Literature Review

Healthcare access dimensions and racial disparities in end-of-life care quality among ovarian cancer patientsCancer Research Communications; by Shama Karanth; Oyomoare L Osazuwa-Peters; Lauren E Wilson; Rebecca A. Previs; Fariha Rahman; Bin Huang; Maria Pisu; Margaret Liang; Kevin C Ward; Maria J Schymura; Andrew Berchuck; Tomi F. Akinyemiju; 3/24This study investigated the association between healthcare access (HCA) dimensions and racial disparities in end-of-life care quality among Non-Hispanic Black (NHB), Non-Hispanic White (NHW), and Hispanic patients with ovarian cancer (OC). The final sample included 4,646 women. After adjustment for HCA dimensions, NHB patients had lower quality EOL care compared to NHW patients, defined as increased risk of hospitalization in the last 30 days of life (RR 1.16, 95% CI:1.03-1.30), no hospice care (RR 1.23, 95% CI:1.04-1.44), in-hospital death (RR 1.27, 95% CI:1.03-1.57), and higher counts of poor-quality EOL care outcomes (Count Ratio:1.19, 95% CI:1.04-1.36).

Illness trajectories of incurable solid cancersBMJ, by Eric C T Geijteman, Evelien J M Kuip, Jannie Oskam, Diana Lees, Eduardo Bruera; 3/24[See article for] updated treatment illness trajectories for patients with incurable solid cancer include major temporary improvement, long term ongoing response, and rapid decline. Supportive and palliative care should be provided in conjunction with newer anticancer therapies to address patients’ physical, psychological, social, and spiritual challenges.

Aging is not an illness: Exploring geriatricians' resistance to serious illness conversationsJournal of Pain and Symptom Management, by Alexis Drutchas MD; Deborah S. Lee MD; Sharon Levine MD; Jeffrey L. Greenwald MD; Juliet Jacobsen MD, MPH; 9/23Three key themes emerged that help explain the reluctance of clinicians caring for older patients to have or document serious illness conversations: 1) aging in itself is not a serious illness; 2) geriatricians often focus on positive adaptation and social determinants of health and in this context, the label of “serious illness conversations” is perceived as limiting; and 3) because aging is not synonymous with illness, important goals-of-care conversations are not necessarily documented as serious illness conversations until an acute illness presents itself.

Digital ‘communication bridge’ for seniors with aphasia is $13M closer to reality McKnights Senior Living; by Aaron Dorman; 3/5/24 An upcoming research program will examine the potential for telehealth and wearable sensors to address a specific and nasty form of aphasia. The University of Chicago was awarded $13.2 million by the National Institutes of Health to study the disease, as part of its five-year Communication Bridge Research Program. The university recently announced the grant windfall and has begun reaching out to potential participants for a clinical trial.  

Knowledge gaps in end-of-life family caregiving for persons living with dementia: A study of hospice clinician perspectivesAmerican Journal of Hospice and Palliative Medicine, by Meghan McDarby, David Russell, Lori King, Elissa Kozlov, Elizabeth A Luth; 5/23More than 35% of hospice care recipients 65 and older have a dementia diagnosis. Yet family care partners of persons living with dementia report feeling unprepared to address their hospice recipient's changing needs nearing end of life. Hospice clinicians may have unique insight into the knowledge needs of family care partners and strategies for end-of-life dementia caregiving.

Case histories of significant advances: Cicely Saunders and the modern hospice movementHarvard Business School, by Amar Bhide, Srikant Datar; 2/25/24This Case history describes the role of Dame Cicely Saunders (1918- 2005) in shaping the modern hospice movement. It is narrated in the first person through the words of her brother, Christopher Saunders (1926-2024) as told to one of the authors of this paper.

Private equity's plot against older AmericansJournal of the American Geriatrics Society, by James Webster MD MS; 2/24/24Over the past several decades more than 140 private equity investment firms have acquired entities in major components of healthcare in the United States... Private Equity firms have undertaken acquisitions of financially or administratively distressed hospitals, nursing homes, physician practices especially emergency care and medical specialties, hospices, home care agencies, physical therapy and rehabilitation operations, ambulance services, and nursing registries... Of particular importance for older Americans, Private Equity firms currently own a significant percentage of U.S. nursing homes; estimates range from 5% to 11%, and a rapidly increasing percentage of hospice and home care agencies. All three are important sources of seniors' care. Why should we be concerned about these issues considering all of the other current challenges to the medical system?... 

Palliative medicine fellows’ discussions, perceptions, and training regarding medical cannabisJournal of Pain and Sympotom Management, by Dylan R. Sherry MD, Rushad Patell MD, Harry J. Han MD, Laura E. Dodge ScD MPH, Ilana M. Braun MD, Mary K. Buss MD MPH; 2/27/24Medical cannabis is increasingly considered for palliation of pain, nausea/vomiting, anorexia, and other symptoms. We aimed to determine whether training in hospice and palliative medicine (HPM) adequately prepares fellows to counsel patients about medical cannabis.

Ethics at the end of life in the newborn intensive care unit: Conversations and decisionsSeminars in Fetal and Neonatal Medicine, by Mark R. Mercurio, Lynn Gillam; 6/23The unexpected birth of a critically ill baby raises many ethical questions for neonatologists. Some of these are obviously ethical questions, about whether to attempt resuscitation, and, if the baby is resuscitated and survives, whether to continue life sustaining interventions. Other ethical decisions are more related to what to say rather than what to do. Although less obvious, they are equally as important, and may also have far-reaching ramifications... This may serve as a helpful guide for ethical deliberation, and helpful scripting for parental discussion, in similar cases.

What aspects of quality of life are important from palliative care patients’ perspectives? A framework analysis to inform preference‑based measures for palliative and end‑of-life settingsThe Patient - Patient-Centered Outcomes Research, by Nikki McCaffrey, Julie Ratcliffe, David Currow, Lidia Engel, Claire Hutchinson; 11/23Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Drugs, delirium, and ethics at the end of lifeJournal of the American Geriatric Society, by Columba Thomas, MD; Yesne Alici, MD; William Breitbart, MD; Eduardo Bruera, MD; Liz Blackler, MBE, LCSW-R; Daniel P. Sulmasy MD, PhD; 1/24For older persons with delirium at the end of life, treatment involves complextrade-offs and highly value-sensitive decisions. The principles of beneficence,nonmaleficence, respect for autonomy, and justice establish important parametersbut lack the structure necessary to guide clinicians in the optimal management ofthese patients. We propose a set of ethical rules to guide therapeutics—the canonsof therapy—as a toolset to help clinicians deliberate about the competing concernsinvolved in the management of older patients with delirium at the end of life.

Disparities in the geographic distribution of palliative care specialists in 2022Journal of General Internal Medicine, by Julia L Frydman, Karen McKendrick, Yingtong Chen, Jonathan Wun, Nathan E Goldstein, R Sean Morrison, Laura P Gelfman; 2/12/24In 2022, the number of HPM board-certified clinicians was 8,935 (6,448 = physicians (72.2%); 2,487 = NPs (27.8%)), which represents 0.7% of the NP workforce and 0.6% of the physician workforce... Our study highlights the uneven geographic distribution of board-certified HPM clinicians, which depends on state, metropolitan status, and area-level SES.