, often necessitating targeted interventions to optimize care and support. We assessed changes in ED use before and after incident dementia diagnosis among Medicare beneficiaries aged 65 years and older. Within the entirety of the 12-month period assessed, having a diagnosis of dementia was associated with a 40% increase in the likelihood of having an ED visit. The observed changes in ED use, with peaks before and after dementia diagnosis, suggest that the diagnostic process may precipitate acute health care crises and increased health care–seeking behavior among individuals with dementia and their caregivers.

Person-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP [person-centered care planning]: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.

VITAS touts significant Q3 success, projects future growth McKnights Home Care; by Adam Healy; 10/31/24 VITAS, the home care and hospice subsidiary of Chemed, achieved robust financial results in the third quarter of 2024 and is poised for continued growth, company leadership said Wednesday during an earnings-related conference call. “We are excited about the continued strong results of VITAS,” Kevin McNamara, president and chief executive officer of Chemed, said, according to a transcript. “We are very bullish on the prospects for VITAS for the remainder of 2024 and beyond.” In the quarter ended Sept. 31, VITAS generated $53.4 million in profits, a 20.6% increase compared with the prior year quarter. Revenues rose 17.2% to $391.4 million. Chemed as a whole produced $75.7 million in net profit, a 1% increase year-over-year, behind revenues that increased nearly 7.4% to $606.1 million, according to an earnings report.

The Alliance Celebrates National Care at Home MonthNational Alliance for Care at Home (formerly NAHC and NHPCO); 10/31/24 November marks the start of National Care at Home Month, a new observance created to honor the valuable contributions of home care providers nationwide and inspire outreach to communities, media, and policymakers. National Care at Home Month is spearheaded by the newly formed National Alliance for Care at Home (the Alliance), bringing together the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO). ... National Care at Home Month, like the new Alliance, honors the full continuum of care-at-home providers and the patients and families they serve. This community of providers is stronger together, and National Care at Home Month brings this message into public awareness. ... “National Care at Home Month is an opportunity for our community to come together, celebrate and honor one another, and highlight the transformative care and support provided to patients and their loved ones across the US each day,” said Dr. Steve Landers, CEO for the Alliance. ... [Click on the title's link to continue reading.]

Happiness is when what you think, what you say, and what you do are in harmony. ~ Mahatma Gandhi

Underrepresentation of Black men in physician assistant and associate trainingJAMA Network Open; Lucy W. Kibe, DrPH, MS, MHS, PA-C; Katrina M. Schrode, PhD; Samuel Paik, MPAS, PA-C; Dominique Frias-Sarmiento, MA; 10/24In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate Black male applicants and matriculate Black men annually.

Promotion of knowledge and trust surrounding scarce resource allocation policies-A randomized clinical trialJAMA Health Forum; Russell G. Buhr, MD, PhD1; Ruby Romero, BA; Lauren E. Wisk, PhD; 10/24The COVID-19 pandemic prompted rapid development of scarce resource allocation policies (SRAPs) in case demand for critical health services eclipsed capacity. [This] trial found that a brief educational video is sufficient to explain complex ethical tenets and mechanics of SRAP and improved knowledge of such policies and trust in health systems to implement them equitably while not exacerbating anxiety about potential policy implications. This informs practice by providing a framework for educating people about the use of these policies during future situations necessitating crisis standards of care.

Perspectives of nursing home staff in advance care planning conversations: Experiences from the APPROACHES projectJournal of the American Medical Directors Association; by Kathleen T. Unroe, Hillary D. Lum, Susan E. Hickman; 9/24Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences e a Role offering Alzheimer’s patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP... Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.

High-risk medications in persons living with dementia-A randomized clinical trialJAMA Internal Medicine; Sonal Singh, MD, MPH; Xiaojuan Li, PhD, MSPH; Noelle M. Cocoros, DSc, MPH; Mary T. Antonelli, PhD, RN, MPH; Ramya Avula, MS; Sybil L. Crawford, PhD; Inna Dashevsky, MS; Hassan Fouayzi, PhD, MS; Thomas P. Harkins, MA, MPH; Kathleen M. Mazor, EdD; Ashley I. Michnick, PharmD, PhD; Lauren Parlett, PhD; Mark Paullin, MS; Richard Platt, MD, MSc; Paula A. Rochon, MD, MPH; Cassandra Saphirak, MA; Mia Si, MS; Yunping Zhou, MS; Jerry H. Gurwitz, MD; 10/24Question: Does a one-time mailed educational intervention to patients and their clinicians reduce prescribing of antipsychotics, sedative-hypnotics, and strong anticholinergic agents in community-dwelling persons living with Alzheimer disease (AD) or AD-related dementias (ADRD)? In this randomized clinical trial of 12,787 patients, there were no clinically meaningful or statistically significant differences from the mailed educational intervention compared with usual care in continued use of medications targeted for deprescribing. These findings suggest medication-specific educational mailings targeting patients with AD or ADRD and their clinicians are not effective in reducing the use of high-risk medications.