Literature Review

End-of-life emergency department use and healthcare expenditures among older adults: A nationally representative studyJournal of the American Geriatrics Society; by Cameron J Gettel, Courtney Kitchen, Craig Rothenberg, Yuxiao Song, Susan N Hastings, Maura Kennedy, Kei Ouchi, Adrian D Haimovich, Ula Hwang, Arjun K Venkatesh; 9/24Emergency department (ED) visits at end-of-life may cause financial strain and serve as a marker of inadequate access to community services and health care. We sought to examine end-of-life ED use, total healthcare spending, and out-of-pocket spending in a nationally representative sample. One in three older adults visit the ED in the last month of life, and approximately one in two utilize ED services in the last half-year of life, with evidence of associated considerable total and out-of-pocket spending.

Role of hospital connectedness in brain metastasis outcomesJAMA Network Open; by Lilin Tong, Ruchit V Patel, Ayal A Aizer, Amar Dhand, Wenya Linda Bi; 9/23/24Is hospital connectedness associated with clinical outcomes of patients with brain metastases? In this cohort study of 4679 patients with brain metastases in Massachusetts, increased connectedness of a hospital, defined as the weighted sum of ties to other care facilities, was associated with improved inpatient mortality. Hospital connectedness operated independently from hospital volume in its association with inpatient mortality and length of stay. These findings suggest that relationships between hospitals are associated with changes in patient outcomes in the interdisciplinary care of patients with brain metastases, likely owing to specialized and interdisciplinary care required in the disease management.

Top ten tips palliative care clinicians should know about applying key psychotherapy concepts in practiceJournal of Palliative Medicine; by Danielle Chammas, Brianna Williamson, Teddy Scheel, Neha Goyal, Leah B. Rosenberg, Daniel Shalev, Alex Gamble, Mike Polisso, William E. Rosa, Keri O. Brenner; 9/24Psychological symptoms are notably prevalent in palliative care (PC) settings, significantly impacting quality of life for patients and their families. Given the inherent multidimensionality of suffering in PC, addressing these psychological aspects is essential. This article aims to introduce and integrate discrete concepts from various schools of psychotherapy, which are directly applicable to PC practices, thereby providing clinicians with a rich toolkit to manage psychological distress. [Tips include:]

Hidden From sight - From the closet to the paywall: A rapid evaluation of restricted and monetized access to LGBTQ+ inclusive palliative, end-of-life, and bereavement care researchJournal of Pain and Symptom Management; by William E Rosa, Donna Wakefield, Hannah M Scott, Debbie Braybrook, Richard Harding, Katherine Bristowe; 9/24Health and social care professionals and policy makers rely on access to high quality evidence to inform their work. Failing to make articles related to the needs of LGBTQ+ people and populations OA risks further marginalisation and worsened inequities. Innovative journal policies and funding are needed to enable access, particularly for research that foregrounds the needs of marginalised communities. Where articles are currently behind paywalls, there is a need for accessible summaries or policy briefs to inform inclusive policy and practice.

Racial disparities in palliative care at end-of-life in children with advanced heart disease in the SouthJournal of Pediatrics; by Harrison Turner, Elizabeth S Davis, Isaac Martinez, Shambihavi Anshumani, Santiago Boresino, Susan Buckingham, Caroline Caudill, Chen Dai, Erika Mendoza, Katie M Moynihan, Lucas A Puttock, Raba Tefera, Smita Bhatia, Emily E Johnston; 8/24We performed a retrospective study from electronic health records of children (≤21 years at death) who died with advanced heart disease at a single institution between 2012 and 2019 (n=128). The main outcome was specialty pediatric palliative care (SPPC) consult; we assessed clinical and sociodemographic factors associated with SPPC. The median age at death was 6 months (IQR=1-25 months) with 80 (63%) ≤1 year... Twenty-nine children (22%) received SPPC. Children ≤1 year at time of death and Black children were less likely to receive SPPC. SPPC was associated with death while receiving comfort-focused care, do not resuscitate orders, and hospice enrollment (no children without SPPC care were enrolled in hospice) but not medically intense EOL care (ICU admission, mechanical ventilation, hemodialysis, or CPR) or death outside the ICU. Children dying with advanced heart disease in Alabama did not have routine SPPC involvement; infants and Black children had lower odds of SPPC. SPPC was associated with more comfort-focused care.

Research involving the recently deceased: ethics questions that must be answeredJournal of Medical Ethics; by Brendan Parent, Olivia S Kates, Wadih Arap, Arthur Caplan, Brian Childs, Neal W Dickert, Mary Homan, Kathy Kinlaw, Ayannah Lang, Stephen Latham, Macey L Levan, Robert D Truog, Adam Webb, Paul Root Wolpe, Rebecca D Pentz; 8/24Research involving recently deceased humans that are physiologically maintained following declaration of death by neurologic criteria-or 'research involving the recently deceased'-can fill a translational research gap while reducing harm to animals and living human subjects. It also creates new challenges for honouring the donor's legacy, respecting the rights of donor loved ones, resource allocation and public health. As this research model gains traction, new empirical ethics questions must be answered to preserve public trust in all forms of tissue donation and in the practice of medicine while respecting the legacy of the deceased and the rights of donor loved ones. This article suggests several topics for immediate investigation to understand the attitudes and experiences of researchers, clinical collaborators, donor loved ones and the public to ensure research involving the recently deceased advances ethically.

