Literature Review

"Grief explodes all relationships": Experiences of grief and coping among parents and siblings following the death of a childOmega (Westport); by Katy A Tenhulzen, Amy M Claridge, Abigail McCarthy, Meredith Craven, Libby Faith McClendon; 10/24The death of a child is an intense loss for families, which impacts the wellbeing of parents, surviving siblings, and the family as a whole. This study expanded on existing literature by collecting qualitative accounts from bereaved parents and siblings about their experiences before, during, and after the death of a child in their family... Findings highlighted three periods of the grieving process, which were not linear but rather ongoing and often happening simultaneously: (1) Crisis; (2) Learning to cope; and (3) Establishment of a new equilibrium... Findings have implications for palliative care and bereavement professionals in terms of supporting parent, sibling, and family coping before, during, and after the death of a child.

Beyond infection: Mortality and end-of-life care associated with infectious disease consultation in an academic health systemClinical Infectious Diseases; by Alison G. C. Smith, Michael E. Yarrington, Rasha Raslan, Wil L. Santivasi, Arthur W. Baker, Nicholas A. Turner, Gary M. Cox, Kristen V. Dicks, John J. Engemann, Patricia Kohler, Ahmad Mourad, Rebekah H. Wrenn, Sofia Zavala, Jason E. Stout; 10/24Infectious diseases (ID) physicians are increasingly faced with the challenge of caring for patients with terminal illnesses or incurable infections. This was a retrospective cohort of all patients with an ID consult within an academic health system from 1 January 2014 through 31 December 2023, including community, general, and transplant ID consult services. There were 60,820 inpatient ID consults involving 37,848 unique patients... In total, [2898] 7.5% of patients receiving an ID consult died during admission and 1006 (2.6%) of patients were discharged to hospice... In total 2866 (7.6%) of all patients receiving ID consultation also received palliative care consultation during the same hospitalization... Patients receiving ID consultation were increasingly complex and more likely to die soon after consultation. These results provide a framework for ID clinicians to consider their role in end-of-life care.Publisher's note: How often does your hospice work with infectious disease physicians and patients?

A comprehensive perspective on educational and economic barriers for utilization of palliative radiation therapy in hospice: A narrative reviewAdvances in Radiation Oncology; by Sarah J Hendee, Kareem Fakhoury, Sana D Karam; 10/24Despite the agreed-on efficacy and benefits of palliative radiation therapy (PRT) to alleviate end-of-life complications related to cancer progression, PRT remains an underused treatment in the hospice-care setting. Common barriers for hospice patient use of PRT include educational and economic limitations. This paper discussed these barriers and ways to eliminate them based on previously published interventions.

Mortality and function after widowhood among older adults with dementia, cancer, or organ failureJAMA Network Open; Rebecca Rodin, MD, MSc; Alexander K. Smith, MD, MS, MPH; Edie Espejo, MPH; Siqi Gan, MPH; W. John Boscardin, PhD; Lauren J. Hunt, PhD, RN; Katherine A. Ornstein, PhD, MPH; R. Sean Morrison, MD; 9/24In this cohort study including 13,824 participants in the Health and Retirement Study, widowhood was associated with functional decline and increased 1-year mortality in functionally impaired older adults with dementia and cancer. The study findings suggest that older adults with functional impairment and cancer or dementia are at risk of adverse outcomes following widowhood, including functional decline and a marked elevation in the risk of death, in the year after widowhood.

Patterns of migration following dementia diagnosisJAMA Network Open; Momotazur Rahman, PhD; Bishnu Bahadur Thapa, PhD; Christopher Santostefano, MPH, RN; Pedro Gozalo, PhD; Ulrike Muench, RN, PhD; Cyrus M. Kosar, PhD; Hyesung Oh, PhD; Elizabeth White, APRN, PhD; Vincent Mor, PhD; 10/24In this cohort study of more than 1 million Medicare fee-for-service beneficiaries, individuals with a diagnosis of dementia were almost twice as likely to migrate to another county or state compared with those with diagnoses of myocardial infarction, chronic obstructive pulmonary disease, or colon cancer. Of the excess migrations resulting from dementia diagnosis, 55% occurred in community settings, and 45% occurred in institutional settings. The marked increase in migration among patients following a dementia diagnosis highlights a distinctive need for policy and support interventions tailored to their unique migration patterns and care requirements.

Online plain language tool and health information quality-A randomized clinical trialJAMA Network Open; Julie Ayre, PhD; Carissa Bonner, PhD; Danielle M. Muscat, PhD; Erin Cvejic, PhD; Olivia Mac, MPH; Dana Mouwad, MHSc (Nsg); Heather L. Shepherd, PhD; Parisa Aslani, PhD; Adam G. Dunn, PhD; Kirsten J. McCaffery, PhD; 10/24National and international policies recognize that health literacy—a person’s capacity to access, understand, and act on health information—is a critical source of inequity in our health systems. Low health literacy contributes to higher mortality, morbidity, rates of hospitalization, emergency department visits, and medication errors independently of other social determinants of health, such as age, education, and socioeconomic disadvantage. In this randomized clinical trial, the Health Literacy Editor helped users simplify health information and apply health literacy guidelines to written text. The findings suggest the tool has high potential to improve development of health information for people who have low health literacy.

