Literature Review

Current challenges in neurocritical care: A narrative reviewWorld Neurosurgery; Safa Kaleem, William T. Harris II, Stephanie Oh, Judy H. Ch'ang; 1/25Neurocritical care as a field aims to treat patients who are neurologically critically ill due to a variety of pathologies. As a recently developed subspecialty, the field faces challenges, several of which are outlined in this review ... [including confusion around] brain death testing or the diagnosis of brain death itself ... Given these difficult scenarios encountered in the neuro-ICU, conversations with patients’ decision-makers are often done with the assistance of palliative care services ... the most common reasons for palliative care consultation in the neuro-ICU were discussing prognosis, eliciting patient and family values, understanding medical options, and identifying conflict. Collaboration with hospital chaplains and palliative care services can be helpful, but cultural humility also needs to be a priority for neurocritical care providers to be able to navigate difficult conversations.

Conscience at the end of lifeNursing Reports; Ralph Neil Baergen, James Skidmore; 12/24Caring for patients at the end of life can involve issues that are ethically and legally fraught: withholding or withdrawing artificial nutrition and hydration, pain control that could hasten death, aggressive treatment that is continued when it seems only to be prolonging suffering, patients who request medical assistance in dying, and so forth. Clinicians may find that their deeply held ethical principles conflict with law, institutional policy, or patients' choices. In these situations, they may consider either refusing to participate in procedures that they find morally abhorrent (conscientious refusal) or providing care that they believe to be ethically obligatory despite being contrary to law or policy (conscientious commitment). Healthcare providers who refuse to provide medical services should be expected to explain their reasons, make prompt referrals, and bear some of the resulting costs or burdens.

Caregiver reported experiences of not-for-profit hospice agencies with a religious affiliationJournal of the American Geriatrics Society; by Xiao (Joyce) Wang, Joan M. Teno, Momotazur Rahman, Emmanuelle Belanger; 12/24Compared to those without a religious affiliation, the religiously affiliated hospices were smaller in size, newer, had a higher shares of patients with dementia, and also a higher percentage of patients living in nursing homes, and were more likely to be in the Midwest. These hospices also had lower scores across all CAHPS measures, with the magnitude of these differences by religious affiliation being small to medium. Compared to hospices without a religious affiliation, a much lower proportion of hospices with a religious affiliation received four or five stars (66.5% vs. 47.6%).Publisher's note: While for-profit hospices have been grouped into various categories (e.g., private equity owned or publicly traded companies), this is the first article I recall grouping nonprofit hospices into various categories.

Recommendations to ensure safety of AI in real-world clinical careJAMA; Dean F. Sittig, PhD; Hardeep Singh, MD, MPH; 11/24As HCOs [health care organizations] adapt their clinical and administrative workflows to new AI [artificial intelligence]-driven technologies, unintended adverse consequences will inevitably occur, particularly during transitions. To address these risks, HCOs and AI/EHR [electronic health record] developers must collaborate to ensure that AI systems are robust, reliable, and transparent. HCOs must proactively develop AI safety assurance programs that leverage shared responsibility principles, implement a multifaceted approach to address AI implementation, monitor AI use, and engage clinicians and patients. Monitoring risks is crucial to maintaining system integrity, prioritizing patient safety, and ensuring data security. 

Evolution in documented goals of care at end of life for adolescents and younger adults with cancerJAMA Network Open; Rosemarie Mastropolo, Colin Cernik, Hajime Uno, Lauren Fisher, Lanfang Xu, Cecile A Laurent, Nancy Cannizzaro, Julie Munneke, Robert M Cooper, Joshua R Lakin, Corey M Schwartz, Mallory Casperson, Andrea Altschuler, Lawrence Kushi, Chun R Chao, Lori Wiener, Jennifer W Mack; 12/24Little is known about the nature of change in goals of care (GOC) over time among adolescents and younger adult (AYA) patients aged 12 to 39 years with cancer near the end of life. Understanding how GOC evolve may guide clinicians in supporting AYA patients in making end-of-life decisions. In this cross-sectional study of AYA patients who died of cancer, palliative goals were rarely documented before the last month of life, highlighting the need for timely and ongoing GOC discussions.

