Literature Review

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. 

Researcher explores using AI to overcome language barriers with patientsJAMA Network; Yulin Hswen, ScD, MPH; Kate Schweitzer; 12/24In the US, 25 million people with language barriers receive worse health care by nearly every standard than those who speak English fluently. In a recent Viewpoint in JAMA, K. Casey Lion, MD, MPH, an associate professor of pediatrics at the University of Washington School of Medicine, listed the poorer-quality outcomes: inferior comprehension, lower adherence, higher costs, and more frequent serious safety events, to name a few. In this study, we want to understand how it performs under real-world conditions because those are the conditions we would be using it in. I would also encourage other health care systems that are thinking about implementing AI for language access to think about talking to and involving their patients and families in the work to be sure that it’s reflecting what our patients and families actually want rather than what we think they want.

Greater education needed to bring palliative care to cancer patients Hospice News; by Jim Parker; 12/18/24 Cancer patients generally need palliative care, but widespread misperceptions often stand in their way, both among the public and many clinicians themselves. This is according to Nadine Barrett, president of the Association of Cancer Care Centers (ACCC). The organization has been holding a series of webinars designed to better educate the oncology community about palliative care. The association is also in the process of studying racial and ethnic gaps in advance care planning, among other projects funded by its research arm, the ACCC Community Oncology Research Institute. Palliative Care News sat down with Barrett to discuss the barriers that cancer patients often experience when it comes to accessing palliative care. [Click on the title's link to read more.]

Lawmakers, health care providers raise alarm about growing antisemitism in medical field Jewish Insider - Health Care Hazard; by Marc Rod; 12/18/24 Speaking on a panel on Capitol Hill on Tuesday, lawmakers, medical professionals and Jewish community advocates sounded the alarm about the spread of antisemitism in the health care field, both within medical schools and in clinical settings. They said that the issue deserves and requires greater attention from Capitol Hill, akin to the attention campus antisemitism has received over the past year. “That’s truly scary, the idea that somehow your religious background or your identity would inform or impact the type of care that you get is not only antisemitic, it’s not only anti-American, it is anti-democratic,” Rep. Dan Goldman (D-NY), the incoming chair of the House antisemitism task force, said at the Jewish Federations of North America-organized briefing.

Hospice utilization rebounds to pre-pandemic levels, but fraud casts a shadow Hospice News; by Jim Parker; 12/17/24 The nation’s hospice utilization rate among Medicare decedents has once again surpassed 50%, for the first time since the pandemic. However, fraud issues in the space create questions around the quality of care patients are receiving. Hospice utilization reached 51.7% in 2023, up more than two percentage points from the prior year, according to recent data from the Medicare Payment Advisory Commission (MedPAC). This is the highest rate since 2019. MedPAC observed increases in utilization across the board, even when stratified into subgroups by age, sex, race and rural or urban location. ... Despite these positive trends, an influx of new hospices continued in states considered hotbeds for Medicare fraud, including Arizona, California, Nevada and Texas. Many of these new additions came in areas where additional hospices were likely not necessary based on the needs of the patient population. Georgia also saw a large spate of new providers emerge in 2023.

December challenge: Gift ideas part two ActiveRain; by Kat Palmiotti; 12/17/24 ... My mother dealt with cancer the last four years of her life with an upbeat attitude, ...  So what did she do with the time she had left? The same as always. It was late November 2011 at this point. So what she decided to do was to make a point of purchasing us all our last Christmas present. ... So for me, she purchased me a coffee cup with a lid which is pictured in the feature photo. ... But my mom didn't stop there. She also wrote each of her family members a handwritten letter. Her letter to me talked about me being her first born, and about what I was like during my childhood, and how she felt about my life as an adult. It was a beautiful letter that makes me smile and cry every time I read it. I treasure it. ... So why am I sharing this? Because when I think back on all the gifts I've ever received, it's not jewelry or clothing or anything else that pops into my mind first. It's a $5 cup and a piece of paper with writing on it. And both of those were my mom giving me love. So, when giving gifts to those you care about, give them love. Perhaps grab a piece of paper and a pen and let them know how much you care about them. Or buy them a small carefully selected item that they might use on a daily basis, smiling because it's from you. Because really, it truly is the thought that counts. Let that thought be love.

National Alliance for Care at Home and Transcend Strategy Group publish Rural American Hospice Insights Report National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 12/19/24The National Alliance for Care at Home (the Alliance) and Transcend Strategy Group published the results of new research exploring perceptions of hospice care among rural and small-town communities. This survey of 400 people is part of the Alliance’s commitment to health equity and to breaking down barriers to accessing hospice and home care through knowledge sharing, data collection, and collaborative discussion. Along with key research findings, the Rural American Hospice Insights report offers recommendations for hospice providers to help increase understanding of hospice care and help overcome barriers to access. Key findings and recommendations include:

Characteristics of patients enrolled in hospice presenting to the emergency department American Journal of Emergency Medicine; by Kayla P Carpenter, Fernanda Bellolio, Cory Ingram, Aaron B Klassen, Sarayna S McGuire, Alisha A Morgan, Aidan F Mullan, Alexander D Ginsburg; 12/9/24, online ahead of print Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. ... Patients enrolled in hospice most frequently presented to the ED for trauma [36%; with 15% for pain, 12% for catheter/tube malfunction]. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for needs for ED care? Ie.,

Cancer mortality in Louisiana’s correctional system, 2015-2021JAMA Network Open; Totadri Dhimal, MD; Paula Cupertino, PhD; Zijing Cheng, MS; Erika E. Ramsdale, MD; Bailey K. Hilty Chu, MD; Brian J. Kaplan, MD; Andrea Armstrong, JD, MPA; Xueya Cai, PhD; Yue Li, PhD; Fergal J. Fleming, MD, MPH; Anthony Loria, MD, MSCI; 11/24Nearly 2 million individuals are incarcerated annually in the US, predominantly low-income men from racial and ethnic minority backgrounds. The prison population is also aging, with those aged 55 years or older projected to constitute one-third of all incarcerated individuals by 2030. Imprisonment is associated with accelerated physiological aging, and national data show that incarcerated individuals have 22% higher odds of receiving a cancer diagnosis compared with the general population. Our study found that the cancer-specific mortality rate among incarcerated individuals in Louisiana was higher than the national rate but lower than the state’s, with the majority of these deaths occurring among those older than 55 years. Medical compassionate release remains an underutilized option, and the effect of providing a dignified death for families, health care professionals, incarcerated individuals, payers, and policymakers needs further evaluation.

The ISNP opportunity for hospice providers  Hospice News; by Jim Parker; 12/5/24 Hospice providers can collaborate with institutional special needs Medicare Advantage plans (ISNP) to reach patients who reside in long-term care facilities. ISNPs restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC), skilled nursing facility, a LTC nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility. The nonprofit senior services organization Empath Health, which operates several hospices, recently partnered with the MA organization American Health Plans to bring their services to ISNP-enrolled patients.

Patient, caregiver, and clinician perspectives on the time burdens of cancer careJAMA Network Open; Arjun Gupta, MD; Whitney V. Johnson, MD; Nicole L. Henderson, PhD; Obafemi O. Ogunleye, MEd; Preethiya Sekar, MD; Manju George, MVSc, PhD; Allison Breininger, MA; Michael Anne Kyle, PhD, RN; Christopher M. Booth, MD; Timothy P. Hanna, MD, PhD; Gabrielle B. Rocque, MD; Helen M. Parsons, PhD; Rachel I. Vogel, PhD; Anne H. Blaes, MD, MS; 11/24Cancer and its care impose significant time commitments on patients and care partners. These commitments, along with their associated burden, have recently been conceptualized as the “time toxicity” of cancer care. Patients with advanced solid tumors spend approximately 20% to 30% of their days alive with health care contact. In this qualitative analysis of patients, informal care partners, and clinicians, participants highlighted the diverse sources of time burdens, how these time burdens affected care partners alongside patients, and how the time burdens extended to the wider network around them. Time burdens had outcomes ranging from causing psychosocial distress, and “seemingly short” ambulatory appointments turning into all-day affairs. These findings will guide the oncology community to map, measure, and address time burdens for persons affected by cancer.

Characteristics of health systems operating Medicare Advantage PlansJAMA Health Forum; Aaron Hedquist, MSc; Eric Yu, MPH; Pasha Hamed, MA; E. John Orav, PhD; Austin Frakt, PhD; Thomas C. Tsai, MD, MPH; 11/24Health care delivery has rapidly transitioned from independent physicians and hospitals to integrated delivery networks. More than three-quarters of inpatient facilities are affiliated with a health system. Nearly 1 in 7 MA [Medicare Advantage] beneficiaries are enrolled in system-operated MA plans, which remain a consistent source of Medicare enrollment. The findings of this study suggest that larger and church-affiliated health systems are associated with a higher likelihood of operating an MA plan. System-operated MA plans were associated with higher quality ratings and patient satisfaction than unaffiliated MA plans.

How hospice CNAs provide comfort in end-of-life care Intelligent Living; by Jennifer Barns; 12/8/24 End-of-life care is one of the most challenging yet meaningful services that healthcare professionals can offer. During such a delicate time, the role of a hospice CNA becomes essential. ... Table of Contents: