Literature Review

[The Netherlands] The focus on life-prolonging anticancer treatment hampers shared decision-making in people with advanced cancer: A qualitative embedded multiple-case studyPalliative Medicine; Daisy Jm Ermers, Maartje J van Geel, Yvonne Engels, Demi Kellenaers, Anouk Sj Schuurmans, Floortje K Ploos van Amstel, Carla Ml van Herpen, Yvonne Schoon, Henk J Schers, Kris Cp Vissers, Evelien Jm Kuip, Marieke Perry; 9/24Implementing shared decision-making in oncology practice is often limited, particularly integrating the patient's context into decision-making. Four themes were identified [in this study]: shared decision-making is a dynamic and continuous process (1), in which the medical oncologist's treatment recommendation is central (2), fuelled by the patients' experience of not having a choice (3), and integrating the patient's context into shared decision-making was considered important but hampered (4), for example, by the association with the terminal phase. The prevailing tendency among medical oncologists and persons with advanced cancer to prioritize life-prolonging anticancer treatments restricts the potential for shared decision-making.

[Germany] Impacts of clinical decision support systems on the relationship, communication, and shared decision-making between health care professionals and patients: Multistakeholder interview studyJournal of Medical Internet Research; Florian Funer, Diana Schneider, Nils B Heyen, Heike Aichinger, Andrea Diana Klausen, Sara Tinnemeyer, Wenke Liedtke, Sabine Salloch, Tanja Bratan; 8/24Clinical decision support systems (CDSSs) are increasingly being introduced into various domains of health care. The results indicate that using CDSSs could restructure established power and decision-making relationships between (future) health care professionals and patients. In addition, respondents expected that the use of CDSSs would involve more communication, so they anticipated an increased time commitment. The results shed new light on the existing discourse by demonstrating that the anticipated impact of CDSSs on the health care professional-patient relationship appears to stem less from the function of a CDSS and more from its integration in the relationship.

[United Kingdom] 'Cuts to hospice care are a tragedy' BBC News, United Kingdom; by Helen Drew and James W. Kelly; 9/22/24 A south London hospice has made several staff redundant and cut services because funding levels are failing to meet rising operating costs, its chief executive has said. Nick Stevens said St Raphael's Hospice's operating costs have risen by £1m over the last four years but only received a £140,000 uplift from the NHS, which provides a quarter of the charity's funding. Among the cuts was the disbandment of the "hospice at home" service which serves the local area. ... Mr. Stevens said they have had to reduce their clinical nurse community team by 20%. "That is a real tragedy. We've lost members with decades of expertise and experience who have supported hundreds of people through the last stages of their lives," he said. Mr. Stevens described such staff as "irreplaceable" and their loss will have a "detrimental impact" on the services offered by the hospice. Editor's Note: This trend continues to grow throughout the United Kingdom, with huge fundraisers to help pay costs. What implications might it have for the United States, or not?

[Canada] Cognitive symptoms across diverse cancersJAMA Network Open; Samantha J. Mayo, RN, PhD; Kim Edelstein, PhD; Eshetu G. Atenafu, MSc, PStat; Rand Ajaj, HBSc; Madeline Li, MD, PhD; Lori J. Bernstein, PhD; 8/24In this cross-sectional study of 5078 survey respondents with cancer seeking psychosocial support, over half of these patients reported having cognitive symptoms of any severity. A third of these patients reported moderate to severe cognitive symptoms, which were associated with disease, treatment, and other symptoms. Findings of this study suggest that higher severity of cognitive symptoms was consistently associated with higher symptom burden; these findings could be used to inform decision-making regarding access to cognitive screening, assessment, and supportive care in outpatient oncology clinics.

[England] Hospice 'held family together' after baby sons die a year apartBBC; 9/11/24A husband and wife, who lost two babies within a year of each other, have spoken of their gratitude to the hospice which "held the family together". Claire and Rob Gaskarth, from Clevedon, Somerset, lost seven-month-old Freddie in July 2012 and then Louis, who was born safely in May 2013, but who died 12 days later of the same inherited genetic disorder. "The hospice helped us get through one of the most painful times of our lives, and, for that, we will be forever grateful," said Mr. Gaskarth.

[Norway] Quality of life and relationships in caregivers of people with dementia. A gender perspectiveAmerican Journal of Alzheimer's Disease and Other Dementias; Heidi Bjørge, Kari Kvaal, Ingun Ulstein; Jan-Dec 2024Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.

AI scribes show promising results in helping family doctors and nurse practitioners spend more time with patients and less time on paperwork LaGrange Daily News, Toronto, Canada; by PR Newswire / Canada Newswire; 9/11/24 Family doctors report spending 70% to 90% less time on paperwork in a study evaluating the use of artificial intelligence (AI) scribe technology. OntarioMD (OMD), a subsidiary of the Ontario Medical Association (OMA), announced this week the findings of the study that examined the use of AI scribes by more than 150 family doctors and nurse practitioners (NPs) over a three-month period. AI scribes capture conversations between family doctors or nurse practitioners (NPs) and their patients and summarizes them into detailed electronic medical notes. The family doctors and NPs assessed AI scribes' effectiveness in reducing their time spent on administrative tasks and the results are very promising. ... The results also support the Ministry of Health and Ontario Health's Patients Before Paperwork (Pb4P) initiative aimed at helping doctors spend more time caring for patients instead of doing unnecessary paperwork.

