August 11, 2021

Association Between Spirituality and Pain Linguistic Bias in Medical Records Dementia Medicare Experiences at EOL Effect of Home Hospice on Survival Barriers to ACP for Pediatric Patients The Power Clinician Empathy Opioid Use Behaviors Rave Reviews Spirituality, Religiosity, Spiritual Pain, Symptom Distress, Quality Life Among Latin American with Advanced Cancer: A Multicenter Study Background: religiosity can be used as integrative therapy promote general well-being health.1–4 What is the association between spirituality, religiosity, spiritual pain, symptom distress, coping, quality life among patients advanced cancer? Design Participants: This study determined frequency intensity spirituality their physical psychological symptoms, receiving palliative care cancer three US, Guatemalan, Chilean institutions. completed validated assessments: Faith, Importance Influence, Community, Address tool; Edmonton Assessment Scale-Financial/Spiritual; Penn State Worry Questionnaire-Abbreviated; Center Epidemiologic Studies Depression Scale; Brief-coping strategies (COPE); Brief religious coping (RCOPE); Functional Chronic Illness Therapy-Spiritual Well-Being, Expanded version (FACIT-Sp-Ex). Descriptive statistics, tabulation, Kruskal-Wallis test, Spearman correlation were used. Results: (N = 325) age median 58 years (range 19–85), 60% female, 62% Catholic (30% Christian not Catholic). Ninety-seven percent considered themselves (intensity 7 [IQR 5–10], 0–10 scale) 89% (7 [5–9]). Spirituality/religiosity importance was 10 (IQR 8–10). associations spirituality/religiosity various items were: helps cope illness (98%, r 0.66), a source strength/comfort (99%, 0.73), has positive effect (81%, 0.42) emotional symptoms (84%, 0.17), caregivers (100%, 0.40) (all P<0.0001). Sixty reported spiritual/religious needs had been supported by medical team; 52% pain 6 5–8]). associated fatigue, depression, anxiety, worry, behavioral disengagement, FACIT-Sp-Ex score, negative RCOPE P<0.05). Commentary: often are underserved hospice community. multicenter surveyed 325 subjects regarding symptoms. Participants both felt these beliefs impact lives. On other hand, half which Surprisingly, enrolled specialty clinics did feel team. There no data presented evaluating feeling supported, nor information about chaplain staffing clinics. Bottom Line: support seen nonessential may cut first sign institutional belt tightening. To provide better, care, just medicine but rest medical/business/industrial complex understand embrace bio/psycho/social/spiritual model care. Reviewer: Gregory L. Phelps, MD MPH FAAAHPM, Alleo Health System/Hospice Chattanooga, TN Source: Delgado-Guay MO, Palma A, et al. cancer: [published online ahead print April 12, 2021]. J Palliat Med. doi: 10.1089/jpm.2020.0776 References1.Delgado-Guay MO. supportive Curr Opin Support Care. 2014;8:308–313. doi:10.1097/SPC.00000000000000792.Greer JA, Applebaum AJ, Jacobsen JC, Temel JS, Jackson VA. Understanding addressing role cancer. Clin Oncol. 2020;38:915–925. doi:10.1200/JCO.19.000133.Angela AS. An examination folk healing practice curanderismo Hispanic Commun Nurs. 2018;35:148–161. doi:10.1080/07370016.2018.14758014.Rand KL, Cripe LD, Monahan PO, Tong Y, Schmidt K, Rawl SM. appraisal, responses men Care Cancer. 