Literature Review

Sunday NewslettersTop read stories of the last week (in order) is the focus of Sunday newsletters - enjoy!

I think the good and the great are only separated by the willingness to sacrifice. — Kareem Abdul-Jabbar

Predicting end-of-life in a hospital settingJournal of Multidisciplinary Healthcare, by Gezy Weita Giwangkancana, Heni Nur Anina, Hadyana Sukandar; 2/9/24(Indonesia) [Early Warning Score] and decreased consciousness are significant predictors of in-hospital mortality. It is crucial in clinical setting to use multiple indicators to predict death and improve patient care.

Ethics at the end of life in the newborn intensive care unit: Conversations and decisionsSeminars in Fetal and Neonatal Medicine, by Mark R. Mercurio, Lynn Gillam; 6/23The unexpected birth of a critically ill baby raises many ethical questions for neonatologists. Some of these are obviously ethical questions, about whether to attempt resuscitation, and, if the baby is resuscitated and survives, whether to continue life sustaining interventions. Other ethical decisions are more related to what to say rather than what to do. Although less obvious, they are equally as important, and may also have far-reaching ramifications... This may serve as a helpful guide for ethical deliberation, and helpful scripting for parental discussion, in similar cases.

What aspects of quality of life are important from palliative care patients’ perspectives? A framework analysis to inform preference‑based measures for palliative and end‑of-life settingsThe Patient - Patient-Centered Outcomes Research, by Nikki McCaffrey, Julie Ratcliffe, David Currow, Lidia Engel, Claire Hutchinson; 11/23Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.

Drugs, delirium, and ethics at the end of lifeJournal of the American Geriatric Society, by Columba Thomas, MD; Yesne Alici, MD; William Breitbart, MD; Eduardo Bruera, MD; Liz Blackler, MBE, LCSW-R; Daniel P. Sulmasy MD, PhD; 1/24For older persons with delirium at the end of life, treatment involves complextrade-offs and highly value-sensitive decisions. The principles of beneficence,nonmaleficence, respect for autonomy, and justice establish important parametersbut lack the structure necessary to guide clinicians in the optimal management ofthese patients. We propose a set of ethical rules to guide therapeutics—the canonsof therapy—as a toolset to help clinicians deliberate about the competing concernsinvolved in the management of older patients with delirium at the end of life.

Disparities in the geographic distribution of palliative care specialists in 2022Journal of General Internal Medicine, by Julia L Frydman, Karen McKendrick, Yingtong Chen, Jonathan Wun, Nathan E Goldstein, R Sean Morrison, Laura P Gelfman; 2/12/24In 2022, the number of HPM board-certified clinicians was 8,935 (6,448 = physicians (72.2%); 2,487 = NPs (27.8%)), which represents 0.7% of the NP workforce and 0.6% of the physician workforce... Our study highlights the uneven geographic distribution of board-certified HPM clinicians, which depends on state, metropolitan status, and area-level SES. 

Planning Ahead: Medicare, Medicaid or Hospice for at-home careThe Mercury, by Janet Colliton; 2/21/24If you are seeking at-home care assistance for a family member that is paid either in full or in part by the government, you can find that the system is complicated and, unless your loved one fits within one of the designated categories, you may be limited to paying from your family member’s asset or your own. Here are some of the differences and criteria.Editor's Note: This concise, user-friendly article by a Certified Elder Law Attorney provides simple descriptions of this all-important information. What Hospice Medicare information does your staff need to know and use? What clarity do you provide to the public / community you serve?

New outlook report shows home-based care providers bullish on near-term revenue opportunities in the year aheadWTWH Media LLC, by Marshall Matheson; 2/20/24Home Health Care News, a WTWH Media publication, has released the results of its 2024 Home-Based Care Outlook Survey, identifying the top challenges and opportunities for home-based care providers in the year ahead.

Other Business Headlines of Interest, updated 2/22/24 per nasdaq.com

Exploring whether a diagnosis of severe frailty prompts advance care planning and end of life care conversationsNurs Older People, by Stacey Dodson; 2/21/24Findings: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects.

Psychological issues in palliative care: Elissa Kozlov and Des AzizoddinGeriPal podcast, by Alex Smith; 2/22/24Today we talk with two psychologists who are deeply invested in addressing psychological aspects of care for people living with serious illness. Elissa Kozlov, a geropsychologist and director of a new population aging MPH at Rutgers, surveyed AAHPM members, and found that doctors reported major shortcomings in level of comfort and knowledge caring for patients with psychological illness. She conducted a systematic review and meta-analysis of 38 palliative care trials, finding that many excluded people with serious illness, and a lack of impact on psychological outcomes.  Analyzing the Health and Retirement Study, she found 60% of older adults screened positive for depression in the last year of life.