Literature Review

Challenges and coping strategies in transitioning from caregiving to widowhood: A systematic reviewResearch in Aging; by Abby Baumbach, M Courtney Hughes, Yujun Liu; 5/24Ninety-one percent of surviving spouses in the U.S. cared for their spouses before they died. This review explores the challenges of the transition from caregiving to widowhood and different coping strategies used by widowed spousal caregivers... Challenges for widowed caregivers included experiencing care burden, letting go of the caregiver role, grief, and triggers. Widowed caregivers' coping strategies included social support and services use, filling the time gap, finding spirituality, and engaging in unhealthy behaviors. Future research is needed to determine the efficacy of widowed caregivers' coping strategies.

Understanding deep disadvantage at the end of life: A nationwide analysis of unclaimed deaths Social Science and Medicine; by Jennifer Bridte DrPH, Frank Heiland, PhD, and Deborah Balk PhD; 11/25/24 This is the first systematic examination of unclaimed deaths at the county level and offers a novel way to understand marginalized populations, such as the unhoused and others living in extreme social or economic deprivation. Unclaimed death rates may also provide an objective measure of social support that can be measured over time. ... This is of public health importance because unclaimed death can be seen as a negative health outcome that may be the result of cumulative disadvantage over the life course. ... Highlights:

Goals of surgical interventions in youths receiving palliative careJAMA Network Open; Danielle I. Ellis, MD, MTS; Li Chen, MS; Samara Gordon Wexler, BA; Madeline Avery, MPH; Tommy D. Kim, MD; Amy J. Kaplan, BS; Emanuele Mazzola, PhD; Cassandra Kelleher, MD; Joanne Wolfe, MD, MPH; 11/24In this cohort study of 197 youths receiving palliative care, interventions were performed with goals of helping youths feel better and live longer and for the purposes of diagnosis, cure and repair, and assistive technology more so than for symptom support or as a temporizing measure. Youths with more acute illnesses underwent the most curative and repair interventions (particularly in the early postdiagnosis period), whereas those with more chronic illnesses underwent most of the supportive interventions. These findings suggest that conversations using the proposed framework concerning goals and purposes of surgical intervention may facilitate goal-concordant, high-quality care for youths with serious illness.

Analysis of mortality causes and locations in veterans with ALS: A decade reviewMedical Science Monitor; Meheroz H Rabadi, Kimberly A Russell, Chao Xu; 11/24Amyotrophic lateral sclerosis (ALS) is a motor neuron disease that leads to rapid degeneration of nerves in the brain and spinal cord, with eventual loss of voluntary movements, including breathing. This retrospective study of medical record data from 105 US veterans diagnosed with ALS at the Oklahoma City VA Medical Center between 2010 and 2021 aimed to identify patient demographics, and the causes and places of death for these veterans. This study's findings are that in veterans with ALS, the main cause of death is respiratory disease (failure). The main location of death was the home, with their family members. The all-cause mortality rate among veterans with ALS was 26 times greater than for the general Oklahoma population.

Nurse burnout and patient safety, satisfaction, and quality of care-A systematic review and meta-analysisJAMA Network Open; Lambert Zixin Li, MPhil; Peilin Yang, BS; Sara J. Singer, PhD, MBA; Jeffrey Pfeffer, PhD; Maya B. Mathur, PhD; Tait Shanafelt, MD; 11/24Occupational burnout syndrome is characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment and is prevalent among nurses. In this systematic review and meta-analysis of 85 studies including 288,581 nurses, nurse burnout was associated with a lower patient safety climate and patient safety grade; more nosocomial infections, patient falls, medication errors, and adverse events; lower patient satisfaction ratings; and lower nurse-assessed quality of care. The associations were consistent across nurse age, sex, work experience, and geography. These findings suggest that systems-level interventions for nurse burnout may improve patient outcomes.

