The analysis of hospice trends in the United States in 2020 among Medicare beneficiaries
American Journal of Hospice and Palliative Medicine; Noor Chughtai, BS; Cortland Brown, MS; Jordan Shelestak, MS; Jared Nichols, DO; 3/25
While hospice care has many benefits, there is variability among the service throughout the United States. Public hospice care data from data.cms.gov were analyzed to explore these trends. Findings indicate that Medicare beneficiaries in the South and West regions of the U.S. experience longer hospice stays, and in contrast, those in the Northeast and Midwest (including Alaska) reflected reduction from this average. Notably, states with shorter hospice durations showed a higher proportion of neoplastic disorders as the primary diagnosis, while those with longer stays showed an inverse relationship with greater prevalence of circulatory system disorders and lower incidence of neoplastic diagnoses. Additionally, the analysis reveals a consistent decline in average hospice length with increasing age among patients aged 80-85 across all U.S. regions, as expected.

Hospice use among Medicare beneficiaries with Parkinson Disease and Dementia with Lewy bodies
JAMA Network Open; Meredith Bock, MD; Siqi Gan, MPH; Melissa Aldridge, PhD; Krista L. Harrison, PhD; Kristine Yaffe, MD; Alexander K. Smith, MD; John Boscardin, PhD; Lauren J. Hunt, PhD; 3/25
Lewy body disease (LBD)—an umbrella term that includes Parkinson disease (PD) and dementia with Lewy bodies (DLB)—describes progressive, incurable neurodegenerative disorders. Parkinson disease is the second most common neurodegenerative disorder after Alzheimer disease (AD) and is the fastest growing neurologic disorder in the world.
In this cohort study of ... Medicare beneficiaries enrolled in hospice between 2010 and 2020, hospice enrollees with both PD and DLB were less likely to be disenrolled due to extended prognosis than those with AD. Enrollees with PD—but not DLB–were more likely to have longer lengths of stay and revoke hospice. The findings of this study suggest a higher likelihood of revocation of hospice care in PD, raise important questions about their unmet needs in hospice, and highlight the need to disaggregate dementia subtypes for policy analysis. 

Wealth disparities in end-of-life symptom burden among older adults
JAMA Network Open; Irena Cenzer, Kenneth E Covinsky, Sarah H Cross, Claire K Ankuda, Lauren J Hunt, Melissa D Aldridge, Krista L Harrison; 3/25
This cohort study found that lower wealth was associated with a higher symptom burden at the end of life, mediated in part by higher rates of multimorbidity, functional impairment, and dementia. These findings highlight the need for policies and programs to support patients with lower financial resources to improve end-of-life experiences and mitigate wealth disparities. 

The preference for acute rehospitalization scale: Evaluating preference for acute rehospitalization in pediatric hospice patients
Journal of Palliative Medicine; Kelley Newcomer, Katherine Maddox; 3/25
Since the passage of the Affordable Care Act, children are able to access pediatric hospice while still pursuing life-prolonging care. This can create confusion between hospice and palliative care staff and families about current goals of care (GOC), which evolve over time. Hospice and palliative care teams created, implemented, and evaluated a five-point scale to summarize the Preference for Acute Rehospitalization (PAR) Scale for children on concurrent care hospice. Most users reported they agreed or strongly agreed the PAR Scale helped them to understand families' GOC and feel more confident giving advice with urgent questions.

Palliative care nurse specialists' perspectives on spiritual care at end of life: A scoping review
Journal of Hospice and Palliative Nursing; Bronagh Dunning, Michael Connolly, Fiona Timmins; 3/25
The research demonstrates that specialist palliative care nurses perceive spiritual care as an important element of holistic care at end of life; however, these nurses also agree that spiritual care is lacking. This deficiency results from a lack of education in spirituality; experience of the nurse; the nurses' own spiritual and religious beliefs and values, fears, and difficulties in communication; and the nurse-patient relationship. The findings demonstrate the necessity to increase the level of spiritual care education in nurse programs, educating nurses on the provision of spiritual care, and how to deal with conflicts in spiritual and religious beliefs.

