Literature Review

A scoping review of end-of-life discussions and palliative care: Implications for neurological intensive care in Latin America and the CaribbeanJournal of Palliative Medicine; Monica M Diaz, Lesley A Guareña, Bettsie Garcia, Christoper A Alarcon-Ruiz, Stella M Seal, Clio Rubinos, Dulce Cruz-Oliver, J Ricardo Carhuapoma; 12/24Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC. 

Caregiver-Reported Quality in Hospices Owned by Private Equity Firms and Publicly Traded CompaniesJAMA; by Alexander E. Soltoff, Mark Aaron Unruh, David G. Stevenson, Dio Kavalieratos, Robert Tyler Braun; 12/17/24The US hospice industry has shifted from not-for-profit to for-profit ownership models, producing concerns aboutcare quality... Hospices owned by private equity firms (PEFs) or publicly traded companies (PTCs) performed significantly worse across CAHPS measures relative to not-for-profit and non-PEF/PTC for-profit agencies... These findings raise questions as to how patients are affected when PEFs and PTCs own hospices and suggest the need for greater transparency and accountability of hospice ownership.Publisher's note: Also see related articles by these authors: Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations, JAMA Internal Medicine, 8/21; Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies; JAMA Network Open, 9/23.

Race and ethnicity, gender, and promotion of physicians in academic medicineJAMA Network Open; Lauren Clark, MS; Elena Shergina, PhD; Nathalia Machado, PhD; Taneisha S. Scheuermann, PhD; Nasrin Sultana, MS; Deepika Polineni, MD; Grace H. Shih, MD; Robert D. Simari, MD; Jo A. Wick, PhD; Kimber P. Richter, PhD, MPH; 11/24Medical school faculty training the next generation of physicians do not resemble the diversity of America. Compared with the US working population, American Indian, Black, and Hispanic people are underrepresented in the physician workforce. These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

Redefining acute virtual care for overburdened health systemsJAMA Network Open; Michael J. Maniaci, MD; Richard D. Rothman, MD; Jessica A. Hohman, MD; 11/24Over the past decade, the concept of delivering acute hospital-level care in the home has gained traction, particularly with advances in telemedicine and remote patient monitoring. This retrospective cohort study compared the outcomes of 876 patients who received acute virtual care at home with outcomes of 1590 patients who were treated using traditional in-hospital care for similar conditions. The study found that the Safer@Home patients spent a mean of 4 fewer days in the hospital (1.3 vs 5.3 days), without a significant increase in 30-day readmission or mortality rates. This all-virtual model effectively avoided the use of 3505 bed-days without compromising safety, both making this an impactful exploration of alternatives to traditional inpatient care as well as offering a promising alternative for underresourced health systems unable to support in-home care.

Researcher explores using AI to overcome language barriers with patientsJAMA Network; Yulin Hswen, ScD, MPH; Kate Schweitzer; 12/24In the US, 25 million people with language barriers receive worse health care by nearly every standard than those who speak English fluently. In a recent Viewpoint in JAMA, K. Casey Lion, MD, MPH, an associate professor of pediatrics at the University of Washington School of Medicine, listed the poorer-quality outcomes: inferior comprehension, lower adherence, higher costs, and more frequent serious safety events, to name a few. In this study, we want to understand how it performs under real-world conditions because those are the conditions we would be using it in. I would also encourage other health care systems that are thinking about implementing AI for language access to think about talking to and involving their patients and families in the work to be sure that it’s reflecting what our patients and families actually want rather than what we think they want.

Contextualizing attitudes toward medical aid in dying in a national sample of interdisciplinary US hospice clinicians: hospice philosophy of care, patient-centered care, and professional exposurePalliative Care and Social Practice; Todd D Becker, John G Cagle, Cindy L Cain, Joan K Davitt, Nancy Kusmaul, Paul Sacco; 12/24Findings suggest that contextual factors-namely, the environments in which hospice clinicians practice-may shape attitudes toward MAID [medical aid in dying]. Unanticipated results indicating that hospice professionals' adherence to hospice values was not significantly associated with attitudes toward MAID underscore the need for further research on these complex associations, given previous theoretical and empirical support.

How innovative designs can help ease ethical tension in good dementia caregiving and decision-makingAMA Journal of Ethics; Emily Roberts, PhD; 12/24The European dementia village is a pioneering health care site: 4 acres of integrated housing and amenities that include large exterior walkways around gardens, restaurants, and shops. A US-based conceptual model is the dementia friendly city center [DFCC], which integrates health care service delivery into adaptive reuse and urban revitalization. Separately and together, we can work to deliver new interventions that can make a difference for those living with dementia and their families. Further exploration of the DFCC model is required to address possible financial and regulatory constraints that accompany the development of necessary public health infrastructure.