2012;20:1719–1728. doi:10.1007/s00520-011-1265-y Access this article PubMed. Testimonial Injustice: Black Women “If there ever book racism, it should probably called, ‘They Don't Believe Us.’”1,2 Do race gender biases manifest records? cross-sectional identified linguistic mechanisms physicians communicate disbelief records then explored racial differences use such language. All physician notes written within 2017 electronic record an academic ambulatory internal studied. Content analysis 600 revealed features suggesting disbelief: 1) quotes (e.g., “reaction” medication); 2) specific “judgment words” that suggest doubt “claims” or “insists”); 3) evidentials, sentence construction patients’ experience hearsay. Natural language processing evaluated prevalence remaining mixed-effects regression tested account clustering providers. Nine thousand two hundred fifty-one 165 3,374 (74% Black, 58% female) included. Notes greater odds containing ≥1 quote (OR 1.48, 95% CI 1.20–1.83; P<0.001) judgment word 1.25, 1.02–1.53; P<0.05) more evidentials (β 0.32, 0.17–0.47; versus white patients. female male differ terms words 1.22, 1.05–1.44; race-by-gender interaction (P 0.007) quotes. clinicians say reflects (implicit explicit) biases. Our contribute perpetuate healthcare disparities who Indigenous, people color. especially true women. For example, though including patient-reported concerns common suggests how we reflect those disbelief) undermine patient credibility now future. Though limitations, nonetheless wake-up call recognize our own choose carefully. We must inform avoid using stigmatizing judgmental phrases, instead objective, accurate, respectful documentation well speech. Words matter. Recognizing neutralizing important steps towards reducing health Mei-Ean Yeow, BMBCh FACP FAAHPM, Palliative Medicine, Mayo Clinic, Rochester, MN Beach MC, Saha S, Park J, injustice: bias black Gen Intern 2021 Jun;36(6):1708–1714. doi:10.1007/s11606-021-06682-z References1.Beach Branyon E, S. Diverse perspectives respect healthcare: qualitative study. Patient Educ Couns. 2017;100:2076–2080. doi:10.1016/j.pec.2017.05.0102.Schencker ‘Nine times out 10, I completely brushed off’: Chicagoans confront hope change. Chicago Tribune. August 13, 2020. https://www.chicagotribune.com/news/breaking/ct-chicago-health-care-racism-george-floyd-implicit-bias–20200813-nxrujltiyvg37pks2hyf6iwb7m-story.html. Accessed July 7, 2021. Dying Advantage, Accountable Organizations, Traditional Alzheimer's disease related dementias families burdensome costly end-of-life interventions limited benefit unaligned patients' preferences.1–3 alternative payment models, incentivized reduce intensity? retrospective compared decedents dementia Advantage (MA), accountable organizations (ACOs), traditional (TM). Decedents nursing home stay 91–180 days prior death, ≥2 functional impairments, mild-to-severe cognitive impairment. Measurements included hospitalization, invasive mechanical ventilation (IMV) use, in-hospital death last 30 billing. statistics multivariable logistic 370,094 persons dementia, 25% MA (age mean 87 [SD 7.7], 68% 80% white), 11% ACOs (87 [7.6], 67%, 86%), 64% TM [7.8], 68%, 81%). proportion hospitalized (28%) ACO than (21%; P<0.001). After adjustment sociodemographics, cognitive/functional comorbidities, hospital referral region, adjusted hospitalization 0.72 (95% 0.70–0.74) 1.05 (1.02–1.09) relative TM. Relative TM, 0.78 (0.75–0.81) 1.02 (0.96–1.08) ACOs. lower risk IMV (0.80, 0.75–0.85) largely driven avoiding hospitalizations (among hospitalized, 0.96 [0.89–1.0]). Cost constant tension all fields medicine. end life. Clinicians wonder whether TM's fee-for-services incentives. Previous studies have showed numbers enrollees enrollees4 examines compares dementia. Findings overall, one four (26.0%) life, 8.3% dying acute hospital, supporting hypothesis reduces burdensome, low value, Unfortunately, ACOs' ability control costs. Compared enrollment reduced hospitalizations, less IMV, rates Reviewers: Justin Buzick, MD, University Iowa Hospitals Clinics, City, IA, Yuya Hagiwara, MACM, Carver College IA Teno JM, Keohane LM, Mitchell SL, organizations, May 14, Am Geriatr Soc. doi:10.1111/jgs.17225. References1.Teno Mor V, DeSilva D, Kabumoto G, Roy Wetle T. feeding tubes residents severe JAMA. 2002;287:3211–3212. https://jamanetwork.com/journals/jama/article-abstract/10319422.Mitchell V. Clinical organizational factors tube 2003;290:73–80. doi:10.1001/jama.290.1.733.Mitchell Gozalo PL, Servadio JL, JM. Tube US 2000–2014. 