Literature Review

Challenges and solutions of conducting dementia clinical trials: A palliative care at home pilot for persons with dementiaJournal of the American Geriatrics Society; by Leah V. Estrada, PhD, Laura Gelfman, MD, Meng Zhang, MD, Christian Espino, BA, Nathan Goldstein, MD; 4/24We enrolled 30 patients and their 30 caregivers in our pilot trial of home-based palliative care. We found two significant barriers to enrollment: (1) the electronic health record was insufficient to determine the severity ofpatients' dementia; and (2) rates of follow-up survey completion were low, with completion rates at 6 months between 14 and 44%. We created an iterative training process to determine dementia severity from electronic health records and applied person-centered approaches to improve survey completion. ... Electronic health records are not set up to include discrete fields for dementia severity, which makes enrollment of older adults with dementia in a clinical trial challenging. The strain of caring for a loved one with advanced dementia may also make participation in health-services research difficult for patients and their families. Novel approaches have the potential to counteract these challenges, improve recruitment and retention, and ultimately improve care for people with dementia and their caregivers.

The complexity of physician powerScience; by Laura Nimmon; 5/16/24Inequitable variation in physician effort and resource use is revealed. Power is present in all human relationships. Thus, there is no interaction in which power and its potential to exert influence is not relevant in medicine. Although the role of power in medical interactions is important, few studies investigate how physicians allocate effort and execute their power when interacting with patients. ... The nature of physicians’ relationships with patients is characterized as top down and asymmetrical (1). This unequal relationship is thought to be a product of physicians possessing legitimized expert knowledge and legal decision-making authority and patients who are reliant on care and services. Underpinning this power afforded to physicians is societal trust that physicians will always act altruistically and ethically toward patients.Publisher's Note: Also see the related article How power shapes behavior: Evidence from physicians by Stephen D. Schwab, Manasvini in the same issue. [They] investigate how physician power in the US Military Health System interfaces with sociological phenomena such as hierarchy, status, and authority. Their findings reveal the variability and complex mechanisms through which physician power is exerted, ultimately providing nuance about how the ethics of physician power is understood as it interfaces with other hierarchical systems of power.

Medical aid in dying to avoid late-stage dementiaJournal of the American Geriatrics Society; by Thaddeus Mason Pope, Lisa Brodoff; 4/24Many patients with dementia want the option of using medical aid in dying (MAID) to end their lives before losing decision-making capacity and other abilities that impact their desired quality of life. But, for over two decades, it has been widely understood that these patients cannot (solely because of their dementia diagnosis) satisfy three statutory eligibility requirements in all U.S. MAID laws: (1) decisional capacity, (2) the ability to self-administer the life-ending medications, and (3) a terminal condition with 6 months or less to live. Now, because of recent statutory amendments together with the use of voluntarily stopping eating and drinking (VSED) to quickly advance to a terminal condition, this dementia exclusion from MAID might no longer apply. If combining VSED and MAID is now a possibility for patients with dementia, then clinicians need more guidance on whether and when to support patients seeking to take this path. In this article, we begin to provide this guidance. 

Impact of a Nurse-Led Palliative Care Screening Tool on Medical Oncology UnitsClinical Journal of Oncology Nursing; by Kaitlyn Whyman, Katherine Thompson, Michelle M. Turner; 2/24There is a lack of early integration of palliative care in patients with advanced cancer, which has been shown to result in suboptimal quality of life across their disease continuum. Standardized palliative care screening tools are valuable for identifying patients with early palliative care needs but have yet to be adapted into standard practice in the oncology community. This project aimed to determine whether a nurse-led palliative care screening tool increased palliative care consultations, decreased the average length of stay, reduced readmission rates among adult patients with solid tumor malignancies, and improved knowledge and confidence among nurses regarding palliative care.

Training opportunities for managers in home health, hospice, and community-based care settingsThe Journal of Nursing Administration; by Ann M Nguyen, Alfred F Tallia, Tami M Videon, Robert J Rosati; 6/24The aim of this study was to identify areas for developing management skills-focused continuing education for managers working in home health, hospice, and community-based settings. For all 33 management tasks, managers with 6+ years of experience reported greater confidence than managers with 0 to 5 years of experience. Tasks with the lowest confidence were budgeting, interpreting annual reports, strategic planning, measuring organizational performance, and project planning. Managers were clustered into 5 "profiles." Management training is not 1-size-fits-all. Healthcare organizations should consider investing in training specific to the identified low-confidence areas and manager roles to better support and develop a robust management workforce.

