Literature Review

Few older patients with advanced heart failure are evaluated for advanced therapiesCardiology Advisory; by Jessica Nye; 10/3/24Only a small proportion of older patients with advanced heart failure (HF) are evaluated for left-ventricular assist device (LVAD) implantation or heart transplant (HT) and palliative care is underutilized, according to study results submitted to the Heart Failure Society of America (HFSA) Annual Scientific Meeting 2024, held virtually from September 27 to 30, 2024... Fewer than a third of patients (29%) were referred for palliative care.

Patient considerations of social media account management after deathSupportive Care in Cancer; Rida Khan, Jacqueline Tschanz, Maxine De La Cruz, David Hui, Diana Urbauer, Astrid Grouls, Eduardo Bruera; 10/24Social media is widely used but few studies have examined how patients with advanced cancer want their accounts managed after death. The objective of this study was to determine the proportion of our patients with advanced cancer who have discussed the post-mortem management of their social media accounts with their family or friends. Conclusion: Few patients have had conversations on the management of their accounts after death, although more were interested in exploring their options further. More research is needed to examine the role of social media as a digital legacy and a coping tool for patients with advanced cancer.

Is end-of-life care consistent with wishes of patients with dementia? Oklahoma University News, Oklahoma City, OK; by April Wilkerson; 10/8/24 Soon after a dementia diagnosis, many people document their preferences for medical care near the end of their lives, often stipulating that they want to avoid hospitalizations and aggressive interventions. A new University of Oklahoma study aims to discover whether the actual care they receive aligns with their preferences. Lee Jennings, M.D., a geriatrician and associate professor in the OU College of Medicine, recently received a $2.3 million grant from the National Institutes of Health to analyze the end-of-life experiences of about 550 people with dementia, as well as their caregivers. The findings will advance medical knowledge of how best to care for people with an incurable disease that often robs them of their cognition, causes swallowing disorders, and leads to immobility and falls. An estimated 5 million Americans are affected by Alzheimer’s disease and related dementias, a number that is expected to increase to 10.5 million over the next 25 years. 

From small to tall: breed-varied household pet dogs can be trained to detect Parkinson's DiseaseAnimal Cognition; Lisa Holt, Samuel V Johnston; 10/24Parkinson's Disease (PD) is a clinically diagnosed disease that carries a reported misdiagnosis rate of 10-20%. Recent scientific discoveries have provided evidence of volatile organic compounds in sebum that are unique to patients with PD. Twenty-three canines of varying breeds, ages, and environmental backgrounds were included. For this two-year reporting period, when averaged as a group, the 23 dogs were 89% sensitive and 87% specific to olfactory distinction between PD-positive and PD-negative human donor samples. Study findings support the application of companion dogs, trained with force-free, reward-based methodologies, for the detection of PD-positive and PD-negative samples under controlled conditions.

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Harnessing natural language processing to assess quality of end-of-life care for children with cancerJCO Clinical Cancer Informatics; Meghan E Lindsay, Sophia de Oliveira, Kate Sciacca, Charlotta Lindvall, Prasanna J Ananth; 9/24Data on end-of-life care (EOLC) quality, assessed through evidence-based quality measures (QMs), are difficult to obtain. Natural language processing (NLP) enables efficient quality measurement and is not yet used for children with serious illness. Conclusion: A high proportion of decedents attained specified EOLC-QMs more than 30 days before death. Our findings indicate that NLP is a feasible approach to measuring quality of care for children with cancer at the end of life and is ripe for multi-center research and quality improvement.

Top ten tips palliative care clinicians should know about hospice live dischargeJournal of Palliative Medicine; Stephanie P Wladkowski, Lauren J Hunt, Elizabeth A Luth, Joan Teno, Krista L Harrison, Cara L Wallace; 9/24Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as disenrollment or a "live discharge." Live discharge from hospice is a common and often distressing issue for hospice patients, their caregivers, and also for hospice professionals and agencies. This paper discusses common issues surrounding live discharge that clinicians and other healthcare professionals should consider when dealing with live discharge in their own clinical practices. Where applicable, we provide practical steps for hospice and palliative care clinicians to better support patients and families through this critical care transition. Further, we offer strategic directions interprofessional clinicians can take to affect systemic change to improve live discharge experiences.

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention. 

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative studyJournal of the American Geriatrics Society; by Cameron J Gettel, Courtney Kitchen, Craig Rothenberg, Yuxiao Song, Susan N Hastings, Maura Kennedy, Kei Ouchi, Adrian D Haimovich, Ula Hwang, Arjun K Venkatesh; 9/24Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Role of hospital connectedness in brain metastasis outcomesJAMA Network Open; by Lilin Tong, Ruchit V Patel, Ayal A Aizer, Amar Dhand, Wenya Linda Bi; 9/23/24Is hospital connectedness associated with clinical outcomes of patients with brain metastases? In this cohort study of 4679 patients with brain metastases in Massachusetts, increased connectedness of a hospital, defined as the weighted sum of ties to other care facilities, was associated with improved inpatient mortality. Hospital connectedness operated independently from hospital volume in its association with inpatient mortality and length of stay. These findings suggest that relationships between hospitals are associated with changes in patient outcomes in the interdisciplinary care of patients with brain metastases, likely owing to specialized and interdisciplinary care required in the disease management.

Using AI and social media to understand health disparities for transgender cancer careJAMA Network Open; Augustine Annan, PhD; Yeran Li, PhD; Jingcheng Du, PhD; Yezhou Sun, MS; A. I. Asante-Facey, MD; Xiaoyan Wang, PhD; Matthew Monberg, PhD; 8/24Transgender individuals experience lower health care use and higher health care discrimination rates. This qualitative study revealed 3 barriers in transgender cancer care: lack of awareness, access issues, and clinical challenges. The consistent reporting of clinical challenges indicates the need for tailored medical guidelines and gender-affirming support systems. Addressing these disparities requires enhanced clinician education, evidence-based guidelines, policy reforms, and inclusive health coverage. Despite potential biases and limitations in the representativeness of social media data, this study may offer valuable insights to guide future initiatives toward achieving equitable health care for transgender individuals.

Racial differences in palliative care and hospice among adults with chronic obstructive pulmonary diseaseRespiratory Medicine; by Natalia Smirnova, Sarah H Cross, Amanda Light, Dio Kavalieratos; 9/24Individuals with COPD often experience frequent hospitalizations and high-intensity care at the end-of-life (EOL). Although people with COPD experience a higher symptom burden and worse functional status than patients with other serious illness such as cancer, people with COPD are less likely to receive specialty palliative care (PC) or hospice and more likely to die in the hospital or the intensive care unit (ICU). Furthermore, evidence of inequities within COPD exist. For example, Black individuals and those with lower socioeconomic status are likelier to experience COPD exacerbations and have worse quality of life than White individuals and those with higher socioeconomic status.