Literature Review

Staying connected: A longitudinal, multisite, interprofessional rural fellowship collaborationJournal of Pain & Symptom Management; by Rhianon R. Liu, Rebecca N. Hutchinson, Stephen H. Berns, Nastasha Stitham, Jackie Fournier, John W. Wax MD , Lisa A. Stephens, Jonathan S. Jolin, Maxwell T. Vergo; 11/25Four interprofessional Hospice and Palliative Medicine (HPM) fellowship programs in rural northern New England states created an in-person educational retreat series. The goal of the series was to maximize shared educational resources and foster community amongst faculty and fellows, in an upstream attempt to improve recruitment/retention of clinicians in three rural states with inadequate access to specialty palliative care. At least 88% of fellows rated the retreats effective in strengthening their clinical, communication, teamwork, and leadership skills. Over four-fifths of faculty and fellows felt the retreats increased their sense of belonging and decreased professional isolation. The retreats were a top factor influencing fellowship choice for 29% of fellows, as well as a major incentive to remain practicing in the region for 32% of faculty.

Self-efficacy change among diverse family caregivers in dementia care The Journals of Gerontology Series B; by Deborah M Oyeyemi, Erich J Greene, Yunshan Xu, David R Lee, Rafael Samper-Ternent, Maya L Lichtenstein, Alan Stevens, Jeff D Williamson, Arun S Karlamangla, Debra Saliba, David B Reuben; 11/25Objectives: to determine whether changes in caregiver self-efficacy (beliefs about one’s ability to manage dementia-related problems and access help) differed by caregiver race and ethnicity across all participants enrolled in a large pragmatic trial of comprehensive dementia care. Black, Latino, and White dementia caregivers reported similar improvements in caregiver self-efficacy after participating in a comprehensive dementia care trial. Caregiver self-efficacy change did not differ significantly by caregiver race and ethnicity. Personalized aspects of comprehensive dementia care appear to address the needs of diverse caregiver populations.

Palliative care specialist use among Medicare decedents who had poor-prognosis cancersJAMA Network; by Isaac S. Chua, Haiden A. Huskamp, Ateev Mehrotra, Andrew D. Wilcock; 7/25Has specialty palliative care (PC) use among Medicare decedents who had cancers with poor prognoses changed in the context of greater telehealth use and more advanced practice clinicians in the field? In this cohort study..., the proportion with specialty PC use increased 24% from 2018 to 2023 [from 30% to 37%], largely driven by outpatient encounters and care by advanced practice clinicians. Decedents who were older, had lower incomes, and were living in nonmetropolitan areas remained less likely to receive any PC... These findings suggest that different strategies are needed to increase PC use among some disadvantaged subpopulations.Publisher's Note: Similar to Hua's article (Validation of a claims-based algorithm for specialist palliative care delivery in metastatic cancer), palliative care specialists were defined as those with NPI provider specialty code 17 or those who  included an ICD-10 Z51.5 code on at least 80% of their evaluation and management encounters.

Value bias and ethnocentrism and its effect on advance care planning: Mind the gapJournal of General Internal Medicine; Jeffrey T Berger, Dana Ribeiro Miller; 11/25After decades of efforts by academic and professional organizations and by governmental agencies to promote advance care planning, less than half of adults in the USA have formally executed advance directives. For patients who have completed these documents, studies find limited impact on end-of-life care. In this paper, we discussed ways in which bias towards certain values in the health care enterprise including ethnocentrism, the centering of one set of cultural norms, may contribute to the public's ambivalence and the relative inefficacy of advance directives. We offer a more expansive perspective on this aspect of clinical care with the goal of serving all patients more effectively.

Adolescents' and young adults' perspectives on decision-making and the emotional experience of having advanced cancerJournal of Pain and Symptom Management; by Nelda Itzep, Jessica Moore, Colleen Gallagher, Michael Roth, Peyton Martin, Mike Hernandez, Karen M Moody; 12/25Adolescents and young adults (AYAs) with advanced cancer represent a unique and vulnerable population. Little is known about the optimal approach to support their medical decision-making needs... Most participants reported acceptance and peace with their illness, yet many struggled with changes in physical appearance, the unfairness of getting cancer, and angry feelings related to their illness. Participants also reported high levels of therapeutic alliance with their doctors. These AYAs reported remaining hopeful and future oriented despite their prognosis. They also reported a strong belief that AYAs should be involved in decision-making.

