Hospice & Palliative Care Today

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Welcome to Hospice & Palliative Care Today, a daily email summarizing numerous topics essential for understanding the current landscape of serious illness and end-of-life care. Teleios Collaborative Network podcasts review Hospice & Palliative Care Today monthly content - explore these and all TCN Talks podcasts.

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April 25th, 2026

Saturday newsletters focus on headlines and research - enjoy!

Contents

Research News

   1. The operation was successful and the patient died: Processes for achieving a good death
   2. Discontinuation of medications with limited benefit at end of life in community-dwelling older veterans
   3. Responding to parental requests for potentially nonbeneficial treatment in life-threatening situations: Clinical report
   4. Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategy
   5. Bridging urology and palliative care: A narrative review of current practice and evolving priorities
   6. Medicaid Home and Community-Based Services initiation and acute services use
   7. Bridging the gap: Aligning clinical decision support regulation with clinical practice in the era of artificial intelligence
   8. Unpacking scopes & challenges in AI-driven health safety monitoring: A systematic literature review toward real-time fall and wandering monitoring for patients with dementia
   9. Fathers' grief in action

International News

10. [Brazil] When treatment no longer makes sense: Antibiotics in end-of-life patients-A practice that needs to change?
11. [Greece] Tele-palliative care in rural areas, implementation and patient experiences: A systematic review

Today's Encouragement

12. If you want to fly...

Research News

The operation was successful and the patient died: Processes for achieving a good death

Qualitative Sociology; by Timothy B. Elder; 3/26

Clinicians in Hospice and Palliative Medicine (HPM) specialize in caring for terminally ill patients, a population often regarded as representing the “failures” of medical intervention. This unique context challenges conventional definitions of success in medicine, which prioritize cure and longevity. Drawing on extensive qualitative data from interviews and ethnographic fieldwork, this article explores how HPM clinicians navigate these challenges by shifting their definition of success to a process rather than an outcome. These clinicians rely upon the strategy of “hewing” to achieve success, which includes discovering and crafting shared, achievable goals with clinical stakeholders—patients, families, and colleagues. This article introduces the concept of hewing to describe how HPM clinicians coordinate patients, families, and colleagues around shared goals under conditions where standard definitions of medical success fail.

Discontinuation of medications with limited benefit at end of life in community-dwelling older veterans
Journal of the American Geriatrics Society; by Joshua M Thorpe, Kelvin A Tran, Sherrie L Aspinall, Shelli L Feder, Brystana G Kaufman, Ann Kutney-Lee, Maria K Mor, Loren J Schleiden, Florentina E Sileanu, Carolyn T Thorpe, Courtney H Van Houtven; 4/26
Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life prescribing has focused on nursing homes or hospice settings. [This study setting was] community-residing, non-hospice older veterans. Among community-dwelling older veterans in their final year of life, 73% were receiving at least one LBM at the start of that year, and 78% of these individuals continued LBM use until death. These rates parallel those reported in long-term care populations and underscore the need for community-based healthcare providers to routinely screen for LBMs and support appropriate medication discontinuation in older patients with advanced illnesses and limited life expectancy.

National Partnership for Healthcare and Hospice Innovation (NPHI)

Sponsor of Hospice & Palliative Care Today

Responding to parental requests for potentially nonbeneficial treatment in life-threatening situations: Clinical report

Pediatrics; by Deena R. Levine, Naomi T. Laventhal, Robert Macauley, Committee on Bioethics; 3/26

Although consensus on medical treatment for critically ill children is ideally achieved through shared decision making, disagreements on the appropriate course of action can occur. This clinical report provides practical guidance for pediatricians and other physicians in navigating and resolving disputes when parents (or other appropriate surrogate decision makers for children) request interventions that are not medically recommended and are determined to be “potentially nonbeneficial.” This statement provides ethical background in a historical context, offers a basic framework for approaching disagreements about provision and continuation of life-sustaining interventions, and offers a stepwise approach to preventing intractable disputes. This process includes working to form a goal-concordant treatment plan and systematically responding to parental requests for potentially nonbeneficial treatment by way of diligent information gathering, mobilization of institutional resources, and providing families with options for transfer and appeal.