Caregiver policies in the United States: A systematic reviewJournal of Public Health Policy; By Makenna R Green, M Courtney Hughes, Sadia Afrin, Erin VernonIn the United States, there are nearly 53 million informal or unpaid caregivers, many of whom experience mental and physical stress related to their caregiving duties and increased financial responsibility. We identified federal and state informal caregiver support policies authorized by specific legislation along with their key provisions and conducted a systematic review of the academic literature related to quantitative evaluations of these policies... Increased legislation to support informal caregivers may be warranted. The limited academic research examining existing caregiver policies identifies mixed outcomes for caregivers. Prioritizing vulnerable populations in such policy research examining outcomes could help improve caregiver support efforts.

Always Politically Correct: Supporting Seriously Ill Older Populations and Their FamiliesJournal of Social Work in End-of-Life & Palliative Care; M. Courtney Hughes, Erin Vernon; 8/24We have been researching outcomes related to seriously ill individuals for over a decade, critically examining countless research articles from around the world, and extensively interviewing various stakeholders in this space, including hospital leaders, hospice leaders, lobbyists, nurses, social workers, and informal caregivers... In a world with so many dividing issues, increasing support for these vulnerable groups needing more attention should stand above the fray and become something that all leaders of any political party should support.Publisher's note: Thank you Courtney and Erin, well said.

Guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults-A WikiGuidelines group consensus statementJAMA Network Open; Zachary Nelson, PharmD, MPH; Abdullah Tarık Aslan, MD; Nathan P. Beahm, PharmD; Michelle Blyth, MD, MSPH; Matthew Cappiello, MD; Danielle Casaus, PharmD; Fernando Dominguez, MD; Susan Egbert, PharmD; Alexandra Hanretty, PharmD; Tina Khadem, PharmD; Katie Olney, PharmD; Ahmed Abdul-Azim, MD; Gloria Aggrey, MD; Daniel T. Anderson, PharmD; Mariana Barosa, MD, MSc; Michael Bosco, PharmD; Elias B. Chahine, PharmD; Souradeep Chowdhury, MBBS; Alyssa Christensen, PharmD; Daniela de Lima Corvino, MD; Margaret Fitzpatrick, MD, MS; Molly Fleece, MD; Brent Footer, PharmD; Emily Fox, PharmD; Bassam Ghanem, PharmD, MS; Fergus Hamilton, MRCP, PhD; Justin Hayes, MD, MPH; Boris Jegorovic, MD, PhD; Philipp Jent, MD; Rodolfo Norberto Jimenez-Juarez, MD; Annie Joseph, MBBS; Minji Kang, MD; Geena Kludjian, PharmD; Sarah Kurz, MD; Rachael A. Lee, MD, MSPH; Todd C. Lee, MD, MPH; Timothy Li, MBChB; Alberto Enrico Maraolo, MD, MSc; Mira Maximos, PharmD, MSc, ACPR; Emily G. McDonald, MD, MSc; Dhara Mehta, PharmD; Justin William Moore, PharmD, MS; Cynthia T. Nguyen, PharmD; Cihan Papan, MD; Akshatha Ravindra, MD; Brad Spellberg, MD; Robert Taylor, PhD; Alexis Thumann, PharmD; Steven Y. C. Tong, MBBS (Hons), PhD; Michael Veve, PharmD, MPH; James Wilson, DO; Arsheena Yassin, PharmD; Veronica Zafonte, PharmD; Alfredo J. Mena Lora, MD; 11/24Urinary tract infections (UTIs) are among the most common infections globally, notably impacting patient quality of life and posing substantial clinical and economic challenges. In this third WikiGuidelines consensus statement, we provide an evidence-based approach to UTI management developed by a global network of experts for practical use across diverse clinical settings. This guideline fills a critical gap by providing pragmatic, broadly applicable recommendations tailored for generalist care and systems-based practice. Our guidance is rooted in the best available evidence and is designed for clinicians from various backgrounds and health care environments. It emphasizes a patient-centered approach to the diagnosis, prevention and treatment of UTIs and related genitourinary infections.

