Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social support
JAMA Network Open; by Peter A. Boling; 3/25
On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.

Nursing home residents, family members, and staff members views about a good death and preferred place of death for a nursing home resident
Omega-Journal of Death and Dying; by Janet Sopcheck, Ruth M. Tappen; 2/25
Our study ... revealed that residents, like family members and staff members, had mixed opinions of the place of death for the NH resident, highlighting the importance of having advance care planning sessions with residents and their families to gain an understanding regarding their choices. Our study found the predominant and common qualities across the three participant groups of a good death include painless or pain-free, without suffering, peaceful, quiet, and dying in my sleep. Interestingly, almost one-fifth of the participants disagreed with the term good death, offering that death is not good as the person is no longer alive. Based on this study’s finding, using the term a good death in research and in advance care planning sessions may not be relevant or appropriate and instead focus on what care is necessary to promote a natural death, as mentioned by a few participants.

Medical interpreters’ experiences with patients who are near end-of-life and their family members
Journal of Pain and Symptom Management; by Joycelyn Howard, Alexia M. Torke, Susan E. Hickman, Greg Sachs, Sylk Sotto-Santiago, James E. Slaven, Denise Robinson; 3/25
In 2019 the United States Census Bureau reported 8% of the United States Population “speak English less than very well”. Ensuring individuals with a non-English language preference (NELP), previously referred to as limited English proficiency, have equitable access to healthcare includes providing high quality interpreter services. Although self-efficacy for interpreting EOL [end of life]conversations is generally high, interpreters desire education about EOL care. Interventions are also needed to address the high emotional toll of interpreting EOL conversations. Education and training about EOL care may help them to not only convey information accurately but also cope with emotional nuances characteristic of these significant conversations, ultimately elevating the quality of care for patients and family members in vulnerable and important moments.

Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysis
JAMA Network Open; by Rachel V. Aaron, Scott G. Ravyts, Nicolette D. Carnahan, Kavya Bhattiprolu, Nicole Harte, Claire C. McCaulley, Lauren Vitalicia; Alexandria B. Rogers, Stephen T. Wegener, Joanne Dudeney; 3/25
Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development. 

Perceptions of patient-clinician communication among adults with and without serious illness
JAMA Network Open; by Carine Davila, Sarah Nouri, Stephanie H Chan, Brian Feltz, Anna Gosline, Zamawa Arenas, Jane Kavanagh, Joanna Paladino, Lindsay A Dow, Vicki A Jackson, Rebecca Sudore, Christine S Ritchie, Elizabeth Lindenberger; 3/25
In this cross-sectional study, adults with serious illness more often had worse patient-clinician communication experiences. Compared with adults without serious illness, adults with serious illness were more likely to report leaving a visit unsure about next steps ...; being afraid to ask questions or speak up ...; believing they were talked down to or made to feel inferior...; and believing that they were treated unfairly by clinicians ... Further research is needed to better understand and develop interventions to improve perceptions of patient-clinician communication experiences for adults with serious illness.

Inpatient use of valproic acid in agitated delirium by palliative medicine
American Journal of Hospice and Palliative Medicine; by Sarah Jacobs, Leah Herbst, Carlos Fernandez, Zankhana Y. Mehta, Amanda Young, Mellar P. Davis; 2/25
Valproic acid (VPA), an anti-epileptic medication available in intravenous and parenteral forms, has recently been used to treat agitation associated with delirium. VPA as an adjunct in treating delirium has been reported to be opioid, antipsychotic and benzodiazepine sparing. ... this study did show that 50% of patients did not require benzodiazepines or antipsychotics at all, and that VPA might have a role in sparing the use of medications such as antipsychotics and benzodiazepines which have poor evidence in the management of agitation in delirium.

