Literature Review

The sowers of seeds: A qualitative analysis of the role of palliative care educators in facilitating goals-of-care conversations and palliative care referrals American Journal of Hospice & Palliative Care; by Seth N Zupanc, Lisa M. Quintiliani, Amy M. LeClair, Michael K. Paasche-Orlow, Angelo Volandes, Akhila Penumarthy, Lori Henault, Jennifer E. Itty, Aretha D. Davis, Joshua R. Lakin; 8/28/24 online ahead of print Twenty-four individuals were interviewed (12 clinical staff of medical and surgical wards, seven palliative care team members, and five PCEs). Four themes were identified: (1) The work completed by the PCEs provided a foundation for future palliative care involvement; (2) Constituting the new role in practice required revision and creativity; (3) Communication was important to providing continuity of care; and (4) Establishing trust catalyzed the acceptance of the role.

"At least I can push this morphine": PICU nurses' approaches to suffering among dying childrenJournal of Pain and Symptom Management; Elizabeth G Broden, Ijeoma Julie Eche-Ugwu, Danielle D DeCourcey, Joanne Wolfe, Pamela S Hinds, Jennifer Snaman; 8/24Parents of children who die in the pediatric intensive care unit (PICU) carry memories of their child's suffering throughout a lifelong grieving experience. Given their prolonged time at the bedside, PICU nurses are poised to attend to dying children's suffering. While physical suffering may be remedied with direct nursing care, holistically attending to EOL suffering in the PICU requires both bolstering external processes and strengthening PICU nurses' internal resources. Improving psychosocial training and optimizing interprofessional care systems could better support dying children and their families. 

Psilocybin-assisted psychotherapy for existential distress: practical considerations for therapeutic application-a reviewAnnals of Palliative Medicine; Arum Kim, Barley Halton, Akash Shah, Olivia M Seecof, Stephen Ross; 8/24Existential distress is commonly experienced by patients diagnosed with a life-threatening illness. This condition has been shown to adversely impact quality of life and is correlated with increased suicidal ideation and requests for hastened death. While palliative care teams are experienced in treating depression and anxiety, existential distress is a distinct clinical condition for which traditional medications and psychotherapy approaches demonstrate limited efficacy or duration of effect. Psychedelic drugs, including psilocybin and lysergic acid diethylamide (LSD), in conjunction with psychotherapy have been shown to produce rapid and sustained reductions in existential and psychiatric distress and may be a promising treatment for patients facing existential distress in palliative care settings.

Cancer research provides a model for advancing clinical trials in dementia in the era of disease-modifying Alzheimer's-type dementia therapiesAlzheimer's Research and Therapy; Gregory A Jicha, Thomas C Tucker, Susanne M Arnold, Peter T Nelson; 8/24Dementia and cancer are multifactorial, widely-feared, age-associated clinical syndromes that are increasing in prevalence. There have been major breakthroughs in clinical cancer research leading to some effective treatments, whereas the field of dementia has achieved comparatively limited success in clinical research. The lessons of cancer research may help those in the dementia research field in confronting some of the dilemmas faced when the clinical care regimen is not entirely safe or efficacious. There is also evidence from both cancer and dementia research that individuals enrolled in the placebo arms of clinical trials have unexpectedly good outcomes, indicating that participation in clinical trial can have medical benefits to enrollees.

Nursing Home Compare star ratings before versus after a change in nursing home ownershipJournal of the American Geriatrics Society; by Kira L Ryskina, Emily Tu, Junning Liang, Seiyoun Kim, Rachel M Werner; 7/24Nursing Home Compare ratings decreased slightly after a change in facility ownership, driven by lower staffing and health inspection ratings and mitigated somewhat by higher quality measure ratings. These conflicting trends underscore the need for transparency around changes in facility ownership and a better understanding of consequences of changes in ownership that are salient to patients and families.Publisher's note: This article might have interesting implications in the hospice field.

Clinical reasoning and artificial intelligence: Can AI really think? Transactions of the American Clinical and Climatological Association; Richard M. Schwartzstein, MD; 2024Artificial intelligence (AI) in the form of ChatGPT ... holds great promise for more routine medical tasks, may broaden one’s differential diagnosis, and may be able to assist in the evaluation of images, such as radiographs and electrocardiograms, the technology is largely based on advanced algorithms akin to pattern recognition. One of the key questions raised in concert with these advances is: What does the growth of artificial intelligence mean for medical education, particularly the development of critical thinking and clinical reasoning? AI will clearly affect medicine in the years to come and will change the ways in which doctors work. It will also make the ability to reason, to think, to analyze problems, and to know how best to apply principles of human biology at the bedside more important.

Pediatric complex chronic condition systemJAMA Open Network; Lisa C. Lindley, PhD, RN; 7/24The pediatric complex chronic condition (CCC) system is the gold standard in classifying patients younger than 18 years who are seriously ill in pediatric research. Feinstein et al report on the development and comparison of the most recent revision (V3) of the CCC system [which includes] modifications to new, missing, and retired ICD-10-CM and procedure codes. The authors recommend using the newest V3 of the CCC system for research because it incorporates the evolving ICD-10 system. ICD-10 codes are continually being added, deleted, and modified, and the CCC system, which is based on the ICD and procedure codes, needs to keep pace. Feinstein et al are to be commended for their significant effort to update codes, especially ahead of the imminent US transition to the International Classification of Diseases, 11th Revision (ICD-11).

