Literature Review
All posts tagged with “Research News.”
Top ten tips palliative care clinicians should know before their patient undergoes surgery?
07/20/24 at 03:15 AMTop ten tips palliative care clinicians should know before their patient undergoes surgery? Journal of Palliative Medicine; by Rachel Hadler, Lara India, Angela M Bader, Orly N Farber, Melanie L Fritz, Fabian M Johnston, Nader N Massarweh, Ravi Pathak, Sandra H Sacks, Margaret L Schwarze, Jocelyn Streid, William E Rosa, Rebecca A Aslakson; 7/15/24 online ahead of print Many seriously ill patients undergo surgical interventions. Palliative care clinicians may not be familiar with the nuances involved in perioperative care, however they can play a valuable role in enabling the delivery of patient-centered and goal-concordant perioperative care. ... This article, written by a team of surgeons and anesthesiologists, many with subspecialty training in palliative medicine and/or ethics, offers ten tips to support palliative care clinicians and facilitate comprehensive discussion as they engage with patients and clinicians considering surgical interventions.
Utility of do-not-resuscitate orders for critically ill infants in the NICU
07/20/24 at 03:10 AMUtility of do-not-resuscitate orders for critically ill infants in the NICU Pediatric Research - the American Pediatric Society, the European Society for Paediatric Research, and the Society for Pediatric Research; by Shannon Y. Adams, Katherine Redford, Randall Li, Ana Malfa, Richard Tucker and Beatrice E. Lechner; 7/5/24 To better understand the value of DNR orders for critically ill infants in the NICU, a prospective mixed-methods approach was utilized including chart review of infants who died in a regional NICU over a twenty-six-month period and surveys of their neonatologists, neonatal fellows, and nurses. Impact:
Tools for tomorrow: a scoping review of patient-facing tools for advance care planning
07/20/24 at 03:05 AMTools for tomorrow: a scoping review of patient-facing tools for advance care planning Palliative Care and Social Practice; by Sean R. Riley, Christiane Voisin, Erin E. Stevens, Seuli Bose-Brill, Karen O. Moss; 6/24/24 first published online Our scoping review reveals an evolving landscape of ACP tools [Advanced Care Planning], marked by increasing diversity in delivery methods and a trend toward personalized, adaptable resources. The integration of technology and patient- and family-centered approaches signifies promising progress in end-of-life care, offering new paths for engagement with patients and families. Critics questioning the utility of ACP may need to revisit their perspectives in light of these innovative developments. Our findings highlight the need for further research on the effective implementation and integration of these tools as well as other unique approaches into healthcare systems and community-based settings. Ultimately, the continual advancement of these tools may reshape health services research, leading to more patient- and family-centered care and improving end-of-life decision-making processes outcomes for all people thereby promoting health equity.
It starts with a story: A four-step narrative-based framework for serious illness conversations
07/20/24 at 03:00 AMIt starts with a story: A four-step narrative-based framework for serious illness conversations Journal of Palliative Medicine; by Natalie Lanocha, Sara Taub, Jason N Webb, Mary Wood, Tyler Tate; 7/5/24 online ahead of print An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). ... By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill.
Hospice enrollment and central nervous system–active medication prescribing to Medicare decedents with dementia
07/20/24 at 02:00 AMHospice enrollment and central nervous system–active medication prescribing to Medicare decedents with dementia JAMA Psychiatry; by Lauren B. Gerlach, DO, MS; Lan Zhang, PhD; Joan Teno, MD, MS; Donovan T. Maust, MD, MS; 7/17/24 Central nervous system (CNS)–active medications, including benzodiazepines and antipsychotics, are commonly prescribed in hospice for behavioral and physical symptom management.1 Such medications are not without risks, especially among patients living with Alzheimer disease and related dementias (ADRD), where potential harms may outweigh benefits for some patients.2 We explored the extent to which hospice enrollment is associated with CNS–active medication exposure among Medicare decedents with ADRD.
Report shows substantial financial opportunity in prioritizing research, education on women’s heart health
07/16/24 at 03:00 AMReport shows substantial financial opportunity in prioritizing research, education on women’s heart health Pharmacy Times; by Alexandra Gerlach; 7/13/24 A report published by authors from the American Heart Association (AHA) and the McKinsey Health Institute showed that addressing the gender gaps prevalent in the treatment of cardiovascular disease (CVD) could boost the US economy by $28 billion annually by 2040 and potentially address the 1.6 million years of life lost due to barriers to care experienced by women. The paper identifies multiple pathways to addressing the lack of representation and access to care for women with CVD... CVD is the leading cause of death in women in the United States, affecting nearly 60 million individuals, and it makes up over a third of the health gap between men and women.
Characterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States
07/13/24 at 03:40 AMCharacterizing disparities in receipt of palliative care for Asian Americans, Native Hawaiians, and Pacific Islanders with metastatic cancer in the United States Supportive Care in Cancer: Official journal of the Multinational Association of Supportive Care in Cancer; by Khushi Kohli, Mahi Kohli, Bhav Jain, Nishwant Swami, Sruthi Ranganathan, Fumiko Chino, Puneeth Iyengar, Divya Yerramilli, Edward Christopher Dee; 7/9/24 Palliative care plays essential roles in cancer care. However, differences in receipt among individuals identifying as Asian American, Native Hawaiian, and Other Pacific Islanders (AA&NHPI) with cancer are not well-characterized, especially when these diverse groups are disaggregated. We characterized disparities in receipt of palliative care among AA&NHPI patients with AJCC Stage IV prostate, breast, or lung cancer. Conclusions and relevance: Our findings demonstrate disparities in receipt of palliative care upon disaggregation of diverse AA&NHPI groups, the need for disaggregated research and targeted interventions that address the unique cultural, socioeconomic, and healthcare system barriers to palliative care receipt.
Disparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State
07/13/24 at 03:35 AMDisparities in end-of-life care for minoritized racial and ethnic patients during terminal hospitalizations in New York StateJournal of the American Geriatrics Society; Miguel Cid, Main Lin Quan Vega, Zhixin Yang, Jean Guglielminotti, Guohua Li, May Hua; 7/24Racial and ethnic minorities often receive care at different hospitals than non-Hispanic white patients, but how hospital characteristics influence the occurrence of disparities at the end of life is unknown. ... During terminal hospitalizations, Black patients were less likely than non-Hispanic White patients to have documented end-of-life care. This disparity appears to be more pronounced in non-teaching hospitals than in teaching hospitals.
The promise and challenge of value-based payment
07/13/24 at 03:30 AMThe promise and challenge of value-based paymentJAMA Internal Medicine; by Daniel K Shenfeld, Amol S Navathe, Ezekiel J Emanuel; 7/24Fee-for-service (FFS) systems pay physicians and health care institutions based on the number of services provided, whereas value-based payment (VBP) links payment to quality and outcomes. In 2021, the Centers for Medicare & Medicaid Services (CMS) announced the goal to use VBP for all Medicare beneficiaries’ health care by 2030. Some commercial insurers are also aligning their contracts to VBP. This broad alignment stems from increasing recognition that to reduce health care costs, incentives must be realigned to change practice patterns, prioritizing quality and cost lowering over quantity of services... Paying for value rather than more health care is without any question a wise approach. VBP fits with the intrinsic motivation of doing good, which led most physicians to medicine. Yet, achieving this is difficult due to operational and financial challenges inherently associated with the transition to VBP. A more efficient, economical method of assessing the underlying risk of a population and measuring the value and quality of care is needed. Various stakeholders across the public and private sectors are working to realize this vision.
The unintended and anticompetitive consequences of laws to control health care costs [CON implications]
07/13/24 at 03:25 AMThe unintended and anticompetitive consequences of laws to control health care costsJAMA Forum; by Lanhee J. Chen; 6/24An array of federal and state laws, and accompanying regulations, restrict the supply of health care, driving up costs and making health care less affordable and accessible for many in the US. Too few health policy analysts and commentators have paid attention to these supply-side limitations that play a significant role in limiting the number of clinicians and health care facilities. Even though some of these policies were well-intentioned and designed to control costs, they have, in practice, undermined competition and ironically led to higher prices in the long run... Together, CON and COPA laws, as well as the ACA restrictions on POHs, have been associated with a host of unintended consequences, such as the aggregation of market power in increasingly larger health care facilities, limited access to care, and higher costs for patients. Indeed, these supply-side restrictions have been critiqued by analysts across the ideological spectrum. Policymakers at both the state and federal level should take note of the unintended effects of these laws and their accompanying regulatory provisions and consider whether their repeal or modification would benefit patients and the communities where they live.
