Literature Review

The real cost of cancer: 49% of patients carry $5K+ in medical debt Becker's Hospital Review; by Ashleigh Hollowell; 5/28/24 ... Now, 47% of cancer patients accumulate debt as a result of their medical needs, The Wall Street Journal reported May 28. ... Some Americans are facing $38,000 or even more in medical debt, the Journal found. Additionally, more cancer patients are filing for bankruptcy, which one study linked to an 80% increased risk of dying. ... A 2024 survey of 1,284 cancer patients and survivors led by the American Cancer Society Cancer Action Network also found that: ...

Nephrologists' perspectives and experiences with hospice among older adults with end-stage kidney disease Journal of the American Geriatrics Society; by Melissa W Wachterman, Anupallavi Sinha, Tarikwa Leveille, Sushrut S Waikar, Eric Widera, Kai Romero, Barbara Bokhour; 5/22/24 Background: ... Hospice use among older adults with end-stage kidney disease (ESKD) is markedly lower than among older adults with other serious illnesses, and the majority of those with ESKD who use hospice enroll in the last days of life. ... Conclusions: Our findings suggest that, in addition to Medicare policy change, nephrologists need to receive more training in primary palliative care skills including in indications for hospice, initiating conversations about hospice with patients, and collaborating with hospice clinicians to care for these vulnerable patients.

Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia JAMA Health Forum - JAMA Network; by Cyrus M. Kosar, PhD; Bishnu B. Thapa, MPA, PhD; Ulrike Muench, RN, PhD; Christopher Santostefano, RN, MPH; Emily A. Gadbois, PhD; Hyesung Oh, MA, MBA; Pedro L. Gozalo, PhD; Momotazur Rahman, PhD; Elizabeth M. White, APRN, PhD; 5/10/24 Question: Is nurse practitioner (NP) care associated with end-of-life outcomes for nursing home residents with Alzheimer disease and related dementias (ADRD), and do these associations differ between states with full vs restrictive NP scope of practice regulations? Findings: The results of this cohort study including 334 618 US nursing home residents with ADRD indicated that decedents with greater NP involvement at end of life had fewer hospitalizations and higher hospice use. The adjusted differences in outcomes between decedents with extensive vs minimal NP care were larger in states with full scope of practice regulations than in states with restrictive regulations.

New dementia guide provides best Standards of Care from 100+ not-for-profit hospice, palliative and advanced illness organizations PR Newswire; by National Partnership for Healthcare and Hospice Innovation (NPHI); 5/9/24 The National Partnership for Healthcare and Hospice Innovation (NPHI), the national voice for not-for-profit hospice care, in collaboration with Aliviado Health and the Center to Advance Palliative Care (CAPC), announces today the release of the NPHI "Dementia Care Resources Provider Guide." The new guide aims to improve the quality of life for patients with dementia, reducing hospitalizations, and easing the burden of advanced illness for families and caregivers. A dementia diagnosis poses substantial challenges for both patients and their families, impacting millions of Americans nationwide. Shockingly, the Alzheimer's Association reports that an estimated 6.7 million individuals in the U.S. currently live with dementia. 

Shocked at end-of-life: An educational video for hospice workers about Implantable Cardioverter-Defibrillators Journal of Pain and Symptom Management; by Sarah Godfrey, MD, MPH; Christine L. Chen, MD; Melanie S. Sulistio, MD; Sharika Kumar, MD; and Kelley Newcomer, MD; 2/24 Introduction: Hundreds of thousands of patients with implantable cardioverter-defibrillators (ICDs) die yearly. Though ICD shocks can be lifesaving, they can also be severely painful. One third of ICD patients are shocked in the last day of life irrespective of DNR status. Over 97% of hospice programs admit patients with ICDs, yet only 10% have deactivation policies and less than 50% of hospice patients have their ICD deactivated. ...  Conclusion: Hospice personnel have limited knowledge about ICDs, prohibiting best care of patients with these devices at EOL. A short educational video increased knowledge and may serve as a helpful tool. Improving ICD knowledge amongst hospice personnel is essential to ensuring the unique needs of hospice patients with ICDs are met.

Primary and specialty palliative care utilization at a regional Burn center Oxford Academic / Journal of Burn Care & Research; by Zoe Tao, MD, Alexandra Hoffman, BS, Anna Stecher, MD, Niknam Eshraghi, MD, FACS; 4/20/24There is little research informing appropriate specialty palliative care consultation over primary palliative care practice, or the ability of the burn surgeon to perform skills such as effective goals of care discussions. ... There is bias in diverting both primary and specialty palliative care resources toward acutely ill patients and those with less immediate projected mortality may need additional attention.

Emory University receives $3.1 million NIH grant to improve quality of life for people with cystic fibrosis Emory University, by Brian Katzowitz; 4/16/24... A new five-year, $3.1 million grant from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) will help Emory researchers undertake a novel study combining biological, social, and clinical research methods to better understand the underlying processes of these symptoms – and identify opportunities to improve quality of life. ... Dio Kavalieratos, PhD, [is the] director of research for the Emory Palliative Care Center and the study’s principal investigator ... 

Shared decision-making between nephrologists, patients key to conservative kidney management Healio, by Mark E. Neumann; 4/15/24 ... Conservative kidney management: Patients who decline dialysis treatment do so for many reasons, Fahad Saeed, MB, BS, and colleagues wrote in a paper published in the American Journal of Nephrology. Patients told researchers that quality of life; fewer symptoms caused by dialysis; more personal time; avoiding the burden of dialysis, including for family and friends; witnessing a family member or friend on dialysis and wanting to have a peaceful death were reasons to select conservative kidney management.

Ethical issues abound in adoption of Artificial Intelligence in cancer care Oncology Nurse Advisor; 4/4/24There may be ethical barriers to the adoption of artificial intelligence (AI) into cancer care, according to a study published online March 28 in JAMA Network Open. Andrew Hantel, M.D., from the Dana-Farber Cancer Institute in Boston, and colleagues evaluated oncologists’ views on the ethical domains of the use of AI in clinical care. The analysis included 204 survey responses from 37 states. ... “These findings suggest that the implementation of AI in oncology must include rigorous assessments of its effect on care decisions as well as decisional responsibility when problems related to AI use arise,” the authors write.

Malnutrition, thyroid cancer result in high rates of death among home care, hospice patients, studies finds McKnights Home Care, by Adam Healy; 4/5/24 Two separate studies analyzing disparities in patients’ place of death revealed high death rates related to malnutrition and thyroid cancer among patients receiving care at home and in hospice. The first study, “Disparities in Place of Death Among Malnourished Individuals in the United States,” found that more than 31,000 malnutrition-related deaths occurred among home care and hospice patients between 1999 and 2020. ... Another study, “Disparities in the Place of Death for Patients With Malignant Neoplasms of the Thyroid Gland,” discovered that roughly half of all patients who died of thyroid cancer between 1999 and 2020 did so in home care or hospice.

Dana-Farber’s new push to integrate palliative, behavioral services in cancer careHospice News, by Audrie Martin; 4/2/24Boston-based Dana-Farber Cancer Institute has launched the Neuro-Inclusive Oncology Care and Empowerment Program, a psychosocial oncology initiative focused on adults with intellectual and/or developmental disabilities (IDD). ... Patients with disabilities are largely underserved, but they represent a growing need as well as an untapped market for providers. More palliative care and hospice companies are developing programs to meet the specific concerns of these patients to improve access to care.

Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challengesCurrent Opinion in Cardiology, by Sarah Chuzi and Katharine Manning; online ahead of May 1, 2024 printRecent findings: Patients with chronic heart failure [HF], as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of palliative care [PC] needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. ... PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes.

Should we be using palliative care for scleroderma? The Medical Republic, by Karina Bray; 4/2/24Almost three-quarters of systemic sclerosis patients could benefit from specialist palliative care, according to Australian research. The first-of-a-kind study, published in Arthritis Care & Research, set out to examine and quantify the need for palliative care to address high symptom burden as an integrated part of systemic sclerosis management. ... “Almost 75% of SSc patients may benefit from specialist palliative care input to manage specific severe symptoms, and the overlapping nature of such symptoms highlights the complex symptom management needs of SSc patients,” the authors wrote.