Literature Review

The treatment of chemotherapy-induced peripheral neuropathy: A review of current management options and a potential role for scrambler therapyFrontiers in Pain Research; by Hassan Aboumerhi, Henry Vucetic, Andrew Gruenzel, Bahar Moftakhar, Mona Gupta, Santosh K Rao, Michael D Staudt; 7/25Chemotherapy-induced peripheral neuropathy (CIPN) presents a growing medical and financial burden on patients and the healthcare system alike. This has been treated with conservative and interventional care limited by efficacy, side effects, and lack of coverage. As such, there is an unmet treatment need for effective non-invasive or minimally invasive therapies for the treatment of CIPN. Scrambler therapy (ST) is a peripheral, non-invasive neuromodulation technique, which uses transcutaneous electrical stimulation to modulate pain signals. ST has shown mixed results in clinical trials; while some patients report symptom relief, more robust evidence is required before it can be widely recommended.

Expanding the conceptualization of bereavement in the perinatal periodThe Journal of Obstetric, Gynecologic & Neonatal Nursing; by Rana Limbo, Natasha Nurse-Clarke; 7/25Contemporary definitions of perinatal loss encompass a range of involuntary and unintended pregnancy outcomes, including miscarriage (loss of pregnancy before 20 weeks gestation; Mayo Clinic, 2023), ectopic pregnancy (fertilized egg implanted outside the uterus), stillbirth (the birth of a fetus who shows no signs of life at or after 20 weeks gestation; Gregory et al., 2022), and neonatal death (the death of a live-born fetus within the first 28 days of life; National Center for Health Statistics, 2024). The loss of a pregnancy or fetus or the death of a newborn is an event, and perinatal bereavement is the emotional response to that event. The need for perinatal palliative care, which refers to care provided to families who receive a life-limiting fetal diagnosis, has also emerged as a critical component in supporting families through these losses (Limbo & Wool, 2016).

Evaluating the role of palliative care in emergency department opioid use among advanced cancer patientsSupportive Care in Cancer; by Joel Nortey, Shiyun Zhu, Andrew Lynch, Hannah Whitehead, Nirmala Ramalingam, Raymond Liu; 7/25 Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department [ED] visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens.

Effect of a multi-component palliative care intervention on goals of care discussions for critical patients in the emergency departmentInternal & Emergency Medicine; by Julia Murray, Zacharia Grami, Katherine Benson, Christopher Hritz, Samantha Lawson, Corita Reilley Grudzen, Allison Cuthel, Lauren Talanda-Fath Southerland; 7/25Goals of care (GOC) discussions are vital to understanding patients' values and preferences during serious illness, but they occur infrequently during Emergency Department (ED) care. We report a single site sub-study of a stepped wedge pragmatic trial of a multi-component intervention of primary palliative care in the ED (PRIM-ER), focused on GOC conversations. The intervention did not change the proportion of patients receiving a GOC conversation in the ED ... [however patients] presenting with a cancer-related complaint ... or a respiratory emergency ... were associated with increased odds of a GOC conversation occurring. Of the 60 GOC conversations that occurred, 76.7% ... resulted in a change in code status, patient care plans, hospice, or updated advance care planning documents. While the intervention did not increase this secondary outcome of GOC conversations, the discussions that did occur frequently impacted ED care.Assistant Editor's note: This study concluded that the intervention employed in the ED did not increase the proportion of patients receiving GOC conversations. Yet the study also concluded that almost 77% of the patients who DID receive the conversation had a change in code status, care plan, hospice or advance care planning documents. This study clearly reminds us that GOC conversations, employed even in the ED, can help patients embrace a palliative approach to care when faced with serious illness.

