Literature Review

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.

Implementation and outcomes of a dementia-friendly training program in five hospitalsGeriatric Nursing; Ellen Roberts, Ellen C Schneider, Maureen Dale, Cristine B Henage, Casey J Kelley, Jan Busby-Whitehead; 10/24Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased ... Conclusions: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

The prevalence of lifetime trauma and association with physical and psychosocial health among adults at the end of lifeJournal of the American Geriatics Society; by Kate A. Duchowny, Alexander K. Smith, Irena Cenzer, Chelsea Brown, Grace Noppert, Kristine Yaffe, Amy L. Byers, Carla Perissinotto, Ashwin A. Kotwal; 10/24National guidelines recognize lifetime trauma as relevant to clinical care for adults nearing the end of life. We determined the prevalence of early life and cumulative trauma among persons at the end of life by gender and birth cohort, and the association of lifetime trauma with end-of-life physical, mental, and social well-being. Older adults in the last years of life report a high prevalence of lifetime traumatic events which are associated with worse end-of-life physical and psychosocial health. A trauma-informed approach to end-of-life care and management of physical and psychosocial needs may improve a patient's quality of life.

Feasibility of a digital palliative care intervention (Convoy-Pal) for older adults with heart failure and multiple chronic conditions and their caregivers: a waitlist randomized control trialBMC Palliative Care; by Lyndsay DeGroot, Riley Gillette, Jennifer Paola Villalobos, Geoffrey Harger, Dylan Thomas Doyle, Sheana Bull, David B Bekelman, Rebecca Boxer, Jean S Kutner, Jennifer D Portz; 10/24Although older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers. Recruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users.

Data points to need for trauma-centered care at end of lifeMcKnight's Long-Term Care News; by Kristen Fischer; 10/2/24A new study has found that early life and cumulative trauma are linked to poorer physical and psychosocial health at the end of life. The report was published Tuesday in the Journal of the American Geriatrics Society. Among participants, 19% reported no trauma, while 47% experienced one to two traumatic events and 25% had three to four traumatic events. A total of 9% of people reported more than five traumatic events in their lives. “Findings highlight the need for clinicians caring for seriously ill older adults to ensure interdisciplinary care for trauma symptoms and potentially adopting a trauma-informed approach to end-of-life care,” the authors wrote.

[Germany] Impacts of clinical decision support systems on the relationship, communication, and shared decision-making between health care professionals and patients: Multistakeholder interview studyJournal of Medical Internet Research; Florian Funer, Diana Schneider, Nils B Heyen, Heike Aichinger, Andrea Diana Klausen, Sara Tinnemeyer, Wenke Liedtke, Sabine Salloch, Tanja Bratan; 8/24Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional-patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship.

Utilization of inpatient palliative care services in cardiac arrest complicating acute pulmonary embolismResuscitation Plus; by Aryan Mehta, Mridul Bansal, Chirag Mehta, Ashwin A Pillai, Salman Allana, Jacob C Jentzer, Corey E Ventetuolo, J Dawn Abbott, Saraschandra Vallabhajosyula; 9/24The role of palliative care services in patients with cardiac arrest complicating acute pulmonary embolism has been infrequently studied. Palliative care services are used in only 16.8 % of admissions with cardiac arrest complicating pulmonary embolism with significant differences in the populations, suggestive of selective consultation.

Screening familial risk for hereditary breast and ovarian cancerJAMA Network; by Daniel Kiser, Gai Elhanan, Alexandre Bolze, Iva Neveux, Karen A Schlauch, William J Metcalf, Elizabeth T Cirulli, Catherine McCarthy, Leslie A Greenberg, Savanna Grime, Jamie M Schnell Blitstein, William Plauth, Joseph J Grzymski; 9/25/24In a large health system, how many ungenotyped patients meet family history genetic testing criteria for hereditary breast and ovarian cancer? In this cross-sectional analysis, 2.9% of patients had no evidence of prior genetic testing but had electronic health records indicating they met family history criteria. These criteria were associated with significantly increased prevalence of genetic risk variants among 38 003 genotyped patients. These findings suggest that substantial gaps exist in identifying and testing patients meeting family history criteria for hereditary breast and ovarian cancer, and other methods may be needed to close these gaps.

Using AI and social media to understand health disparities for transgender cancer careJAMA Network Open; Augustine Annan, PhD; Yeran Li, PhD; Jingcheng Du, PhD; Yezhou Sun, MS; A. I. Asante-Facey, MD; Xiaoyan Wang, PhD; Matthew Monberg, PhD; 8/24Transgender individuals experience lower health care use and higher health care discrimination rates. This qualitative study revealed 3 barriers in transgender cancer care: lack of awareness, access issues, and clinical challenges. The consistent reporting of clinical challenges indicates the need for tailored medical guidelines and gender-affirming support systems. Addressing these disparities requires enhanced clinician education, evidence-based guidelines, policy reforms, and inclusive health coverage. Despite potential biases and limitations in the representativeness of social media data, this study may offer valuable insights to guide future initiatives toward achieving equitable health care for transgender individuals.