Assistant Editor's note: The phrase "futile care/treatment" has fallen out of favor in recent years. And for good reason. The phrase is ambiguous and subjective. It may sound judgemental to the listener (patient/loved ones). The phrase used instead in this article summary, "potentially nonbeneficial" in reference to care/treatments, infers that dialogue is needed to fully explore its meaning. The language sounds inviting and implies that shared decision making with the patient (when appropriate), loved ones and health care team members will lead to clearer communications and expectations.

Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategy
Journal of Pain & Symptom Management; by Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev; 3/26
Depression in serious illness is common, disabling, and often requires rapid improvement. In the psychiatric literature, SGA [second-generation antipsychotics] augmentation improves response and remission rates ... , with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No RCTs have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.
Assistant Editor's note: RCT is not defined in this article summary but it is assumed to mean "Randomized Controlled Trial" or "Randomized Clinical Trial".

Sponsor of Hospice & Palliative Care Today

Bridging urology and palliative care: A narrative review of current practice and evolving priorities

Current Opinion in Urology; by Banner, Andreasa; Madersbacher, Stephana; Hugar, Lee A.; Masel, Eva K.; 3/26

Inpatient palliative care use rose from 4.9 to 31.5% in renal cell carcinoma and from 5.9 to 19.0% in testicular cancer. Yet, ... disparities persist, including lower palliative care utilization among certain ethnic groups and uninsured patients, and higher odds of receiving high-intensity EOL care among socioeconomically vulnerable populations. Symptom burden remains substantial, with up to 82% of patients reporting multiple symptoms. This underscores the need for more timely palliative care involvement and more standardized reporting. Communication gaps, particularly regarding prognosis and EOL preferences, highlight opportunities for urologists to engage more actively in initiating palliative care discussions.

Medicaid Home and Community-Based Services initiation and acute services use
JAMA Health Forum; by Emmaline Keesee, Chanee D. Fabius, Jennifer Kim, David Stevenson, Laura M. Keohane; 3/26

Over the last 4 decades, the US federal government has incentivized rebalancing Medicaid long-term services and supports (LTSS) away from nursing homes, a mandatory Medicaid benefit, to home and community-based services (HCBS), a voluntary benefit. As of 2022, approximately 2.5 million dually eligible beneficiaries used Medicaid HCBS to assist with personal care and home health needs. In this cohort study among 1,218 older adults across 11 states, Medicaid HCBS initiation was associated with a 24% decrease in within-person probability of emergency department use and a 32% decrease in inpatient discharge.

Sponsor of Hospice & Palliative Care Today

Bridging the gap: Aligning clinical decision support regulation with clinical practice in the era of artificial intelligence
The Lancet Digital Health; by Maëlle-Marie Corso, Paul T Kim, Brenna T Loufek, Leslie R Lamb, Prof Regina Barzilay; 3/26

Clinical decision support (CDS) software broadly refers to software intended to provide health-care professionals and patients with clinical information to improve health-care delivery. Common examples of CDS tools include risk prediction models, diagnostic support tools, treatment decision aids, clinical calculators, computerised alerts, patient triage systems, and ambient AI scribes powered by large language models. On the one hand, health systems are aware that some CDS software they use fall within regulatory oversight. On the other hand, the current regulatory ambiguity and low-intensity enforcement maintain existing practice. This situation raises questions around regulatory consistency and patient safety, particularly for high-risk CDS software that shapes standard-of-care practices. In response, we propose three key directions centred on radical transparency: public disclosure of CDS software, structured dialogue between industry and the US Food and Drug Administration (FDA), and updates to existing FDA guidance.

