Literature Review

Low rates of hospice utilization in blood cancer patientsCU Anschutz News; by Tari Advani; 10/24Patients with hematologic malignancies enroll in hospice at significantly lower rates than patients with solid malignancies and are more likely to die in the hospital. Cost of transfusions in comparison to standard per diem reimbursement for hospice is greatest limitation to hospices offering transfusions to blood cancer patients and this lack of option for transfusion is limiting hospice utilization by patients with blood cancers overall and leading to late enrollment when it happens. It is felt that innovative hospice payment models to improve end-of-life care for patients with blood cancers would be the most useful course of action.

A quality improvement initiative for inpatient advance care planningJAMA Health Forum; Olivia A Sacks, Megan Murphy, James O'Malley, Nancy Birkmeyer, Amber E Barnato; 10/24The Centers for Medicare & Medicaid Services (CMS) implemented advance care planning (ACP) billing codes in 2016 to encourage practitioners to conduct and document ACP conversations, and included ACP as a quality metric in the CMS Bundled Payments for Care Improvement Initiative in 2018. Increased ACP billing rates were significantly associated with decreased rates of inpatient death in the intervention group ... compared to the nonintervention ... and control groups ... Conclusions and relevance: This nationwide cohort study suggests that while the ACP quality initiative increased ACP billing, changes in clinical outcomes were inconsistent with the hypotheses.

Socioeconomic status and major adverse transplant events in pediatric heart transplant recipientsJAMA Network Open; Christina Hartje-Dunn, MD; Kimberlee Gauvreau, ScD; Heather Bastardi, PNP; Kevin P. Daly, MD; Elizabeth D. Blume, MD; Tajinder P. Singh, MD, MSc; 10/24In this cohort study of pediatric HT recipients, there was no difference in posttransplant outcomes among recipients stratified by SES, a notable improvement from prior studies. These findings may be explained by state-level health reform, standardized posttransplant care, and early awareness of outcome disparities.

Implementation and outcomes of a dementia-friendly training program in five hospitalsGeriatric Nursing; Ellen Roberts, Ellen C Schneider, Maureen Dale, Cristine B Henage, Casey J Kelley, Jan Busby-Whitehead; 10/24Hospitalized patients living with dementia (PLWD) age 65+ generally experience poor outcomes. This study's purpose was to implement dementia-friendly training with staff, track patient outcomes, and implement sustainable system changes. Positive changes in staff ratings from pre- to post- intervention were observed. Number of falls and readmissions did not change. The average number of stays per patient decreased ... Conclusions: Dementia-friendly hospital training is effective in improving staff recognition of the symptoms and needs of PLWD, and responding appropriately.

Feasibility of a digital palliative care intervention (Convoy-Pal) for older adults with heart failure and multiple chronic conditions and their caregivers: a waitlist randomized control trialBMC Palliative Care; by Lyndsay DeGroot, Riley Gillette, Jennifer Paola Villalobos, Geoffrey Harger, Dylan Thomas Doyle, Sheana Bull, David B Bekelman, Rebecca Boxer, Jean S Kutner, Jennifer D Portz; 10/24Although older adults with heart failure (HF) and multiple chronic conditions (MCC) frequently rely on caregivers for health management, digital health systems, such as patient portals and mobile apps, are designed for individual patients and often exclude caregivers. There is a need to develop approaches that integrate caregivers into care. This study tested the feasibility of the Social Convoy Palliative Care intervention (Convoy-Pal), a 12-week digital self-management program that includes assessment tools and resources for clinical palliative care, designed for both patients and their caregivers. Recruiting informal caregivers proved challenging. Nonetheless, Convoy-Pal retained patients and collected meaningful self-reported outcomes, showing potential benefits for both patients and caregivers. Given the importance of a patient and caregiver approach in palliative care, further research is needed to design digital tools that cater to multiple simultaneous users.

Few older patients with advanced heart failure are evaluated for advanced therapiesCardiology Advisory; by Jessica Nye; 10/3/24Only a small proportion of older patients with advanced heart failure (HF) are evaluated for left-ventricular assist device (LVAD) implantation or heart transplant (HT) and palliative care is underutilized, according to study results submitted to the Heart Failure Society of America (HFSA) Annual Scientific Meeting 2024, held virtually from September 27 to 30, 2024... Fewer than a third of patients (29%) were referred for palliative care.

Is end-of-life care consistent with wishes of patients with dementia? Oklahoma University News, Oklahoma City, OK; by April Wilkerson; 10/8/24 Soon after a dementia diagnosis, many people document their preferences for medical care near the end of their lives, often stipulating that they want to avoid hospitalizations and aggressive interventions. A new University of Oklahoma study aims to discover whether the actual care they receive aligns with their preferences. Lee Jennings, M.D., a geriatrician and associate professor in the OU College of Medicine, recently received a $2.3 million grant from the National Institutes of Health to analyze the end-of-life experiences of about 550 people with dementia, as well as their caregivers. The findings will advance medical knowledge of how best to care for people with an incurable disease that often robs them of their cognition, causes swallowing disorders, and leads to immobility and falls. An estimated 5 million Americans are affected by Alzheimer’s disease and related dementias, a number that is expected to increase to 10.5 million over the next 25 years. 

