An Environmental Scan of Tools That Help Individuals Living With Mild Cognitive Impairment or Neurocognitive Disorders Achieve Their Preferred Health or Well-Being.

BACKGROUND AND OBJECTIVES: Older adults experiencing neurocognitive disease (NCD) contend with complex care often characterized by high emotional strain. Mitigating complex care with decision support tools can clarify options. When used in conjunction with the practice of shared decision making (SDM), these tools can improve satisfaction and confidence in treatment. The use of these tools for cognitive health has increased, but more is needed to understand how these tools incorporate social needs into treatment plans. RESEARCH DESIGN AND METHODS: We conducted an environmental scan using a MEDLINE-informed search strategy and feedback from an expert steering committee to characterize current tools and approaches for engaging older adults experiencing NCD. We assessed their application and development, incorporation of social determinants, goals or preferences, and inclusion of caregivers in their design. RESULTS: We identified 11 articles, 7 of which show that SDM helps guide tool development and that most center on clinical decision making. Types of tools varied by clinical site and those differences reflected patient need. A collective value across tools was their use to forge meaningful conversations. Most tools appeared designed without the explicit goal to elicit patient social needs or incorporate nonclinical strategies into treatment plans. DISCUSSION AND IMPLICATIONS: Several challenges and opportunities exist that center on strategies to engage patients in the design and testing of tools that support conversations with clinicians about cognitive health. Future work should focus on building and testing adaptable tools that support patient and family social care needs beyond clinical care settings.

Palliative care in rural Minnesota. Findings from Stratis Health's Minnesota Rural Palliative Care Initiative.

Palliative medicine involves managing symptoms, controlling pain and addressing stress caused by chronic illness. It can help keep patients out of the hospital and allow them to stay in their homes and live more comfortably with their illnesses. Most palliative care programs are found in urban areas, and both national and statewide studies have found a dearth of such services in rural communities. This article describes Stratis Health's Minnesota Rural Palliative Care Initiative, which is bringing representatives from organizations within rural communities together to learn from each other how to provide palliative care services. It also highlightsthe efforts of organizations in four communitiesthat are providing such care and discusses plans for evaluating these and other programs.