Literature Review

Racial differences in hospice care outcomes among patients with advanced heart failure: Systematic review and meta-analysisAm J Cardiol, by Diego Chambergo-Michilot, Victor G Becerra-Gonzales, Veraprapas Kittipibul, Rosario Colombo, Katia Bravo-Jaimes; 2/19/24There remains a paucity of investigational data about disparities in hospice services among people with non-cancer diagnoses, specifically in heart failure. Black patients with advanced heart failure have been disproportionally affected by health care services inequities but their outcomes after hospice enrollment are not well studied. We aimed to describe race-specific outcomes in patients with advanced heart failure who were enrolled in hospice services.

AI-generated clinical summaries require more than accuracyJAMA Network; by Katherine E. Goodman, JD, PhD; Paul H. Yi, MD; and Daniel J. Morgan, MD, MS; Originally published 1/29/24, redistributed 2/20/24 ... Currently, there are no comprehensive standards for LLM-generated [Large Language Model] clinical summaries beyond the general recognition that summaries should be consistently accurate and concise. Yet there are many ways to accurately summarize clinical information. Variations in summary length, organization, and tone could all nudge clinician interpretations and subsequent decisions either intentionally or unintentionally. To illustrate these challenges concretely, we prompted ChatGPT-4 to summarize a small sample of deidentified clinical documents. [Click on the title's link to view the example.]

Barriers and facilitators to end-of-life care delivery in ICUs: A qualitative studyCrit Care Med; by Lauren M Janczewski, Adithya Chandrasekaran, Egide Abahuje, Bona Ko, John D Slocum, Kaithlyn Tesorero, My L T Nguyen, Sohae Yang, Erin A Strong, Kunjan Bhakta, Jeffrey P Huml, Jacqueline M Kruser, Julie K Johnson, Anne M Stey; 2/19/24Objectives: To understand frontline ICU clinician's perceptions of end-of-life care delivery in the ICU.Setting: Seven ICUs across three hospitals in an integrated academic health system.Subjects: ICU clinicians (physicians [critical care, palliative care], advanced practice providers, nurses, social workers, chaplains).Conclusions: Standardized work system communication tasks may improve end-of life discussion processes between clinicians and families.

Embodied decisions unfolding over time: a meta-ethnography systematic review of people with cancer's reasons for delaying or declining end-of-life careBMC Palliat Care, by Jessica Young, Antonia Lyons, Richard Egan, and Kevin Dew; 2/19/24Conclusions: Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making. ... The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.

Death can be isolating and dehumanizing. But what if it didn’t have to be?City Life, by Ben Seal; 2/17/24... In the three years since Elaine’s passing, I’ve longed for a world where more people could be given the chance to die as she did — with the fullness of life surrounding her, and with complete support, emphasizing the emotional and spiritual, not just the medical. In Philadelphia and beyond, a growing community of death-care workers — doulas, nurses, grief counselors, social workers, even funeral directors — is trying to build that world. They are reclaiming death and dying from the institutional model that has become the norm over the past century. Editor's Note: Has hospice now become so institutionalized and medical/regulatory focused that we have lost sight of "emphasizing the emotional and spiritual, not just the medical"? I ask the question, but do not draw judgment, as answers must be contextualized. 

Looking at the challenges involving hospice careNPR WOSU PBS, podcast by All Sides with Anna Staver; 2/19/24Hospice care prioritizes comfort and quality of life by reducing pain and suffering for patients facing the end of life. However, physicians are voicing concerns about a prevalence of serious deficiencies in hospice care and believe it is in need of fixing.Host: Mike Thompson, WOSU chief content director of radioGuests: Dr. Ira Byock, palliative care physician and advocate; Dr. Jennifer Hirsh, hospice & palliative medicine specialist, Mt. CarmelEditor's Note: Originally aired 7/24/23; reposted 2/19/24

Causes and ways of death in patients with head and neck cancerJAMA Otolaryngol Head Neck Surg; by Boyd N. van den Besselaar, MD; Aniel Sewnaik, PhD; Arta Hoesseini, MD; et al; 2/15/24 The results of this study potentially illuminate causes and ways of death in patients with HNC and support health care professionals in providing more patient-centered care, particularly for those in the palliative phase.