From small to tall: breed-varied household pet dogs can be trained to detect Parkinson's DiseaseAnimal Cognition; Lisa Holt, Samuel V Johnston; 10/24Parkinson's Disease (PD) is a clinically diagnosed disease that carries a reported misdiagnosis rate of 10-20%. Recent scientific discoveries have provided evidence of volatile organic compounds in sebum that are unique to patients with PD. Twenty-three canines of varying breeds, ages, and environmental backgrounds were included. For this two-year reporting period, when averaged as a group, the 23 dogs were 89% sensitive and 87% specific to olfactory distinction between PD-positive and PD-negative human donor samples. Study findings support the application of companion dogs, trained with force-free, reward-based methodologies, for the detection of PD-positive and PD-negative samples under controlled conditions.

Racial, ethnic, and socioeconomic differences in critical care near the end of life: A narrative reviewCritical Care Clinics; Katrina E Hauschildt, Judith B Vick, Deepshikha Charan Ashana; 10/24Patients from groups that are racially/ethnically minoritized or of low socioeconomic status receive more intensive care near the end of life, endorse preferences for more life-sustaining treatments, experience lower quality communication from clinicians, and report worse quality of dying than other patients. There are many contributory factors, including system (eg, lack of intensive outpatient symptom management resources), clinician (eg, low-quality serious illness communication), and patient (eg, cultural norms) factors. System and clinician factors contribute to disparities and ought to be remedied, while patient factors simply reflect differences in care and may not be appropriate targets for intervention.

Harnessing natural language processing to assess quality of end-of-life care for children with cancerJCO Clinical Cancer Informatics; Meghan E Lindsay, Sophia de Oliveira, Kate Sciacca, Charlotta Lindvall, Prasanna J Ananth; 9/24Data on end-of-life care (EOLC) quality, assessed through evidence-based quality measures (QMs), are difficult to obtain. Natural language processing (NLP) enables efficient quality measurement and is not yet used for children with serious illness. Conclusion: A high proportion of decedents attained specified EOLC-QMs more than 30 days before death. Our findings indicate that NLP is a feasible approach to measuring quality of care for children with cancer at the end of life and is ripe for multi-center research and quality improvement.

Top ten tips palliative care clinicians should know about hospice live dischargeJournal of Palliative Medicine; Stephanie P Wladkowski, Lauren J Hunt, Elizabeth A Luth, Joan Teno, Krista L Harrison, Cara L Wallace; 9/24Hospice care is designed to support the medical and psychosocial needs of individuals with serious illness and their caregivers through the dying process. Some individuals, though, leave hospice prior to death, generally referred to as disenrollment or a "live discharge." Live discharge from hospice is a common and often distressing issue for hospice patients, their caregivers, and also for hospice professionals and agencies. This paper discusses common issues surrounding live discharge that clinicians and other healthcare professionals should consider when dealing with live discharge in their own clinical practices. Where applicable, we provide practical steps for hospice and palliative care clinicians to better support patients and families through this critical care transition. Further, we offer strategic directions interprofessional clinicians can take to affect systemic change to improve live discharge experiences.

Alzheimer dementia among individuals with down syndromeJAMA Network Open; Eric Rubenstein, PhD; Salina Tewolde, ScM; Amy Michals, MPH; Jennifer Weuve, ScD; Juan Fortea, MD; Matthew P. Fox, ScD; Marcia Pescador Jimenez, PhD; Ashley Scott, MPH; Yorghos Tripodis, PhD; Brian G. Skotko, MD; 9/24In this cohort study of  ... adults with Down syndrome enrolled in Medicaid or Medicare between 2011 to 2019, 23.3% of adults had Alzheimer dementia diagnoses, and the mean age of death was 59.2 years. These findings suggest that Alzheimer dementia is almost universal among people with Down syndrome, and administrative claims data may offer valuable insights into improving care for this diverse population.

Well-being outcomes of health care workers after a 5-hour continuing education intervention-The WELL-B randomized clinical trialJAMA Network Open; J. Bryan Sexton, PhD; Kathryn C. Adair, PhD; 9/24To test the effectiveness of Well-Being Essentials for Learning Life-Balance (WELL-B), a web-based continuing education program [was developed] to deliver ... interventions to improve 4 dimensions of HCW [health care workers] well-being (ie, emotional exhaustion, emotional thriving, emotional recovery, and work-life integration). [The] ... sessions improved short-term HCW emotional exhaustion, emotional thriving, emotional recovery, and work-life integration. Health care worker impressions of WELL-B were positive. These findings suggest that WELL-B is a beneficial intervention.