Crisis in care for dying people says Marie Curie as survey shows suffering Jersey Evening Post, UK News, United Kingdom; by UK News; 9/3/24 A third of dying people in England and Wales were severely or overwhelmingly affected by pain in the last week of life, according to a major survey said to show how “patchy and inconsistent” care for this group has become. End-of-life charity Marie Curie said its study of 1,179 bereaved people means it is the largest nationally representative post-bereavement survey in the UK in almost 10 years. Almost half of survey respondents (49%) said they were unhappy with at least one aspect of the care the dying person received and, of those, one in eight made a formal complaint. The research, in collaboration with King’s College London (KCL), Hull York Medical School and the University of Cambridge, also found that one in five dying people had no contact with their GP in the last three months of life. 

[Australia] Maybe for unbearable suffering: Diverse racial, ethnic and cultural perspectives of assisted dying. A scoping reviewPalliative Medicine; Melissa J Bloomer, Laurie Saffer, Jayne Hewitt, Lise Johns, Donna McAuliffe, Ann Bonner; 8/24Perspectives on assisted dying are dynamic and evolving. Even where assisted dying is legalised, individual's cultural attributes contribute to unique perspectives of assisted dying as an end-of-life option. Thus, understanding a person's culture, beliefs, expectations and choices in illness, treatment goals and care is fundamental, extending beyond what may be already considered as part of clinician-patient care relationships and routine advance care planning.

Hospice patient publishes first poetry book BBC News, Derby, United Kingdom; by Jude Winter; 8/26/24 A woman receiving end-of-life care has fulfilled an ambition by publishing a book of poems. Sarah Colina started writing the poems more than 40 years ago but never got round to getting her work published despite encouragement from friends and family. The 60-year-old has been receiving care at Ashgate Hospice since being admitted to its Inpatient Unit in Old Brampton, Chesterfield. ... he added staff at the hospice had been "so supportive" and is selling 50 of her books to raise money to support their work. "I’m hoping it will be nicely received and people will enjoy reading my poems", said Ms Colina. She added: "Some of the poems are very dark, but some make you laugh. "I'm hoping it gives people an insight into their inner person." 

[Ireland] Does a palliative medicine service reduce hospital length of stay and costs in adults with a life-limiting illness?-a difference-in-differences evaluation of service expansion in IrelandAnnals of Palliative Medicine; by Soraya Matthews, Eimir Hurley, Bridget M Johnston, Pauline Kane, Karen Ryan, Eoin Tiernan, Charles Normand, Peter May; 7/24People approaching end of life account disproportionately for health care costs, and the majority of these costs accrue in hospitals. The economic evidence base to improve value of care to this population is thin. Our primary analytic sample included 4,314 observations, of whom 608 (14%) received timely palliative care. We estimated that the intervention reduced LOS [length of stay] by nearly two days, with an estimated associated saving per admission of €1,820.

Hospice funding crisis: an urgent message ehospice, UK Edition; by Helen Simmons, Chief Executive of St. Christopher's; 8/14/24 Growing numbers of people need hospice support – in the last year alone the number of home visits completed by our teams at St. Christopher’s increased by 10%. But many hospices – one in five – are either cutting specialist palliative and end of life services in the last year or plan to do so. Fortunately, we are not one of those at the moment. ... NHS funding has failed to keep up with the increase in demand and expenditure. We are increasingly relying on people leaving gifts in wills, running marathons and donating clothes to deliver our core services. The model is breaking. ... At St. Christopher’s we receive 34% of our income from the NHS – for the remaining 66% we rely on the generosity of the community. Hospices should not have to rely on the generosity of the community to provide essential healthcare services. ... Editor's Note: St. Christopher's is the first hospice of the modern hospice movement, pioneered by Dame Cicely Saunders in London, UK, in 1967.

[Italy] A transitional care program in a technologically monitored in-hospital facility reduces the length of hospital stay and improves multidimensional frailty in older patients: a randomized clinical trialAging Clinical and Experimental Research; Alberto Pilotto, Wanda Morganti, Marina Barbagelata, Emanuele Seminerio, Simona Morelli, Romina Custureri, Simone Dini, Barbara Senesi, Camilla Prete, Gianluca Puleo, Carlo Berutti Bergotto, Francesco Vallone, Carlo Custodero, Antonio Camurri, PRO‐HOME Project Investigators Group; 8/24Multidimensional frailty is a reversible condition that can be improved by reduced LOS [length of stay]. Longer length of hospital stay (LOS) negatively affects the organizational efficiency of public health systems and both clinical and functional aspects of older patients. Data on the effects of transitional care programs based on multicomponent interventions to reduce LOS of older patients are scarce and controversial. The PRO-HOME transitional care program reduces LOS and multidimensional frailty in hospitalized older patients.