Career impact of palliative care fellowship training for nurse practitioners
07/13/24 at 03:20 AMCareer impact of palliative care fellowship training for nurse practitioners Journal of Palliative Medicine; by Hilary Carroll McGuire, Jennifer Costa, Barbara Reville; 7/8/24 online ahead of print Postgraduate fellowship training for nurse practitioners (NP) in palliative care can ameliorate workforce shortages; however, currently there are few NP fellowships and little evidence about outcomes, such as retention in hospice and palliative nursing, job satisfaction, or professional contributions. Conclusions: NP palliative care fellowship alumni reported multiple career benefits including job satisfaction, professional accomplishment, and ongoing employment at their training institutions.
A hospice transitions program for patients in the Emergency Department
07/13/24 at 03:15 AMA Hospice Transitions Program for patients in the Emergency Department JAMA Network Open; by Christopher W. Baugh, MD, MBA; Kei Ouchi, MD, MPH; Jason K. Bowman, MD; Ayal A. Aizer, MD; Alexander W. Zirulnik, MD, MPH; Martha Wadleigh, MD; Angela Wise, MHA; Paula Remón Baranda, MEM; Richard E. Leiter, MD, MA; Bradley J. Molyneaux, MD, PhD; Andrea McCabe, RN; Panupong Hansrivijit, MD; Kate Lally, MD; Melissa Littlefield, MBA; Alexei M. Wagner, MD, MBA; Katherine H. Walker, MD, MSc; Hojjat Salmasian, MD, MPH, PhD; Kourosh Ravvaz, MD, PhD; Jada A. Devlin, BSN; Karen Lewis Brownell, RN, BSN, CEN; Matthew P. Vitale, MD; Frantzie C. Firmin, MS, RN; Nelia Jain, MD; Jane deLima Thomas, MD; James A. Tulsky, MD; Soumi Ray, PhD; Lynne M. O’Mara, MPAS, PA-C; Elizabeth M. Rickerson, MD; Mallika L. Mendu, MD, MBA; 7/8/24Patients often visit the emergency department (ED) near the end of life. Their common disposition is inpatient hospital admission, which can result in a delayed transition to hospice care and, ultimately, an inpatient hospital death that may be misaligned with their goals of care. Conclusions and relevance: In this quality improvement study, a multidisciplinary program to facilitate ED patient transitions was associated with hospice use. Further investigation is needed to examine the generalizability and sustainability of the program.Editor's Note: We posted an article on 7/10/24 that describes the significance of this research,"Study finds new program streamlined hospice transitions from the emergency department."
End-of-life symptoms and symptom management in older adults with stroke versus cancer
07/13/24 at 03:10 AMEnd-of-life symptoms and symptom management in older adults with stroke versus cancerAmerican Journal of Hospice & Palliative Medicine; Hanna Ramsburg, Meredith MacKenzie Greenle, Janice L Hinkle; 6/24Little is known about the end-of-life (EOL) experience in older adults with stroke or how similar the EOL experience is in older adults with stroke when compared to those with cancer. Older adults with stroke are at risk for inadequate symptom assessment and documentation, as well as poorer symptom management and poorer overall care quality.
Prognoses associated with Palliative Performance Scale scores in modern palliative care practice
07/13/24 at 03:05 AMPrognoses associated with Palliative Performance Scale scores in modern palliative care practiceJAMA Network Open; by Kara E Bischoff, Kanan Patel, W John Boscardin, David L O'Riordan, Steven Z Pantilat, Alexander K Smith; 7/1/24The Palliative Performance Scale (PPS) is one of the most widely used prognostic tools for patients with serious illness. However, current prognostic estimates associated with PPS scores are based on data that are over a decade old. ... Conclusions and relevance: In this prognostic study, prognostic estimates associated with PPS scores were substantially longer than previous estimates commonly used by clinicians. Based on these findings, an online calculator was updated to assist clinicians in reaching prognostic estimates that are more consistent with modern palliative care practice and specific to the patient's setting and diagnosis group.
Integrative oncology for patients with lung cancer: A prospective pragmatic controlled trial
07/13/24 at 03:00 AMIntegrative oncology for patients with lung cancer: A prospective pragmatic controlled trial Lung Cancer; by Eran Ben-Arye, Orit Gressel, Shahar Lifshitz, Nir Peled, Shoshana Keren, Noah Samuels; 6/25/24 Complementary medicine and integrative oncology modalities (IOM) have been included in the clinical practice guidelines of the American College of Chest Physicians in the treatments of patients with lung cancer. The present study examined the impact of a patient-tailored IOM treatment program on quality of life (QoL)-related concerns among patients with non-small and small lung cancer undergoing active oncology treatment. ... High adherence to a 6-week IOM program within supportive/palliative care for patients with lung cancer was found to alleviate pain and emotional concerns, improving overall QoL. Further research is needed to confirm the findings in real-life IOM practice for patients with lung cancer.
