Literature Review

Person-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD3; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.

Leading causes of death in the US, 2019-2023JAMA Network; by Farida B. Ahmad, Jodi A. Cisewski, Robert N. Anderson; 8/8/24The annual mortality burden, the causes of mortality, and the changes over time are key indicators of population change. In the US, mortality statistics are derived from death certificate data from the National Center for Health Statistics National Vital Statistics System. These data provide both the annual mortality burden in numbers and by cause of death. Herein, we summarize the key findings from the newly released report from the National Center for Health Statistics on the leading causes of death in the US from 2019 to 2023. [Top 10 leading causes of death in 2023, which are trended over the past five years, include: heart disease, cancer, unintentional injuries / COVID-19, chronic lower respiratory diseases, stroke, Alzheimer disease, diabetes, kidney disease, influenza and pneumonia, and suicide.]

Perspectives on artificial intelligence–generated responses to patient messagesJAMA Network Open; Jiyeong Kim, PhD, MPH; Michael L. Chen, BA; Shawheen J. Rezaei, MPhil; April S. Liang, MD; Susan M. Seav, MD; Sonia Onyeka, MD; Julie J. Lee, MD, MPH; Shivam C. Vedak, MD, MBA; David Mui, MD, MBA; Rayhan A. Lal, MD; Michael A. Pfeffer, MD; Christopher Sharp, MD; Natalie M. Pageler, MD, MEd; Steven M. Asch, MD, MPH; Eleni Linos, MD, DrPH; 10/24Generative artificial intelligence (AI) has the potential to assist clinicians in responding to patients’ messages. Satisfaction was consistently higher with AI-generated responses than with clinicians overall and by specialty. However, satisfaction was not necessarily concordant with the clinician-determined information quality and empathy. For example, satisfaction was highest with AI responses to cardiology questions while information quality and empathy were highest in endocrinology questions. Interestingly, clinicians’ response length was associated with satisfaction while AI’s response length was not. The findings suggest that the extreme brevity of responses could be a factor that lowers satisfaction in patient-clinician communication in EHR.

"Hospice Care Could Be a Compassionate Choice": ChatGPT Responses to Questions About Decision Making in Advanced CancerJournal of Palliative Medicine; by Meghan McDarby, Emily L Mroz, Jessica Hahne, Charlotte D Malling, Brian D Carpenter, Patricia A Parker; 9/24Objective: To examine the content of ChatGPT responses to a hypothetical patient question about decision making in advanced cancer... ChatGPT responses (N= 96) were coded for mentions of: hospice care, palliative care, financial implications of treatment, second opinions, clinical trials, discussing the decision with loved ones, and discussing the decision with care providers... Responses more frequently mentioned clinical trials for vignettes describing 45-year-old patients compared with 65- and 85-year-old patients. When vignettes mentioned a preexisting recommendation for hospice, responses more frequently mentioned seeking a second opinion and hospice care... ChatGPT responses to questions about advanced cancer decision making can be heterogeneous based on demographic and clinical characteristics. Findings underscore the possible impact of this heterogeneity on treatment decision making in patients with cancer.

Roles of pediatric surgeons in palliative pediatric oncologyPediatric Blood and Cancer; by Hau D Le, Sarah Braungart, Jaime Shalkow-Klincovstein, Nelson Piché; 10/24Pediatric surgeons engaged in oncology will inevitably treat patients receiving palliative care, but their role in this context is poorly described. This article identifies some of the challenges and opportunities of surgical involvement in pediatric oncology palliative care, underscoring how the surgeon's expertise can be exploited to significantly benefit children with cancer. Specific examples of skills (procedural, communication, and coordination) that surgeons can provide to the multidisciplinary palliative care teams are described and the importance of collaboration is highlighted.

Tailoring hospice care to the Veteran populationAmerican Journal of Hospice and Palliative Medicine; by Curtis G Kommer, Autumn Nadolny; 10/24United States Military Veterans are an increasingly elderly population, and more and more veterans are choosing hospice care at the end of life. These veterans, particularly if they served in combat, can bring unique management challenges and opportunities to a hospice team. This review highlights the physical and psychosocial traumas experienced by many veterans, and discusses how these issues can affect their hospice care. Traumatic injury-related issues such as chronic pain, neuropathic pain, insomnia, and chronic headaches can worsen for veterans at the end of life, and the psychological sequelae of these traumatic events such as Post-Traumatic Stress Disorder (PTSD), Chronic Anxiety, Substance Abuse, and increased risk of suicide can also be magnified during this time.

