Literature Review

Challenges in health care for persons with multiple chronic conditions—where to go and how to get there?JAMA Open Network; Gregory M. Ouellet, MD, MHS; Jennifer A. Ouellet, MD, MHPE; Mary E. Tinetti, MD; 10/24Approximately 75% of older adults, and more than one-third of all adults receiving health care, have MCC [multiple chronic conditions]. As has been well reported, siloed, disease-based health care for persons with MCC may be burdensome, fragmented, of uncertain benefit and potential harm, and not aligned with individuals’ health priorities (ie, what matters most to them about their health and health care). The result of all this is the imposition of unwanted and unhelpful care, neglect of potentially helpful interventions that do not fall under the narrow confines of disease-based care, and inattention to what matters to each person. Finally, quality and payment metrics focused on what matters to the individual will both encourage, and result from, a push to whole-person care.

Use of hospice and end-of-life care quality among medical centers with high versus lower specialist palliative care reach among people with heart failure: An observational studyJournal of Palliative Medicine; by Shelli L Feder, Ling Han, Yan Zhan, Erica A Abel, Kathleen M Akgün, Terri Fried, Mary Ersek, Nancy S Redeker; 11/24Rates of specialist palliative care (SPC) vary among Veterans Affairs Medical Centers (VAMCs) for people with advanced heart failure (aHF). We evaluated the associations between facility rates of SPC reach and the quality of end of life (EOL) care received among this population. Families of patients with aHF who die in VAMCs with higher SPC reach report better EOL care quality regardless of whether or not they receive SPC. Research is needed to investigate factors beyond receiving SPC associated with these EOL outcomes.

Underrepresentation of Black men in physician assistant and associate trainingJAMA Network Open; Lucy W. Kibe, DrPH, MS, MHS, PA-C; Katrina M. Schrode, PhD; Samuel Paik, MPAS, PA-C; Dominique Frias-Sarmiento, MA; 10/24In this cohort study of PA applicants and matriculants, Black men remained substantially underrepresented despite overall growth of PA training programs. The low representation among matriculants was due in part to the low numbers of applicants but also to substantially lower matriculation success. This persistent underrepresentation highlights systemic barriers and underscores the need for targeted interventions to achieve a more representative health care workforce. To achieve equitable admissions, each PA program should aim to evaluate Black male applicants and matriculate Black men annually.

Promotion of knowledge and trust surrounding scarce resource allocation policies-A randomized clinical trialJAMA Health Forum; Russell G. Buhr, MD, PhD1; Ruby Romero, BA; Lauren E. Wisk, PhD; 10/24The COVID-19 pandemic prompted rapid development of scarce resource allocation policies (SRAPs) in case demand for critical health services eclipsed capacity. [This] trial found that a brief educational video is sufficient to explain complex ethical tenets and mechanics of SRAP and improved knowledge of such policies and trust in health systems to implement them equitably while not exacerbating anxiety about potential policy implications. This informs practice by providing a framework for educating people about the use of these policies during future situations necessitating crisis standards of care.

Perspectives of nursing home staff in advance care planning conversations: Experiences from the APPROACHES projectJournal of the American Medical Directors Association; by Kathleen T. Unroe, Hillary D. Lum, Susan E. Hickman; 9/24Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences e a Role offering Alzheimer’s patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP... Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program.

High-risk medications in persons living with dementia-A randomized clinical trialJAMA Internal Medicine; Sonal Singh, MD, MPH; Xiaojuan Li, PhD, MSPH; Noelle M. Cocoros, DSc, MPH; Mary T. Antonelli, PhD, RN, MPH; Ramya Avula, MS; Sybil L. Crawford, PhD; Inna Dashevsky, MS; Hassan Fouayzi, PhD, MS; Thomas P. Harkins, MA, MPH; Kathleen M. Mazor, EdD; Ashley I. Michnick, PharmD, PhD; Lauren Parlett, PhD; Mark Paullin, MS; Richard Platt, MD, MSc; Paula A. Rochon, MD, MPH; Cassandra Saphirak, MA; Mia Si, MS; Yunping Zhou, MS; Jerry H. Gurwitz, MD; 10/24Question: Does a one-time mailed educational intervention to patients and their clinicians reduce prescribing of antipsychotics, sedative-hypnotics, and strong anticholinergic agents in community-dwelling persons living with Alzheimer disease (AD) or AD-related dementias (ADRD)? In this randomized clinical trial of 12,787 patients, there were no clinically meaningful or statistically significant differences from the mailed educational intervention compared with usual care in continued use of medications targeted for deprescribing. These findings suggest medication-specific educational mailings targeting patients with AD or ADRD and their clinicians are not effective in reducing the use of high-risk medications.