2016;316:769–770. doi:10.1001/jama.2016.93744.Teno P, Trivedi AN, Site place transitions beneficiaries, 2000–2015. 2018;320:264–271. Dementia: Nurse Visits increased “live discharge,” causing family caregiver stress burden.1–3 Why disenrolled from alive? cohort received (2013–2017) large not-for-profit New York City agency examine nurse visit relate in-hospice death. Multivariable survival analyses examined effects (vs. home) timing visits equal six months after live discharge long length (>180 days). 3,837) 90 (SD 7.5), 72% 54% white, 21% Hispanic, 16% Black. spent 83 hospice. Thirty-nine experienced stay. hospice) likelier (adjusted hazard ratio death: 0.77, 0.69–0.86; Frequency inversely (i.e., prompted clinical attention) (2.87, 2.47–3.33; living homes, home-based primary comorbid diagnosis likely die admission prone discharge. consistent data4 result being benefiting extra caregiving home.5 More exploring reasons finding reflecting its implication—the lapse resulting creates unnecessary burden caregivers.6 corresponding editorial Hunt Harrison describes potential large-scale solutions, loosening eligibility criteria, disincentivizing agencies lengthy enrollment, investigating models.7 Fundamentally, readiness carefully assessed enrollment. considerable number stays homes. Paul D. Farah, DO, Renato Samala, MHPE HMDC Cleveland Cleveland, OH Luth EA, Russell DJ, Xu dementia: visits. Jun;69(6):1529–1538. doi:10.1111/jgs.17066 References1.National Organization. Facts & figures: America, 2020 edition. https://www.nhpco.org/factsfigures/. Published 20, 2021.2.De Vleminck Morrison RS, Meier DE, Aldridge MD. United States: longitudinal Med Dir Assoc. 2018;19:633–638. doi:10.1016/j.jamda.2017.10.0033.Aldridge Canavan M, Cherlin Bradley EH. Has changed? 2000–2010 utilization patterns. 2015;53:95–101. doi:10.1097/MLR.00000000000002564.Russell Diamond EL, Lauder B, 2017;65:1726–1732. doi:10.1111/jgs.148595.Mitchell Morris JN, PS, Fries BE. Terminal settings. 2004;7:808–816. doi:10.1089/jpm.2004.7.8086.Campbell RW. Being discharged alive: lived families. 2015;18:495–499. doi:10.1089/jpm.2014.02287.Hunt LJ, KL. Live isn't "graduating"—it's getting expelled. Jun;69:1457–1460. doi:10.1111/jgs.17107 Identified Strategies Advance Planning Seriously Ill Parents’ desire opportunities advance planning (ACP) adoption seriously ill children remains underrealized.1–4 current approaches circumvent provision barriers? conducted in-person, semistructured focus groups centers (2018–2019) explore clinician perceptions perceived barriers improve provision. Eligible cared children, adolescents, young adults chronic conditions, defined month condition expected year (unless intervenes) involving several organ systems system enough require pediatric tertiary hospitalization. Iterative multistage thematic key contexts themes. Seven (three nonphysicians, physicians). Physicians (n 18) 67% 94% 39% critical specialists, 56% five experience. Multidisciplinary providers 16; practitioners, nurses, social workers, child specialist, respiratory therapist, psychologist) 88% 100% 81% initiating engaging discussions identified, mixed messaging, lack knowledge goals, prognostic uncertainty, poor awareness, unstandardized documentation, dynamics. also overcome facilitate discussions, enhancing multidisciplinary communication, creating shared communication framework, formal training normalize throughout child's trajectory. With value established, authors took moving concept identifying facilitators ACP. versed PC principles address many level. patients, they help ensure cohesive message providing continuity facilitating clear teams. Systemically, empower targeted skills emotionally colleagues engage challenging work. lays foundation future racially diverse positioned pediatrics multiple levels. Research includes needed better apply pediatrics. Megan J. Thorvilson, MDiv, Clinic Children's Center, Basu MR, Partin L, Revette Wolfe DeCourcey DD. Manage. Apr 3;S0885-3924(21)00229-3. doi:10.1016/j.jpainsymman.2021.03.006 References1.Lotz JD, Jox RJ, Borasio GD, Führer M. planning: systematic review. Pediatrics. 