Clinician perspectives on palliative care for older adults with serious mental illnesses: A multisite qualitative studyThe American Journal of Geriatric Psychiatry; by Daniel Shalev, Maureen Ekwebelem, Lilla Brody, Karolina Sadowska, Sanam Bhatia, Dania Alvarez, Catherine Riffin, M Carrington Reid; 9/24Approximately 5.5% of the population live with serious mental illnesses (SMI). Older adults with SMI experience a high burden of serious medical illnesses and disparities in advance care planning, symptom management, and caregiver support. The objectives of this study are to explore interdisciplinary clinician perspectives on the palliative care needs of older adults with SMI and serious medical illnesses... Major themes identified were: (1) Current paradigms of palliative care do not meet the needs of patients with SMI; (2) Clinicians are motivated to care for this population but require more training and interdisciplinary practice; (3) There is a need for structural integration of psychiatric and palliative care services. The study underscores the inadequacy of current palliative care models in meeting the unique needs of older adults with SMI. Models of integrated psychiatric and serious illness care and enhanced training are needed to improve the delivery of palliative care. Integrated care models and workforce development at the interface of serious illness care and psychiatric have the potential to improve outcomes for this vulnerable population.

[Netherlands] The spiritual dimension of parents' experiences caring for a seriously ill child: An interview studyJournal of Pain and Symptom Management; by Marije A Brouwer, Marijanne Engel, Saskia C C M Teunissen, Carlo Leget, Marijke C Kars; 10/24The spiritual dimension plays a central role in the experiences of parents who care for children with life-threatening conditions, but they receive little support in this dimension, and care needs often go unnoticed. If we want to provide high-quality pediatric palliative care including adequate spiritual support for parents, we should focus on the wide range of their spiritual experiences, and provide support that focuses both on loss of meaning as well as on where parents find growth, joy or meaning.

[UK] Symptom management for people with advanced dementia who are receiving end of life careCurrent Opinion in Supportive and Palliative Care; Maria Drummond , Bridget Johnston; 10/24Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

Research synthesis related to oncology family caregiver spirituality in palliative care Journal of Palliative Medicine; by Betty R. Ferrell, Tami Borneman, Marianna Koczywas, and Paul Galchutt;  10/21/24 online ahead of print Family caregivers are central to the delivery of serious illness care and also have needs related to their role and experience. One aspect of the family caregiver quality of life (QOL) that has received less attention is caregiver spirituality. The research objectives for this analysis were (1) Describe spirituality in oncology family caregivers. (2) Determine the impact of palliative care interventions on spirituality and related variables in oncology family caregivers. (3) Describe findings from the research literature related to spirituality in family caregivers. The authors include two nurse researchers (BF, TB) and a physician (MK) who conducted these studies and a board-certified chaplain (PG) who contributed his expertise in chaplaincy.  ... The authors' research synthesis and the literature support the importance of additional research and clinical focus in family caregiver spirituality in serious illness care. 

[Canada] Aerobic physical activity and depression among patients with cancer-A systematic review and meta-analysisJAMA Network Open; Matthew Kulchycki, MD; Henry Ratul Halder, MSc; Nicole Askin, MLIS; Rasheda Rabbani, PhD; Fiona Schulte, PhD; Maya M. Jeyaraman, MD; Lillian Sung, MD, PhD; Deepak Louis, MD; Lisa Lix, PhD; Allan Garland, MD, MA; Alyson L. Mahar, PhD; Ahmed Abou-Setta, PhD; Sapna Oberoi, MD, MSc; 10/24A cancer diagnosis increases the risk of anxiety, depression, and emotional distress among patients. Depression prevalence among patients with cancer ranges from 13% to 27%, which is 2 to 3 times higher than the general population. In this systematic review and meta-analysis, APA [aerobic physical activity]was associated with modest short-term and long-term reductions of depression among adults with cancer. Future studies should discern the effectiveness of APA in combination with other strategies for managing depression across various populations of patients with cancer.

Effectiveness of a mobile app (Meds@HOME) to improve medication safety for children with medical complexity: Protocol for a randomized controlled trialJMIR Research Protocols; Nicole E Werner, Makenzie Morgen, Sophie Kooiman, Anna Jolliff, Gemma Warner, James Feinstein, Michelle Chui, Barbara Katz, Brittany Storhoff, Kristan Sodergren, Ryan Coller; 9/24The Meds@HOME mobile app provides a promising strategy for improving PCG [primary caregiver] medication safety for CMC [children with medical complexity] who take high-risk medications. In addition, this protocol highlights novel procedures for recruiting SCGs [secondary caregivers] of CMC. In the future, this app could be used more broadly across diverse caregiving networks to navigate complex medication routines and promote medication safety.

Racial differences in pain assessment and false beliefs about race in AI modelsJAMA Network Open; Brototo Deb, MD, MIDS; Adam Rodman, MD, MPH; 10/24Physicians undertreat Black patients’ pain compared with White patients, irrespective of setting and type of pain, likely from underassessment of pain and undertreatment of pain on recognition. Large language models (LLMs) encode racial and ethnic biases and may perpetuate race and ethnicity–based medicine. Although LLMs rate pain similarly between races and ethnicities, they underestimate pain among Black individuals in the presence of false beliefs. Given LLMs’ significant abilities in assisting with clinical reasoning, as well as a human tendency toward automation bias, these biases could propagate race and ethnicity–based medicine and the undertreatment of pain in Black patients. Mitigating these biases involves many strategies during dataset preparation, training, and posttraining stages.