To calm and to commend: Veterans’ musical preferences anticipating end of lifeMilitary Medicine; by Beatrice J Krauss; 11/24Listening to music was the most prevalent of the 20 coping mechanisms for stress in this sample of 30 veterans. Musical preferences were stable across age groups. For calming, music at resting heartbeat rhythms was chosen. Music from early adulthood or from the timelessness of the classics was selected most often. Modern music with lyrics has themes of duty, affirmation, gratitude, and relief. The nearly universal soothing effects of lullabies were recognized. For music for honor ceremonies, desires were often independent of the military branch. Patriotic songs, or songs recognizing multiple service branches, or with themes of peace and affirmation were more often chosen than music from a particular service branch.Publisher's note: Anticipating Veteran's Day on Monday.

How four partnerships are advancing cutting-edge cancer care Modern Healthcare; by Caroline Hudson; 11/4/24 Top cancer treatment organizations are leaning into partnerships to take care delivery to the next level. The National Cancer Institute estimates more than 2 million cases of cancer will be diagnosed in 2024. Healthcare leaders say collaboration among technology companies, research institutes, academic medical centers and universities allows them to combine resources and develop cutting-edge treatments more quickly — potentially at a fraction of the cost of standalone projects. ... Here’s what executives say about how four partnerships are advancing cancer care and why collaboration made the most sense for their systems.

Morphomics, survival, and metabolites in patients with metastatic pancreatic cancerJAMA Network Open; Valerie Gunchick, MS; Edward Brown, MS; Juan Liu, PhD; Jason W. Locasale, PhD; Philip A. Philip, MD, PhD; Stewart C. Wang, MD, PhD; Grace L. Su, MD; Vaibhav Sahai, MBBS, MS; 10/24In this large cohort study, we observed no association of BMI [body mass index] with survival for patients with metastatic PDA [pancreatic ductal adenocarcinoma]. However, longer survival was associated with more subcutaneous fat and a higher muscle-to-fascia ratio, whereas shorter survival was associated with more dense visceral fat. In addition, we observed large-magnitude associations of subcutaneous fat and muscle-to-fascia ratio with several metabolites, which provide key biological insight.

An authentic learning experience for medical students on conducting a family meetingAmerican Journal of Hospice and Palliative Care; by Mariana Khawand-Azoulai, Elisse Kavensky, Julia Sanchez, Ileana M Leyva, Corinne Ferrari, Marcio Soares, Khin M Zaw, Maria H van Zuilen; 9/24Medical schools often lack training for serious illness conversations with patients and caregivers. We developed a curriculum in our elective Transitioning to Residency medical student course, focused on end-of-life discussions. This paper provides an overview of the curriculum and outcomes from an advanced preparation assignment and student evaluations.

Six basic rules of palliative care and their Buddhist counterpartsAmerican Journal of Hospice and Palliative Medicine; by Jonathan D. Walker, Steven Radwany; 10/24As healthcare workers in palliative care, every day brings its share of awfulness and beauty, suffering and connection, meaning and cynicism. Without a way to support ourselves, we cannot help our patients, let alone one another. But how do we cope? Despite the unpredictability inherent in our work, we can discern certain patterns that offer an approach for dealing with these stressors. These patterns can be summarized into six simple rules of palliative care—rules that are coterminous with the teachings of Buddhism... The Six Rules of Palliative Care we propose are as follows:

Healthcare utilization in pediatric cancer patients near the end-of-lifeAmerican Journal of Hospice and Palliative Medicine; by James P. Kelly, Daniel V. Runco, James E. Slaven, Jason Z. Niehaus; 10/24Describe the healthcare utilization in the last 60 days of life in pediatric patients with cancer who died at home under hospice care and those that died in the hospital. Patients dying under hospice care spent a median of 44 days at home. Patients dying in the hospital spent a median of 30.5 days in the hospital, 10.5 days in the intensive care unit, and underwent 3.5 procedures requiring anesthesia. 45% of those that died in the hospital were compassionately extubated. Conclusion: For those dying with a cancer diagnosis, hospice care can allow for significant time at home with minimal healthcare while those dying in the hospital do spend a significant time in the hospital.

Person-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD3; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.