Psychedelics for cancer pain and associated psychological distress: A narrative review of a potential strategy
Cancer Medicine; Erika Belitzky, Lis Victoria Ravani Carvalho, Melissa Taylor, Cristina Naranjo Ortiz, Laura Baum, David A Fiellin, Maryam B Lustberg; 3/25
Cancer pain can ... be exacerbated by anxiety, depression, quality of life challenges, and fear of death and dying, as well as by fear of recurrence or progression. Psychedelics, such as lysergic acid diethylamide (LSD), psilocybin, mescaline, and N,N-dimethyltryptamine (DMT), are under consideration as new pharmacologic strategies for mitigating pain and the distress associated with cancer pain and associated symptom burden. Although published studies are limited, regulatory hurdles have decreased. Many clinical trials are underway to assess further the use of psychedelics and behavioral counseling for patients with cancer and comorbidities such as anxiety or depression. Early results are promising, and additional research is needed to understand efficacy and tolerability in broader cancer populations. 

Understanding and addressing the US hospital bed shortage: Build, Baby, Build
JAMA Network Open; Alexander T. Janke, MD, MHS, MSc; Arjun K. Venkatesh, MD, MBA, MHS; 2/25
In the study by Leuchter et al, they provide simple yet provocative projections for the future of hospital care. They project that national hospital occupancy will exceed 85% by 2032, a critical threshold where basic hospital operations can become dysfunctional and even unsafe. Leuchter et al begin to quantify the story already felt at the bedside in hospitals across the nation—namely, a trajectory toward inadequate supply of hospital care for the anticipated demand of the coming decade. US residents are older and more medically complex than ever. Technologically sophisticated surgical interventions and medical therapies have transformed the long-term survival rates for serious conditions, such as end-stage kidney disease, heart failure, and chronic obstructive lung disease. The US needs greater hospital bed capacity, particularly for critical care and complex care services.

Researcher proposes new framework for language equity in health technology
JAMA; Yulin Hswen, ScD, MPH; Nora Collins; 2/25
In a recent Editorial in JAMA Network Open, Pilar Ortega, MD, MGM, a clinical associate professor of medical education and emergency medicine at the University of Illinois College of Medicine in Chicago, and her coauthors emphasized the urgent need for integrating language equity into digital health solutions. “Technology may enhance health equity, but only if marginalized populations’ perspectives and root causes of health disparities are considered across key aspects of health care provision and at every stage of project development: design, evaluation, implementation, and revision,” they wrote. There are [more than] 350 languages spoken in the US. We need to do things that on a system level make it possible for individuals of any language preference to not only access care but that the health care quality they receive is comparable and equitable, so they can be enrolled in clinical trials [and] access all the different levels of care they might need. 

[Canada] Use of feeding tubes among hospitalized older adults with dementia
JAMA Network Open; Anne-Marie Hartford, MSc; Wenshan Li, PhD; Danial Qureshi, MSc; Robert Talarico, MSc; Stephen G. Fung, MPH; Shirley H. Bush, MBBS; Genevieve Casey, MSc, MBBS; Sarina R. Isenberg, MA, PhD; Colleen Webber, PhD; Peter Tanuseputro, MHSc, MD; 2/25
In this cohort study of hospitalized individuals with dementia, feeding tube insertion was not associated with improved survival or postdischarge outcomes. Being male or younger and having swallowing problems and greater functional impairments were associated with increased odds of feeding tube use, while having a do-not-resuscitate directive and living in rural settings were associated with reduced odds. Factors that were (or were not) associated with feeding tube placement were sometimes misaligned with best practice guidelines. Goals of care conversations, alternative intervention options, and improved clinical protocols are recommended. 

[UK] Exploring the challenges experienced by patients and families using palliative and end-of-life care services: A qualitative focus group study
Palliative and Supportive Care; Gina Kallis, Gary Hodge, Hannah Wheat, Tomasina M Oh, Susie Pearce; 3/25
In the UK, access to dignified and compassionate palliative care is increasingly being reported as inadequate. A range of challenges were identified at different stages of the patient and family carer journey near the end-of-life. These included issues related to the delivery of care, such as communication challenges, a lack of out of hours care, and also a lack of personalized care. Patients and families also experienced everyday challenges due to the impact of living with a life-shortening condition and altered family dynamics as family members became carers. There were also some traumatic experiences of death and a sense of abandonment when care could not be accessed. 

In three words I can sum up everything I've learned about life: It goes on. ~Robert Frost