An end-of-life care approach defining a new standard of care
JAMDA; by David N. Hoffman; 6/26
The Institute for Healthcare Improvement (IHI) Leadership Alliance established an End-of-Life Care/Ending-Life Care Accelerator to define a continuum of care for patients as they progress from curative care, to palliative care, to hospice care, to final care planning, including ending life care interventions such as Medical Aid in Dying (MAiD), Voluntarily stopping eating and drinking (VSED), and palliative sedation. This accelerator defined as its goal the task of breaking down barriers between care providers which has been illuminated by research recently conducted by the Completed Life Initiative (CLI). CLI’s research efforts in this area started with an ongoing examination of nationwide hospice organization policies to provide referral for active intervention at the end of life. That effort was refocused on the widespread noncompliance of California and Washington state hospice organizations with a state law requirement to post on the organizations website a list of interventions made available by the hospice organization.

Survival variation and predictors of length of stay in US hospice patients
International Perspectives and Future Directions for Practice, Research, and Policy; by Ian Duncan, Xiyue Liao, Terri Maxwell; 6/26
End-of-life (EOL) patients in the US Medicare program represent a large and growing population, as well as a disproportionate share of Medicare’s costs. Survival of patients in hospice is, however, highly variable, implying an opportunity for improved management by enhancing the prediction of survival. Actuaries, health economists, policy analysts, and health services researchers have studied expenditures at the EOL for Medicare decedents for many years, finding that survival at EOL is highly variable. We discuss the utilization of hospice benefits for patients at the EOL in the United States.

Outcomes for hospitalized patients with comfort measures only orders
Journal of Palliative Medicine; by Gina Piscitello, Donna Durant, Tami Minnier, Marika Haranis, Robert M Arnold, Jane Schell; 6/26
Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur. Our primary aim was to assess the associations of specialty palliative consults (SPC) or documented goals of care conversations (GOCC) with in-hospital mortality among patients with CMO orders. Of 6,789 hospitalized patients with CMO orders ... seventy-three percent died in-hospital, and 22% were discharged with hospice. SPC placed anytime during hospital admission were associated with lower in-hospital mortality ... and higher discharge with hospice ... In contrast, documented GOCC anytime during admission were associated with higher in-hospital mortality ...  and lower discharge with hospice ...

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods study
Journal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26
After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in <25% each. Emphasis on efficient perioperative optimization and minimizing prolonged hospitalizations competed with perceived time for delivery of GOCC and specialty PC. Clinicians described a rescue-oriented surgical culture in which the palliative value of surgical repair for hip fracture paradoxically limited surgeons' view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

Early palliative care for people with primary malignant brain tumors: A systematic review
Journal of Palliative Medicine; by Jennifer C. Hall, Connor Barrett, Soren Christensen, Juliet Dalton, Samantha Kaplan, Christopher A. Jones, Margaret O. Johnson; 6/26
In some populations with advanced cancers, early palliative care (ePC) has been shown to improve quality of life (QoL) and reduce aggressive interventions, but its role and timing in primary malignant brain tumors (PMBT) remains poorly defined. Definitions of ePC varied with “early” defined relative to diagnosis, treatment milestones, or death. Across studies, a minority of patients received PC (15%–40%), with most referrals occurring late in the disease course. Earlier PC was associated with reduced aggressiveness of EoL care, decreased health care utilization, and, in some cases, longer survival. Evidence suggests ePC for PMBT is infrequently implemented yet feasible and may reduce aggressive EoL care and improve outcomes. 

Impact of specialized pediatric palliative care on bereaved parents' mental and physical health
Journal of Pain & Symptom Management; by Claudia Delgado-Corcoran, Huong D. Meeks, Sarah E. Wawrzynski, Barry P. Markovitz, Brandy Harman, Jasmine R. Masih, Kuan Li, Mark Harousseau, Dominic Moore, Jacob Wilkes, Stefanie G. Ames; 6/26
Pediatric death can lead to long-term adverse effects on parents’ health. [In this study] of 776 deceased children linked to 773 mothers and 711 fathers, 36.1% received a SPPC [specialized pediatric palliative care] consultation prior to death. Higher rates of mental and physical health burden were observed in mothers than fathers across all time points. Lack of SPPC was associated with increased risks for new mental and physical health burden for mothers within 12 months after the child’s death ... Conclusions: Bereaved parents, especially mothers, experienced new mental and physical health burden up to 24 months after a child’s death.

The doctor will see you now--or will they? Theorizing AI’s impact on Black patients and providers in health care
Social Currents; by Adia Harvey Wingfield, Tyrell Spencer; 6/26
As far as recent innovation practices go, artificial intelligence (AI) represents one of the major disruptions reshaping various aspects of human life. Health care is perhaps one of the industries where AI stands to be most transformative, particularly as it is increasingly used to diagnose illnesses, assist in creating treatment plans, reduce human error, and offer routine patient services. Yet despite its rapid growth, AI technology still reflects human biases and perceptions, allowing it to replicate existing inequalities. These inequalities could take on particular significance given persistent occupational stratification and increasing racial diversity. In this paper, we theorize how the growing reliance on AI in the US health care system will affect Black care providers and patients.

Implementation of a serious illness conversation program in a health system: A retrospective observational study
Journal of Palliative Medicine; by Glen Varns, Abbey Sidebottom, Katy Hentges, Sandra Castro-Pearson, Jan Richardson, Emily Downing; 6/26
Serious illness conversation (SIC) is a structured conversation framework designed to improve shared decision making and promote goal-concordant care with patients anticipating end-of-life care decisions. Objective: Examine reach, timeliness, and quality of SIC implementation across a health system after implementation of a SIC Program (SICP) [and] examine factors associated with SIC completion for eligible patients. Factors associated with SIC included palliative care visits ... , a primary care provider in the system ... , and an inpatient admission with discharge to home care ... Patients with dementia ... were less likely to have SIC. Conclusion: Systemwide implementation of an SICP engaged [only] half of eligible patients; many of those had multiple documented conversations prior to death.

Once you carry your own water, you will learn the value of every drop.  ~African proverb