Literature Review

Palliative ECT for catatonia in a terminal cancer patient: A case reportJournal of the Academy of Consultation-Liaison Psychiatry, by Arushi Mahajan B.S., Thanvi Vatti M.P.H., Andrew Coulter M.D., Elias Khawam M.D., Molly Howland M.D.Common end-of-life illnesses and medications can lead to catatonia. Catatonia can decrease interactivity, which worsens a terminal patient's quality of life. Treatment includes medications and electroconvulsive therapy (ECT). Though treating psychiatric disorders aligns with the palliative care philosophy, end-of-life ECT has been rarely reported. The few case reports on palliative ECT involved continuation of prior ECT courses for chronic psychiatric conditions in psychiatric settings after a terminal diagnosis. No studies have explored palliative ECT for acute catatonia.

Evaluation of a novel hospice-specific patient decision aidAmerican Journal of Hospice and Palliative Medicine, by Channing E. Tate, PHD, MPH; Gwendolyn Mami, JD; Monica McNulty, MS; Deborah J. Rinehart, PhD; Robin Yasui, MD; Nicole Rondinelli, FNP; Jonathan Treem, MD; Diane Fairclough, PhD; Daniel D. Matlock, MD, MPH; 4/24[Randomized Controlled Trial] We tested a novel hospice-specific patient decision aid to determine whether the decision aid could improve hospice knowledge, opinions of hospice, and decision self-efficacy in making decisions about hospice... The intervention demonstrated significant improvements in decision self-efficacy but not in hospice knowledge or hospice beliefs and attitudes.

Ethics Consult: Using hospice as "treatment" for behavioral problems of dementiaAmerican Journal of Geriatric Psychiatry, by Luisa Skoble MD, Jonathan Crane MPhil, PhD; 4/24This session will present 2 cases of individuals with advanced dementia who did not meet the traditional Medicare criteria for hospice, as both were ambulatory and did not have significant co-morbid medical issues. Both had significant aggressive behaviors that responded poorly to extensive trials of various medications during extended stays on a geriatric psychiatry inpatient unit. Both were referred to a local inpatient hospice where the staff use “suffering" as a hospice criteria and were “treated” with the usual hospice medications and expired in less than 3 weeks.

Large language models and generative AI in telehealth: A responsible use lensJournal of the American Medical Informatics Association, by Javad Pool, PhD, Marta Indulska, PhD, Shazia Sadiq, PhD; 4/24The findings emphasized the potential of LLMs, especially ChatGPT, in telehealth. They provide insights into understanding the use of LLMs, enhancing telehealth services, and taking ethical considerations into account. By proposing three future research directions with a focus on responsible use, this review further contributes to the advancement of this emerging phenomenon of healthcare AI.

The realities of work/life balance in palliative careBritish Journal of Community Nursing, by Brian Nyatanga; 3/24The philosophy of palliative care makes the idea of work/life balance a crucial component to providing that care. However, the difficulty of achieving this idealistic work/life split demands another way of looking at the concept.

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?...