Veteran Honored: 101-year-old recognized for bravery on the battlefield
07/09/24 at 03:00 AMVeteran Honored: 101-year-old recognized for bravery on the battlefieldThe Glendale Star, Tempe AZ; by Lin Sue Flood; 7/5/24 At the tender age of 18, Ned Kent joined the Army. That was January 1940 ... and he served faithfully through July 1945 ... [Kent] fought on the front lines of the Battle of the Bulge in Belgium. He and his troop won a Bronze Heart for their heroic actions in storming Normandy while under German bombardment on D-Day, now over 80 years ago. His daughter Debi is enormously proud of his courage. “My dad is a hero, but my dad is also a humble man,” she said. Proving her point, the 101-year-old was quick to add, “I’m no hero. I just served in the Army.” But those five years of service were difficult to talk about. It took Kent decades to open up about what he experienced, including the horrors witnessed while liberating a concentration camp. One of the people he shared openly with was Hospice of the Valley social worker Roberta Fellows. Once she learned about his time in the service, she was determined to give him some much-needed recognition for all he endured. [Click on the title's link to continue reading.]
Ethics at the end of life
07/06/24 at 03:30 AMEthics at the end of lifeMedicine; by John Idris Baker; 7/24End-of-life care has always been prominent in discussions of clinical ethics. Almost 30% of hospital inpatients are in their last year of life. Doctors frequently encounter people with end-of-life care needs and should to be equipped to respond... Key points:
National health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade
07/06/24 at 03:25 AMNational health expenditure projections, 2023–32: Payer trends diverge as pandemic-related policies fade Health Affairs - Research Article - Costs & Spending; by Jacqueline A. Fiore, Andrew J. Madison, John A. Poisal, Gigi A. Cuckler, Sheila D. Smith, Andrea M. Sisko, Sean P. Keehan, Kathryn E. Rennie, and Alyssa C. Gross; 6/12/24 Health care spending growth is expected to outpace that of the gross domestic product (GDP) during the coming decade, resulting in a health share of GDP that reaches 19.7 percent by 2032 (up from 17.3 percent in 2022). National health expenditures are projected to have grown 7.5 percent in 2023, when the COVID-19 public health emergency ended. This reflects broad increases in the use of health care, which is associated with an estimated 93.1 percent of the population being insured that year. ... Amonth eh major payers, Medicare has the highest projected ten-year average spending growth rath, mainly because of enrollment into the program. [Click on the title's link to examine this article's content and tables.]
Clinician- and patient-directed communication strategies for patients with cancer at high mortality risk
07/06/24 at 03:20 AMClinician- and patient-directed communication strategies for patients with cancer at high mortality risk JAMA Network Open - Oncology; by Samuel U. Takvorian, MD, MSHP; Peter Gabriel, MD, MSE; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/1/24 Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. ... In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.
A scoping review of dementia interventions in home-based primary care
07/06/24 at 03:15 AMA scoping review of dementia interventions in home-based primary careJournal of the American Medical Directors Association; by Jeffrey D. Weiner BA, Bruce Leff MD, Christine S. Ritchie MD, MSPH; 6/24Home-based primary care (HBPC) provides interdisciplinary, longitudinal, comprehensive care at home to homebound older adults. The prevalence of dementia among HBPC recipients is approximately 50%... Despite high prevalence of dementia among homebound older adults receiving HBPC, there are a dearth of studies on HBPC-specific dementia interventions. Future studies should consider adapting and testing interventions found to be effective in other settings to HBPC.
Variation in specialist palliative care reach and associated factors among people with advanced heart failure in the Department of Veterans Affairs
07/06/24 at 03:10 AMVariation in specialist palliative care reach and associated factors among people with advanced heart failure in the Department of Veterans AffairsJournal of Pain and Symptom Management; by Shelli L Feder, Ling Han, Yan Zhan, Erica A Abel, Kathleen M Akgün, Terri Fried, Mary Ersek, Nancy S Redeker; 7/24Clinical practice guidelines recommend palliative care for people with advanced heart failure (aHF), yet it remains underutilized. We examined medical center variation in specialist palliative care (SPC) and identified factors associated with variation among people with aHF... SPC reach varies widely across VAMCs for people with aHF. Outpatient palliative is common among high-reach VAMCsbut its role in reach warrants further investigation. Strategies used by high-reach VAMCs may be potential targets to test for implementation and dissemination.
