Literature Review

Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

Aligning pill burden and palliative care needs in late-stage CVD: AHA TCTMD - Cardiovascular Research Foundation; by L.A. McKeown; 7/2/24 The first scientific statement from the American Heart Association (AHA) that focuses specifically on pharmacotherapy considerations in the palliative management of patients with CVD [cardiovascular diesease] urges a patient-centered, compassionate approach to de-escalating and deprescribing. ... In addition to shedding light on how and when to start deprescribing and de-escalating common cardiovascular drugs, the statement discusses palliative drugs for pain, shortness of breath, and appetite in the context of CVD, which [Katherine E.] Di Palo [PharmD (Montefoiore Medical Center, NY)] said the committee identified as a gap in knowledge given that much of the evidence for these drugs comes from patients with serious illnesses like cancer. ... Important Takeaways: Di Palo and colleagues note that palliative care complements cardiovascular care in several important ways, including reducing physical symptom burden, managing emotional and spiritual distress, providing sufficient support for caregivers, and helping patients choose treatment in line with their goals for care. Editor's Note: Click here for the American Heart Association's statement, which we posted on 7/2/24. 

Factors affecting palliative care collaboration with pain medicine specialists Clinical Pain Advisor; by James Maitlall, MD; 6/27/24 Structured collaboration between physicians working in palliative care (PC) and pain medicine (PM) may increase PC physician referral of seriously ill patients to PM specialists and potentially optimize their care, according to study results published in the Journal of Pain and Symptom Management. ... In a survey study, a multicenter team of investigators explored attitudes and beliefs among US PC physicians regarding PM specialists, as well as factors potentially impacting collaboration between physicians in these 2 areas of practice. ... The American Academy of Hospice and Palliative Medicine (AAHPM) approved the survey for distribution to 1000 of its physician members, who were selected at random. ... The investigators concluded, “Although we found that PC physicians have highly positive attitudes about the value of PM specialists, referral rates remain low, even for IDDS implantation, which has perhaps the largest body of evidence for patients with complex cancer-associated pain.”  

Q&A: What is the ID clinician’s role in end-of-life care? Healio; by Caitlyn Stulpin; 6/27/24 Patients receiving infectious diseases (ID) consultation over the past decade were increasingly complex, generally sicker and more likely to die soon after a consultation was performed, according to a study. Researchers said that the rate of infectious diseases (ID) consultation relative to hospital admissions doubled during that time, suggesting that ID physicians are more often being faced with the challenge of caring for complex patients. Because of this, Alison G.C. Smith, MD, MSC, and Jason E. Stout, MD, MHS, and colleagues aimed to assess the role of these physicians when it came to end-of-life care, leading them to conduct a retrospective cohort study of all patients with an ID consult at the Duke University Health System between Jan. 1, 2014, and Dec. 31, 2023.

End-of-life care needs in cancer patients: a qualitative study of patient and family experiences BMC Palliative Care; by Mario López-Salas, Antonio Yanes-Roldán, Ana Fernández, Ainhoa Marín, Ana I Martínez, Ana Monroy, José M Navarro, Marta Pino, Raquel Gómez, Saray Rodríguez, Sergio Garrido, Sonia Cousillas, Tatiana Navas, Víctor Lapeña, Belén Fernández; 6/21/24  Results: Four major themes emerged from the interviews that explored the needs and concerns of patients with cancer at the end of life: (1) physical well-being (2) emotional well-being (3) social well-being and (4) needs relating to information and autonomous decision-making. The interviews also shed light on the specific needs of family members during this period, namely the difficulties of managing increased caregiver burden and maintaining a healthy work-life balance.

Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of U.S. older adults eClinical Medicine, Part of THE LANCET Discovery Science; by Yenee Soh, Ichiro Kawachi, Laura D. Kubzansky, Lisa F. Berkman, and Henning Tiemeier; 6/24/24 Loneliness has been implicated as a stroke risk factor, yet studies have examined loneliness at only one time point. The association of loneliness changes and risk of incident stroke remains understudied. Our aim was to examine the association of loneliness with incident stroke, particularly the role of loneliness chronicity. Chronic loneliness was associated with higher stroke risk independent of depressive symptoms or social isolation. Addressing loneliness may have an important role in stroke prevention, and repeated assessments of loneliness over time may help identify those particularly at risk.Editor's Note: This is the source research for an article we posted yesterday, 6/28/24, titled 

Palliative care physician: ‘Healing is possible’ even when cure is not Healio, Chicago, IL; by Jennifer Byrne; 6/26/24During her fellowship as a palliative care physician, Sunita Puri, MD, met a patient who taught her that healing is possible even when cure is not. Alice, a 35-year-old woman, had acute myeloid leukemia. ... Nobody wanted to say it out loud, but Alice was dying. “She was only a couple years older than me. She’d lived in San Francisco, a few streets away from where I lived in my residency,” Puri, program director of the hospice and palliative medicine fellowship program at UMass Chan School of Medicine. ... “She had a vibrancy that I had always hoped to embody, but she was intubated, wide awake, on dialysis and starting to suffer from ascending paralysis.” ... During rounds one day, Puri told her attending that she was at a loss about how to help Alice and didn’t feel she was doing anything meaningful for her. “My attending said, ‘What if just being at her bedside is achieving something meaningful?’” Puri recalled. “I’d always understood healing and cure to be different, but this was when I really felt it.” ... “What if healing is choosing to understand that there’s going to be suffering that we can’t alleviate — and sometimes that’s our own — but the most important thing to bring to that is presence?” she said. [Click on the article's title to continue reading.] Editor's Note: Though not directly related to this article, read "Today's Encouragement" at the end of today's newsletter.