Unpacking scopes & challenges in AI-driven health safety monitoring: A systematic literature review toward real-time fall and wandering monitoring for patients with dementia
Smart Health; by Awan-Ur-Rahman, Soarov Chakra Borty, Sumit Chakravarty, Mary Dioise Ramos, Nazmus Sakib; 3/26

Alzheimer’s disease is one of the leading causes of death among older adults. Patients diagnosed with Alzheimer’s disease and related dementias (AD/ADRD) suffer from multiple problems, and falls or wandering are among those issues. An efficient remote monitoring system is crucial to improving patients’ quality of life with AD/ADRD and lessening caregivers’ burden. The findings of this study demonstrate that radar-based monitoring systems have multiple advantages over other technologies and can be efficiently used for monitoring purposes.

Louisiana ~ Mississippi Hospice & Palliative Care Organization (LMHPCO)

Sponsor of Hospice & Palliative Care Today

Fathers' grief in action

Archives of Psychiatric Nursing; by Christine Denhup; 4/26

A child's death is a traumatic life-altering event, which significantly affects parents' mental health and well-being. Literature provides insights on parents' grief; however, less is known about how fathers cope with grief due to underrepresentation in research studies. This article presents selected findings about how fathers grieve, which emerged from a phenomenological study aimed at describing fathers' lived experience of bereavement. Participants described how societal norms influence their grief as men, and shared actionable ways they cope with profound grief. Various practical, creative, and thinking actions helped participants grieve and connect with their child's loss.

International News

[Brazil] When treatment no longer makes sense: Antibiotics in end-of-life patients-A practice that needs to change?

The Brazilian Journal of Infectious Diseases; by André Piccolo Pereira, Marcelo Carneiro, Rochele Mosmann Menezes, Paula Trevisan, Manuela Jacques, Ingrid Pilz, Anna Júlia Castoldi Ravazio, Bruna Bombel da Luz, Felipe Provensi Rangel, Maísa Miguel Benette, Hoberdan Oliveira Pereira, Iagro Cesar de Almeida, Jessica Vieira; 3/26

The use of antibiotics in end-of-life patients remains a controversial practice. Despite their limited clinical effectiveness in this context, these medications are frequently prescribed, often in the absence of an identifiable infectious focus, contributing to adverse events, bacterial resistance, and increased healthcare costs. The high frequency of antibiotic use in end-of-life patients without an evident infectious focus highlights the need for institutional guidelines and physician training in palliative care. Early implementation of comfort-centered strategies can prevent disproportionate interventions, improve the quality of end-of-life care, and promote the rational use of antimicrobials.

Sponsor of Hospice & Palliative Care Today

[Greece] Tele-palliative care in rural areas, implementation and patient experiences: A systematic review
American Journal of Hospice & Palliative Medicine; by Athanasios Pitis, Maria Nikoloudi, Kyriaki Mystakidou; 3/26
Specialist palliative care remains highly uneven in rural and remote settings for patients with life-limiting illness and their families. This review aimed to examine the implementation characteristics, clinical and service-level outcomes, and patient experiences of tele-palliative care interventions for individuals living in rural or remote settings with limited access to specialist palliative care. Conclusions: Tele-palliative care can extend specialist palliative care to rural and remote communities by reducing travel burden and supporting continuity, particularly when delivered through hybrid models embedded in local care pathways.

Today's Encouragement

If you want to fly, you have to give up the things that weigh you down. ~Toni Morrison

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The Fine Print:
Paywalls: Some links may take readers to articles that either require registration or are behind a paywall. Disclaimer: Hospice & Palliative Care Today provides brief summaries of news stories of interest to hospice, palliative, and end-of-life care professionals (typically taken directly from the source article). Hospice & Palliative Care Today is not responsible or liable for the validity or reliability of information in these articles and directs the reader to authors of the source articles for questions or comments. Additionally, Dr. Cordt Kassner, Publisher, and Dr. Joy Berger, Editor in Chief, welcome your feedback regarding content of Hospice & Palliative Care Today. Unsubscribe: Hospice & Palliative Care Today is a free subscription email. If you believe you have received this email in error, or if you no longer wish to receive Hospice & Palliative Care Today, please unsubscribe here or reply to this email with the message “Unsubscribe”. Thank you.