Hospice Readmission, Hospitalization, and Hospital Death Among Patients Discharged Alive from HospiceJAMA Network; by Elizabeth A. Luth, Caitlin Brennan, Susan L. Hurley, Veerawat Phongtankuel, Holly G. Prigerson, Miriam Ryvicker, Hui Shao, Yongkang Zhang; 5/24This retrospective cohort study of burdensome transitions following live hospice discharge found that non-Hispanic Black race, short hospice stays, and care from for-profit hospices were associated with higher odds of experiencing a burdensome transition. These findings suggest that changes to clinical practice and policy may reduce the risk of burdensome transitions, such as hospice discharge planning that is incentivized, systematically applied, and tailored to needs of patients at greater risk for burdensome transitions.

A survey of Jewish attitudes and experiences relating to end-of-life care and the “right to die”American Journal of Hospice and Palliative Medicine; by Christopher M. Moreman, Ayona Chatterjee; 3/24We conducted a survey of Jewish attitudes towards, and experiences with, end-of-life care. Questions fell into three areas: (1) Expectations for Jewish end-of-life care; (2) Experiences with such care; and (3) Attitudes toward the “right to die.” Examining denominational differences in belief in, and adherence to, Halakha (Jewish law), we confirm many expectations described in the literature. We find notable nuances in specific areas of need across Jewish denomination, and in terms of acceptance of the withdrawal of life support vs assisted suicide. Care for the nuances of Jewish belief is indicated for effective and satisfying Jewish end-of-life care.

Association between physician age and patterns of end-of-life care among older AmericansJournal of the American Geriatrics Society; by Hiroshi Gotanda, Ryo Ikesu, Anne M. Walling, Jessica J. Zhang, Haiyong Xu, David B. Reuben, Neil S. Wenger, Cheryl L. Damberg, David S. Zingmond, Anupam B. Jena, Nate Gross, Yusuke Tsugawa; 4/15We found that differences in patterns of EOL care between ben-eficiaries cared for by younger and older physicians were small, and thus, notclinically meaningful. Future research is warranted to understand the factorsthat can influence patterns of EOL care provided by physicians, including ini-tial and continuing medical education.

Developing, implementing, and evaluating the visiting Neighbors’ program in rural Appalachia: A quality improvement protocolPLoS One; by Ubolrat Piamjariyakul, Susan R. McKenrick, Angel Smothers, Angelo Giolzetti, Helen Melnick, Molly Beaver, Saima Shafique, Kesheng Wang, Kerri J. Carte, Brad Grimes, Marc W. Haut, R. Osvaldo Navia, Julie Hicks Patrick, Kirk Wilhelmsen; 1/24Older adults living alone in rural areas frequently experience health declines, social isolation, and limited access to services. To address these challenges, our medical academic university supported a quality improvement project for developing and evaluating the Visiting Neighbors program in two rural Appalachian counties. Our Visiting Neighbors program trained local volunteers to visit and guide rural older adults in healthy activities. These age-appropriate activities (Mingle, Manage, and Move- 3M's) were designed to improve the functional health of older adults. The program includes four in-home visits and four follow-up telephone calls across three months.

Top ten tips palliative care clinicians should know about the psychiatric manifestations of nonpsychiatric serious illness and treatmentsJournal of Palliative Medicine; Gregg A. Robbins-Welty, Paul A. Riordan, Daniel Shalev, Danielle Chammas, Paul Noufi, Keri O. Brenner, Joshua Briscoe, William E. Rosa, Jason A. Webb; 5/24Mental health issues are widespread and significant among individuals with serious illness. Among patients receiving palliative care, psychiatric comorbidities are common and impact patient quality of life. Despite their prevalence, PC clinicians face challenges in effectively addressing the intricate relationship between medical and psychiatric disorders due to their complex, intertwined and bidirectionally influential nature.

In praise of hospiceJAMA; by James R. Nicholas, MD; 4/24... Joan did what she wanted to do: she, with the help of hospice, made her dying as easy as possible for me and our children. I have the same wish for myself. I doubt if I will achieve it as well as did Joan, but I will have her as a guide. And I hope I will have the kind of hospice team that Joan had.

The value of screening for a history of incarceration in the palliative care settingAmerican Journal of Hospice and Palliative Medicine; by Joseph Michael Schnitter, Joshua Hauser; 5/24In this article, we explore existing literature that highlights the unique physical, cognitive, and psychosocial challenges that formerly incarcerated patients face. We proceed to argue that palliative care providers should screen for a history of incarceration to identify and address the needs of this patient population. We also offer strategies to create a safe, welcoming environment to discuss past traumas related to these patients’ time in prison.

Associations between Certificate of Need policies and hospice quality outcomesAmerican Journal of Hospice & Palliative Medicine; by Arlen G. Gaines, John G. Cagle; 5/24Approximately 86% of hospices are in states without a hospice CON provision. The unadjusted mean HIS scores for all measures were higher in CON states (M range 94.40-99.59) than Non-CON (M range 90.50-99.53) with significant differences in all except treatment preferences. ... The study suggests that CON regulations may have a modest, but beneficial impact on hospice-reported quality outcomes, particularly for small and medium-sized hospices.