Health Insurance and Interhospital Transfer for Critically Ill Patients With Respiratory Failure.

Importance: Critically ill patients with acute respiratory failure may benefit from transfer to higher-volume centers with specialized care. However, health insurance is often considered prior to interhospital transfer and may represent a factor other than severity of illness that influences transfer processes and outcomes for patients with respiratory failure.

Objective: To examine the association between patient health insurance, interhospital transfer, and mortality for critically ill patients with acute respiratory failure.

Mapping the Science of palliative care: A bibliometric analysis of the top 100 cited articles.

Background: The palliative care evidence base has grown substantially in recent years with the benefits, barriers, and facilitators of care delivery well established across many settings and contexts.

Aim: We aimed to rigorously and systematically delineate the trends, themes, and scope of the top 100 papers aided by bibliometrics to map the field of palliative care science and identify future directions for the field.

Design: We conducted a bibliometric analysis in accordance with the BIBLIO checklist for reporting the bibliometric reviews.

Goal-Concordant Care Among Seriously Ill Hospitalized Patients With Treatment Limitations on POLST: A Mixed-Methods Study.

Background: POLST enables patients with serious illness to document care preferences. POLST-discordant care is common, but little is known about the context in which this occurs and whether it represents goal-discordant care. We sought to examine the context in which seriously ill patients receive POLST-discordant care and inform efforts to align end-of-life care with patients' preferences.

The Influence of Hospital Policies on Clinicians' Decisions to Withhold or Withdraw Life-Sustaining Treatment.

Background: There is considerable variation in clinicians' approaches to decisions to withhold or withdraw life sustaining treatment (LST) across US hospitals. These differences are not explained by patient preferences alone and are likely influenced by other factors (eg, hospital policies, hospital culture, state laws, medical society guidelines).

Research Question: How do hospital policies influence clinician approaches to decisions to withhold or withdraw LST among patients admitted to an ICU?

Study Design And Methods: We conducted semistructured interviews with ICU nurses and physicians at 3 geographically diverse hospital systems across the United States between July and October 2024.

Institutional support for navigating abortion bans in pulmonary and critical care: a multistate qualitative study.

Abortion bans enacted by numerous US states between 2022 and 2024 offered little guidance to health care systems on pragmatic implementation. Early studies identified meaningful impacts to obstetric and gynecological patients and clinicians and strategies for institutions to support clinicians in these specialties. There is widespread concern regarding the legal implications of these bans on all specialties, and the impact of institutional responses to abortion bans on clinicians outside of obstetrics and gynecology is unknown.

Stories Make for Better Letters of Recommendation and Award Nominations.

Letters of recommendation and nomination play an essential role in the distribution of many key positions, prizes, awards, and grants, particularly for early career nominees. There is very little scientific evidence about how to write such letters most effectively when the goal is to win in a competitive field. When writing a nomination letter, we believe a compelling narrative is a powerful and sometimes underused tool to make a more effective nomination.

US Physicians' Perceived Impacts of Abortion Bans in Pulmonary and Critical Care Medicine.

Background: Eighteen US states implemented abortion bans between 2022 and 2024. Although emerging evidence shows bans have impacted obstetrics and gynecology, little is known about their impact on other specialties. We hypothesize that pulmonary and critical care medicine may be adversely impacted due to the time-sensitive, high-acuity needs of their patients.

Improving lung cancer decision-making using a conversation tool (iDECIDE): a stepped wedge pragmatic clinical trial.

Lung cancer is a leading cause of cancer-related mortality. However, few treatment decision-making resources exist. In this study, we evaluate a low literacy lung cancer treatment conversation tool to enhance shared decision-making (SDM).

Estimating the Causal Effect of Double-Blind Peer Review for a Pulmonary, Critical Care, and Sleep Medicine Journal.

Background: Double-blind peer review (DBPR; reviewers masked to author identities and vice versa) aims to reduce biases. The effectiveness of DBPR has not been studied in pulmonary, critical care, and sleep journals.

Research Question: What was the causal effect on bias of DBPR at CHEST?

