Literature Review

Multidisciplinary clinician perceptions on utility of a machine learning tool (ALERT) to predict 6-month mortality and improve end-of-life outcomes for advanced cancer patientsCancer Medicine; Nithya Krishnamurthy, Melanie Besculides, Ksenia Gorbenko, Melissa Mazor, Marsha Augustin, Jose Morillo, Marcos Vargas, Cardinale B. Smith; 3/25There are significant disparities in outcomes at the end-of-life (EOL) for minoritized patients with advanced cancer, with most dying without a documented serious illness conversation (SIC). This study aims to assess clinician perceptions of the utility and challenges of implementing a machine learning [ML] model (ALERT) to predict 6-month mortality among patients with advanced solid cancers to prompt timely SIC. Our study found that clinicians expressed widespread acceptability of ALERT and identified clear benefits, particularly in triggering earlier SIC and standardizing prognosis discussions across care teams. [Additionally,] a recent study found that ML prognostic models decreased use of aggressive chemotherapy at EOL and increased SIC frequency fourfold.

Ethics in patient preferences for artificial intelligence–drafted responses to electronic messagesJAMA Network Open; Joanna S. Cavalier, MD; Benjamin A. Goldstein, PhD; Vardit Ravitsky, PhD; Jean-Christophe Bélisle-Pipon, PhD; Armando Bedoya, MD, MMCi; Jennifer Maddocks, PT, MMCi; Sam Klotman, MPH; Matthew Roman, PT, MHA, MMCi; Jessica Sperling, PhD; Chun Xu, MB; Eric G. Poon, MD, MPH; Anand Chowdhury, MD, MMCi; 3/25The rise of electronic communication sent to clinicians via the patient portal has directly led to clinician burnout and dissatisfaction. With patients increasingly messaging their clinicians, replying to in-basket messages (akin to email) has become a burdensome task consisting of medical questions, refill requests, and administrative and scheduling requests. This survey study of 1,455 respondents showed that while overall satisfaction was high (>75%) regardless of author, respondents preferred responses written by AI [artificial intelligence] over those written by a human ... However, when an AI author was disclosed, satisfaction was lower for AI compared with a human author ... Meaning: Reduced satisfaction due to AI disclosure should be balanced with the importance of patient autonomy and empowerment.

Racial disparities in ALS progression: Time to clinical events observed in a single center Wiley Online Library; by Shanshan Chen, Demetrius Carter, Jillian Prier, JoBeth Bingham, Shital Patel, Manisha Kotay, Paula Burke Brockenbrough, Kelly Gwathmey; 3/10/25 Studies examining racial differences in ALS have previously focused on diagnostic delay and disease severity. Time to critical clinical events has rarely been investigated, despite its importance in revealing differences in ALS patients' disease courses. This study explores racial disparities in time to specific clinical events in Black and non-Hispanic White ALS patients at a single center. ... Our single-center findings demonstrate a large racial difference in time to clinical events for Black versus White ALS patients referred for NIV, AAC, hospice, and wheelchair, suggesting more advanced disease at the time of presentation or more rapid progression.

Quality of life in heart failure. The heart of the matter. A scientific statement of the Heart Failure Association and the European Association of Preventive Cardiology of the European Society of CardiologyEuropean Journal of Heart Failure; Maurizio Volterrani, Geza Halasz, Stamatis Adamopoulos, Pier Giuseppe Agostoni, Javed Butler, Andrew J.S. Coats, Alan Cohen-Solal, Wolfram Doehner, Gerasimos Filippatos, Ewa Jankowska, Carolyn S.P. Lam, Ekaterini Lambrinou, Lars H. Lund, Giuseppe Rosano, Marco Metra, Stefania Paolillo, Pasquale Perrone Filardi, Amina Rakisheva, Gianluigi Savarese, Petar Seferovic, Carlo Gabriele Tocchetti, Massimo Piepoli; 3/25 Patients with heart failure (HF) experience much worse QoL [quality of life] and effort intolerance than both the general population and people with other chronic conditions, since they present a range of physical and psychological symptoms, including shortness of breath, chest discomfort, fatigue, fluid congestion, trouble with sleeping, and depression. The importance of QoL for patients with HF is highlighted in a survey showing that 61% attached more weight to QoL over longevity, with 9% and 14% willing to trade 6 and 12 months, respectively, for perfect health and better QoL.It is for these reasons that the Heart Failure Association is developing a new score for QoL in HF, sensitive to mechanism-specific interventions and tailored to be sensitive to changes within individual patients. 