Improving advanced care planning for late-stage cancer Medical Xpress; by Melissa Rohman; 6/24/24 Multilevel care interventions improved clinician–documented advanced care planning (ACP) compared with a clinician-level intervention alone for patients with genitourinary cancer, according to findings published in JAMA Oncology. "Clinicians often have limited time to assist patients in fully understanding ACP. This intervention is one approach to improve ACP and care delivery among patients with advanced stages of genitourinary cancer," said Gladys M. Rodriguez, MD, MS, assistant professor of Medicine in the Division of Hematology and Oncology and lead author of the study. For patients diagnosed with late-stage cancer, ACP can help reduce unnecessary acute care, increase palliative care and improve quality of life. However, previous reports have found that less than 20% of patients will engage in ACP with their health care providers. ... The primary outcome was ACP documentation in the electronic health record by the patient's oncology clinician within 12 months. Secondary outcomes included shared decision-making, palliative care use, hospice use, emergency department visits and hospitalizations within 12 months.

Parental history of memory impairment and β-amyloid in cognitively unimpaired older adults JAMA Neurology; by Mabel Seto, PhD; Timothy J. Hohman, PhD; Elizabeth C. Mormino, PhD; Kathryn V. Papp, PhD; Rebecca E. Amariglio, PhD; Dorene M. Rentz, PsyD; Keith A. Johnson, MD; Aaron P. Schultz, PhD; Reisa A. Sperling, MD; Rachel F. Buckley, PhD; Hyun-Sik Yang, MD; 6/17/24 Objective: To characterize maternal vs paternal history of memory impairment in terms of brain Aβ-positron emission tomography (Aβ-PET) and baseline cognition among a large sample of cognitively unimpaired older adults. Conclusions and Relevance  In this study, maternal history (at any age) and paternal history of early-onset memory impairment were associated with Aβ burden among asymptomatic older individuals. Sex-specific parental history may help inform clinicians on likelihood of Aβ burden in offspring and help identify high-risk individuals at the earliest stages of disease for prevention.Editor's Note: We posted a descriptive, less data-oriented article that was about this research on 6/21/24, "Alzheimer’s history on maternal side linked to higher disease risk, study finds"

Mass General Brigham union could shape hospital-at-home’s future Modern Healthcare; by Diane Eastabrook; 6/17/24 Nurses at one of the nation’s largest hospital-at-home programs have unionized, a move they hope could influence the future of in-home acute care and encourage more people working in home healthcare to join unions. The union vote at Boston’s Mass General Brigham comes as hospitals push aggressively to expand care outside of their walls, while a worker shortage and increased demand for healthcare contribute to rising labor strife among caregivers. Approximately 80 Mass General Brigham home hospital nurses voted overwhelmingly on May 16 to join the Massachusetts Nurse Association. The National Labor Relations Board certified the union to represent the nurses on May 24 and they are in the midst of selecting a bargaining team that will begin negotiating a contract with the hospital system within the next few months. ...  The hospital system is set to expand the number of patients the program can accommodate from 50 patients a day to 200 over the next few years. 

Cancer therapy at end of life may not boost survival Cure; by Brielle Benyon; 6/17/24 Patients with advanced solid cancers who received systemic therapy toward the end of life typically did not live any longer than patients who did not receive treatment, according to research published in JAMA Oncology. Because cancer treatments can damper quality of life, it is crucial that patients and their loved ones discuss goals of care and prognosis with their oncology team, two experts emphasized. “I think once we progress to advanced and metastatic cancer when cure is no longer feasible, it’s important to consider goals-of-care conversations,” said study author Maureen Canavan, associate research scientist at Yale School of Medicine.

Telehealth can broaden reach of palliative care for lung cancer patients, per MGH study MedCity News; by Frank Vinluan; 6/16/24 Palliative care provided by video was equivalent to in-person visits with a clinician, according to study results presented during the recent annual meeting of the American Society of Clinical Oncology. Investigators say these results indicate telehealth can make palliative care accessible to more cancer patients. ... Guidelines of ASCO and other professional organizations recommend integrating palliative care from the time of a diagnosis of advanced cancer. Nevertheless, many patients don’t get this care, Greer said. On the clinician side, there are not enough specially trained palliative care clinicians, he explained. From the patient perspective, living in a rural area or lacking transportation can make it difficult to access such care.

Why doctors aren’t participating in organ donation after cardiac death Physician's Weekly; by Frank D. Brodkey, MD, FCCM; 6/13/24Organ donation after cardiac death (DCD) differs from the more traditional organ donation after brain death (DBD) insofar that DCD donors are alive and donate organs after discontinuation of life support so that a natural death with cessation of heartbeat and circulation may occur, followed by extraction of organs. This may increase the availability of transplantable organs, leading to improvement in the lives of other humans.  According to the Health Resources and Services Administration, 5896 donations, representing 36% of all donations in 2023, were DCD, representing an increase of 40.7% over the preceding three years. There, however, are significant ethical and scientific issues in the performance of DCD with concepts of end-of-life care, personal autonomy, and concepts of dignity of life and death. ...