"Life… Gets Turned Upside-Down…" Opportunities to improve palliative care for high-grade gliomaJournal of Pain and Symptom Management; by Rita C Crooms, Jeannys F Nnemnbeng, Jennie W Taylor, Nathan E Goldstein, Barbara G Vickrey, Ksenia Gorbenko; 9/24Early palliative care referral is recommended broadly in oncology. Yet, few patients with high-grade gliomas (HGG) - highly aggressive brain tumors - receive specialty palliative care consultation. The palliative care needs of HGG relative to other cancers across palliative care domains are distinguished by poor prognosis, physical and cognitive deficits, and neuropsychiatric symptoms. Themes on indications for palliative care referral differed between neuro-oncologists and palliative physicians. Neuro-oncologists favored selective referral for clinical indications such as high non-neurologic symptom burden requiring time-intensive management. Palliative physicians favored early referral of most HGG patients, to allow for maximal benefit across HGG trajectory.

Vaccine mandates for health care workers—An effective policy tool for past and future pandemics JAMA Open Network; John B. Lynch, MD, MPH; 8/24COVID-19 vaccines reduce the risk of infection, severe disease, long COVID, and death. Although COVID-19 vaccines were free and obtainable in 2021 and as early as December 2020 for some health care workers (HCWs), a considerable proportion of people in the US chose not to get vaccinated. Wang and colleagues investigated this challenging and critically important question: do public policies that required health care workers to get vaccinated increase vaccine uptake? ... by the second week after a mandate was implemented, Wang et al found an increase in the proportion of HCWs ever vaccinated or who had completed or intended to complete the primary vaccination series. These results join those of other studies that found an association between vaccine mandates and increased vaccinations in specific populations. Studies like that by Wang et al provide more information that could be used to design mandates and communicate the impact of future mandates, providing much needed and better measures of the perceived tradeoffs of governmental action in preparation for the next pandemic and in the prevention of nonpandemic infectious diseases.

Lay-led intervention for war and refugee trauma-A randomized clinical trialJAMA Network Open; Lori A. Zoellner, PhD; Jacob A. Bentley, PhD; Kawther Musa, MA; Farhiya Mohamed, MSW; Luul B. Ahmed, BA; Kevin M. King, PhD; Norah C. Feeny, PhD; for the Islamic Trauma Healing Clinical Team; 8/24The global refugee crisis disproportionately affects the Muslim world [and] forced displacement often results in trauma-related mental health issues. Effective psychotherapy exists, but there are barriers to uptake by refugee groups as well as a lack of culturally appropriate interventions. In a randomized clinical trial with a US-based sample of 101 refugees, Islamic Trauma Healing showed significant effects on posttraumatic stress disorder, depression, and well-being, compared with the control group, with gains maintained through 12-week follow-up. Islamic Trauma Healing was well received by community members, consistent with faith and culture. The findings of this study suggest that this deep-cultural–adapted intervention has the potential to provide an easily trainable and scalable model to reach war and refugee communities unlikely to either have access to or seek Western-based mental health interventions.

Individual-and community-level risk factors of cancer-related financial hardship among cancer survivorsJAMA Network Open; Apoorv Dhir, MD; Kristian Donald Stensland, MD, MS, MPH; Lindsey Allison Herrel, MD, MS; Rishi Robert Sekar, MD, MS; 8/24Cancer survivors face substantial economic hardships during and after oncologic care, compounding the physical and psychosocial implications of a cancer diagnosis and compromising treatment adherence, quality of life, and survival. In this cross-sectional study, approximately 50% of cancer survivors experienced cancer-related financial hardship, with a disproportionate number of survivors who were younger, were Medicare or Medicaid beneficiaries, were socioeconomically disadvantaged, and had advanced disease. Although policy efforts to curb the costs of cancer care are essential, acknowledging the role of community and structural barriers and identifying socially vulnerable populations for targeted interventions represent a potential strategy toward mitigating financial hardship and delivering equitable cancer care.

Injurious fall risk differences among older adults with first-line depression treatmentsJAMA Network Open; Grace Hsin-Min Wang, PharmD, MS; Edward Chia-Cheng Lai, PhD; Amie J. Goodin, PhD; Rachel C. Reise, PharmD, MS; Ronald I. Shorr, MD, MS; Wei-Hsuan Lo-Ciganic, PhD, MS, MSPharm; 8/24One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.

Rita and Alex Hillman Foundation announces $500,000 in funding for nine projects to improve serious illness and end of life care Globe Newswire; by Rita & Alex Hillman Foundation; 9/10/24 The Rita and Alex Hillman Foundation ... announced nine grants to support innovative, early-stage interventions that address the serious illness and end of life needs of marginalized populations. The $500,000 in funding, part of a collaborative effort with The Arthur Vining Davis Foundations, will advance nursing-driven initiatives that improve care for diverse populations and expand access to high-quality end of life services. ... This year’s grants demonstrate a commitment to the design, development, and delivery of better and more equitable care. The 2024 HSEI grant recipients are:

Incorporating patient values in large language model recommendations for surrogate and proxy decisionsCritical Care Explorations; Victoria J Nolan, Jeremy A Balch, Naveen P Baskaran, Benjamin Shickel, Philip A Efron, Gilbert R Upchurch Jr, Azra Bihorac, Christopher J Tignanelli, Ray E Moseley, Tyler J Loftus; 8/24Surrogates, proxies, and clinicians making shared treatment decisions for patients who have lost decision-making capacity often fail to honor patients' wishes, due to stress, time pressures, misunderstanding patient values, and projecting personal biases. Advance directives intend to align care with patient values but are limited by low completion rates and application to only a subset of medical decisions. [Likert] scores were highest when patient values were captured as short, unstructured, and free-text narratives based on simulated patient profiles. This proof-of-concept study demonstrates the potential for LLMs [large language models] to function as support tools for surrogates, proxies, and clinicians aiming to honor the wishes and values of decisionally incapacitated patients.