Pediatric imminent death donation: Is it ethical?Journal of Pain and Symptom Management; by Gabriel Chain, Laura Pucillo, Mindy Dickerman, Richard James, Stephen Dunn, Elissa G Miller; 12/25Imminent death donation (IDD) is a form of organ donation that would occur just prior to the withdrawal of life-sustaining technology (WOLST). While IDD may offer a valuable opportunity for organ donation, for example when donation after circulatory death (DCD) is not feasible, it raises significant ethical concerns, particularly in pediatric cases... Clinicians from critical care, transplant surgery, palliative care and our hospital ethics committee offer differing views on how to address [a complex case].

Inpatient palliative care and post-operative healthcare utilization among older surgical patientsAnnals of Surgery; by Orly N Farber, Hiba Dhanani, Mengyuan Ruan, Masami Tabata-Kelly, Cameron Comrie, Amanda J Reich, Kate Sciacca, Tamryn F Gray, Lyle Suh, Stuart R Lipsitz, Elizabeth J Lilley, Christine S Ritchie, Charlotta Lindvall, Zara Cooper; 11/25Summary background data: National guidelines recommend palliative care processes for patients with serious illness undergoing major surgery. However, outcomes associated with palliative care delivery to elective surgical patients are understudied... Among 1,082 patients, 54.1% had a documented surrogate decision-maker, 4.3% had code status limitations, 2.6% had goals of care conversations, and <2.0% had assessment for hospice or palliative care consultations... Inpatient palliative care processes such as surrogate decision maker-designation are not associated with changes in one-year healthcare utilization after elective surgery.

Evaluating the impact of the End-of-Life Nursing Consortium Curricula: A systematic review of assessments and outcomesJournal of Hospice & Palliative Nursing; by Olga Ehrlich, Theresa Jizba, Mariela Hristova, Christine S Davidson, Dennis C Powless, Toni L Glover; 12/25The End-of-Life Nursing Education Consortium (ELNEC) curricula prepare nurses to provide high-quality, evidence-based palliative care to patients with serious illness and their families. The original ELNEC program has been adapted to include nursing subspecialties and online learning modules, reaching nurses and students worldwide. This systematic literature review described the outcomes of nursing knowledge, attitudes, practice changes, and patient outcomes in studies that used ELNEC as a primary intervention. The findings revealed significant enhancements in knowledge of palliative care among nursing students and nurses, as well as a notable positive shift in attitudes toward caring for seriously ill and dying patients. However, findings also indicate a need for studies that apply rigorous methods using valid and reliable assessment instruments aligned with nursing competencies.

Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-Hispanic White surrogate decision makersEquity Neuroscience; by Imadeddin Hijazi, Lewis B Morgenstern, Robert Michael Miller, Erin Case, Madeline Kwicklis, Darin B Zahuranec; 10/25 Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Contrary to our original hypothesis, we did not identify an ethnic difference in surrogate reports of the quality of death and end-of-life care after stroke between MA patients and NHW [non-Hispanic White] patients after adjusting for demographic and clinical factors. This result is encouraging, as it implies that in this community, ethnic disparities in end-of-life care may not be as pronounced as reported in other populations. Furthermore, the high scores on both surveys indicate overall satisfaction with care regardless of ethnicity. 

Trends in hospice use among older adults with dementia and cancer by race and ethnicity 2011–2021Journal of the American Geriatrics Society; by Inbal Mayan, Siqi Gan, John Boscardin, Krista L. Harrison, Jennifer E. James, Alexander Smith, Lauren J. Hunt; 11/25Hospice use among older adults has expanded substantially, with more than 1.7 million Medicare beneficiaries enrolled annually. Yet, disparities by race and ethnicity in hospice remain. It is unknown whether these disparities have narrowed over time or whether trends differ by clinical condition. We examined changes in hospice use by race and ethnicity among decedents with dementia and cancer, two common terminal diagnoses with different trajectories and implications for hospice eligibility.

Hospice, palliative care, and care experiences among Medicare beneficiaries with cancerJournal of Geriatric Oncology; by Lisa M Lines, Miku Fujita, Kim N Danforth, Daniel H Barch, Michael T Halpern, Michelle A Mollica, David T Eton, Ashley Wilder Smith; 11/25Among 37,025 Medicare beneficiaries with cancer, 11.1 % received hospice (with or without PC) and 7.4 % received PC only. Nearly 30 % of the sample died within five years of diagnosis; fewer than one-third of decedents received hospice. Factors associated with receiving hospice included increasing age, non-Hispanic ethnicity, American Indian/Alaska Native and multiracial identities, living in higher-income neighborhoods, survey-completion proxy assistance, fair/poor general health, advanced stage at diagnosis, and more illness burden. Independent predictors of PC encounters included age 75-79, female identification, no dual enrollment, no proxy assistance, and more illness burden. Differences in care experience associated with hospice or PC use were shown for two care experience measures: doctor communication scores and doctor rating scores were higher among beneficiaries who received neither hospice nor PC relative to beneficiaries who received hospice.