Literature Review

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. ...

Hope in oncology: Where art and science collide Medscape; by Sharon Worcester, MA; 6/12/24 Carlos, a 21-year-old, laid in a hospital bed, barely clinging to life. Following a stem cell transplant for leukemia, Carlos had developed a life-threatening case of graft-vs-host disease. But Carlos' mother had faith. "I have hope things will get better," she said, via interpreter, to Richard Leiter, MD, a palliative care doctor in training at that time. "I hope they will," Leiter told her. "I should have stopped there," said Leiter, recounting an early-career lesson on hope during the ASCO Voices session at the American Society of Clinical Oncology (ASCO) 2024 annual meeting. "But in my eagerness to show my attending and myself that I could handle this conversation, I kept going, mistakenly." ... Carlos' mother looked Leiter in the eye. "You want him to die," she said. ...Editor's Note: Click on the title's link to continue reading this insightful reflection and discussion about the importance of "hope." Engage your oncology/palliative/hospice chaplains (hopefully CPE trained and Board Certified) with your medical team members to explore this core belief in "hope." Alert: AI referrals for palliative and hospice care are increasing exponentially. Clinicians must be sensitive to the human dimensions and dynamics of "hope" (which shift and change), and not be driven just by technological data.

Reply to: Frailty and ethics at the end of life: The importance of a comprehensive assessmentJournal of the American Geriatrics Society; by Colum Thomas MD, Eduardo Bruera MD, William Breitbart MD, Yesne Alici MD, Liz Blackler MBE, LCSW-R, Julia D. Kulikowski MD, Daniel P. Sulmasy MD, PhD; 6/5/24The care of older persons at the end of life often involves competing concerns and highly value-sensitive decisions. In a recent article, we proposed a set of ethical rules—the canons of therapy—to help clinicians navigate complex cases involving older adults with delirium at the end of life. The canons of therapy most pertinent to such cases are restoration, means-end proportionality, discretion, and parsimony (see Table 1 for a description). These canons provide a structured toolset aligned with practical wisdom, which can serve as an ethical heuristic for guiding therapeutic judgments. ...

ASCO updates Guidelines on Palliative Care Hematology Adviosor; by Jen Smith; 5/30/24 The American Society of Clinical Oncology (ASCO) has released an update to its guidelines on palliative care for cancer patients. The guidelines and related information were published in the Journal of Clinical Oncology and JCO Oncology Practice. To develop updated recommendations for integrating palliative care into cancer care, an expert panel reviewed randomized controlled trials, systematic reviews, and meta-analyses published during 2015-2023. Based on their findings, the experts recommend that patients with advanced cancer be referred to specialized interdisciplinary palliative care teams soon after diagnosis, while the patients are still receiving active cancer treatment.

Hospice patient in Red Wing died after being given morphine by mistakeBring Me the News (MN); by Tommy Wiita; 5/29/24A hospice patient at a Red Wing assisted living facility suffering a diabetic emergency died after being given morphine by mistake. A Minnesota Department of Health State Rapid Response Investigative Report found that the allegation of neglect against the Mayo Clinic Hospice at 906 College Way was substantiated as the staff member "failed to provide timely care, monitoring, and safe medication administration services. The report says the staff member provided five times the resident's prescribed dose of morphine "in error" and didn't provide interventions when the resident was having a seizure and had a critically low blood sugar of 29.

‘We don’t talk about death’: Winston-Salem journalist seeks to help people understand dying, deathbed visions Fox 8 WGHP - High Point, NC; by Bob Buckley; 5/29/24 There may not be anything that fascinates people more than death. It may be the thing many people avoid confronting the most. “In our culture, we’re pretty separated from death. And I don’t know the figures, but the vast majority … take place in hospitals. We don’t talk about death a lot in our culture,” said Phoebe Zerwick, a journalist based in Winston-Salem who recently wrote about deathbed visions for the New York Times Magazine. ... Zerwick became aware of the work of Dr. Christopher Kerr. ... “The biggest difference between hallucinations and these experiences is how the person is made to feel,” Dr. Kerr said. “Most hallucinations leave the person distressed and agitated and would be further confused. These experiences bring comfort. They bring meaning. They’re drawn from life. They really validate the life.” ... “I think the moral of the story is to be present and to be present with people when they are terminally ill. Be present when they’re dying,” Zerwick said.