Research Roundup: Death-Hastening Options; Medicare Part D; And Preventive Care
Here is a selection of recent research.
JAMA Internal Medicine:
Voluntarily Stopping Eating And Drinking Among Patients With Serious Advanced Illness—Clinical, Ethical, And Legal Aspects
Patients with advanced illnesses sometimes request that physicians help hasten their death. Increasingly in North America and Europe, legal options allow physicians to perform this role. Among death-hastening options, the spotlight has been on physician-assisted death. However, voluntarily stopping eating and drinking (VSED) is also a course that patients may choose. Although VSED theoretically does not require physician involvement, clinician participation is critical in terms of initial assessment and ongoing management. In this review, we examine both clinical issues in assessing patients who are considering VSED and the clinical challenges that may emerge during VSED. We also explore some of the underlying ethical and legal considerations for physicians who either care for or decline to care for these patients. Physicians who care for seriously ill patients should be prepared to respond to patients’ requests to participate in VSED. (Quill et al., 11/6)
The Kaiser Family Foundation:
No Limit: Medicare Part D Enrollees Exposed To High Out-Of-Pocket Drug Costs Without A Hard Cap On Spending
Since 2006, the Medicare Part D prescription drug benefit has helped improve the affordability of medications for people with Medicare. Yet even with Part D, enrollees can face relatively high out-of-pocket costs because there is no hard cap on out-of-pocket spending under Part D. ... This analysis examines out-of-pocket prescription drug spending among Medicare Part D enrollees with costs above the catastrophic coverage threshold. ... In 2015, 3.6 million Medicare Part D enrollees had total drug spending above the catastrophic coverage threshold. Of this total, 2.6 million enrollees received low-income subsidies, but 1 million enrollees did not, and incurred out-of-pocket drug spending above the catastrophic threshold. (Cubanski et al., 11/7)
JAMA Pediatrics:
Association Between Adolescent Preventive Care And The Role Of The Affordable Care Act
Question: Has the provision of preventive care for adolescents, in terms of a preventive well visit and preventive services, increased since implementation of the Affordable Care Act?Findings: This secondary data analysis of the Medical Expenditure Panel Survey, a national survey, showed that rates of preventive well visits for adolescents 10 to 17 years of age increased from 41% (2007-2009) to 48% (2012-2014). Among adolescents who received any health care visit in the past year, 8 of 9 preventive services rose, with increases ranging from 2% to 9%. Meaning: Preventive care rates have increased moderately or modestly; however, most adolescents did not receive past-year well visits or most preventive services. (Adams et al., 11/6)
JAMA Oncology:
Fiber Intake And Colorectal Cancer Survival
In this prospective cohort study that included 1575 patients with stage I to III colorectal cancer, higher intake of fiber, especially from cereals, was associated with a lower risk of colorectal cancer–specific and overall mortality. Patients who increased their fiber intake after diagnosis from levels before diagnosis showed better survival; higher intake of whole grains was also associated with favorable survival. (Song, Wu, Meyerhardt, et. al., 11/2)