Clinician-and patient-directed communication strategies for patients with cancer at high mortality risk-A cluster randomized trialJAMA Open Network; Samuel U. Takvorian, MD; Peter Gabriel, MD, MS; E. Paul Wileyto, PhD; Daniel Blumenthal, BA; Sharon Tejada, MS; Alicia B. W. Clifton, MDP; David A. Asch, MD, MBA; Alison M. Buttenheim, PhD, MBA; Katharine A. Rendle, PhD, MSW, MPH; Rachel C. Shelton, ScD, MPH; Krisda H. Chaiyachati, MD, MPH, MSHP; Oluwadamilola M. Fayanju, MD, MA, MPHS; Susan Ware, BS; Lynn M. Schuchter, MD; Pallavi Kumar, MD, MPH; Tasnim Salam, MBE, MPH1; Adina Lieberman, MPH; Daniel Ragusano, MPH; Anna-Marika Bauer, MRA; Callie A. Scott, MSc; Lawrence N. Shulman, MD; Robert Schnoll, PhD; Rinad S. Beidas, PhD; Justin E. Bekelman, MD; Ravi B. Parikh, MD, MPP; 7/24Serious illness conversations (SICs) that elicit patients’ values, goals, and care preferences reduce anxiety and depression and improve quality of life, but occur infrequently for patients with cancer. Behavioral economic implementation strategies (nudges) directed at clinicians and/or patients may increase SIC completion. In this cluster randomized trial, nudges combining clinician peer comparisons with patient priming questionnaires were associated with a marginal increase in documented SICs compared with an active control. Combining clinician- and patient-directed nudges may help to promote SICs in routine cancer care.

Reducing central nervous system–active medications to prevent falls and injuries among older adults-A cluster randomized clinical trialJAMA Open Network; Elizabeth A. Phelan, MD, MS; Brian D. Williamson, PhD; Benjamin H. Balderson, PhD; Andrea J. Cook, PhD; Annalisa V. Piccorelli, PhD; Monica M. Fujii, MPH; Kanichi G. Nakata, PhD; Vina F. Graham, BS; Mary Kay Theis, MA, MS; Justin P. Turner, PhD; Cara Tannenbaum, MD, MSc; Shelly L. Gray, PharmD, MS; 7/24This cluster randomized clinical trial found that a health system–embedded deprescribing intervention was no more effective than usual care in reducing medically treated falls among community-dwelling older adults prescribed CNS-active medications. For health systems that attend to deprescribing as part of routine clinical practice, additional interventions may confer modest benefits on prescribing without a measurable effect on clinical outcomes.

Fairness in predicting cancer mortality across racial subgroupsJAMA Open Network; Teja Ganta, MD; Arash Kia, MD; Prathamesh Parchure, MSc; Min-heng Wang, MA; Melanie Besculides, DrPH; Madhu Mazumdar, PhD; Cardinale B. Smith, MD; 7/24In this cohort study, a machine learning [ML] model to predict cancer mortality for patients aged 21 years or older diagnosed with cancer ... was developed. ... The lack of significant variation in performance or fairness metrics indicated an absence of racial bias, suggesting that the model fairly identified cancer mortality risk across racial groups. The findings suggest that assessment for racial bias is feasible and should be a routine part of predictive ML model development and continue through the implementation process.

Modeling nursing home harms from COVID-19 staff furlough policiesJAMA Open Network; by Sarah M Bartsch, Colleen Weatherwax, Bruce Leff, Michael R Wasserman, Raveena D Singh, Kavya Velmurugan, Danielle C John, Kevin L Chin, Kelly J O'Shea, Gabrielle M Gussin, Marie F Martinez, Jessie L Heneghan, Sheryl A Scannell, Tej D Shah, Susan S Huang, Bruce Y Lee; 8/24What is the tradeoff between COVID-19–related harms and non–COVID-19–related harms when allowing nursing home staff with mild COVID-19 to work while masked? The findings of this study suggest that allowing nursing home staff who were mildly ill with COVID-19 to work while masked was associated with less harm from alleviated missed tasks, outweighing increasing harm from COVID-19 transmission.

Transitional palliative care for family caregivers: Outcomes from a randomized controlled trialJournal of Pain and Symptom Management; by Joan M Griffin, Jay N Mandrekar, Catherine E Vanderboom, William S Harmsen, Brystana G Kaufman, Ellen M Wild, Ann Marie Dose, Cory Ingram, Erin E Taylor, Carole J Stiles, Allison M Gustavson, Diane E Holland; 8/24Patients receiving inpatient palliative care often face physical and psychological uncertainties during transitions out of the hospital. Family caregivers often take on responsibilities to ensure patient safety, quality of care, and extend palliative care principles, but often without support or training, potentially compromising their health and well-being. This study tested an eight-week intervention using video visits between palliative care nurse interventionists and caregivers to assess changes in caregiver outcomes and patient quality of life. Addressing rural caregivers' needs during transitions in care can enhance caregiver outcomes and improve patient quality of life.

Is it early enough? The authentic meaning of the pediatric palliative approach between early and late referral in pediatric oncology: a case studyFrontiers in Oncology; by Anna Santini, Irene Avagnina, Maria C Affinita, Anna Zanin, Franca Benini; 7/24The literature widely supports the benefits of early integration of palliative care into pediatric oncological care; however, many barriers to its successful integration remain. Integrating palliative care as early as possible in the oncology pathway is critical, but other criteria are relevant to positive results. This paper aims to contribute to the early/late referral dualism in pediatric palliative care (PPC) and highlight the importance of a collaborative approach between oncologists and palliative care teams. This study investigates the impact of early versus late referral to PPC, intersecting it with the synergy work between services and the related outcomes.