Evaluating performance of the Surprise Question to predict 12-month mortality in patients with end-stage liver disease
American Journal of Hospice and Palliative Care; by Sarah Homann, Jamie Pfaff, Elizabeth Stovicek, Rajiv Agarwal, Sumathi K. Misra, Jill M. Pulley, Justin K. Siemann, Ashley Spann, Stacey Tillman, Cheryl L. Gatto, Mohana Karlekar; 2/25
ESLD [end-stage liver disease] is associated with significant morbidity and mortality. Early PC engagement has been proposed as a solution to improve the physical and psychological burden associated with ESLD. ... hepatologists were asked the SQ [surprise question]: “Would you be surprised if this patient were to die in the next 12 months?” as a prompt to consider consultation to specialty PC [palliative care]. While the SQ should not be solely used as a prognostic indicator of death, our study proves that the SQ can be utilized by hepatologists as a screening tool with good sensitivity for identifying patients with ESLD who may be at higher risk of death and therefore may benefit from PC co-management.

Employer-sponsored digital health platforms for mental wellness—A good investment
JAMA Network Open; by Molly Candon, Rebecca E. Stewart; 2/25
The authors evaluate an employer-sponsored digital health platform (Spring Health; Spring Care Inc) that screens employees for mental health conditions and, when warranted, connects them to treatment. Hawrilenko et al found a reduction in health care spending among digital health platform users compared with a matched comparison group. These findings contribute to a broader literature that considers the economic value of employer-sponsored interventions aimed at mental wellness ... There are broader implications of the study by Hawrilenko et al, because employer-sponsored digital health platforms are among the quickest and easiest pathways to grant a majority of US individuals accessible mental health care. 

Feasibility study of using electronic patient-reported outcomes to screen patients with advanced solid cancers for palliative care needs
Journal of Palliative Medicine; by Tara L Kaufmann, Matthew Kearney, Dagoberto Cortez, John W Saxton, Katie Goodfellow, Carolyn Smith, Patrick Chang, Katherine Sebastian, Aaron Galaznik, Julie Scott, Elizabeth Ann Kvale, Arif H Kamal, Antonia V Bennett, Angela M Stover, Ashley M Henneghan, Michael Pignone, Gabrielle Betty Rocque; 3/25
Standardized, needs-based screening and triage systems are essential to more effectively address patients' palliative care needs. We developed a 13-item ePRO [electronic patient-reported outcomes] palliative care survey to assess multidimensional palliative care needs and conducted a pilot study (n = 25) of a palliative care screening intervention using ePRO monitoring and presentation of ePRO reports to a multidisciplinary care team. Patients found the ePRO palliative survey acceptable and appropriate. Screening patients for unmet palliative needs using ePRO monitoring is feasible, acceptable, and appropriate among patients, but more work is needed to understand the perspectives of diverse patients and how to integrate ePRO palliative care screening into clinical workflows.

[UK] Why we need to consider frailty in the assisted dying debate
Age and Aging; by Sarah A Hopkins, Annabel Price, Simon N Etkind; 2/25
Assisted dying/assisted suicide (AD/AS) is legal or decriminalised in several countries and Bills to legalise it are currently being considered by the UK and Scottish Parliaments. Older adults living with frailty make up an increasing proportion of those who die, yet the possible implications of AD/AS for these individuals are relatively unexplored. Frailty complicates AD/AS in relation to eligibility because of ambiguity over whether frailty constitutes a terminal illness, challenges in accurately predicting prognosis, and difficulty determining reversibility of suffering. Frailty also blurs the distinction between terminal illness and disability, in contrast to the clear-cut language of current proposed legislation where those with a terminal illness are eligible, but those with disability are not. Further consideration is needed regarding eligibility, safeguards in the context of relational autonomy and for those who already feel a burden, and how to mitigate risks of further entrenching ableist and ageist attitudes.

[Germany] Web-based educational tools and decision aids for patients with advanced cancer: A systematic review
Patient Education and Counseling; by Phoebe Ullrich, Henrike Voß, Laura Unsöld, Michael Thomas, Matthias Villalobos; 2/25
In advanced cancer care, patient involvement in decision-making is complex. Web-based solutions are promising because of easy accessibility and dissemination and the ability to adapt information to patients' needs and new treatment developments. Still, only a few evidence-based web-based educational tools and decision aids are available. Filling this gap is essential to empower patients to make informed and goal-concordant treatment decisions.

Beware the ides of March! ~William Shakespeare’s play The Tragedy of Julius Caesar, 1599