Literature Review

Vaccine mandates for health care workers—An effective policy tool for past and future pandemics JAMA Open Network; John B. Lynch, MD, MPH; 8/24COVID-19 vaccines reduce the risk of infection, severe disease, long COVID, and death. Although COVID-19 vaccines were free and obtainable in 2021 and as early as December 2020 for some health care workers (HCWs), a considerable proportion of people in the US chose not to get vaccinated. Wang and colleagues investigated this challenging and critically important question: do public policies that required health care workers to get vaccinated increase vaccine uptake? ... by the second week after a mandate was implemented, Wang et al found an increase in the proportion of HCWs ever vaccinated or who had completed or intended to complete the primary vaccination series. These results join those of other studies that found an association between vaccine mandates and increased vaccinations in specific populations. Studies like that by Wang et al provide more information that could be used to design mandates and communicate the impact of future mandates, providing much needed and better measures of the perceived tradeoffs of governmental action in preparation for the next pandemic and in the prevention of nonpandemic infectious diseases.

Lay-led intervention for war and refugee trauma-A randomized clinical trialJAMA Network Open; Lori A. Zoellner, PhD; Jacob A. Bentley, PhD; Kawther Musa, MA; Farhiya Mohamed, MSW; Luul B. Ahmed, BA; Kevin M. King, PhD; Norah C. Feeny, PhD; for the Islamic Trauma Healing Clinical Team; 8/24The global refugee crisis disproportionately affects the Muslim world [and] forced displacement often results in trauma-related mental health issues. Effective psychotherapy exists, but there are barriers to uptake by refugee groups as well as a lack of culturally appropriate interventions. In a randomized clinical trial with a US-based sample of 101 refugees, Islamic Trauma Healing showed significant effects on posttraumatic stress disorder, depression, and well-being, compared with the control group, with gains maintained through 12-week follow-up. Islamic Trauma Healing was well received by community members, consistent with faith and culture. The findings of this study suggest that this deep-cultural–adapted intervention has the potential to provide an easily trainable and scalable model to reach war and refugee communities unlikely to either have access to or seek Western-based mental health interventions.

Individual-and community-level risk factors of cancer-related financial hardship among cancer survivorsJAMA Network Open; Apoorv Dhir, MD; Kristian Donald Stensland, MD, MS, MPH; Lindsey Allison Herrel, MD, MS; Rishi Robert Sekar, MD, MS; 8/24Cancer survivors face substantial economic hardships during and after oncologic care, compounding the physical and psychosocial implications of a cancer diagnosis and compromising treatment adherence, quality of life, and survival. In this cross-sectional study, approximately 50% of cancer survivors experienced cancer-related financial hardship, with a disproportionate number of survivors who were younger, were Medicare or Medicaid beneficiaries, were socioeconomically disadvantaged, and had advanced disease. Although policy efforts to curb the costs of cancer care are essential, acknowledging the role of community and structural barriers and identifying socially vulnerable populations for targeted interventions represent a potential strategy toward mitigating financial hardship and delivering equitable cancer care.

Injurious fall risk differences among older adults with first-line depression treatmentsJAMA Network Open; Grace Hsin-Min Wang, PharmD, MS; Edward Chia-Cheng Lai, PhD; Amie J. Goodin, PhD; Rachel C. Reise, PharmD, MS; Ronald I. Shorr, MD, MS; Wei-Hsuan Lo-Ciganic, PhD, MS, MSPharm; 8/24One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.

Rita and Alex Hillman Foundation announces $500,000 in funding for nine projects to improve serious illness and end of life care Globe Newswire; by Rita & Alex Hillman Foundation; 9/10/24 The Rita and Alex Hillman Foundation ... announced nine grants to support innovative, early-stage interventions that address the serious illness and end of life needs of marginalized populations. The $500,000 in funding, part of a collaborative effort with The Arthur Vining Davis Foundations, will advance nursing-driven initiatives that improve care for diverse populations and expand access to high-quality end of life services. ... This year’s grants demonstrate a commitment to the design, development, and delivery of better and more equitable care. The 2024 HSEI grant recipients are:

Incorporating patient values in large language model recommendations for surrogate and proxy decisionsCritical Care Explorations; Victoria J Nolan, Jeremy A Balch, Naveen P Baskaran, Benjamin Shickel, Philip A Efron, Gilbert R Upchurch Jr, Azra Bihorac, Christopher J Tignanelli, Ray E Moseley, Tyler J Loftus; 8/24Surrogates, proxies, and clinicians making shared treatment decisions for patients who have lost decision-making capacity often fail to honor patients' wishes, due to stress, time pressures, misunderstanding patient values, and projecting personal biases. Advance directives intend to align care with patient values but are limited by low completion rates and application to only a subset of medical decisions. [Likert] scores were highest when patient values were captured as short, unstructured, and free-text narratives based on simulated patient profiles. This proof-of-concept study demonstrates the potential for LLMs [large language models] to function as support tools for surrogates, proxies, and clinicians aiming to honor the wishes and values of decisionally incapacitated patients.

Palliative care for dialysis-dependent pediatric patients: A survey of providers, nurses, and caregiversKidney360; Joshua Lipsitz, Mark Stockton Beveridge, Katherine Maddox; 8/24Dialysis-dependent pediatric patients and their families face significant biopsychosocial burdens and low health-related quality of life. Palliative care consultations can alleviate some degree of suffering for patients and families but remain underutilized within pediatric nephrology. 90% of providers and all nurses desired more palliative care education. Of the 22% of caregivers whose child had already received palliative care services, all found the consultation to be helpful. These data support further palliative care education for pediatric nephrology providers and nurses and more robust and systematic involvement of subspecialty palliative care for dialysis-dependent pediatric patients.