The effects of private equity ownership in U.S. nursing homes quality and financial performance: A systematic reviewHealth Policy; by Gregory N. Orewa, Aizhan Karabukayeva, Rohit Pradhan, Itopa Jimoh, Robert Weech-Maldonado; 7/25Private equity (PE) investment in U.S. nursing homes has increased significantly over the past two decades. The emergence of this novel ownership model has prompted concerns regarding its effects on nursing home performance, especially quality... Across studies, PE ownership was linked to higher number of deficiencies, increased hospitalization rates, and higher mortality, although some improvements in care processes were noted. Financial outcomes showed initial financial gains but long-term challenges, primarily due to high debt loads... Findings suggest that PE strategies may prioritize short-term profitability, which may compromise quality of care in some instances. These findings highlight the need for financial transparency, and reimbursement models that incentivize long-term quality.

Evaluating a large language model in translating patient instructions to Spanish using a standardized frameworkJAMA Pediatrics; Mondira Ray, MD, MBI; Daniel J. Kats, MD, MBI; Joss Moorkens, PhD; Dinesh Rai, MD; Nate Shaar, BA; Diane Quinones, MS, RN, CPNP; Alejandro Vermeulen, BFA, CMI; Camila M. Mateo, MD, MPH; Ryan C. L. Brewster, MD; Alisa Khan, MD, MPH; Benjamin Rader, PhD; John S. Brownstein, PhD; Jonathan D. Hron, MD; 7/25Patients and caregivers who use languages other than English in the US encounter barriers to accessing language-concordant written instructions after clinical visits. Large language models (LLMs), such as OpenAI’s GPT-4o ... can translate Spanish translations of real-world personalized written patient instructions that are comparable in quality to those generated by professional human translators. Independent professional medical translators preferred the GPT-4o–generated translations over the human translations, and error analysis revealed a higher rate of mistranslation errors in the human translations. These findings demonstrate GPT-4o’s ability to produce quality translations in Spanish ...

How health care systems shape end-of-life care—A step toward transparencyJAMA Network Open; by Jacqueline M. Kruser, Gordon D. Rubenfeld; 7/25Our health care systems, in all their multifaceted complexities, are more influential in shaping the delivery of care than individual human effort or error. Influential system-level factors span many different domains: how we are paid, the buildings we work in, the technology around us, who and how many we have on the team caring for patients, our workload, and our local social networks of influence. One pragmatic first step in addressing the problem of invisible, inaccessible, and/or inflexible patterns of end-of-life care is to build awareness of and foster transparency about the current patterns and their default orientation. Building from this deeper understanding of how our everyday routines and practice patterns influence care, we can then take the bigger step of intentionally designing our routine clinical practice patterns to be systematic yet flexible in their support of patients with serious illnesses.

Parental goals of care for children with rare diseases: A content analysis of pediatric advance care planning conversationsAmerican Journal of Hospice and Palliative Medicine; Tamiko Younge, MD, MSHS; Hailey Moore, MS; Jessica D. Thompkins, BSN, RN, CPN; Maureen E. Lyon, PhD; 7/25Caregivers and surrogate decision makers for children with rare diseases often make complex medical decisions with limited prognostic information specific to their child’s disease. Our objective was to describe goals of care as explored through advance care planning conversations among the high-risk and high-need community of families with children with rare diseases. We identified 13 goals of care themes: maintaining stability, being happy, moving the body, thriving along their own path, reducing interventions, living a long life, curing disease, avoiding complications, connecting with others, having a village, an understanding world, knowing our child, and partnering with our medical team. Conclusions:Parents of children with rare diseases have a multitude of holistic goals related to their child’s care. High-quality advance care planning conversations may help families articulate these goals.

Benefits of emergency department-initiated goals of care conversations and palliative care consultations among older adults with chronic or serious life-limiting illnessesJournal of the American College of Emergency Physicians Open; by Jennifer Johnson, Timmy Li, Megan Mandile, Santiago Lopez, Molly McCann-Pineo, Landon Witz, Payal Sud; 8/25Initiating goals of care (GOC) conversations and palliative care consultations in emergency departments (EDs), compared with inpatient settings, may be associated with improved outcomes among older adults with chronic or serious life-limiting illnesses. ED-initiated GOC conversations were associated with approximately 3-day shorter hospitalizations and a $2689 contribution margin increase, suggesting increased health care cost savings. ED-initiated palliative care consultations were associated with approximately 7-day shorter hospitalizations, 6 fewer excess days in acute care, 1 fewer intensive care day, and higher odds of hospice discharge. Starting these discussions earlier in the ED may help hospitals optimize resources while ensuring treatment aligns with patients’ palliative needs and care preferences.