Nursing Home Star Ratings and end-of-life care quality: Lessons learned from the Veterans Health Administration
07/06/24 at 03:05 AMNursing Home Star Ratings and end-of-life care quality: Lessons learned from the Veterans Health AdministrationJournal of the American Medical Directors Association; by Joan Carpenter, Daniel Kinder, Dawn Smith, Mary Ersek, Melissa Wachterman, Joshua Thorpe, Donald R Sullivan, Jennifer Bailey, Scott Shreve, Ann Kutney-Lee; 6/24Our findings suggest that the current [VA nursing homes, known as Community Living Centers (CLCs)] star rating system is not sufficient to assess the quality of EOL care. [The VA's Bereaved Family Survey (BFS)] scores, or a comparative EOL quality of care measure, should be integrated into CLC quality rating systems.Publisher's Note: If the VA is integrating an EOL quality measure into their NF Star Rating, should Medicare?
Palliative care for patients with cancer: ASCO guideline update
07/06/24 at 03:00 AMPalliative care for patients with cancer: ASCO guideline updateJournal of Clinical Oncology; by Justin J Sanders, Sarah Temin, Arun Ghoshal, Erin R Alesi, Zipporah Vunoro Ali, Cynthia Chauhan, James F Cleary, Andrew S Epstein, Janice I Firn, Joshua A Jones, Mark R Litzow, Debra Lundquist, Mabel Alejandra Mardones, Ryan David Nipp, Michael W Rabow, William E Rosa, Camilla Zimmermann, Betty R Ferrell; 7/24Evidence-based recommendations address the integration of palliative care in oncology. Oncology clinicians should refer patients with advanced solid tumors and hematologic malignancies to specialized interdisciplinary palliative care teams that provide outpatient and inpatient care beginning early in the course of the disease, alongside active treatment of their cancer. For patients with cancer with unaddressed physical, psychosocial, or spiritual distress, cancer care programs should provide dedicated specialist palliative care services complementing existing or emerging supportive care interventions... The Expert Panel suggests early palliative care involvement, especially for patients with uncontrolled symptoms and QOL concerns. Clinicians caring for patients with solid tumors on phase I cancer trials may also refer them to specialist palliative care. Additional information is available at www.asco.org/supportive-careguidelines.
A palliative care curriculum may promote resident self-reflection and address moral injury
06/29/24 at 03:30 AMA palliative care curriculum may promote resident self-reflection and address moral injury The Journal of Surgical Research; by Shruti Koti, Lyudmyla Demyan, Danielle Deperalta, Sophia Tam, Gary Deutsch; 6/22/24 online ahead of print Introduction: There is a lack of formal palliative care education for surgical trainees, and the demanding nature of surgical training and exposure to challenging clinical scenarios can contribute to moral injury. We developed a palliative care curriculum to promote self-reflection, aiming to address moral injury in residents.Conclusions: The described palliative care curriculum accomplishes several goals as follows: it educates residents on palliative care topics, teaches communication tools, encourages self-reflection, and provides space for building peer relationships. The ease of implementation makes this curriculum applicable across various types of institutions, offering the potential to positively impact surgical training on a national scale.
Patient experiences of specialty palliative care in the perioperative period for cancer surgery
06/29/24 at 03:25 AMPatient experiences of specialty palliative care in the perioperative period for cancer surgery Journal of Pain and Symptom Management; by Laura M Holdsworth, Rachel Siden, Anna Sophia Lessios, Mae Verano, Elizabeth Rickerson, Bridget Fahy, Fabian M Johnston, Brittany Waterman, Rebecca Aslakson; 6/19/24 online ahead of print Context: Though patients undergoing treatment for upper gastrointestinal (GI) cancers frequently experience a range of sequelae and disease recurrence, patients often do not receive specialty palliative care soon after diagnosis and it is unknown in what ways they may benefit. Results: We found five themes that characterized patient experiences and perceptions of specialty palliative care. Patients typically had limited prior awareness of palliative care (theme 1), but during the study, came to understand it as a "talking" intervention (theme 2). Patients whose concerns aligned with palliative care described it as being impactful on their care (theme 3). However, most patients expressed a focus on cure from their cancer and less perceived relevance for integration of palliative care (theme 4). Integrating specialist palliative care practitioners with surgical teams made it difficult for some patients to identify how palliative care practitioners differed from other members of their care team (theme 5).