Long-term dementia risk in Parkinson DiseaseNeurology; Julia Gallagher, Caroline Gochanour, Chelsea Caspell-Garcia, Roseanne D Dobkin, Dag Aarsland, Roy N Alcalay, Matthew J Barrett, Lana Chahine, Alice S Chen-Plotkin, Christopher S Coffey, Nabila Dahodwala, Jamie L Eberling, Alberto J Espay, James B Leverenz, Irene Litvan, Eugenia Mamikonyan, James Morley, Irene H Richard, Liana Rosenthal, Andrew D Siderowf, Tatyana Simuni, Michele K York, Allison W Willis, Sharon X Xie, Daniel Weintraub, Parkinson's Progression Markers Initiative; 9/24It is widely cited that dementia occurs in up to 80% of patients with Parkinson disease (PD), but studies reporting such high rates were published over two decades ago, had relatively small samples, and had other limitations. We aimed to determine long-term dementia risk in PD using data from two large, ongoing, prospective, observational studies. Participants from the Parkinson's Progression Markers Initiative (PPMI), a multisite international study, and a long-standing PD research cohort at the University of Pennsylvania (Penn), a single site study at a tertiary movement disorders center, were recruited. Results from two large, prospective studies suggest that dementia in PD occurs less frequently, or later in the disease course, than previous research studies have reported.

Creating a palliative care clinic for patients with cancer pain and substance use disorderJournal of Pain and Symptom Management; Sachin S Kale, Gennaro Di Tosto, Laura J Rush, Justin Kullgren, Deborah Russell, Martin Fried, Blessing Igboeli, Julie Teater, Katie Fitzgerald Jones, Devon K Check, Jessica Merlin, Ann Scheck McAlearney; 8/24Opioids are a first-line treatment for severe cancer pain. However, clinicians may be reluctant to prescribe opioids for patients with concurrent substance use disorders (SUD) or clinical concerns about non-prescribed substance use. We created the Palliative Harm Reduction and Resiliency Clinic, a palliative care clinic founded on harm reduction principles and including formal collaboration with addiction psychiatry. The formal collaboration with addiction psychiatry and the integration of harm reduction principles and practices into ambulatory palliative care improved our ability to provide treatment to a previously underserved patient population with high symptom burden.

Respect for the patient-oncologist relationship may limit serious illness communication by acute and postacute care clinicians after discharge to a skilled nursing facilityJCO Oncology Practice; by Sarguni Singh, Ashley Dafoe, John Cagle, Elizabeth R. Kessler, Hillary D. Lum, Brooke Dorsey Holliman, Stacy Fischer; 6/24There is a need to increase palliative care access for hospitalized older adults with cancer discharged to a skilled nursing facility (SNF) at risk of poor outcomes. Assessing and Listening to Individual Goals and Needs (ALIGN) is a palliative care intervention developed to address this gap. This study gathered perspectives from clinicians across care settings to describe perceptions on serious illness communication and care coordination for patients with cancer after discharge to a SNF to guide ALIGN refinements... These findings suggest that acute and postacute care clinicians defer serious illness conversations to the oncologist when patients are on a steep trajectory of decline, experiencing multiple care transitions, and may have limited contact with their oncologist. There is a need to clarify roles among nononcology and oncology clinicians in discussing prognosis and recommending hospice for older adults discharged to SNF.

Private equity acquisitions of hospices are increasing; Ownership remains opaqueHealth Affairs; by Melissa D. Aldridge, Lauren J. Hunt, Zelle Halloran, Krista L. Harrison; 9/24Private equity ownership across the US health care system is rapidly increasing, yet ownership structures are complex and opaque. We used an economic data set tracking mergers and acquisitions linked to Medicare data to identify private equity hospice acquisitions. Given the influence of for-profit ownership on hospice quality, transparent data on private equity investment are fundamental to ensuring high-quality end-of-life care.

Site-of-Care shifts and payments—A viable strategy to control health care costs?JAMA Open Network; Lee A. Fleisher, MD, ML; Sheila P. Burke, RN, MPA; 8/24The authors sought to determine what proportion of care was currently being performed in hospital-based settings and investigated how much could be shifted to nonhospital settings today and 7 to 10 years in the future with technological advances. They found that the major barriers to site-of-care shifts were economic arrangements, ownership models, and perceived loss of continuity of care at alternative sites. These results affirm their view that to reduce health care spending and protect Medicare trust funds, it will be critical to develop financial incentives and, just as importantly, eliminate financial disincentives to drive care to the safest and lowest-cost site of service.

Reviewing ethical guidelines for the care of patients with Do-Not-Resuscitate orders after 30 years: rethinking our approach at a time of transition Anesthisiology; Matthew B. Allen, M.D.; Shahla Siddiqui, M.D., D.A.B.A., M.Sc.; Omonele Nwokolo, M.D.; Catherine M. Kuza, M.D.; Nicholas Sadovnikoff, M.D., H.E.C.-C.; David G. Mann, M.D., D.Be.; Michael J. Souter, M.B., Ch.B., D.A.; 9/24The American Society of Anesthesiologists (ASA) opposes automatic reversal of do-not-resuscitate orders during the perioperative period, instead advocating for a goal-directed approach that aligns decision-making with patients’ priorities and clinical circumstances. Implementation of ASA guidelines continues to face significant barriers including time constraints, lack of longitudinal relationships with patients, and difficulty translating goal-focused discussion into concrete clinical plans. These challenges mirror those of advance care planning more generally, suggesting a need for novel frameworks for serious illness communication and patient-centered decision-making.