Who is my hospice physician? A descriptive study of the US hospice medical director workforce
Journal of Pain and Symptom Management; by Alexander Soltoff, Sarah Cross, Robert Tyler Braun, Tara Friedman, Dio Kavalieratos; 10/26
In 2024, the Centers for Medicare & Medicaid Services (CMS) began requiring hospices to report their hospice medical director (HMD), enabling the first national study of this workforce. We identified 2,387 HMDs across 2,914 agencies. Fewer than half of U.S. hospices reported HMDs to CMS. HPM board certification and formal HMD certification were uncommon, raising questions about how physicians are prepared for the clinical and leadership responsibilities of hospice medical directorship.

Medical debt in the United States—A growing and deadly cancer
JAMA Network Open; by Nicole M. Mott, Fumiko Chino; 10/26
Health care in the United States has become progressively characterized by escalating prices, increased cost sharing, and uninsurance or underinsurance for millions of US residents. Resultant high out-of-pocket costs lead to nearly 1 in 5 patients in the United States facing medical debt in collections. Medical debt has surpassed nonmedical debt in both total debt and new debt in collections in the last decade. High health care costs have both immediate and long-lasting negative downstream effects on patients and families. Financial barriers associated with medical debt may prevent patients from seeking preventive or timely care and have been associated with worse overall mortality; this phenomenon is particularly salient in the context of cancer, where an earlier stage at diagnosis means deescalated treatment, better survival, and (ironically) less costly care.

Medical debt and advanced cancer stage at diagnosis
JAMA Network Open; by Jiazhang Xing, Xuesong Han, Xin Hu, Lingbin Meng, Lang Qu, Ryan D. Nipp, K. Robin Yabroff, Changchuan Jiang; 10/26
Medical debt is a pervasive challenge for US households and has emerged as a key social determinant of health. Approximately 1 in 6 individuals in the US report medical debt, with millions facing debt in collections, and this situation disproportionately impacts low-income, uninsured, and racially and ethnically minoritized and socially deprived populations. At the community level, medical debt reflects broader structural and policy-related factors, including local insurance market characteristics, state Medicaid policies, hospital billing and collection practices, and regional socioeconomic conditions. In this cross-sectional study of US counties, higher medical debt burden was associated with higher incidence rates of late-stage and overall cancer across multiple cancer types.

Palliative care trigger process in the pediatric intensive care unit: A quality improvement project available to purchase
Critical Care Nurse; by Cynthia Myo, Beth Nachtsheim Bolick, Julie Reed, Kimberly A. Pyke-Grimm; 10/26
Early integration of palliative care for pediatric intensive care unit patients and their families is beneficial for establishing goals of care and complex decision-making. Trigger criteria were developed through a literature review and interprofessional work group discussions. The pediatric palliative care trigger criteria process was integrated into 3 areas of the pediatric intensive care unit workflow. Staff members identified patients meeting the trigger criteria and initiated team discussion on the appropriateness of palliative care. Conclusion: Implementation of a trigger criteria process to identify patients with high needs for palliative care was successful and effective in the pediatric intensive care unit in the setting of limited palliative care availability.

A power in death: Death as a site of resistance in prison
MDPI; by Joanne B. DeCaro, Christopher Seeds; 10/26
The prison is often discussed as an institution that imposes death, be it physical, social, or spiritual death. For some, however, resistance centers not only on life, but on death—seeking to control one’s death, fighting against death as it is imposed by the system, or making efforts to die on one’s own terms. Drawing on extensive interviews with older people living with chronic illness in 11 prisons in a US State, including a prison hospice in the State, this article examines ways in which incarcerated people approach death by choosing to die in ways that have meaning to them. We examine how incarcerated people create alternative pathways for autonomy and community in the death process, through “everyday death resistances”, including refusing to accept prison medical care, strategizing to die on the mainline rather than in prison medical clinics, and finding a “good death” in hospice.

End-of-life care for people who are incarcerated—Reply
JAMA; by Nicole Mushero, Brie Williams; 10/26
We appreciate the response to our article by Ms Ofori-Darko and Dr McClelland and agree wholeheartedly that the definition of palliative care for incarcerated patients should be comprehensive and match the community standard. This standard includes all evidence-based interventions that palliate symptoms during serious, life-limiting illness. We also agree that short-course or single-fraction regimens of radiation therapy may be indicated for incarcerated patients with serious illness who may face additional barriers to longer-duration treatments. Other palliative treatments may also include some forms of chemotherapy, immunotherapy, antibiotics, blood transfusions, and diuresis. Some treatments may lose palliative effectiveness over time and thus be stopped as a person transitions to hospice care.

Perceptions of telemedicine use for specialist care in skilled nursing facilities
JAMA Network Open; by Gillian K. SteelFisher, Mary G. Findling, Eran N. Ben-Porath, Andrew D. Wilcock, Ateev Mehrotra, David C. Grabowski, Michael L. Barnett; 10/26
More than one million people live as long-term residents in US skilled nursing facilities (SNFs). Quality of care in these settings is often suboptimal, and among the key challenges is insufficient use of specialist care. In this national survey of 379 directors of nursing at SNFs, most of those whose residents used telemedicine confirmed the advantages of telemedicine, although they also reported additional time burdens on nursing staff. The top reasons for not using telemedicine among less-frequent users and nonusers were that specialists offered telemedicine only infrequently and there were limited improvements in quality of care over normal practices. The findings suggest that specialist telemedicine care is seen as a useful tool for SNFs, but incentives for specialists to offer telemedicine and reimbursement for nursing staff time are needed.

I need a six-month vacation twice a year.  ~Anonymous