Hospice, palliative care, and care experiences among Medicare beneficiaries with cancer
Journal of Geriatric Oncology; by Lisa M Lines, Miku Fujita, Kim N Danforth, Daniel H Barch, Michael T Halpern, Michelle A Mollica, David T Eton, Ashley Wilder Smith; 11/25
Among 37,025 Medicare beneficiaries with cancer, 11.1 % received hospice (with or without PC) and 7.4 % received PC only. Nearly 30 % of the sample died within five years of diagnosis; fewer than one-third of decedents received hospice. Factors associated with receiving hospice included increasing age, non-Hispanic ethnicity, American Indian/Alaska Native and multiracial identities, living in higher-income neighborhoods, survey-completion proxy assistance, fair/poor general health, advanced stage at diagnosis, and more illness burden. Independent predictors of PC encounters included age 75-79, female identification, no dual enrollment, no proxy assistance, and more illness burden. Differences in care experience associated with hospice or PC use were shown for two care experience measures: doctor communication scores and doctor rating scores were higher among beneficiaries who received neither hospice nor PC relative to beneficiaries who received hospice.

GUIDE and beyond: Strategies for comprehensive dementia care integration
Journal of the American Geriatrics Society; by Kristin Lees Haggerty, David B Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R Lee, Madelyn Johnson, Morgan J Minyo, Katherine L Possin, Quincy M Samus, Lynn Spragens, Lee A Jennings, Gary Epstein-Lubow; 10/25
The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach.  Drawing from the experiences of six previously tested programs ... we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.

Trends in hospice use among older adults with dementia and cancer by race and ethnicity 2011–2021
Journal of the American Geriatrics Society; by Inbal Mayan, Siqi Gan, John Boscardin, Krista L. Harrison, Jennifer E. James, Alexander Smith, Lauren J. Hunt; 11/25
Hospice use among older adults has expanded substantially, with more than 1.7 million Medicare beneficiaries enrolled annually. Yet, disparities by race and ethnicity in hospice remain. It is unknown whether these disparities have narrowed over time or whether trends differ by clinical condition. We examined changes in hospice use by race and ethnicity among decedents with dementia and cancer, two common terminal diagnoses with different trajectories and implications for hospice eligibility.

Utilization of the No One Dies Alone Program to support dying patients
Journal of Pain & Symptom Management; by Austin Chen, Ketki Sathe, Yixuan C Zhang, Lyndia C Brumback, Addy L Elketami, Jamie T Nomitch, Timothy J Shipe, Cynthia M Thelen, Katherine G Hicks, Ann L Jennerich; 11/25
We conducted a retrospective cohort study of hospitalized patients enrolled in the NODA [No One Dies Alone] program at Harborview Medical Center (HMC), a level I trauma center in Seattle, WA. The No One Dies Alone ... program has utilized trained volunteers to provide support to dying patients for over 20 years.The NODA program was utilized for patients with and without family support. Some patients were unable to benefit from the program due to timing of referral relative to death, highlighting the importance of early consultation to maximize program benefits.

Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-Hispanic White surrogate decision makers
Equity Neuroscience; by Imadeddin Hijazi, Lewis B Morgenstern, Robert Michael Miller, Erin Case, Madeline Kwicklis, Darin B Zahuranec; 10/25
Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Contrary to our original hypothesis, we did not identify an ethnic difference in surrogate reports of the quality of death and end-of-life care after stroke between MA patients and NHW [non-Hispanic White] patients after adjusting for demographic and clinical factors. This result is encouraging, as it implies that in this community, ethnic disparities in end-of-life care may not be as pronounced as reported in other populations. Furthermore, the high scores on both surveys indicate overall satisfaction with care regardless of ethnicity. 

Why reflexivity matters in the literature of suffering, death, and dying in eating disorders
Journal of Eating Disorders; by Scout Silverstein; 10/25
Current debates on medical aid in dying and treatment futility in longstanding eating disorders emphasize diagnostic frameworks, ethical principles, and legal statutes. What remains underexamined is how an author's own experiences with suffering, death, and dying shape their perspective and conclusions. I argue that every manuscript on end-of-life care, decision-making capacity, or futility in eating disorders should include a reflexivity statement detailing the author's relationship to mortality. By mandating reflexivity disclosures alongside ethics and funding statements, journals can enhance transparency and allow readers to contextualize empirical claims and ethical positions. I propose a template for a reflexivity paragraph in which authors succinctly state their clinical or research focus, experiences with suffering, and forces that shape their views on suffering, futility, and dying.

The smallest deed is better than the greatest intention. ~John Burroughs