Literature Review

Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysisJAMA Network Open; Rachel V. Aaron, PhD; Scott G. Ravyts, PhD; Nicolette D. Carnahan, PhD; Kavya Bhattiprolu, BS; Nicole Harte, MClinPsychol; Claire C. McCaulley, BA; Lauren Vitalicia; Alexandria B. Rogers, PhD; Stephen T. Wegener, PhD; Joanne Dudeney, PhD; 3/25Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development. 

Sarcopenia in terminally ill patients with cancer: Clinical implications, diagnostic challenges, and management strategies Journal of Hospice & Palliative Care; by Se-Il Go, Myoung Hee Kang, and Hoon-Gu Kim; 3/1/25 Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration.

[Canada] Use of feeding tubes among hospitalized older adults with dementiaJAMA Network Open; Anne-Marie Hartford, MSc; Wenshan Li, PhD; Danial Qureshi, MSc; Robert Talarico, MSc; Stephen G. Fung, MPH; Shirley H. Bush, MBBS; Genevieve Casey, MSc, MBBS; Sarina R. Isenberg, MA, PhD; Colleen Webber, PhD; Peter Tanuseputro, MHSc, MD; 2/25In this cohort study of hospitalized individuals with dementia, feeding tube insertion was not associated with improved survival or postdischarge outcomes. Being male or younger and having swallowing problems and greater functional impairments were associated with increased odds of feeding tube use, while having a do-not-resuscitate directive and living in rural settings were associated with reduced odds. Factors that were (or were not) associated with feeding tube placement were sometimes misaligned with best practice guidelines. Goals of care conversations, alternative intervention options, and improved clinical protocols are recommended. 

Understanding and addressing the US hospital bed shortage—Build, Baby, BuildJAMA Network Open; Alexander T. Janke, MD, MHS, MSc; Arjun K. Venkatesh, MD, MBA, MHS; 2/25In the study by Leuchter et al, they provide simple yet provocative projections for the future of hospital care. They project that national hospital occupancy will exceed 85% by 2032, a critical threshold where basic hospital operations can become dysfunctional and even unsafe. Leuchter et al begin to quantify the story already felt at the bedside in hospitals across the nation—namely, a trajectory toward inadequate supply of hospital care for the anticipated demand of the coming decade. US residents are older and more medically complex than ever. Technologically sophisticated surgical interventions and medical therapies have transformed the long-term survival rates for serious conditions, such as end-stage kidney disease, heart failure, and chronic obstructive lung disease. The US needs greater hospital bed capacity, particularly for critical care and complex care services.

Wealth disparities in end-of-life symptom burden among older adultsJAMA Network Open; Irena Cenzer, Kenneth E Covinsky, Sarah H Cross, Claire K Ankuda, Lauren J Hunt, Melissa D Aldridge, Krista L Harrison; 3/25This cohort study found that lower wealth was associated with a higher symptom burden at the end of life, mediated in part by higher rates of multimorbidity, functional impairment, and dementia. These findings highlight the need for policies and programs to support patients with lower financial resources to improve end-of-life experiences and mitigate wealth disparities. 

Palliative care nurse specialists' perspectives on spiritual care at end of life-A scoping reviewJournal of Hospice and Palliative Nursing; Bronagh Dunning, Michael Connolly, Fiona Timmins; 3/25The research demonstrates that specialist palliative care nurses perceive spiritual care as an important element of holistic care at end of life; however, these nurses also agree that spiritual care is lacking. This deficiency results from a lack of education in spirituality; experience of the nurse; the nurses' own spiritual and religious beliefs and values, fears, and difficulties in communication; and the nurse-patient relationship. The findings demonstrate the necessity to increase the level of spiritual care education in nurse programs, educating nurses on the provision of spiritual care, and how to deal with conflicts in spiritual and religious beliefs.

The analysis of hospice trends in the United States in 2020 among Medicare beneficiariesAmerican Journal of Hospice and Palliative Medicine; Noor Chughtai, BS; Cortland Brown, MS; Jordan Shelestak, MS; Jared Nichols, DO; 3/25 While hospice care has many benefits, there is variability among the service throughout the United States. Public hospice care data from data.cms.gov were analyzed to explore these trends. Findings indicate that Medicare beneficiaries in the South and West regions of the U.S. experience longer hospice stays, and in contrast, those in the Northeast and Midwest (including Alaska) reflected reduction from this average. Notably, states with shorter hospice durations showed a higher proportion of neoplastic disorders as the primary diagnosis, while those with longer stays showed an inverse relationship with greater prevalence of circulatory system disorders and lower incidence of neoplastic diagnoses. Additionally, the analysis reveals a consistent decline in average hospice length with increasing age among patients aged 80-85 across all U.S. regions, as expected.

[Canada] 'Getting everyone on the same page': Long-term-care nurses' experiences with advance care planningInternational Journal of Older People Nursing; Preetha Krishnan, Susan McClement, Genevieve Thompson, Marie Edwards, Philip St John; 3/25Ensuring comfort for LTC [long-term care] residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP [advance care planning] level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place. Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.

