Literature Review

Current use and evaluation of artificial intelligence and predictive models in US hospitalsHealth Affairs; by Paige Nong, Julia Adler-Milstein, Nate C. Apathy, A. Jay Holmgren, Jordan Everson; 1/25Effective evaluation and governance of predictive models used in health care, particularly those driven by artificial intelligence (AI) and machine learning, are needed to ensure that models are fair, appropriate, valid, effective, and safe, or FAVES. We analyzed data from the 2023 American Hospital Association Annual Survey Information Technology Supplement to identify how AI and predictive models are used and evaluated for accuracy and bias in hospitals. Hospitals use AI and predictive models to predict health trajectories or risks for inpatients, identify high-risk outpatients to inform follow-up care, monitor health, recommend treatments, simplify or automate billing procedures, and facilitate scheduling. We found that 65 percent of US hospitals used predictive models, and 79 percent of those used models from their electronic health record developer.Publisher's note: It would be interesting if hospices collected and reported similar information.

Development and outcomes of a provider-driven, online continuing education program on integrative palliative care: Randomized controlled trialGlobal Advances in Integrative Medicine and Health; William Collinge, PhD, MPH; Leila Kozak, PhD; Scott Mist, PhD, MAcOM; Robert Soltysik, MS; 1/25While conventional medicine excels in emergency and acute care, complementary therapies are increasingly being integrated into efforts for symptom management and quality of life (QoL) in hospital, hospice and nursing home environments. The term “complementary” denotes a cooperative or collaborative relationship between conventional and unconventional modalities, and when such integration takes place, the terms “complementary” and “integrative” are commonly used interchangeably. Hospices have been early adaptors of such therapies with surveys in various states showing between 60-90% of hospices offering these modalities. This provider-driven CE/CME program led to significant positive changes in practitioners’ self-efficacy and implementation of integrative care practices in PC settings. The results indicate that CE/CME can have measurable impacts that benefit providers and may potentially impact patients, families and the culture of care.

Preferred and actual location of death in adolescents and young adults with cancerJAMA Network Open; by Oreofe O. Odejide, Colin Cernik, Lauren Fisher, Lanfang Xu, Cecile A. Laurent, Nancy Cannizzaro, Julie Munneke, Robert M. Cooper, Joshua R. Lakin, Corey M. Schwartz, Mallory Casperson, Andrea Altschuler, Lori Wiener, Lawrence Kushi, Chun R. Chao, Jennifer W. Mack; 1/14/25In this cohort study of 1929 adolescent and young adult (AYA) decedents, 1226 (63.6%) had a documented discussion about their preferred location of death, with home being most frequently desired. Among these, 224 of 317 (70.7%) who wanted to die at home were able to do so, as were 164 of 172 (95.3%) who preferred a hospital death. The fact that over a quarter of AYA patients with cancer who preferred to die at home were unable to do so suggests a need for effective interventions to improve goal-concordant end-of-life care for AYA patients with cancer.

Sociodemographic disparities in the use of hospice by U.S. nursing home residents: A systematic reviewAmerican Journal of Hospice and Palliative Medicine; Christine E. DeForge, PhD, RN, CCRN; Hsin S. Ma, MPP, MA; Andrew W. Dick, PhD; Patricia W. Stone, PhD, RN, FAAN, CIC; Gregory N. Orewa, PhD; Lara Dhingra, PhD; Russell Portenoy, MD; Denise D. Quigley, PhD, MA; 1/25 Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use.

Effective solutions for caregivers of older adults: A review of systematic reviewsJournal of Applied Gerontology; Molly McHugh, Ellen Munsterman, Hannah Cho; 1/25This umbrella review aims to describe caregiver interventions tested across populations of informal caregivers of older adults and to examine the effect of caregiver interventions on depression, burden, and quality of life across intervention types and care-recipient populations. Most commonly, interventions focused on improving outcomes for caregivers of older adults with dementia. Among the included reviews, caregiver depression was most likely to be reduced by caregiver interventions, and cognitive behavioral therapy (CBT) and mindfulness-based interventions (MBI) were most effective. The use of information and communication technologies to deliver caregiver interventions is increasingly common. Standardization of intervention classifications and transparent reports of intervention delivery details will strengthen research in this field.

“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partnersJournal of Applied Gerontology; Haley M. Shiff, Theresa A. Allison, Madina Halim, Kenneth E. Covinsky, Alexander K. Smith, Deborah E. Barnes, Jennie M. Gubner, Kara Zamora; 1/25In the United States, spouses provide 17% of in-home care for people living with dementia. We found common features underlying the care provided by spouses/partners, including challenges and motivators guided by notions of loyalty and commitment. As cognition and function declined, care partners found the relationship increasingly difficult. They shared the feeling of being stuck as well as the loss of identity and freedom. This finding follows what Westrelin et al. (2024) describe in their study on spousal caregivers of partners living with dementia, in which spouses perceived changes not only in their partner but also in themselves and oscillated between their identity as a caregiver and as a spouse, highlighting the dynamic nature of caregiver identity construction within the context of caring for a partner living with dementia.