Behavioral symptoms and treatment challenges for patients living with dementia: Hospice clinician and caregiver perspectivesJournal of the American Geriatrics Society; Karolina Sadowska BA; Molly Turnwald BA; Thomas O'Neil MD; Donovan T. Maust MD, MS; Lauren B. Gerlach DO, MS; 12/24Dementia affects one in three older adults over age 85 and individuals with dementia constitute the fastest growing population of patients entering hospice care. While cognitive impairment is the hallmark of dementia, behavioral symptoms are reported in nearly all patients with advanced dementia, contributing to both the complexity of end-of-life care and caregiver burden. Behavioral symptoms of dementia are highly prevalent among the US hospice population and are often managed with psychotropic medications prescribed off-label. There are limited treatment guidelines in this population, so the appropriate risk and benefit balance may be highly individual. This qualitative study can help to inform the decision-making of hospice clinicians and caregivers regarding anticipated behavioral changes and limitations of treatment options in dementia end-of-life care. 

Estimation of cancer deaths averted from prevention, screening, and treatment efforts, 1975-2020JAMA Oncology; Katrina A. B. Goddard, PhD; Eric J. Feuer, PhD; Jeanne S. Mandelblatt, MD, MPH; Rafael Meza, PhD; Theodore R. Holford, PhD; Jihyoun Jeon, PhD; Iris Lansdorp-Vogelaar, PhD; Roman Gulati, MS; Natasha K. Stout, PhD; Nadia Howlader, PhD; Amy B. Knudsen, PhD; Daniel Miller, BA; Jennifer L. Caswell-Jin, MD; Clyde B. Schechter, MD; Ruth Etzioni, PhD; Amy Trentham-Dietz, PhD; Allison W. Kurian, MD, MSc; Sylvia K. Plevritis, PhD; John M. Hampton, MS; Sarah Stein, PhD; Liyang P. Sun, MS; Asad Umar, DVM, PhD; Philip E. Castle, PhD; 12/24Overall US mortality has declined over time for most major cancer sites because of progress in prevention, screening, and treatment. Nevertheless, the reignited Cancer Moonshot goal to reduce the age-adjusted cancer mortality rate by 50% in the next 25 years will not be achieved without accelerating progress. In this model-based study using population-level cancer mortality data, an estimated 5.94 million deaths were averted from these 5 cancers [breast, cervical, colorectal, lung, and prostate] combined. Prevention and screening accounted for 8 of every 10 averted deaths, and the contribution varied by cancer site. A comprehensive plan to reduce cancer mortality includes interventions in cancer prevention, detection, diagnosis, treatment, and survivorship care.

Cannabidiol for scan-related anxiety in women with advanced breast cancer-A randomized clinical trialJAMA Network Open; Manan M. Nayak, PhD, MA; Peter Chai, MD; Paul J. Catalano, ScD; William F. Pirl, MD, MPH; James A. Tulsky, MD; Stephanie C. Tung, MD; Nancy U. Lin, MD; Nicole Andrade, BA; Sabrina Johns, MPH; Clint Vaz, MD; Melissa Hughes, MSc; Ilana M. Braun, MD; 12/24The findings of this randomized clinical trial show that CBD [cannabidiol] can be used safely in women with advanced breast cancer and clinical anxiety. Although the study did not meet its primary end point comparing preingestion vs postingestion anxiety change scores between study arms, anxiety levels in the CBD arm were significantly lower 2 to 4 hours after ingestion, suggesting a possible anxiolytic effect and warranting further investigation. 

US FDA approval of pediatric artificial intelligence and machine learning–enabled medical devicesJAMA Pediatrics; Ryan C. L. Brewster, MD; Matthew Nagy, MD, MPH; Susmitha Wunnava, PhD; Florence T. Bourgeois, MD, MPH; 12/24Despite rapid growth in the availability of AI/ML [artificial intelligence and machine learning]-enabled devices in recent years, only a small number have been authorized for pediatric use. The current regulatory framework may expose children to off-label use, differential performance of algorithms, and safety risks. Additionally, the lack of standardized reporting of pediatric device characteristics precludes informed decision-making by health care clinicians on appropriate device use. Pediatric AI/ML-enabled devices should be validated using representative datasets and should include complete and standard documentation on pediatric testing and authorization. Such changes will require cooperation across regulatory and industry stakeholders with a commitment to safe, equitable, and effective AI/ML development for children. 