2013;131:e873–e880. doi:10.1542/peds.2012-23942.Lotz perspective professionals: interview 2015;29:212–222. doi:10.1177/02692163145520913.Durall Zurakowski conducting life-threatening conditions. 2012;129:e975–e982. doi:10.1542/peds.2011-26954.Heckford Beringer AJ. challenges pediatricians. 2014;17:1049–1053. doi:10.1089/jpm.2013.0374 Clinician-Expressed Increase Information Recall Breast Cancer Care: Observational Exploring Mediating Role Anxiety Clinician-expressed empathy reassurance attentive silence) improves recall consultations cancer.1–4 Can clinician-expressed setting (focusing entire trajectory)? relationship breast mediated anxiety. Consultations oncologists audio recorded post-consultation pre- anxiety (0–100) assessed. self-created questionnaire scored observers (0–100). Structural equation modelling 41) 57 range 31–84). Clinicians’ score 59 18, 19–83). remembered 61% discussed relation treatment options, aims/positive effects, side effects. best options (77%), followed (63%), lowest (40%). Patients’ decreased 28 points (pre-consultation: M 57, SD 29, 0–100; post-consultation: 26, 0–83) < 0.001). total (B 0.70, 0.03, 1.38; P 0.041) 0.88, 0.10, 1.66; 0.028) recall. Direct (controlled anxiety) 0.66, -0.03, 1.34) 0.69, 1.41) trended toward significance. anxiety: indirect individual parts near zero. perceive fully informed involved receive person-centered care.5 Retention necessary when deliberating decisions. However, 40%–80% provided during forgotten. One factor contributes distress serious news.6 linked improved empathy, underlying mechanism unknown.2 In study, aims. consultation, These results line studies1-4 confirm generalizability scenarios, determining mediating difficult because confounders, receipt cancer, unknown. Corey X. Tapper, MS, Johns Hopkins School Baltimore, Westendorp Stouthard Meijers power increase care: observational May;104(5):1109–1115. doi:10.1016/j.pec.2020.10.025 References1.Sep van Osch Vliet Smets EMA, Bensing clinicians’ affective communication: non-abandonment physiological arousal bad news consultations. experimental analogue 2014;95:45–52. doi:10.1016/j.pec.2013.12.0222.van Sep Dulmen Reducing improving Psychol. 2014;33:1382–1390. doi:10.1037/hea00000973.Visser LN, Tollenaar de Haes HCJM, EMA. physicians’ affect-oriented information. 2017;100:2116–2120. doi:10.1016/j.pec.2017.06.0054.Visser LNC, Doornen LJP, Does silence speak louder words? oncologists’ emotion-oriented stress. 2019;102:43–52. doi:10.1016/j.pec.2018.08.0325.van Veer AJE, Raijmakers NJH, Francke A. Is benefits risks care?: survey incurably 2019;22:797–803. doi:10.1089/jpm.2018.05916.Kessels RP. memory R Soc 2003;96(5):219–222. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC544650 Cancer-Related Opioids main cancer-related nonmedical opioid behavior (NMOUB) presents significant challenge providers.1–4 predictors NMOUB Factors Associated Nonmedical Behavior Receiving (referred Anderson 2016–2018) taking opioids (greater week), Screener (SOAPP; assesses inappropriate NMOUB) initial outpatient follow up months. Established diagnostic criteria consecutive NMOUB. underwent screening Scale (ESAS), SOAPP seven elevated risk), Cut Down, Annoyed, Guilty, Eye Opener-Adapted Include Drugs (CAGE-AID [scores 2–4 indicate alcoholism risk]) tool. Charts