Healthy days at home and prognosis of older adults with cancer and non-cancer serious life-limiting illnessesBMC Geriatrics; Oluwaseun J. Adeyemi, Nina Siman, Allison M. Cuthel, Keith S. Goldfeld, Corita R. Grudzen; 7/25Approximately 75% of U.S. older adults with serious life limiting illnesses visit the emergency department (ED) in the last six months of life, with three quarters of these individuals being admitted to the hospital. In this context, Healthy Days at Home (HDaH) and prognosis have emerged as important concepts for assessing and guiding care among older adults with serious life-limiting illnesses. HDaH is a patient-centered outcome measure that captures the number of days individuals spend at home without hospitalizations or ED visits. Among US older adults with serious life-limiting illnesses, worse prognosis is associated with fewer HDaH. Increasing age is associated with fewer HDaH, with substantial variability by race/ethnicity. In contrast, cancer is associated with more HDaH.Assistant Editor's note: "Healthy Days at Home (HDaH)" is such a fabulous concept, and so in keeping with the intent and goals of palliative care. Perhaps a HDaH is a quality measure that palliative care providers might consider using. 

Exploring a collective grief experience in the U.S.: Qualitative findings from older parents whose only child has diedOmega; Yongqiang Zheng, Leslie G Wuest, Jeongah Kim, Rebecca A Rodriguez; 6/25Despite its profound physical and mental health impacts, research on the loss of an only child in later life among older U.S. adults remains scarce. This phenomenological qualitative study explores the lived experiences and meanings older bereaved parents attribute to their loss. Inductive thematic analysis revealed 6 themes: the enduring intensity of grief, significant secondary losses, feelings of isolation and alienation, the role of social support in coping, and spirituality and religion's influence on their journey. By amplifying these parents' voices, the study lays a foundation for understanding their unique grief and underscores the gaps in U.S. policy and mental health services. These findings deepen insight into an understudied population, highlighting the need for enhanced resources for older bereaved parents.

Effectiveness of an educational intervention in enhancing end-of-life care understanding and decision-making in African AmericansPalliative & Supportive Care; Delicia Pruitt, Megan Reilly, Stephen Zyzanski, Neli Ragina; 7/25AA [African American] patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL [end of life] care options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Palliative video consultation and symptom distress among rural inpatients-A randomized clinical trialCritical Care Medicine; Marie A. Bakitas, DNSc, RN; Shena Gazaway, PhD, RN; Felicia Underwood, MSW, MPS, LICSW-S; Christiana Ekelem, BS; Vantrice T. Heard, PhD; Richard Kennedy, MD, PhD; Andres Azuero, PhD; Rodney Tucker, MD, MMM; Susan McCammon, MD, PhD; Joshua M. Hauser, MD; Lucas McElwain, MD; Ronit Elk, PhD; 7/25The triple threat of rural geography, racial inequities, and older age has hindered access to high-quality palliative care for many people in the US. Only 70% of the deep South vs 85% to 94% of the rest of the US has palliative care despite the deep South having the greatest needs due to suboptimal health care access and elevated morbidity and mortality. In this RCT [randomized clinical trial] among Black or African American and White chronically ill hospitalized adults, culturally based specialist palliative care video consultation was not associated with statistically significant reduced symptom distress compared with usual care, but there was a clinically meaningful difference ... between groups. Contrary to our hypotheses, intervention participants’ QOL [quality of life] and resource use (secondary outcomes) also were not improved. Assistant Editor's note: This study reminds us that palliative care delivered virtually, as opposed to in-person, may not be of benefit to some individuals. It also reminds us that palliative care, at its best, is delivered on an ongoing basis by a known, trusted professional, as opposed to a one-time session with a consultant.