Loneliness and social and emotional support among sexual and gender minority caregiversJAMA Network Open; Zhigang Xie, PhD; Hanadi Hamadi, PhD; Kassie Terrell, PhD; Laggy George, MPH; Jennifer Wells, BA; Jiaming Liang, PhD; 12/24In the current landscape of US health care, informal unpaid caregiving provided by family members and friends is indispensable for managing diseases and ensuring long-term care in residential settings. Sexual and gender minority (SGM) adults in the US are more likely than their non-SGM counterparts to provide informal care to their family members and/or friends. Caregiving can impose substantial physical, mental, and social connection issues on caregivers.Conclusions and Relevance In this cross-sectional study of social connections, SGM adults experienced significantly higher levels of loneliness compared with straight adults, irrespective of caregiving status. 

Mobile app–facilitated collaborative palliative care intervention for critically ill older adults-A randomized clinical trialJAMA Internal Medicine; Christopher E. Cox, MD, MPH; Deepshikha C. Ashana, MD, MBA, MS; Katelyn Dempsey, MPH; Maren K. Olsen, PhD; Alice Parish, MSPH; David Casarett, MD; Kimberly S. Johnson, MD; Krista L. Haines, DO; Colleen Naglee, MD; Jason N. Katz, MD, MHS; Mashael Al-Hegelan, MD, MBA; Isaretta L. Riley, MD, MPH; Sharron L. Docherty, RN, PNP, PhD; 12/24An automated electronic health record–integrated, mobile application–based communication platform that displayed family-reported needs over 7 days, coached ICU attending physicians on addressing needs, and prompted palliative care consultation if needs were not reduced within 3 study days. In this randomized clinical trial, a collaborative, person-centered, ICU-based palliative care intervention had no effect on palliative care needs or psychological distress compared to usual care despite a higher frequency of palliative care consultations and family meetings among intervention participants.

A scoping review of end-of-life discussions and palliative care: Implications for neurological intensive care in Latin America and the CaribbeanJournal of Palliative Medicine; Monica M Diaz, Lesley A Guareña, Bettsie Garcia, Christoper A Alarcon-Ruiz, Stella M Seal, Clio Rubinos, Dulce Cruz-Oliver, J Ricardo Carhuapoma; 12/24Palliative care (PC) is essential to improve quality of life for individuals with life-limiting acute neurological conditions, particularly in resource-limited settings. In Latin America and the Caribbean (LAC), there is limited health care professional training and education on PC. Our review demonstrates a need to improve PC knowledge and access to end-of-life care resources. Regional educational efforts are needed to improve PC knowledge among health care providers who care for patients with acute neurological conditions in LAC. 

Caregiver-Reported Quality in Hospices Owned by Private Equity Firms and Publicly Traded CompaniesJAMA; by Alexander E. Soltoff, Mark Aaron Unruh, David G. Stevenson, Dio Kavalieratos, Robert Tyler Braun; 12/17/24The US hospice industry has shifted from not-for-profit to for-profit ownership models, producing concerns aboutcare quality... Hospices owned by private equity firms (PEFs) or publicly traded companies (PTCs) performed significantly worse across CAHPS measures relative to not-for-profit and non-PEF/PTC for-profit agencies... These findings raise questions as to how patients are affected when PEFs and PTCs own hospices and suggest the need for greater transparency and accountability of hospice ownership.Publisher's note: Also see related articles by these authors: Acquisitions of Hospice Agencies by Private Equity Firms and Publicly Traded Corporations, JAMA Internal Medicine, 8/21; Changes in Diagnoses and Site of Care for Patients Receiving Hospice Care From Agencies Acquired by Private Equity Firms and Publicly Traded Companies; JAMA Network Open, 9/23.