Ethical considerations in the design and conduct of clinical trials of artificial intelligenceJAMA Network Open; Alaa Youssef, PhD; Ariadne A. Nichol, BA; Nicole Martinez-Martin, JD, PhD; David B. Larson, MD, MBA; Michael Abramoff, MD, PhD; Risa M. Wolf, MD; Danton Char, MD, MS; 9/24In this qualitative study, interviews with 11 investigators involved in clinical trials of AI [artificial intelligence] for diabetic retinopathy screening confirmed the applicability of current ethical principles but also identified unique challenges, including assessing social value, ensuring scientific validity, fair participant selection, evaluation of risk-to-benefit ratio in underrepresented groups, and navigating complex consent processes. These results suggest ethical challenges unique to clinical trials of AI, which may provide important guidance for empirical and normative ethical efforts to enhance the conduct of AI clinical trials. These considerations call for further guidance on where to focus empirical and normative ethical efforts to best support conduct clinical trials of AI and minimize unintended harm to trial participants.

Physician altruism and spending, hospital admissions, and emergency department visitsJAMA Health Forum; Lawrence P. Casalino, MD, PhD; Shachar Kariv, PhD; Daniel Markovits, JD, DPhil; Raymond Fisman, PhD; 10/24This cross-sectional study found that Medicare patients treated by altruistic physicians had fewer potentially preventable hospitalizations and emergency department visits and lower spending. Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures, and cultures that may increase, or at least do not decrease, physician altruism. Further research should seek to identify these and other modifiable factors, such as physician selection and training, that may shape physician altruism. Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience.

Applying a health equity lens to better understand end-of-life prognosticationAMA Journal of Ethics; by Newsha Nikzad, Joelle Robertson-Preidler, Faith E. Fletcher; 10/24Racial and ethnic inequity exists throughout the lifespan, including at the end of life (EOL). Although prognostication is inherently fraught with uncertainty, many underrepresented minorities get prognoses that are overly optimistic, which can exacerbate inequity by depriving patients of details needed to make informed decisions and plan for EOL care. This article applies a health equity lens to facilitate better ethical and clinical understandings of how to care for patients of color more equitably at the EOL.

Home health care and place of death in Medicare beneficiaries with and without dementiaGerontologist; Hyosin Dawn Kim , Paul R Duberstein, Anum Zafar, Bei Wu, Haiqun Lin , Olga F Jarrín; 11/24Home health care supports patient goals for aging in place. Use of home health care during the last 3 years of life was associated with reduced rates of inpatient death without hospice, and increased rates of home death with hospice. Increasing affordable access to home health care can positively affect end-of-life care outcomes for older Americans and their family caregivers, especially those with dementia.

Socioeconomic trends in palliative care: A six-year studyCureus; by Andrej Sodoma, Muhammad Wahdan Naseeb,Samuel Greenberg, Nicholas J. Knott, Jonathan Arias, Argirios Skulikidis, Mary Makaryus; 10/24Our study investigates trends in PC utilization, focusing on socioeconomic characteristics. The National Inpatient Sample (NIS) from 2015 to 2020 was used to identify adults hospitalized in the United States (US). International Classification of Diseases, Tenth Revision (ICD-10), was used for PC encounters, code Z51.5. An equal number of random records, stratified by year and without this code, were selected to serve as controls [5.2M visits]. Men were more likely to receive PC consults. Medicare/Medicaid holders’ PC access was limited compared to private insurance holders. Racial minorities, particularly Hispanics and Blacks, were less likely to engage in PC. Compared to urban teaching hospitals, rural hospitals had a decreased rate of PC utilization. Smaller hospitals had significantly fewer PC referrals than large hospitals. A lower socioeconomic status was associated with a reduced propensity to utilize PC services compared to an upper socioeconomic status.

A quality improvement initiative for inpatient advance care planningJAMA Health Forum; Olivia A Sacks, Megan Murphy, James O'Malley, Nancy Birkmeyer, Amber E Barnato; 10/24The Centers for Medicare & Medicaid Services (CMS) implemented advance care planning (ACP) billing codes in 2016 to encourage practitioners to conduct and document ACP conversations, and included ACP as a quality metric in the CMS Bundled Payments for Care Improvement Initiative in 2018. Increased ACP billing rates were significantly associated with decreased rates of inpatient death in the intervention group ... compared to the nonintervention ... and control groups ... Conclusions and relevance: This nationwide cohort study suggests that while the ACP quality initiative increased ACP billing, changes in clinical outcomes were inconsistent with the hypotheses.

Socioeconomic status and major adverse transplant events in pediatric heart transplant recipientsJAMA Network Open; Christina Hartje-Dunn, MD; Kimberlee Gauvreau, ScD; Heather Bastardi, PNP; Kevin P. Daly, MD; Elizabeth D. Blume, MD; Tajinder P. Singh, MD, MSc; 10/24In this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.