Literature Review

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.

First Swiss hospice for terminally and critically ill children closes a gap in care NZZ; by Erich Aschwanden, Reidbach near Bern, Switzerland; 8/12/24 As many as 10,000 children and young people in Switzerland live with life-shortening illnesses. Because the state does not help support efforts to care for them in special facilities, private organizations are stepping in. ... Switzerland's first children's hospice is located in a converted farmhouse in Riedbach, a small hamlet on the outskirts of Bern. As idyllic as these surroundings may be, the fate of the children and their families who are taken in by the Allani Foundation is bitter. These are children and young people with life-shortening illnesses such as cancer, genetic defects or neurological diagnoses.

Paramedics treating patients’ palliative needs at home benefits everyone[Canada] The Conversation; 8/5/24In a medical system that seems to be under constant bombardment — economic, pandemic, demographic — it’s refreshing to see solid evidence to support a new idea that improves care while saving valuable time and money. It’s exactly what has been happening in several Canadian provinces that have been implementing innovative palliative programs to improve paramedic support to patients with palliative care needs. The idea is that paramedics, with some extra training, can provide patient-centred care in the homes of people living with cancer and other life-limiting conditions. It is intended to make patients as comfortable as possible as they spend their last days at home, which is where most Canadians say they’d prefer to die.

Doctors could opt out of assisted dying for religious reasons, says peer behind proposed law The Telegraph, United Kingdom; by Kamal Ahmed and Camilla Tominey; 7/26/24 Lord Falconer is launching a bill to make assisted dying legal but which includes a 'conscience clause' to factor in people's faiths. Doctors will be able to opt out of supporting assisted dying in England and Wales if they believe it clashes with their religious beliefs under a new attempt to legalise terminally ill people being able to end their lives.

Assisted dying bill introduced in Parliament BBC News; 7/26/24 A bill which would allow terminally ill adults with six months or fewer to live to get medical help to end their own lives has been introduced in the House of Lords, by former Labour Justice Secretary Lord Falconer. He told the BBC his bill would apply only to people "mentally able to make the decision." Their choice would also need to be approved by two doctors and the high court. Private members' bills introduced in the Lords rarely become law. However, Lord Falconer says he hopes a backbench MP will introduce a similar bill in the Commons, where it will have a greater chance of success.

“At home, even the walls help”: Exploring the palliative care needs, experiences, preferences, and hopes of older people with serious illness in Ukraine (July 2024) OCHA Services; by HelpAge; 7/24/24 Older Ukrainians living with serious illness face significant concerns and challenges within the political, environmental, and social context of the ongoing armed conflict, according to a new report published by HelpAge International, in partnership with HelpAge USA. ... The report highlights an innovative project funded by GlobalGiving which provides palliative care services in Ukraine. It underscores the profound challenges faced by older people due to the combined toll of disease and the ongoing war, and offers key recommendations to enhance their care and support. “Our findings reveal the unimaginable burden faced by older people living with serious illnesses in the midst of war. We are deeply grateful for the generous support of GlobalGiving, which has allowed us to highlight these issues and work to ensure that older people’s needs and preferences are included in healthcare system planning during humanitarian crises,” said Cindy Cox-Roman, CEO and president of HelpAge USA.

[Australia] Methadone versus other opioids for refractory malignant bone pain: a pilot randomised controlled studySupportive Care in Cancer; Merlina Sulistio, Alexandra Gorelik, Hoong Jiun Tee, Robert Wojnar, David Kissane, Natasha Michael; 7/24Refractory cancer-induced bone pain (CIBP) affects a patient's functional capacity and quality of life, but there is limited evidence to guide opioid choice. We assessed the feasibility, tolerability and possible efficacy of methadone rotation (MR) compared to other opioid rotations (OOR) in this cohort. Of 51 eligible participants...both groups displayed significant reduction in average...and worst pain...and total pain interference score. Oral morphine equivalent daily dose was reduced significantly in MR compared to the OOR group (d = - 0.8, p = 0.05). The incidence of opioid-related adverse events following MR was unchanged but lower in the OOR group. There were no within-group or between-group differences in satisfaction with analgesia at the end of the study.