Differences in drug shortages in the US and CanadaJAMA; Mina Tadrous, PharmD, PhD; Katherine Callaway Kim, MPH; Inmaculada Hernandez, PharmD, PhD; Scott D. Rothenberger, PhD; Joshua W. Devine, PharmD, PhD; Tina B. Hershey, JD, MPH; Lisa M. Maillart, PhD; Walid F. Gellad, MD, MPH; Katie J. Suda, PharmD, MS; 10/24There are persistent global drug shortages, in part because drug-related supply chains are increasingly globalized; these drug shortages are associated with delayed or missed treatment and adverse outcomes. In addition, pandemics and natural disasters disrupt global drug production, further affecting supply chains. [In this study] drug-related reports of supply chain issues were 40% less likely to result in meaningful drug shortages in Canada compared with the US. These findings highlight the need for international cooperation between countries to curb the effects of drug shortages and improve resiliency of the supply chain for drugs.

Health professions students’ reflections about principles of interprofessional collaboration after shadowing interprofessional palliative care roundsAmerican Journal of Hospice and Palliative Medicine; Jeannette Kates, PhD, APRN, FPCN; Ceasia Brown, BA; Jenna Campolieto, BA; Maria Brucato, PhD; 10/24Future healthcare professionals are educated on collaborative practice methods through interventions that may include shadowing. While shadowing allows students to learn from and about other health professions, it often fails to offer an opportunity for the student to work and collaborate with other health professionals. These results suggest that shadowing offers an opportunity to identify and learn interprofessional competencies in interprofessional palliative care curricula, as made evident through student reflection assignments.

Willingness to be present throughout patient death via medical aid in dying in a national sample of interdisciplinary US hospice clinicians: a content analysis of rationalesPalliative Care and Social Practice; Todd D. Becker, Cindy L. Cain, John G. Cagle, Joan K. Davitt, Nancy Kusmaul, Paul Sacco; 10/24 The United States is one of a growing number of countries across Europe, North America, Oceania, and South America to have legalized what, domestically, is referred to as medical aid in dying (MAID). The objective of the current study was to explore attitudes toward presence throughout a patient’s death via MAID in hospice physicians, nurses, social workers, and chaplains. Participants who were willing to be present (n = 305 [74%]) attributed their willingness to personal support, definitions of quality clinical care, and values from their professional training. Those who were unwilling (n = 63 [15%]) noted personal objections to the concept of MAID, personal objections to MAID participation, and perceptions of MAID’s misalignment with healthcare. Hospice clinicians would benefit from greater professional guidance and support pertaining to MAID.

Facility- and community-level factors associated with hospice patient experiencePalliative and Supportive Care; by Mengying He, Ganisher Davlyatov, Gregory Orewa, Haiyan Qu, Robert Weech-Maldonado; 11/24For-profit and chain-affiliated hospices were negatively associated with CAHPS® scores. Organizational longevity and Medicare payer mix were positively associated with CAHPS® scores. Hospice community factors including competition, per capita income, and the racial/ethnic minorities' percentage were negatively associated with CAHPS® scores.

Artificial intelligence and machine learning in cancer pain: A systematic reviewJournal of Pain and Symptom Management; by Vivian Salama, Brandon Godinich, Yimin Geng, Laia Humbert-Vidan, Laura Maule, Kareem A Wahid, Mohamed A Naser, Renjie He, Abdallah S R Mohamed, Clifton D Fuller, Amy C Moreno; 12/24Forty four studies from 2006 to 2023 were included. Implementation of AI/ML tools promises significant advances in the classification, risk stratification, and management decisions for cancer pain. Further research focusing on quality improvement, model calibration, rigorous external clinical validation in real healthcare settings is imperative for ensuring its practical and reliable application in clinical practice.