Literature Review

Systemic functioning of Puerto Rican families with a cancer patient: A qualitative-oriented mixed-methods studyJournal of Health Psychology; Nicole M. Vélez Agosto; 4/25Puerto Ricans are part of marginalized communities that are impacted by health disparities, such as lifestyles, health behaviors and access to care (Simmons et al., 2011). The purpose of study was to assess systemic functioning in Puerto Rican families with a cancer patient using the Spanish translated version of the Family Genogram Interview (FGI) that measures Bowen’s four emotional processes in nuclear family and family of origin. Results suggested an acceptable reliability for the FGI-Spanish and higher presence of symptoms in a spouse or partner, symptoms in family of origin, focus on a child and emotional cutoff in family of origin. Qualitative findings suggested that main concerns for participants were related to family changes surrounding illness and familial roles, consistent with Bowen’s theory and clinical implications for designing systemic interventions for Puerto Rican families.

Research disrupted at the NIH Clinical Center STAT - Morning Rounds; by Theresa Gaffney; 5/6/25 The NIH Clinical Center — the nation’s largest hospital devoted solely to medical research — is in crisis. In 2023, the hospital ran around 1,500 studies with a permanent staff of more than 1,800 federal workers. But amid continued disruptions from the Trump administration, researchers are leaving, technicians have been let go, studies are facing major delays, and some patients are deciding to drop out of the hospital’s research.

Increasing timely code status discussions in hospitalized children with medical complexityJournal of Hospital Medicine; James Bowen MD; Laura Brower MD, MSc; Daniel Kadden MD; Jasmine Parker BS; Alexandra Delvalle BSN; Andrew Krueger MD; Kristin Todd MSW; Rachel Peterson MD; 4/25Children with medical complexity (CMC) have an increased risk of hospitalization and clinical deterioration. Documentation of code statuses concordant with family goals is rare, increasing the risk of serious unintended consequences. We aimed to increase the percentage of patients with documentation of timely code status orders (CSOs) from 5% to 80% over 6 months. Multiple plan-do-study-act cycles were performed focusing on interventions aimed at key drivers, including increasing knowledge in performing code status discussions (CSDs) and improving understanding of institutional policies. The average percentage of patients who received a CSO placed in their chart within 72 h of admission to the CCT [complex care team] increased from 5% to 61% over 6 months.

Family caregiving for older persons with dementia at end-of-life: A comprehensive overviewInternational Perspectives on Family Caregiving; Cynthia A. Hovland; 4/25 Family caregiving for older persons with dementia at the end of life is a perplexing, challenging, and growing concern across the United States and other developing countries. This overview looks at these epidemiological forecasts, scope, and impact of dementia on the family and caregiver. Using a bio-psycho-social theoretical framework helps to understand identified problems and issues for the caregiver and implications for the older adult with dementia. Caregiver issues include the burdens as well as positive aspects of this role, but the unknown trajectory of dementia poses significant challenges. Caregivers' responses are impacted by their individual resilience and supports, and recommendations for approaches, strategies, and interventions for caregivers and health professionals are provided.

Breaking with the status quo in end-of-life care through de-implementation Journal of Internal Medicine; by Chetna Malhotra and Ellie Bostwick Andres; 4/17/25... In the realm of serious illness, many patients undergo interventions that may marginally prolong life but often sacrifice quality of life and entail significant costs. These interventions, categorized as ‘low-value care’, often involve complex procedures, frequent hospitalizations and intense medical management, leading to considerable discomfort, reduced functional ability and overall decreased well-being and calling into question the efficiency and effectiveness of current end-of-life (EOL) care practices. ... How to conduct de-implementation in EOL contexts:

Location of terminal care in pulmonary hypertensionCJC Open; Ramzi Ibrahim MD; Adam Habib MD; April Olson MD; Farah Shrourou; Hoang Nhat Pham MD; Mahmoud Abdelnabi MBBCh MSc; Maryam Emami Neyestanak PhD; Sabrina Soin DO; See-Wei Low MD; Bhupinder Natt MD; Mamas A. Mamas BMBCh MA DPhil FRCP; Timothy Barry MB BCh BAO; Chadi Ayoub MBBS PhD; Reza Arsanjani MD; Franz P. Rischard MD; Kwan Lee MD; 4/25Palliative care services have seen an increase in utilization in recent years, yet this uptrend has not been observed uniformly across all groups. The recent decline in mortality within inpatient facilities, despite the persistently high mortality rates of PH [pulmonary hypertension], depicts better coordinated patient-centered care, including hospice and at-home services. Nonetheless, place-of-death disparities remain, linked to demographic variables. Specifically, minority ethnic groups in the US have not experienced this increase. These populations often harbor misconceptions and unconscious biases about the nature of palliative care. The Pulmonary Hypertension Association, recognizing this gap, has advocated for the integration of palliative care into the treatment regimen for patients with PH.

Research study participation: NIH MAiD study recruitmentPersonal communication; by Stacy Fischer, Dan Matlock; 4/22/25We are Dr. Stacy Fischer and Dr. Dan Matlock, physicians at the University of Colorado Anschutz Medical Campus and co-principal investigators on a National Institutes of Health-funded study to understand the experiences of patients seriously considering medical aid in dying and their caregivers. Our multidisciplinary team includes geriatricians, bioethicists, and both quantitative and qualitative experts... Our goal is to recruit 300 patients and caregivers nationwide, and we would deeply appreciate your continued support in helping us connect with individuals who are seriously considering MAiD and their caregivers (e.g., those who have scheduled or completed their first MAiD consultation).