Employer-sponsored digital health platforms for mental wellness—A good investmentJAMA Network Open; Molly Candon, PhD; Rebecca E. Stewart, PhD; 2/25The authors evaluate an employer-sponsored digital health platform (Spring Health; Spring Care Inc) that screens employees for mental health conditions and, when warranted, connects them to treatment. Hawrilenko et al found a reduction in health care spending among digital health platform users compared with a matched comparison group. These findings contribute to a broader literature that considers the economic value of employer-sponsored interventions aimed at mental wellness ... There are broader implications of the study by Hawrilenko et al, because employer-sponsored digital health platforms are among the quickest and easiest pathways to grant a majority of US individuals accessible mental health care. 

Evaluating performance of the Surprise Question to predict 12-month mortality in patients with end-stage liver diseaseAmerican Journal of Hospice and Palliative Care; Sarah Homann, MD; Jamie Pfaff, MD; Elizabeth Stovicek, MD; Rajiv Agarwal, MD, MSC;, Sumathi K. Misra, MD, MPH; Jill M. Pulley, MBA; Justin K. Siemann, PhD; Ashley Spann, MD, MSCAI; Stacey Tillman, MD; Cheryl L. Gatto, PhD; Mohana Karlekar, MD; 2/25ESLD [end-stage liver disease] is associated with significant morbidity and mortality. Early PC engagement has been proposed as a solution to improve the physical and psychological burden associated with ESLD. ... hepatologists were asked the SQ [surprise question]: “Would you be surprised if this patient were to die in the next 12 months?” as a prompt to consider consultation to specialty PC [palliative care]. While the SQ should not be solely used as a prognostic indicator of death, our study proves that the SQ can be utilized by hepatologists as a screening tool with good sensitivity for identifying patients with ESLD who may be at higher risk of death and therefore may benefit from PC co-management.

Perceptions of patient-clinician communication among adults with and without serious illnessJAMA Network Open; Carine Davila, Sarah Nouri, Stephanie H Chan, Brian Feltz, Anna Gosline, Zamawa Arenas, Jane Kavanagh, Joanna Paladino, Lindsay A Dow, Vicki A Jackson, Rebecca Sudore, Christine S Ritchie, Elizabeth Lindenberger; 3/25In this cross-sectional study, adults with serious illness more often had worse patient-clinician communication experiences. Compared with adults without serious illness, adults with serious illness were more likely to report leaving a visit unsure about next steps ...; being afraid to ask questions or speak up ...; believing they were talked down to or made to feel inferior...; and believing that they were treated unfairly by clinicians ... Further research is needed to better understand and develop interventions to improve perceptions of patient-clinician communication experiences for adults with serious illness.

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. 

Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social supportJAMA Network Open; Peter A. Boling, MD; 3/25On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.

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.

The preference for acute rehospitalization scale: Evaluating preference for acute rehospitalization in pediatric hospice patientsJournal of Palliative Medicine; Kelley Newcomer, Katherine Maddox; 3/25Since the passage of the Affordable Care Act, children are able to access pediatric hospice while still pursuing life-prolonging care. This can create confusion between hospice and palliative care staff and families about current goals of care (GOC), which evolve over time. Hospice and palliative care teams created, implemented, and evaluated a five-point scale to summarize the Preference for Acute Rehospitalization (PAR) Scale for children on concurrent care hospice. Most users reported they agreed or strongly agreed the PAR Scale helped them to understand families' GOC and feel more confident giving advice with urgent questions.

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. 

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.