Transition to hospice: how it impacts the mental health of caregivers of persons with dementiaAlzheimer's & Dementia; by Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris; 2024In this study, we aimed to examine caregivers’ mental health indicators and their correlation structure based on the timing of hospice transition... In the context of dementia care, our results highlight that caregivers who just entered hospice are undergoing a challenging transition that often finds them in a mentally vulnerable position. To develop and implement effective strategies for caregivers of persons with dementia, we need to understand the needs and vulnerabilities of caregivers during hospice transition and identify the best timing for the delivery of supportive tools.

The challenge of fractures in patients with chronic kidney diseaseEndocrine Practice; Andrea G Kattah, Silvia M Titan, Robert A Wermers; 12/24People with chronic kidney disease (CKD) are at increased risk of fractures in comparison to the non-CKD population and fractures are associated with high mortality and worsening quality of life. The approach for evaluation of bone disease and fracture risk in CKD is different from the approach in the general population. First, diagnosis of the type of renal osteodystrophy is not based only on assessment of bone density and traditional risk factors for osteoporosis. Second, there may be limitations of currently available fracture risk tools in the CKD population. Third, treatment choice should take into consideration the three components of the TMV classification along with the stage of kidney disease and comorbidities, but the assessment of these components has not been well established. As new medications for the treatment of osteoporosis become available, there is an urgency to establish more clear guidelines for the diagnosis, fracture risk stratification, and treatment of bone disease in CKD.

Which values should guide evidence-based practice?AMA Journal of Ethics; by Amber R. Comer; 1/25Prior to the emergence and availability of evidence-based reviews, physicians and patients made decisions based on anecdotal data, opinion, experience, judgment, conjecture, and conventional wisdom. In 1982, the first textbook describing the methodology of translating biomedical science into clinical practice, Clinical Epidemiology: The Essentials, set the stage for what would eventually become what we now call evidence-based medicine (EBM). EBM incorporates the best available scientific evidence when making decisions about an individual patient’s care. In the years since the adoption of EBM, it has become not only the clinical standard of care, but also an ethical expectation.

What the experiences of young persons can teach us about medical aid in dying for psychiatric illnessJAMA Psychiatry; Brent Kious, MD, PhD; 1/25Medical aid in dying (MAID) is becoming ever more available. While it is most often used by persons with terminal illnesses, it is also becoming more accessible to those with a primary psychiatric illness. Some countries, including the Netherlands, have long allowed MAID for persons experiencing unbearable and irremediable suffering due to a mental illness. In Canada, Quebec’s Superior Court ruled in 2019 that restricting MAID to persons with a “reasonable foreseeable natural death” violates key sections of the Canadian Charter, implying that MAID must be made available to persons with nonterminal conditions, including psychiatric illness. Meanwhile, while only persons with terminal illness can access MAID in those parts of the US that have legalized it, some physicians have argued that certain psychiatric illnesses, especially anorexia nervosa, can be terminal, opening the door to MAID for persons with a primary psychiatric illness. 

Physician engagement in addressing health-related social needs and burnoutJAMA Network Open; Masami Tabata-Kelly, MBA, MA; Xiaochu Hu, PhD; Michael J. Dill, MA; Philip M. Alberti, PhD; Karen Bullock, PhD, LICSW, APHSW-C; William Crown, PhD; Malika Fair, MD, MPH; Peter May, PhD; Pilar Ortega, MD; Jennifer Perloff, PhD; 12/24In this cross-sectional study of 5,447 nationally representative physicians in the US, 34.3% regularly dedicated time to addressing HRSNs [health-related social needs]. The study identified variability in physicians’ engagement in addressing HRSNs and found that higher engagement was associated with a greater likelihood of burnout. The findings suggest the need for thorough assessment of the potential unintended consequences of physicians’ engagement in addressing HRSNs on their well-being.

Cancer prevention, screening averted several million more deaths than treatment over 45 yearsJAMA; Samantha Anderer; 1/25In the US, cancer prevention and screening have saved more lives from 5 types of cancer combined than treatment advances over the past 45 years, according to a modeling study published in JAMA Oncology. An estimated 5.9 million breast, cervical, colorectal, lung, and prostate cancer deaths were avoided from 1975 to 2020 due to prevention, screening, and treatment efforts, but prevention and screening alone were responsible for averting about 4.8 million—4 out of 5—of those deaths. Still, the authors acknowledged that in all cancer types studied, less than half of total cancer deaths were averted, and they recommended increased investment in prevention and screening strategies.

Re-imagining childhood grief: Children as active agents in a transactional processOmega-Journal of Death and Dying; Ceilidh Eaton Russell, Meg Chin, Georg Bollig, Cheryl-Anne Cait, Franco A. Carnevale, Jody Chrastek, Bianca Lavorgna, Catriona Macpherson, Stacy S. Remke, Lies Scaut, Jane Skeen, Regina Szylit, Camara van Breemen, Ronit Shalev; 12/24While undoubtedly, the death of a parent or sibling causes considerable distress for children, the transactional model argues that an individual’s ability to adapt to challenges and problems arises from the transactions - interactions - that occur between them and their environment (Sameroff, 2009). After a loss, it is critical to be aware of the fact that children do grieve, that they impact and are impacted by those around them, reflecting influences on their social environments at any and every age. Their impressions, the feedback they receive, the messages they interpret about what is and is not deemed acceptable by those around them, can have immediate and life-long influences on their thoughts, behaviours, emotional and physical wellbeing. We propose that rather than placing the burden solely on children to seek support, adults have responsibilities to engage in a collaborative process whereby children have opportunities to express their interests and needs.