Tracking US health care spending by health condition and countyJAMA; Joseph L. Dieleman, PhD; Meera Beauchamp, BS; Sawyer W. Crosby, BA; Drew DeJarnatt, MS; Emily K. Johnson, MSc; Haley Lescinsky, MPH; Theresa McHugh, PhD; Ian Pollock, MLS; Maitreyi Sahu, MPH; Vivianne Swart, MPH; Kayla V. Taylor, MPH; Azalea Thomson, MPH; Golsum Tsakalos, MS; Maxwell Weil, MS; Lauren B. Wilner, MPH; Anthony L. Bui, MD, MPH; Herbert C. Duber, MD, MPH; Annie Haakenstad, ScD, MA; Bulat Idrisov, MD, MSc; Ali Mokdad, PhD; Mohsen Naghavi, MD, MPH, PhD; Gregory Roth, MD, MPH; John W. Scott, MD, MPH; Tara Templin, PhD, MS; Christopher J. L. Murray, DPhil, MD; 2/25Health care spending in the US totaled $3.8 trillion in 2019 and is projected to reach more than $7 trillion by 2031. Within the US, spending varies dramatically across states, although many key drivers of health care spending, such as access to care, service prices, disease and injury prevalence, and underlying need for health care, vary at more local levels. Broad variation in health care spending was observed across US counties. Understanding this variation by health condition, sex, age, type of care, and payer is valuable for identifying outliers, highlighting inequalities, and assessing health care gaps.

An opportunity to advance cannabis science—DEA reschedulingJAMA Psychiatry; Kevin P. Hill, MD, MHS; Anshul V. Puli, BS; 2/25In 1970, the US Congress enacted the Controlled Substances Act (CSA), establishing a scheduling system for drugs based on their medical use, abuse potential, and safety. The most restrictive classification is Schedule I; cannabis along with other drugs, such as heroin and lysergic acid diethylamide (LSD), have this classification. May 13, 2024, the Drug Enforcement Agency (DEA), the agency regulating substance scheduling, issued a Notice of Proposed Rulemaking to investigate rescheduling cannabis from Schedule I to Schedule III. This was due to a recommendation from the US Department of Health and Human Services (HHS) to reschedule based on its review of the medical and scientific cannabis research. Still, the FDA investigated HHS’ CAMU [cannabis’ current accepted medical use] claim and found some credible scientific support for treating “anorexia related to a medical condition, nausea and vomiting (eg, chemotherapy-induced), and pain.”

Algorithm-based palliative care in patients with cancer-A cluster randomized clinical trialJAMA Network Open; Ravi B. Parikh, MD, MPP; William J. Ferrell, MPH; Yang Li, MS; Jinbo Chen, PhD; Larry Bilbrey; Nicole Johnson, BSN; Jenna White, MSW; Ramy Sedhom, MD; Natalie R. Dickson, MD; Stephen Schleicher, MD; Justin E. Bekelman, MD; Sandhya Mudumbi, MD; 2/25In this randomized clinical trial conducted in a community oncology network between November 2022 and December 2023 among 562 patients with advanced cancer identified by an automated electronic health record algorithm, default orders increased palliative care consultation (44% vs 8%) and decreased end-of-life systemic therapy (6% vs 16%) compared with usual care but did not improve patient-reported or hospice outcomes. The findings suggest that default algorithm-based palliative care orders are a scalable implementation strategy to increase palliative care referrals and reduce intensive end-of-life care. 

Explaining racial and ethnic disparities in advance care planning: A decomposition analysisJournal of Pain and Symptom Management; Yifan Lou, Emma Zang, Qianqian Li; 2/25The ACP [advance care planning] disparities between White and Hispanic populations were nearly twice as large as the disparity between White and Black populations. Interventions targeting less educated older Black and Hispanic individuals should be prioritized to narrow the ACP disparity. Negative healthcare experiences in previous care and household dynamics should be addressed while working with Black and Hispanic older adults, respectively.

When is the best time to deliver supportive interventions to hospice family caregivers? A Multi-Method StudyGerontologist; by Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris; 2/25While problem-solving interventions can teach caregivers effective coping skills throughout hospice, the optimal timing for introducing such resources remains unclear. We explored how the timing of a problem-solving intervention impacts its effectiveness for hospice caregivers. We conducted a multi-method study analyzing quantitative and qualitative data from a randomized clinical trial of a Problem-solving Intervention to Support Caregivers in End-of-life care Settings (PISCES)... Caregivers' anxiety showed significant pre-post differences regardless of the intervention timing, modality, and components... Three themes emerged from the qualitative analysis: timing for PISCES to be most effective, emotions during various stages of hospice, and the length of PISCES. Strategically integrating PISCES into hospice practice can help alleviate caregivers' distress.