Literature Review

Care for Alzheimer's on Medicaid is unorganized, frustrating, inhumanThe Indianapolis Star, by Darcy Metcalfe; 4/14/24What it is like to die of Alzheimer’s in America? Without a doubt, it is nothing as it is portrayed on NBC’s hit series This is Us. At the end of this series, the character Rebecca dies from Alzheimer’s and falls peacefully asleep, snuggly tucked in her warm bed at home, surrounded by family and 24-hour skilled nursing care. Throughout the six seasons of This is Us, I simultaneously witnessed my father’s slow dying from Alzheimer’s in a reality that was worlds away from Rebecca’s. ...

Shared decision-making between nephrologists, patients key to conservative kidney management Healio, by Mark E. Neumann; 4/15/24 ... Conservative kidney management: Patients who decline dialysis treatment do so for many reasons, Fahad Saeed, MB, BS, and colleagues wrote in a paper published in the American Journal of Nephrology. Patients told researchers that quality of life; fewer symptoms caused by dialysis; more personal time; avoiding the burden of dialysis, including for family and friends; witnessing a family member or friend on dialysis and wanting to have a peaceful death were reasons to select conservative kidney management.

Ethical issues abound in adoption of Artificial Intelligence in cancer care Oncology Nurse Advisor; 4/4/24There may be ethical barriers to the adoption of artificial intelligence (AI) into cancer care, according to a study published online March 28 in JAMA Network Open. Andrew Hantel, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues evaluated oncologists’ views on the ethical domains of the use of AI in clinical care. The analysis included 204 survey responses from 37 states. ... “These findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions as well as decisional responsibility when problems related to AI use arise,” the authors write.

Malnutrition, thyroid cancer result in high rates of death among home care, hospice patients, studies finds McKnights Home Care, by Adam Healy; 4/5/24 Two separate studies analyzing disparities in patients’ place of death revealed high death rates related to malnutrition and thyroid cancer among patients receiving care at home and in hospice. The first study, “Disparities in Place of Death Among Malnourished Individuals in the United States,” found that more than 31,000 malnutrition-related deaths occurred among home care and hospice patients between 1999 and 2020. ... Another study, “Disparities in the Place of Death for Patients With Malignant Neoplasms of the Thyroid Gland,” discovered that roughly half of all patients who died of thyroid cancer between 1999 and 2020 did so in home care or hospice.

Dana-Farber’s new push to integrate palliative, behavioral services in cancer careHospice News, by Audrie Martin; 4/2/24Boston-based Dana-Farber Cancer Institute has launched the Neuro-Inclusive Oncology Care and Empowerment Program, a psychosocial oncology initiative focused on adults with intellectual and/or developmental disabilities (IDD). ... Patients with disabilities are largely underserved, but they represent a growing need as well as an untapped market for providers. More palliative care and hospice companies are developing programs to meet the specific concerns of these patients to improve access to care.

Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challengesCurrent Opinion in Cardiology, by Sarah Chuzi and Katharine Manning; online ahead of May 1, 2024 printRecent findings: Patients with chronic heart failure [HF], as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of palliative care [PC] needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. ... PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes.

Should we be using palliative care for scleroderma? The Medical Republic, by Karina Bray; 4/2/24Almost three-quarters of systemic sclerosis patients could benefit from specialist palliative care, according to Australian research. The first-of-a-kind study, published in Arthritis Care & Research, set out to examine and quantify the need for palliative care to address high symptom burden as an integrated part of systemic sclerosis management. ... “Almost 75% of SSc patients may benefit from specialist palliative care input to manage specific severe symptoms, and the overlapping nature of such symptoms highlights the complex symptom management needs of SSc patients,” the authors wrote. 

Hospice care for those with dementia falls far short of meeting people’s needs at the end of life ArcaMax, Maria J Silveira, University of Michigan; 4/1/24... Strikingly, only 12% of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70% of the time. In my experience caring for dementia patients, the underuse of hospice by dementia patients has more to do with how hospice is structured and paid for in the U.S. than it does patient preference or differences between cancer and dementia.

High intensity of end-of-life care for minority patients with lung cancerU.S. Medicine; 3/27/24While disparities in lung cancer mortality among racial and ethnic minorities are well documented, not as much is understood about how racial and ethnic minority patients with lung cancer are treated at the end of life. A study led by researchers from the Indiana University School of Medicine and the Richard L. Roudebush VAMC, both in Indianapolis, sought to determine if those patients experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic white (NHW) patients.

Alzheimer’s deaths expected to grow and industry not prepared with workers, report show Journal-News, by Samantha Wildow; 3/26/24The number of Alzheimer’s deaths in the U.S. more than doubled between 2000 and 2021, the Alzheimer’s Association says in its latest report, which details how about half of health care workers say their industry is not fully equipped to handle the growing population of people with dementia. ... Multiple factors play into why deaths to Alzheimer’s disease and other forms of dementia are increasing, including how the health care system is getting better at treating other things like heart disease and cancer, one local doctor said.

What is the FAST scale for Alzheimer's?MedicalNewsToday, by Charlotte Lillis and medically reviewed by Shilpa Amin, MD, CAQ, FAAFP; 3/25/24The Reisberg Functional Assessment Screening Tool (FAST) is a scale that doctors use to diagnose and evaluate aspects of Alzheimer’s disease. ... This article provides an overview of the FAST tool, including a breakdown of its individual stages. It also outlines what to expect from the FAST evaluation, what the scale means for hospice care, and more.

"A strong reason why I enjoy coming to work": Clinician acceptability of a palliative and supportive care intervention (PACT) for older adults with acute myeloid leukemia and their care partners Journal of Geriatric Oncology; by Ayomide Okanlawon Bankole, Natasha Renee Burse, Victoria Crowder, Ya-Ning Chan, Rachel Hirschey, Ahrang Jung, Kelly R Tan, Susan Coppola, Mackenzi Pergolotti, Daniel R Richardson, Ashley Leak Bryant; 3/20/24 Introduction: ... In this study, we examined clinician acceptability of a NIH-funded interdisciplinary PAlliative and Supportive Care inTervention (PACT) for older adults with acute myeloid leukemia (AML) and their care partners that transcends both inpatient and outpatient settings. Results: ... Five themes were identified in the thematic analysis: (1) Emotions and affect towards the intervention, (2) Intervention coherence and self-efficacy, (3) Barriers, burden, and opportunity costs of delivering the intervention, (4) Usefulness and effectiveness of the intervention, and (5) Recommendations to improve intervention delivery.

Report: Alzheimer's and dementia caregivers total 840K in Florida, bear heavy burden NPR WMFE, by Joe Byrnes; 3/22/24The number of Floridians serving as caregivers for people with Alzheimer's and other dementias is an estimated 840,000, an increase of 13,000 in just one year, according to an annual report from the Alzheimer's Association. Caregiving takes a toll on families hit by the degenerative brain disease, but a new program from the Centers for Medicare and Medicaid Services could lessen that burden. ... [This] promising resource in the works is the Guiding an Improved Dementia Experience Model, an approach that includes the patient and caregiver. The GUIDE Model -- through the Centers for Medicare & Medicaid Services -- starts in July.