Literature Review

Large language model influence on diagnostic reasoning-A randomized clinical trialJAMA Network Open; Ethan Goh, MBBS, MS; Robert Gallo, MD; Jason Hom, MD; Eric Strong, MD; Yingjie Weng, MHS; Hannah Kerman, MD; Joséphine A. Cool, MD; Zahir Kanjee, MD, MPH; Andrew S. Parsons, MD, MPH; Neera Ahuja, MD; Eric Horvitz, MD, PhD; Daniel Yang, MD; Arnold Milstein, MD; Andrew P. J. Olson, MD; Adam Rodman, MD, MPH; Jonathan H. Chen, MD, PhD; 10/24Large language models (LLMs) have shown promise in their performance on both multiple-choice and open-ended medical reasoning examinations, but it remains unknown whether the use of such tools improves physician diagnostic reasoning. In this trial, the availability of an LLM to physicians as a diagnostic aid did not significantly improve clinical reasoning compared with conventional resources. The LLM alone demonstrated higher performance than both physician groups, indicating the need for technology and workforce development to realize the potential of physician-artificial intelligence collaboration in clinical practice.

Knowledge of palliative care in men and women diagnosed with metastatic breast cancerAmerican Journal of Hospice and Palliative Medicine; Evelyn Robles-Rodriguez, DNP, APN, AOCN; Ashley Weinmann, MSN, APN-C; Generosa Grana, MD, FACP; Teralyn Carter, MD; Bonnie Jerome-D’Emilia, PhD, MPH, RN; 10/24This sample of men and women diagnosed with metastatic breast cancer and being treated in a Cancer Center had limited knowledge and exposure to Palliative Care services across race and ethnicity. While no specific disparity was noted, the utilization of PC [palliative care] was low. Whether a function of a lack of referrals or patient preference, an effort should be made to increase PC referrals for all patients diagnosed with cancer.

Prevalence of unrecognized cognitive impairment in federally qualified health centersJAMA Network Open; Ambar Kulshreshtha, MD, PhD; Erik S. Parker, PhD; Nicole R. Fowler, PhD; Diana Summanwar, MD; Zina Ben Miled, PhD; Arthur H. Owora, PhD; James E. Galvin, MD; Malaz A. Boustani, MD, MPH; 10/24This cross-sectional study found that unrecognized cognitive impairment is ubiquitous among older adults from underrepresented, minoritized racial and ethnic groups and those who are socially vulnerable receiving primary care from FQHCs [federally qualified health centers]. To overcome the disparity in early detection of cognitive impairment, timely, equitable, scalable, and sustainable detection approaches need to be developed.

[UK] Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysisPalliative Medicine; Amy Brown, Sarah Yardley, Ben Bowers, Sally-Anne Francis, Lucy Bemand-Qureshi, Stuart Hellard, Antony Chuter, Andrew Carson-Stevens; 10/24 About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply ... administration ... and prescribing ... Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care.

Timing of palliative care, end-of-life quality indicators, and health resource utilizationJAMA Network Open; Sarah J. Mah, MD, MSc; Daniel M. Carter Ramirez, MD, PhD; Kara Schnarr, MD, PhD; Lua R. Eiriksson, MD, MPH; Anastasia Gayowsky, MSc; Hsien Seow, PhD; 10/24In this cohort study of 8,297 individuals with ovarian cancer decedents, initiating palliative care earlier than 3 months before death was associated with lower rates of death in the hospital, late chemotherapy, intensive care unit admission, and aggressive care at the end-of-life. Implementation strategies for early palliative care initiation are needed to optimize care quality and health resource utilization at the end of life.

Location of pediatric deaths in the US JAMA Network - JAMA Pediatrics; by Sarah H. Cross, PhD, MSW, MPH; Khaliah A. Johnson, MD; Maura A. Savage, MSW; Dio Kavalieratos, PhD; 11/11/24Historically, most seriously ill children in the US have died in hospitals despite a presumed preference for home death. Among the general population, home and hospice facility deaths have increased in the past 2 decades, whereas hospital and nursing facility deaths have decreased; however, recent patterns in location of pediatric deaths are unknown.

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.

[Switzerland] A French-language web-based intervention targeting prolonged grief symptoms in people who are bereaved and separated: Randomized controlled trialJMIR Formative Research; Anik Debrot, Liliane Efinger, Maya Kheyar, Valentino Pomini, Laurent Berthoud; 10/24Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms.

[UK] Large language models for mental health applications: Systematic reviewZhijun Guo, Alvina Lai, Johan H Thygesen, Joseph Farrington, Thomas Keen, Kezhi Li; 10/24The study identifies several issues: the lack of multilingual datasets annotated by experts, concerns regarding the accuracy and reliability of generated content, challenges in interpretability due to the "black box" nature of LLMs [large language models], and ongoing ethical dilemmas. These ethical concerns include the absence of a clear, benchmarked ethical framework; data privacy issues; and the potential for overreliance on LLMs by both physicians and patients, which could compromise traditional medical practices. As a result, LLMs should not be considered substitutes for professional mental health services. However, the rapid development of LLMs underscores their potential as valuable clinical aids, emphasizing the need for continued research and development in this area.

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.