Study Design And Methods: From January 2020 to June 2022, CHEST and Annals of the American Thoracic Society (AATS) used single-blind peer review (reviewers concealed from authors only); in July 2022, CHEST switched to DBPR.

High-Flow Nasal Cannula Liberation: Who, When, and How?

High-flow nasal cannula (HFNC) is a first-line therapy for patients with acute respiratory failure. Despite increased HFNC utilization over recent years-accelerated in part by the COVID-19 pandemic-high-quality evidence to guide HFNC discontinuation is lacking. Decisions about when and how quickly to reduce flow rate, Fio, or both simultaneously are frequently left to clinicians' discretion without clear guidance on an optimal approach.

Workforce Diversity and Equity Among Critical Care Physicians.

Health disparities persist among minoritized populations. A diverse clinician workforce may help address these disparities and improve patient outcomes; however, diversity in the critical are workforce (particularly among women and those historically underrepresented in medicine (URiM)) is lacking. This review describes factors contributing to low respresentation of women and URiM in critical care medicine, and proposes strategies to overcome those barriers.

Interhospital Transfer of Patients With Acute Respiratory Failure in the United States: A Scoping Review.

Objectives: Interhospital transfer of patients with acute respiratory failure (ARF) is relevant in the current landscape of critical care delivery. However, current transfer practices for patients with ARF are highly variable, poorly formalized, and lack evidence. We aim to synthesize the existing evidence, identify knowledge gaps, and highlight persisting questions related to interhospital transfer of patients with ARF.

The Association of Pregnancy With Outcomes Among Critically Ill Reproductive-Aged Women: A Propensity Score-Matched Retrospective Cohort Analysis.

Background: The maternal mortality rate in the United States is unacceptably high. However, the relative contribution of pregnancy to these outcomes is unknown. Studies comparing outcomes among pregnant vs nonpregnant critically ill patients show mixed results and are limited by small sample sizes.

Perspectives on advance care planning needs of persons with advanced dementia from their surrogates and clinicians.

Objectives: This study was designed to understand the experience and needs surrounding advance care planning (ACP) discussions for surrogate decision-makers of persons with advanced dementia (PWAD).

Methods: Semi-structured qualitative interviews based on end-of-life communication models with a convenience sample of 17 clinicians, and 15 surrogates of PWAD. We used a hybrid approach of deductive and inductive thematic analysis.

Intersection of Palliative Care and Hospice Use Among Patients With Advanced Lung Cancer.

Hospice and palliative care (PC) are important components of lung cancer care and independently provide benefits to patients and their families. To better understand the relationship between hospice and PC and factors that influence this relationship. A retrospective cohort study of patients diagnosed with advanced lung cancer (stage IIIB/IV) within the U.

Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making.

Objective: Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM).

Methods: We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content.

Relationships among clinicians are crucial to successful palliative care integration: a qualitative study in lung cancer.

Palliative care integration improves quality of life among patients with lung cancer and their families. Despite these benefits, significant barriers persist and patients do not receive timely integration. This study sought to identify facilitators of and barriers to integration in lung cancer care.

"You're Socially Distant and Trying Not to Be Emotionally Distant." Physicians' Perspectives of Communication and Therapeutic Relationships in the ICU During the COVID-19 Pandemic: A Qualitative Study.

Unlabelled: To: 1) characterize how COVID-19-related policies influence patient-clinician communication and relationships in the ICU, with attention to race and ethnicity as factors and 2) identify interventions that may facilitate patient-clinician communication.

Design: We conducted a qualitative study between September 2020 and February 2021 that explored facilitators and barriers to patient-clinician communication and the formation of therapeutic relationships. We used thematic analysis to develop findings describing patient-communication and therapeutic relationships within the ICU early in the COVID-19 pandemic.

Assessment of Symptom, Disability, and Financial Trajectories in Patients Hospitalized for COVID-19 at 6 Months.

Importance: Individuals who survived COVID-19 often report persistent symptoms, disabilities, and financial consequences. However, national longitudinal estimates of symptom burden remain limited.

Objective: To measure the incidence and changes over time in symptoms, disability, and financial status after COVID-19-related hospitalization.