Calibrating AI reliance—A physician’s superhuman dilemmaJAMA Health Forum; Shefali V. Patil, PhD; Christopher G. Myers, PhD; Yemeng Lu-Myers, MD, MPH; 3/25Assistive artificial intelligence (AI) technologies hold significant promise for transforming health care by aiding physicians in diagnosing, managing, and treating patients. Leveraging AI’s superior diagnostic accuracy in certain specialties, these assistive AI systems aim to reduce medical errors, while also promising to address physician fatigue by alleviating cognitive load and time pressures. Because human operators are perceived as having control over the technology’s use, responsibility unduly shifts to the human operator, even when clear evidence shows that the AI system produces erroneous outputs. Consequently, although scholars have proposed recommendations for shaping AI regulations, the reality is that in the absence of clear policies or established legal standards, future liability will largely hinge on societal perceptions of blameworthiness. This regulatory gap imposes an immense, almost superhuman, burden on physicians: they are expected to rely on AI to minimize medical errors, yet bear responsibility for determining when to override or defer to these systems.

Opening the door to wholistic patient care: Results from a nationally representative database on the use of spiritual and religious counselingHealth Services Insights; Peter J. Mallow, Pierson Savarino; 4/25The introduction of the International Classification of Diseases 10th Revision (ICD-10) code Z71.81 in 2015 enabled the systematic documentation of spiritual and religious counseling (SRC) in hospital settings, opening avenues for research into its effect on patient outcomes and healthcare resource utilization. Religion and spirituality are integral to many patients’ lives, influencing their well-being, recovery and health outcomes. SRC is primarily utilized in complex, high-mortality cases, underscoring its role in holistic care for severely ill patients. The disparities observed highlight the need for standardized SRC documentation and equitable access to SRC. Future research should investigate the clinical and economic impacts of SRC to enhance patient-centered care in alignment with value-based care practices.

Assuring the provision of palliative care as an ethical duty for all physiciansJournal of Pain and Symptom Management; Amber R Comer,Daniel Sulmasy; 4/25Although palliative care is an evidence-based, essential component of care for patients with serious or critical illness and at the end-of-life, access to palliative care continues to be limited by inaccurate definitions, misrepresentation, stigma, and neglect. To help physicians and patients to overcome barriers limiting the provision of palliative care, the American Medical Association (AMA) has recently adopted policy and a new opinion in the Code of Medical Ethics which establishes an ethical duty for all physicians, in all specialties, to assure the provision of palliative care to patients who stand to benefit. Additionally, the new policy and Code opinion expand the depth and breadth of what palliative care access and delivery entail and address misconceptions that have resulted in barriers to the delivery of palliative care.

Disparities in end-of-life care: A retrospective study on intensive care utilization and advance care planning in the Colorado all-payer claims databaseAmerican Journal of Hospice and Palliative Medicine; Darcy Holladay Ford, PsyD, MA, LPC, RDN; Kimberly Landry, MPH; Megha Jha, MPH; Martha Meyer, PhD; 3/25Intensive end-of-life (EOL) care is emotionally and financially burdensome, disproportionally negatively impacting racial and ethnic minorities, rural residents, and lower socioeconomic seniors. ICU Stays: Hispanic/Latino, Asian, and Black members had increased ICU stays compared to Whites ... However, members without ACP [advance care planning] and rural residents had lower ICU stays ... ED Visits: Hispanic/Latino, Asian, Black members, non-dually eligible members (Medicare Fee for Service (MFFS) + Medicaid), and rural residents had increased ED visits ... Meanwhile, members without ACP or hospice care had lower ED visits ... 30-day Readmissions: Asian members and rural residents had increased 30-day readmissions ... In contrast, those on MFFS and not on Medicaid, members without ACP, and those not in hospice care had decreased 30-day readmissions ...

Research study participation: Have you been an unpaid caregiver to a hospice patient?Press release, Northern Illinois University and Seattle University; M. Courtney Hughes, Erin Vernon; 4/23/25You may be eligible to participate in a new survey. Help us understand which services (e.g., meals, transportation) most positively impact hospice patients and their families.

Advance care planning in the inpatient setting: The role of the hospitalistAmerican Journal of Hospice and Palliative Medicine; Nikhil Sood, MD; Rohini Garg, MBBS; Anthony D. Slonim, MD, DrPH, FCCM; 3/25Advance care planning (ACP) is critical to patient-centered health care, particularly in hospital settings where acute and end-of-life decisions often occur. As frontline providers, hospitalists are uniquely positioned to initiate and guide ACP discussions. This article explores the role of hospitalists in ACP, identifies barriers to its implementation, and highlights strategies to overcome these challenges. Key barriers include time constraints, lack of formal training, and uncertainty regarding the appropriate timing of discussions. To address these issues, hospitalists can benefit from structured communication training, integration of ACP prompts into electronic health records, and collaboration with multidisciplinary teams. While ACP has demonstrated benefits, including the alignment of care with patient preferences, reduced unnecessary interventions, and improved satisfaction for patients and families, challenges remain in ensuring consistent and culturally sensitive implementation.