Literature Review

Patient-Reported outcome measures help patients with cancerMichael J. Hassett, MD, MPH; Christine Cronin, BS; 8/24Outside of cancer medicine, there is ample evidence that care management interventions improve patient-related, therapy-related, and health care utilization outcomes, especially when PROMs [patient recorded outcome measures] are incorporated. Altogether, these findings led to the hypothesis that symptom-focused care management programs that rely on PROMs could have a substantial positive impact for patients with cancer. Over the past 2 decades, dozens of clinical trials have explored this question. The analysis by Balitsky and colleagues adds further support to the argument that PROMs should be used routinely in oncology practice.

Trends in post-acute care use in Medicare Advantage versus Traditional Medicare: A retrospective cohort analysisJournal of the American Medical Directors Association; by Robert E Burke, Indrakshi Roy, Franya Hutchins, Song Zhong, Syama Patel, Liam Rose, Amit Kumar, Rachel M Werner; 8/24We sought to describe national trends in hospitalization and post-acute care utilization rates in skilled nursing facilities (SNFs) and home health (HH) for both Medicare Advantage (MA) and Traditional Medicare (TM) beneficiaries, reaching up to the COVID-19 pandemic (2015-2019). We found hospitalizations, SNF stays, and HH stays were all decreasing over time in both populations. Although similar proportions of MA and TM beneficiaries received SNF or HH care, MA beneficiaries received fewer days. The largest difference we found was in the number of post-acute care providers used in TM and MA, with MA using far fewer; however, quality ratings were similar among post-acute care providers used in each program.

Mid-Atlantic primary care providers’ perception of barriers and facilitators to end-of-life conversationPalliative Care and Social Practice; by Melanie A. Horning, Barbara Habermann; 8/24Primary care providers are ideal people to facilitate end-of-life conversations, but these conversations rarely occur in the out-patient setting. Reported barriers in descending order included resistance from patients and families, insufficient time, and insufficient understanding of prognosis and associated expectations. Reported facilitators in descending order included established trusting relationship with provider, physical and/or cognitive decline and poor prognosis; and discussion standardization per Medicare guidelines. The involvement of primary care providers is associated with earlier ACP [advance care planning].

Access to legacy-oriented interventions at end of life for pediatric oncology patients: A decedent cohort reviewPediatric Blood and Cancer; by Sarah Daniels, Nelson D Franqui-Rios, Suraj S Mothi, Elizabeth Gaitskill, Kathryn Cantrell, Erica C Kaye; 8/24Legacy-oriented interventions have the potential to offer pediatric oncology patients and families comfort at end of life and during bereavement. Certified child life specialists often provide these services, and presently little is known about whether disparities exist in the provision of legacy-oriented interventions. [In this study] fifty-two percent of patients received a legacy-oriented intervention. Older adolescents (≥13 years) were less likely ... to receive legacy-oriented interventions than younger ones. Patients with home/hospice deaths were also less likely ... to receive interventions compared to patients who passed away at SJCRH [St. Jude Children's Research Hospital] locations. Hispanic patients ... and those in palliative care ... were more likely to receive interventions.

Crowdsourced feedback to improve resident physician error disclosure skills-A randomized clinical trialJAMA Open Network; Andrew A. White, MD; Ann M. King, MA; Angelo E. D’Addario, MA; Karen Berg Brigham, JD, MPH; Joel M. Bradley, MD; Thomas H. Gallagher, MD; Kathleen M. Mazor, Ed; 8/24Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents’ error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm.

Novel drug treatments for pain in advanced cancer and serious illness: a focus on neuropathic pain and chemotherapy-induced peripheral neuropathyPalliative Care and Social Practice; by Mellar P Davis; 7/24This review will discuss haloperidol, miragabalin, palmitoylethanolamide (PEA), and clonidine as adjuvant analgesics or analgesics. Haloperidol [demonstrates] ... only low-grade evidence that [it] improves pain when combined with morphine, methadone, or tramadol in patients who have cancer, pain from fibrosis, radiation necrosis, or neuropathic pain. Miragabalin is a gabapentinoid approved for the treatment of neuropathic pain ... [and] in randomized trials, patients with diabetic neuropathy have responded to miragabalin. Multiple randomized trials and meta-analyses have demonstrated PEA's effectiveness in reducing pain severity arising from diverse pain phenotypes. Intravenous clonidine has been used in terminally ill patients with poorly controlled symptoms, in particular pain and agitation.

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Does a patient’s ability to pay for health care make their life worth saving?JAMA Open Network; by Zara Cooper, MD, MSc; 7/24In this well-executed study using data from the American College of Surgeons Trauma Quality Improvement Program (TQIP), Hoit et al demonstrated that the timing of withdrawal of life-sustaining treatment (WLST) in critically injured adults between ages 18 and 64 years was statistically associated with the type of insurance they carried. Specifically, the authors showed that even after accounting for patient and hospital characteristics, individuals without insurance were approximately 50% more likely to undergo WLST earlier than others who were insured (eg, private insurance or Medicaid). ... it is incumbent upon individual clinicians and health systems to closely and uncomfortably examine how bias either creeps or marches into the life-and-death decisions we make for everyone under our care.

Connected to the cloud at time of death: a case reportJournal of Medical Case Reports; by Isabel Straw, Claire Kirkby, Preethi Gopinath; 8/24Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the 'Internet of Things', examining how existing guidelines capture data related to death which is no longer confined to the patient's body... Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). Publisher's note: An interesting article posing interesting questions about the impact technology has on death and the potential use / misuse of health information gathered by devices.

African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care Annals of Palliative Medicine; by Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston; 8/5/24 Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial. ... Results: Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer.  

Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary teamAnnals of Palliative Medicine; by M Catherine Trimbur, Bridget Sumser, Chelsea Brown, Timothy Steinhoff, Khaldoun Almhanna, Dana Guyer; 7/24People with a substance use disorder (SUD) have shortened lifespans due to complications from their substance use and challenges engaging with traditional health care settings and institutions. This impact on life expectancy is especially prominent in patients with co-occurring SUDs and cancer, and often has a much worse prognosis from the cancer than a similar patient without a SUD. Palliative care teams are experts in serious illness communication and symptom management and have become increasingly embedded in the routine care of patients with cancer. We argue that the skill set of palliative care teams is uniquely suited for addressing the needs of this oft marginalized group.

Symptom burden and quality of life among patient and family caregiver dyads in advanced cancerQuality of Life Research; by Katrina R Ellis, Allison Furgal, Feyisayo Wayas, Alexis Contreras, Carly Jones, Sierra Perez, Dolapo Raji, Madeline Smith, Charlotte Vincent, Lixin Song, Laurel Northouse, Aisha T Langford; 7/24Symptom management among patients diagnosed with advanced cancer is a high priority in clinical care that often involves the support of a family caregiver. This study seeks to identify patient and caregiver symptom clusters and investigate associations between identified clusters and demographic, clinical, and psychosocial factors (cognitive appraisals and [quality of life] QOL). The most prevalent symptom for patients was energy loss/fatigue and for caregivers, mental distress. Higher symptom burden was associated with more negative appraisals of the cancer and caregiving experience, and poorer QOL (physical, social, emotional, functional, and overall QOL). Dyads whose caregivers had more chronic conditions were more likely to be in the high symptom burden subgroup.