Literature Review

Calibrating AI reliance—A physician’s superhuman dilemmaJAMA Health Forum; Shefali V. Patil, PhD; Christopher G. Myers, PhD; Yemeng Lu-Myers, MD, MPH; 3/25Assistive artificial intelligence (AI) technologies hold significant promise for transforming health care by aiding physicians in diagnosing, managing, and treating patients. Leveraging AI’s superior diagnostic accuracy in certain specialties, these assistive AI systems aim to reduce medical errors, while also promising to address physician fatigue by alleviating cognitive load and time pressures. Because human operators are perceived as having control over the technology’s use, responsibility unduly shifts to the human operator, even when clear evidence shows that the AI system produces erroneous outputs. Consequently, although scholars have proposed recommendations for shaping AI regulations, the reality is that in the absence of clear policies or established legal standards, future liability will largely hinge on societal perceptions of blameworthiness. This regulatory gap imposes an immense, almost superhuman, burden on physicians: they are expected to rely on AI to minimize medical errors, yet bear responsibility for determining when to override or defer to these systems.

Circadian rhythm in end-of-life delirium: a secondary analysis of two randomized controlled trials Journal of Pain and Symptom Management; Sonal Admane MD, MPH; Sarah Pasyar MS; Roland Bassett Jr. MS; Eduardo Bruera MD; David Hui MD, MSc; 4/25Over 90% of patients with advanced cancer in the last weeks and days of life experience delirium, a neurocognitive syndrome associated with increased restlessness, agitation, hallucinations, and even violent behaviors. Long term psychological morbidity is also seen in caregivers, who may develop prolonged grief, anxiety, and post-traumatic stress disorder. Healthcare professionals caring for patients with delirium also report delirium-related distress, particularly in relation to patients with persistent restlessness and agitation. Delirious patients were more restless between 3 pm and 11 pm. This observation of “sundowning” may help clinicians to better anticipate this symptom, schedule monitoring and treatments, and educate patients and caregivers.

Medical aid in dying in the state of Colorado: Perspectives, data, and lessons learned in the first years of a uniquely centralized programJournal of Palliative Medicine; Melanie Mandell, Katie Sue Van Valkenburg, Skye O’Neil, Genie E. Roosevelt, Kerri Mason; 4/25 In 2016, Colorado voters approved Proposition 106, “Access to Medical Aid in Dying,” which amended Colorado statutes to include the Colorado End-of-life Options Act. In 2018, Denver Health and Hospital Authority, an urban, county safety-net hospital established a program to provide comprehensive medical aid in dying care via a centralized clinic with a dedicated team including a medical director, social worker, and a network of volunteer consultants. As the program has developed and matured, it has grown exponentially. This is due to its ease of accessibility, statewide educational efforts, and the relatively low cost and need-based, free services it provides. In six and a half years, our centralized program assisted over 650 Colorado patients in their quest for accessing medical aid in dying care, providing a wide continuum of services from initial intake and counseling, visits, and financial aid to specific grief counseling for loved ones. We believe our centralized system may function as a model for other hospitals considering the need to improve aid in dying access and care.

Disparities in end-of-life care: A retrospective study on intensive care utilization and advance care planning in the Colorado all-payer claims databaseAmerican Journal of Hospice and Palliative Medicine; Darcy Holladay Ford, PsyD, MA, LPC, RDN; Kimberly Landry, MPH; Megha Jha, MPH; Martha Meyer, PhD; 3/25Intensive end-of-life (EOL) care is emotionally and financially burdensome, disproportionally negatively impacting racial and ethnic minorities, rural residents, and lower socioeconomic seniors. ICU Stays: Hispanic/Latino, Asian, and Black members had increased ICU stays compared to Whites ... However, members without ACP [advance care planning] and rural residents had lower ICU stays ... ED Visits: Hispanic/Latino, Asian, Black members, non-dually eligible members (Medicare Fee for Service (MFFS) + Medicaid), and rural residents had increased ED visits ... Meanwhile, members without ACP or hospice care had lower ED visits ... 30-day Readmissions: Asian members and rural residents had increased 30-day readmissions ... In contrast, those on MFFS and not on Medicaid, members without ACP, and those not in hospice care had decreased 30-day readmissions ...