Reimagining end-of-life care: Balancing polypharmacy, treatment modification, and quality of life in advanced cancer patientsBNN, by Mahnoor Jehangir; 2/15/24In a recent groundbreaking study, researchers have illuminated the complexities surrounding polypharmacy and the prescription of potentially inappropriate medications (PIMs) to patients at the end of their lives, particularly those battling advanced cancer. This investigation, involving a cohort of 265 older adults, sheds light on the nuanced challenges and critical decisions faced by healthcare providers in managing the delicate balance between treatment efficacy and quality of life for terminally ill patients. 

The administrative burden on palliative academic physiciansJournal of Pain and Symptom Management, by Rida Khan, Michael Tang, Ahsan Azhar, Eduardo Bruera; 1/24Every faculty member spends annually an approximate average of 5,300 minutes on administrative activities (approximately the equivalent of 29 consults plus 133 follow-ups). Using the department net average per encounter, the approximate value of these encounters is $36, 936 for each faculty member (about 11 clinical days)... We recommend that regulatory agencies and institutions work together to better regulate this list of tasks and their frequency.

What 54% of physicians want enough to take a pay cutBecker's Hospital Review, by Erica Carbajal; 2/13/24Many physicians feel conflicted in their personal lives due to the demands of the job, and more than half say they would take a pay cut for a better work-life balance, according to Medscape's "2024 Physician Lifestyle & Happiness Report." The findings, released Feb. 13, are based on a survey of 9,226 practicing U.S. physicians across 29 specialties.

Scaling palliative care requires adherence to best practicesAJMC, by Tina Basenese, MA, APN, ACHPN; 2/14/24An important milestone came January 1, 2024, when a new add-on code [G2211] took effect for reimbursement for complex Medicare patient visits, including palliative care. ... Having patients map out their wishes through advance directives is an important metric, but it’s not the goal of palliative care, nor is it the only way to measure whether a program works. Rather, comprehensive palliative care must be truly patient centered. This requires building trust and training palliative care specialists in a manner similar to other subspecialties to create and scale processes that are infused with a culture of communication.

Changes in hospice care experiences during the COVID-19 pandemicRand, Journal of the American Geriatrics Society; by Maria DeYoreo, Rebecca Anhang Price, Ann C. Haas, Anagha Alka Tolpadi, Joan M. Teno, Marc N. Elliott; 2/12/24Demand for hospice and palliative care services increased during the COVID-19 pandemic. Hospices strove to meet this demand despite staffing shortages and visitation restrictions that sometimes prevented family members and hospice staff from visiting patients in institutional settings such as nursing homes, assisted living facilities, and hospitals. We examine how the COVID-19 pandemic may have influenced the characteristics of patients receiving hospice care, the settings in which they received care, and their care experiences using national data from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. The survey is completed by bereaved family caregivers following the death of the hospice patient, and is the national standard for assessing patient- and family-centeredness of hospice care.

Patients with cancer underuse hospice care, often because of disparitiesOncology Nursing Society Voice, by Elisa Becze BA, ELS, Editor; 2/13/24Most patients who die from cancer do not use hospice at the time of their death, ONS member and oncology nurse researcher Dena D. Shore, PhD, RN, OCN®, CNE, reported in an article published in ... the Clinical Journal of Oncology Nursing (CJON). ... Shore conducted an extensive literature search for studies of hospice use in U.S. patients with cancer published from 2017–2023. ... According to her literature review, cancer-related, ethnic and racial, and geographic disparities are frequently involved in delayed or nonuse of hospice care.