reviewed 14 behaviors clinic represent fifty-four 61 52–69], 53% women, white) evaluable; 19% (median 1/patient 1 –3]). Seventy-seven NMOUBs occurred ups (29% unscheduled refills); 29% ≥7 17% CAGE-AID. Multivariate modeling marital status (single, 1.6, 1.2–2.2 [P 0.005]; divorced, 1.4, 1.0–2.0 0.04]), (positive vs. negative, 1.0–1.7 0.02]), morphine equivalent daily dose (MEDD) (1.0, 1.0–1.0 [P<0.001]), ESAS level (1.1, 1.1–1.2 [P<0.001]) independently recursive partition analysis, single status, MEDD >50 mg, >7 higher (56%). Random Urine Drug Testing Therapy Anderson's (2017–2019) characteristics urine drug testing (UDT) abnormalities treatment. Demographic random UDT retrospectively historical UDT. ordered regardless potential. Targeted basis estimations risk. Five fifty-two 573 (96%) UDT, whom 24% abnormal result; 38 88 (43%) result. When excluding marijuana, 15% group 37% findings (P<0.001). It time consultation detect abnormality targeted) test 130 274 days; 0.02). Abnormal younger (P<0.0001), sex 0.03), CAGE-AID positivity 0.001), scores 0.01). prescribing balance adequate management mitigation NMOUBs. Currently, guidance adequately screen population. summary single-center, found NMOU uncommon (almost 5), most refills. second Interestingly, detected much sooner thus allowing earlier intervention clinician. Limitations include nature studies. Given proven ongoing epidemic, standardize regular initiation therapy. Also, early involvement team, inclusive work pharmacy, helpful high demonstrate high-risk assist development comprehensive plan addresses patient's while balancing safety. legitimate concern incorporate screening, into practice. Harkiran Sandhu, MB BCh, Sara F. Martin, Vanderbilt Nashville, Sources: Yennurajalingam Arthur Reddy pain. JAMA Mar 1;7(3):404–411. doi:10.1001/jamaoncol.2020.6789 Tang Lu Z, 15;127(6):968–975. doi:10.1002/cncr.33326 References1.Stjernswärd WHO relief programme. Surv. 1988;7:195–208.2.Stjernswärd Colleau SM, Ventafridda World Organization Program. Past, present, 1996;12:65–72. doi:10.1016/0885-3924(96)00109-13.Schepis TS, McCabe SE. Prescription misuse older adults: comorbidities national epidemiologic alcohol conditions-III. Psychiatry. 2019;80:19m12853. doi:10.4088/JCP.19m128534.Martinez Zemore SE, Pinedo Borges Orozco R, Cherpitel C. prescription Texas border communities. Ethn Health. 2019;1–17. doi:10.1080/13557858.2019.1620175 Silva CEA, Guimarães RM, Cunha Sensory neuron-associated macrophages novel modulators neuropathic Rep. 2021;6(1):e873. doi:10.1097/PR9.0000000000000873 month, basic science literature will narrow macrophage modulator inflammation blurring distinction nociceptive appears stands crossroads phenotypes. review emphasizes interactions sensory-associated (NAMs) sensory afferent pathways generating persistent peripheral central NAMS derived yolk sac bone marrow monocytes responsible hypersensitivity through cytokines, toll-like receptors, pathogen-associated molecular pattern proteins, damage-associated protein fibronectin heat shock protein. Geraghty T, Winter DR, Miller RE, Malfait AM. Neuroimmune osteoarthritis pain: macrophages. 2021;6:e892. doi:10.1097/PR9.0000000000000892 Osteoarthritis continuous character. Quantitative demonstrates widespread progression osteoarthritis. Monocyte-derived synovial membranes lead joint destructions. Upstream dorsal root ganglion horn reside macrophages, which, activated, chronic, Andriessen AS, Donnelly CR, Ji R-R. Reciprocal osteoclasts neurons 2021;6:e867. doi:10.1097/PR9.0000000000000867 covers broad array generate recognized nerve sprouting cancerous bone. Nerve growth (NGF) released resident infiltrating plays process. NGF binds tropomyosin receptor kinase sympathetic fibers, activating both. Anti-NGF monoclonal antibodies combined opioids. From monocyte play