Appropriate deprescribing and payment in hospice dementia careJAMA Internal Medicine; Nathan M. Stall, MD, PhD; Sharon K. Inouye, MD, MPH; Lona Mody, MD, MSc; 3/25People living with dementia are one of the largest growing users of hospice care in the US, with approximately 20% of enrollees having a terminal diagnosis of dementia. In the setting of advanced dementia specifically, guidelines recommend deprescribing cholinesterase inhibitors and memantine as there is insufficient evidence for benefit, and there are risks of adverse events including bradycardia, falls, and gastrointestinal adverse effects. The Centers for Medicare & Medicaid Services specifies that hospices are responsible for covering all medications under the Medicare Part A hospice benefit, but audits have revealed that millions of dollars of prescription drug costs are being inappropriately shifted to Medicare Part D. The study by Hunt et al occurs within a context of growing concerns about shifts in US hospice care where more than 70% of hospice agencies serving patients with terminal illness across all settings now operate on a for-profit basis, with increasing acquisition of hospices by private equity firms and publicly traded corporations. Compared with nonprofit hospices, for-profit hospices have more acute care utilization, provide less direct care, and have poorer caregiver-reported care experiences. For-profit hospices also enroll a higher proportion of persons living with dementia, which may relate to their lower acuity and longer stays, as well as more profitable margins under the per-beneficiary daily payment.

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.

[Sweden] Reconciliation in palliative care: A concept analysisPalliative and Supportive Care; Margareta Karlsson, Andrea Uhlman, Benedict Kämper, Britt Hedman Ahlstrom; 9/24Terminal illnesses affect almost all aspects of life and being close to death may lead to a need for reconciliation. The end of life is stressful on an existential level for both patients and relatives. It can therefore be of relevance for palliative care nurses to understand the meaning of reconciliation. We conclude that reconciliation is a concept of importance when caring for patients in end-of-life care. A broader and deeper understanding of the concept facilitates conversations about the meaning of reconciliation in palliative care and can enable patients who strive to achieve reconciliation to be more easily identified and supported.

[The Netherlands] The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case studyPalliative Medicine; Daisy Jm Ermers, Maartje J van Geel, Yvonne Engels, Demi Kellenaers, Anouk Sj Schuurmans, Floortje K Ploos van Amstel, Carla Ml van Herpen, Yvonne Schoon, Henk J Schers, Kris Cp Vissers, Evelien Jm Kuip, Marieke Perry; 9/24Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. Four themes were identified [in this study]: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making.

From small to tall: breed-varied household pet dogs can be trained to detect Parkinson's DiseaseAnimal Cognition; Lisa Holt, Samuel V Johnston; 10/24Parkinson's Disease (PD) is a clinically diagnosed disease that carries a reported misdiagnosis rate of 10-20%. Recent scientific discoveries have provided evidence of volatile organic compounds in sebum that are unique to patients with PD. Twenty-three canines of varying breeds, ages, and environmental backgrounds were included. For this two-year reporting period, when averaged as a group, the 23 dogs were 89% sensitive and 87% specific to olfactory distinction between PD-positive and PD-negative human donor samples. Study findings support the application of companion dogs, trained with force-free, reward-based methodologies, for the detection of PD-positive and PD-negative samples under controlled conditions.

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Trends in location of death for individuals with pediatric cancerJAMA Pediatrics; Urvish Jain, BSc; Angelin Tresa Mathew, BSc; Bhav Jain, BS; Erin Jay Garbes Feliciano, MD, MBA; Edward Christopher Dee, MD; Leonard H. Wexler, MD; Suzanne L. Wolden, MD; 9/24Children and adolescents with cancer face unique symptomatic, psychosocial, and existential challenges at the end of life (EOL). Premature death, severe pain, and complex symptoms can be distressing for patients and families. In contrast to prior literature regarding trends on adults with cancer, in this study, the pediatric population had lower rates of death at home, potentially because pediatric patients receive more aggressive EOL treatment than adult patients. Our study found differences among racial and ethnic minority groups, who were more likely to die in hospitals, outpatient settings, and ED facilities. As such, developing capacities for palliative care teams that can reach patients across many EOL settings may be valuable for helping patients and families achieve a death congruent with their wishes, particularly because of persistent differences by race over the past 20 years paralleling findings in adult populations.

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention.