Literature Review

Developing competencies to advance health care access and quality for Latino, Hispanic, and Spanish origin populations-A consensus statementJAMA Network Open; by Débora H. Silva, John A. Davis Rodríguez, Hector Rasgado-Flores, Pilar Ortega, Deion Ellis, Fernando Sánchez Mendoza, Victor Cueto, Fabiola Quintero-Rivera, Norma Iris Poll-Hunter, Minerva Romero Arenas, Kenneth Lee Dominguez, Juan Emilio Carrillo, José E. Rodríguez, John Paul Sánchez; 8/25Question: What competencies and milestones are essential for advancing health equity for Latina, Latino, Latinx, Latine, Hispanic, and Spanish Origin (LHS+) populations? Since the 1970s, the LHS+ population has increased 6-fold and grown to be the largest ethnic or racial group in the US and accounts for approximately 20% of the US population. The LHS+ health equity competencies and milestones resulting from this study add to prior work by creating a blueprint for standardization and broader application of such educational experiences on a national level. As a tool to enhance CBME [competency-based medical education ] efforts aligned with care for LHS+ populations, the competencies may aid educators and institutions through an LHS+–informed lens in conducting gap analyses for the development of local curricula, developing teaching and assessment materials, supporting the professional development of learners and faculty, and facilitating educational scholarship. 

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

Improving community-based palliative care explanations: Insights from persons declining servicesAmerican Journal of Hospice & Palliative Care; by Kira G Sheldon, Kathryn H Bowles, Elizabeth A Luth; 8/25Beneficiaries and caregivers had mixed understandings of palliative care, including: no knowledge, belief that it was the same as or pre-hospice, and accurate, but often one-dimensional understandings of it. Participants recommended providing individualized, tailored explanations focused on the person's health concerns in simple language with follow-up materials to improve engagement with palliative care. Small adjustments to how palliative care is explained may increase understanding among older adults and caregivers, particularly among those with limited or inaccurate knowledge. Among those familiar with palliative care, providing accessible and clear explanations customized to the person's specific care needs can further broaden understanding and increase perceived relevance.

Implementing education for community adult hospice nurses to expand pediatric hospice and palliative careJournal of Hospice and Palliative Nursing; by Shelly C Wenzel; 8/25Pediatric hospice and palliative patients require specially-trained clinicians to provide holistic support in areas such as disease progression, illness trajectory, and goals of care. An asynchronous online educational module, including a pre- and postmodule survey, was developed to provide education on timely pediatric quality-of-life conversations and skills for nurses who work with the adult population. Following the education module, participants reported an increase in comfort from 25% to 93.3% and willingness from 59% to 93.3%. Additionally, postmodule confidence level increased to 94%. These findings suggest an asynchronous educational module approach benefits the needs of community-based adult hospice and palliative nurses and gains learned from this module may enhance nurse skill and improve access to care.

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.

Estimating the predictability of questionable open-access journalsScience Advances; by Han Zhuang, Lizhen Liang, Daniel E. Acuna; 8/25Questionable journals threaten global research integrity, yet manual vetting can be slow and inflexible. Here, we explore the potential of artificial intelligence (AI) to systematically identify such venues by analyzing website design, content, and publication metadata. Evaluated against extensive human-annotated datasets, our method achieves practical accuracy and uncovers previously overlooked indicators of journal legitimacy... Our study defines “questionable open-access journals” as journals violating the best practices outlined by the Directory of Open Access Journals (DOAJ) and showing indicators of low editorial standards.Publisher's note: The authors use AI to evaluate open-access journals adherence to best publishing practices - an interesting use of AI that could be applied to many other settings. The list of open-access journals can be found here.

Understanding trauma in the context of direct care work in nursing homesJournal of Applied Gerontology; by Alfred Boakye, Jennifer Craft Morgan, Candace L. Kemp, Antonius D. Skipper; 8/25Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents’ care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.

A digital therapeutic intervention for inpatients with elevated suicide risk: A randomized clinical trialJAMA Network; by Craig J. Bryan, Patricia Simon, Samuel T. Wilkinson, Michael H. Allen, Jeremiah Perez, Caleb Adler, Khatiya Moon, Lauren Astorino, Kristen M. Carpenter, Luke Misquitta, Katherine Brownlowe, Lauren R. Khazem, Jarrod Hay, Austin G. Starkey, Julia Tartaglia, Helena Winston, Scott Simpson, Alecia D. Dager, Seth Feuerstein; 8/25Does a smartphone-based digital therapeutic intervention designed to deliver suicide-focused cognitive behavior therapy (CBT) reduce future suicide attempts among patients hospitalized with acutely elevated suicide risk? In this randomized clinical trial of 339 inpatients in psychiatric hospitals, no difference was found in time to first actual suicide attempt between those who used the digital therapeutic intervention and those who used the control application. The digital therapeutic intervention did not impact time to first suicide attempt after discharge among patients admitted for suicidal ideation and/or suicide attempts.Publisher's note: As AI is studied in healthcare, it's interesting to explore both what works and what doesn't.

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Top ten tips palliative care clinicians should know about intensive care unit consultationJournal of Palliative Medicine; by Ankita Mehta, Karen Bullock, Jillian L. Gustin, Rachel A. Hadler, Judith E. Nelson, William E. Rosa, Jennifer B. Seaman, Shelley E. Varner-Perez, Douglas B. White; 8/25Critical illness and ICU stays can be extremely distressing for patients and their loved ones. Providing palliative care in the ICU, although a standard component of comprehensive care delivery, involves understanding the individual culture of each specific ICU, collaboration with multiple providers, and interfacing with surrogate decision makers while patients may not be able to communicate and are undergoing interventions that are unfamiliar to them and loved ones. These top ten tips aim to support palliative care clinicians providing consultation in ICUs. Specifically, these tips address initial relationship building with ICU clinicians and teams to foster effective collaboration, establishing goals of care by assessing health-related values, explaining treatment options, individualizing prognostic discussions, and managing end-of-life symptoms for patients while in the ICU and throughout ICU discharge transition.

Palliative care researchers use qualitative data to understand the full picture of patients' lives St. Jude Research; by Heather Johnson; 8/26/25 The central goal of palliative care is to provide comfort, relieve suffering and improve the quality of life for those dealing with serious illnesses. That care is interdisciplinary. It must be. Quality of life relates to physical, social, emotional, spiritual and psychological needs. Addressing those needs requires teamwork from physicians and clinicians in a range of disciplines. ... Palliative care studies often use mixed methods approaches to capture the full picture of what can be subjective outcomes. For example, scales and surveys may provide a foundation for assessing symptom relief, while qualitative research, such as patient interviews and focus groups, helps researchers understand the meaning behind the numbers.  Editor's Note: Yes. Measures for hospice and palliative success and growth are more than dollar amounts and the number of locations. Pairing qualitative research with quantitative data, researchers and leaders must seek to "understand the meaning behind the numbers." Ongoing, be sure to explore our newsletter's Saturday issues for relevant, timely evidence-based research articles--quantitive and qualitive data--to improve the care of persons who needing hospice and palliative care.

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.