Literature Review

Do not be dismayed by the brokenness of the world. All things break. And all things can be mended. Not with time, as they say, but with intention. So go. Love intentionally, extravagantly, unconditionally. The broken world waits in darkness for the light that is you. – L.R. Knost

Race and ethnicity, gender, and promotion of physicians in academic medicineJAMA Network Open; Lauren Clark, MS; Elena Shergina, PhD; Nathalia Machado, PhD; Taneisha S. Scheuermann, PhD; Nasrin Sultana, MS; Deepika Polineni, MD; Grace H. Shih, MD; Robert D. Simari, MD; Jo A. Wick, PhD; Kimber P. Richter, PhD, MPH; 11/24Medical school faculty training the next generation of physicians do not resemble the diversity of America. Compared with the US working population, American Indian, Black, and Hispanic people are underrepresented in the physician workforce. These findings indicate that preferential promotion of White men within academic medicine continues to persist in the new millennium, with racially and ethnically diverse women experiencing greater underpromotion. To achieve a workforce that reflects the diversity of the US population, this study suggests that academic medicine needs to transform its culture and practices surrounding faculty appointments and promotions.

The patient portal messaging crisisJAMA Neurology; Carrie K. Grouse, MD; Gregory J. Esper, MD, MBA; 12/24The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care utilization, and increasing treatment adherence. Work associated with portal messaging has fallen primarily on physicians, requiring time outside clinical work hours to respond. Appointment access limitations have driven more asynchronous care delivery, resulting in more complex and time-consuming messages. This trend is causing higher levels of physician burnout, and female physicians are disproportionately affected. Burnout associated with excessive after-hours work in EHRs [electronic health records] is now noted among neurologists.

Promoting the resilience of health care information systems—The day hospitals stood stillJAMA Health Forum; Daniel B. Kramer, MD, MPH; Kevin Fu, PhD; 11/24On Friday, July 19, 2024, health care workers woke to emails declaring systemwide information technology (IT) emergencies. Because Crowdstrike had access to the most sensitive core parts of the Windows operating system, the automated process caused an immediate global outage of computer systems using the Crowdstrike Falcon product, which is embedded in many computer systems at health care organizations. Rather than accept this event as inherent to a complex, digitized, and wired health care ecosystem, we urge the US Congress, health care regulators, and the public to insist on proactive preventive methods to avoid future IT catastrophic events rather than simply waiting for the next disruptive crisis requiring an emergent response.

International comparison of underlying disease among recipients of medical assistance in dyingJAMA Internal Medicine; Brandon Heidinger, BSc; Colleen Webber, PhD; Kenneth Chambaere, PhD; Eliana Close, PhD; Luc Deliens, PhD; Bregje Onwuteaka-Philipsen, PhD; Thaddeus Pope, JD, PhD; Agnes van der Heide, MD, PhD; Ben White, DPhil, LLB, (Hons); James Downar, MD, MHSc; 12/24In 2023, 282 million individuals lived in jurisdictions allowing medical assistance in dying (MAID). But regardless of jurisdiction, cancer and amyotrophic lateral sclerosis (ALS) consistently account for up to 80% of MAID cases, despite accounting for fewer than 30% of all deaths. This observation is consistent with the idea that MAID is driven heavily by illness-related factors common to people with those illnesses and inconsistent with the idea that MAID is driven substantially by factors that are external to the individual and that vary by jurisdiction, such as eligibility criteria, culture, social assistance, or palliative care service availability. The overall incidence of MAID increased over time (per 1 calendar year ... )

Advance care planning, end-of-life preferences, and burdensome care-A pragmatic cluster randomized clinical trialJAMA Internal Medicine; Jennifer L. Wolff, PhD; Danny Scerpella, MPH; Erin R. Giovannetti, PhD; David L. Roth, PhD; Valecia Hanna, MS; Naaz Hussain, MD; Jessica L. Colburn, MD; Martha Abshire Saylor, PhD; Cynthia M. Boyd, MD; Valerie Cotter, DrNP; Maura McGuire, MD; Christine Rawlinson, MSN, RN; Danetta H. Sloan, PhD; Thomas M. Richards, MS; Kathryn Walker, PharmD; Kelly M. Smith, PhD; Sydney M. Dy, MD; for the SHARING Choices Investigators; 12/24Advance care planning (ACP) is a communication process that supports adults at any age or stage of health in understanding and sharing their personal values, life goals, and preferences regarding future medical care. In this pragmatic cluster randomized clinical trial, the SHARING Choices intervention increased new documentation of end-of-life preferences but also increased potentially burdensome care at end of life. Mixed findings underscore the importance of comprehensive support for those with serious illness and prioritizing patient-relevant outcomes in ACP interventional research. 

Allostatic load, educational attainment, and risk of cancer mortality among US menJAMA Network Open; Cynthia Li, BS, MD; Sydney P. Howard, DrPH, MS; Charles R. Rogers, PhD, MPH, MS, MCHES; Sydney Andrzejak, MS; Keon L. Gilbert, DrPH; Keith J. Watts, PhD, MSW; Malcolm S. Bevel, PhD, MSPH; Myles D. Moody, PhD, MA; Marvin E. Langston, PhD; Judah V. Doty, MS; Adetunji T. Toriola, MD, PhD, MPH; Darwin Conwell, MD, MSc; Justin X. Moore, PhD, MPH; 12/24Social determinants of health, such as income, occupation, and education, can influence cancer disparities in men. Men with limited access to education and income are more likely to have high allostatic load (AL), a measure of cumulative physiologic stress on the body over time. Chronic stress triggers prolonged neuroendocrine responses, resulting in elevated proinflammatory cytokines, catecholamines, and other proteins. This overactivation can lead to physiologic dysregulation and can promote cancer development. The findings indicate that men with lower educational attainment and high AL face up to a 4-fold increased risk of cancer mortality and nearly 70% increased risk of cancer mortality when accounting possible confounders. 

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Our unrealized imperative: Integrating mental health care into hospice and palliative careJournal of Palliative Medicine; Susan Block; 12/24The field of Hospice and Palliative Medicine (HPM) has its roots in the principles, promulgated by Dame Cicely Saunders, that patient and family are the unit of care and that comprehensive integration of physical, psychological, social, and spiritual care is necessary to address suffering in all its dimensions. Although we aspire to provide comprehensive care for our patients, most hospice and palliative care (HPM) physicians lack basic competencies for identifying and managing patients with psychological distress and mental health distress and disorders, a growing segment of our clinical population. I propose strategies to address these challenges focused on enhancing integration between psychiatry/psychology and HPM, changes in fellowship education and faculty development, addressing the stigma against people with mental health diagnoses, and addressing system and cultural challenges that limit our ability to provide the kind of comprehensive, integrative care that our field aspires to.

Vitas Healthcare unveils inpatient hospice unit at Franciscan Health Olympia Fields GlobeNewswire, Chicago, IL; Press release; 12/12/24 Residents of Olympia Fields and Chicagoland’s surrounding southern suburban communities can now access quality end-of-life care at the VITAS Healthcare Inpatient Hospice Unit at Franciscan Health Olympia Fields. Located on the second floor of the hospital at 20201 South Crawford Ave., this new facility is expected to serve more than 500 seriously ill patients each year. “We are grateful to have this hospice unit as part of our hospital campus, where we can provide compassionate care to patients and families during one of life’s most sacred and challenging times,” said Raymond Grady, president and chief executive officer of Franciscan Health Olympia Fields. “This unit meets a critical need in our community, offering comfort, dignity and spiritual support to those at the end of life.”

Hospice's legacy carried on by new local ownership PRLOG Press Release Distribution, Meridian, ID; by Doctor's Hospice of Idaho; 12/11/24 The locally owned and operated hospice facility known for its dedication to celebrating the lives of patients and providing exceptional care, Doctor's Hospice of Idaho, announced that they have been acquired by Kristopher Stice, Capital Eleven and Willowbridge Group. This strategic move marks a significant step towards further enriching the local hospice care landscape while continuing the legacy established by Cody Freston. "We are thrilled to embark on this journey with Doctor's Hospice of Idaho, a facility deeply rooted in the community it serves. Our vision is to build upon the legacy established by Cody Freston and bring a renewed focus on patient care and employee well-being." said Ashley Copeland, newly appointed CEO/Administrator of Doctor's Hospice of Idaho. "By combining our years of experience in hospice care with the values upheld at Doctor's Hospice of Idaho, we aim to create a world-class hospice that starts from within."

The biggest lesson physicians learned in 2024 Becker's Physician Leadership; by Patsy Newitt; 12/10/24 Five physician leaders joined Becker's to discuss the biggest lesson they learned in 2024. ... [Summary topics include:]