Our unrealized imperative: Integrating mental health care into hospice and palliative careJournal of Palliative Medicine; Susan Block; 12/24The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.

Caring for emotional and spiritual needs of ICU families Medical Xpress; by Regenstrief Institute; 12/10/24 Family members of intensive care unit (ICU) patients often experience psychological and spiritual distress as they deal with serious illness and potential death. A new paper authored by a national team of experts at the intersection of health and spirituality highlights the critical role of the spiritual care provided by chaplains in supporting family members of ICU patients. ... "Our model describes three important ways that chaplain care supports ICU family members and helps them when faced with difficult decisions," said study co-author and chaplain-researcher George Fitchett, DMin, Ph.D., professor of religion, health and human values at Rush University Medical Center. "Chaplains provide family members with spiritual and emotional support. They also facilitate conversation with the medical team and help family members process the information from those conversations. Significantly, our study highlights the care provided by chaplains to ICU patient families and its impact on important outcomes." Editor's note: Click here for Improving Outcomes for for ICU Family Members: The Role of Spiritual Care, published in the Journal of Palliative Medicine, Oct 2024.

From explainable to interpretable deep learning for natural language processing in healthcare: How far from reality?Computational and Structural Biotechnology Journal; by Guangming Huang, Yingya Li, Shoaib Jameel, Yunfei Long, Giorgos Papanastasiou;12/24Deep learning (DL) has substantially enhanced natural language processing (NLP) in healthcare research. However, the increasing complexity of DL-based NLP necessitates transparent model interpretability, or at least explainability, for reliable decision-making. This work presents a thorough scoping review of explainable and interpretable DL in healthcare NLP.

Applying natural language processing to electronic health record data—From text to triageJAMA Network Open; Grace K. Sun, BS; Andrew P. Ambrosy, MD; 11/24Most information about a patient’s clinical status, disease progression, and response to treatment lies in qualitative clinician documentation in the electronic health record (EHR). The New York Heart Association (NYHA) classification was developed to standardize functional status assessments and treatment decisions ... [but] ... due to inconsistent implementation in routine care, much of the critical information remains in unstructured EHR data that is difficult to capture and analyze. Natural language processing (NLP) is an emerging tool that uses artificial intelligence to process unstructured or semistructured free-text data, such as the embedded assessments of HF symptom status in clinician documentation. NLP, a field of artificial intelligence that focuses on understanding, interpreting, and generating human language, is capable of evaluating these data and providing large-scale insights into patient progress and treatment response, with some limitations. Overall, these findings suggest that deep learning approaches may be used to address meaningful gaps in clinician documentation.

Care of the patient nearing the end of life in the Neurointensive Care UnitNeurocritical Care; by Hanna Ramsburg, Abigail G Fischer, Meredith MacKenzie Greenle, Corey R Fehnel; 12/24Neurologically critically ill patients present with unique disease trajectories, prognostic uncertainties, and challenges to end-of-life (EOL) care. Acute brain injuries place these patients at risk for underrecognized symptoms and unmet EOL management needs, which can negatively affect their quality of care and lead to complicated grief in surviving loved ones. To care for patients nearing the EOL in the neurointensive care unit, health care clinicians must consider neuroanatomic localization, barriers to symptom assessment and management, unique aspects of the dying process, and EOL management needs. We aim to define current best practices, barriers, and future directions for EOL care of the neurologically critically ill patient.

Trends in hepatocellular carcinoma mortality rates in the US and projections through 2040JAMA Network Open; Sikai Qiu, MM; Jiangying Cai, MM; Zhanpeng Yang, MM; Xinyuan He, MD; Zixuan Xing, MD; Jian Zu, PhD; Enrui Xie, MD; Linda Henry, MD; Custis R. Chong, MD; Esther M. John, MD; Ramsey Cheung, MD; Fanpu Ji, MD, PhD; Mindie H. Nguyen, MD, MAS; 11/24Primary liver cancer imposes a substantial global disease burden, ranking as the sixth most commonly diagnosed cancer worldwide and the third-leading cause of global cancer-related mortality in 2020. In this cross-sectional study of 188,280 HCC [hepatocellular carcinoma]-related deaths, ASMRs [age-standardized mortality rates] increased from 2006 to 2022 and were projected to continue rising until 2040, primarily due to increased deaths from alcohol-associated liver disease (ALD) and metabolic dysfunction–associated steatotic liver disease (MASLD); deaths from viral hepatitis were under control and were projected to decrease. Large disparities were observed in HCC-related ASMRs by age, sex, and race and ethnicity. ...these findings may serve as a reference for public health decision-making and timely identification of groups at high risk of HCC-related death.