Literature Review

"How lucky we are," said Pooh, "to have friends who make goodbyes so very hard. For it means our time together has been something worth keeping."

Why Black, Hispanic, and Asian patients hesitate to opt for palliative care: Deep metaphors from patients, community leaders, and clinicians with shared cultural identities to shape more effective outreachJournal of Palliative Medicine; by Anthony L Back, MaryGrace S King, Kathy C Shaw, Kelly Willis, Malcolm Brooks, Arigun Bayaraa, Leon He, Vanessa Herman, Ivan Sanchez, Lindsay Zaltman, Marian S Grant; 9/25In the United States, national data show that Black, Hispanic, and Asian patients are less likely than White patients to receive palliative care (PC) despite comparable or greater symptom burden. We enrolled 15 patients (5 Black, 5 Hispanic, 5 Asian), 8 community leaders (5 Black, 3 Hispanic, 1 Asian), and 6 palliative care clinicians (2 Black, 2 Hispanic, 2 Asian). Patients' images about their experiences of being offered PC revealed the metaphor of "inside/outside"-a sense of simultaneous inclusion and exclusion with regard to their community and also the medical system. The patients' sense of belonging and protection felt from their communities was demonstrated in images that evoked the metaphor of "home," as a physical and emotional place with a sense of belonging. The metaphor of home as a place of belonging was mirrored in community leader and PC clinician interviews.

Intense grief attacks: An investigation into the factor structure of a bereavement-related phenomenonJournal of Clinical & Basic Psychosomatics; by Sherman Aclaracion Lee, Tomás Caycho-Rodríguez, Lindsey W. Vilca, Robert A. Neimeyer; 9/25Grief attacks are a highly distressing and potentially debilitating bereavement-related experience. Although empirical research on these intense eruptions of loss-related anguish is limited, the literature suggests that this phenomenon consists of a mixture of both panic attack and grief symptoms. The present study examined the factor structure of intense grief attack symptoms using data from 303 bereaved adults. These findings not only support anecdotal and clinical accounts of grief attacks but also provide partial psychometric support for the Grief Attack Questionnaire in measuring these sudden, unanticipated, and overwhelming responses to bereavement. 

Pastime activities, social connectedness, and grief resolution: A brief report highlighting the salience of socializing for grief resolution among bereaved older adultsThe Journal of Nervous & Mental Disease; by Xin Yao Lin, Holly G Prigerson, Yifan Chou, Paul K Maciejewski; 10/25We sought to examine the relationship between pastime activities (i.e., activity engagement), social connectedness with family and friends, and severity of Prolonged Grief Disorder (PGD) symptoms across younger, middle-aged, and older adults. Cross-sectional findings showed that engagement in pastime activities (e.g., travel, sports) was associated with greater social connectedness for older adults, and social connectedness was associated with lower PGD symptom severity. Engagement in pastime activities was associated with lower PGD symptom severity for middle-aged adults. Results are consistent with the socioemotional selectivity theory and the microsociological theory of adjustment to loss and suggest that grief interventions should have age-specific strategies, encourage specific pastime activities, and promote feelings of social connectedness.

A qualitative study to characterize the experiences of patients and caregivers with dementia diagnostic disclosure communication and care planningJournal of Geriatric Psychiatry and Neurology; by Joanna Paladino, Heily Chavez Granados, Jade A Connor Eruchalu, Carine Davila, Liliana Ramirez Gomez, Alissa Bernstein Sideman, Daniel Dohan, Elizabeth Lindenberger, Lindsay Dow, Ana-Maria Vranceanu, Deborah Blacker, Christine S Ritchie; 10/15/25Clinician communication at the time of a dementia diagnosis often inadequately addresses patient and caregiver needs. We aimed to characterize the communication experiences of patients and caregivers affected by dementia using an evidence-based serious illness communication framework... Dementia diagnostic disclosure would benefit from a structured yet tailored communication approach that prioritizes respectful communication, emotional support, and comprehensive care planning to meet the needs of patients and caregivers.

Correctional health and oncologist perspectives on strategies to improve cancer care in US prisons-A qualitative studyJAMA Network Open; by Christopher R. Manz, Brett Nava-Coulter, Emma Voligny, Daniel A. Gundersen, Alexi A. Wright; 10/25Individuals diagnosed with cancer while incarcerated in US prisons have worse mortality than nonincarcerated individuals. In this qualitative study of clinicians delivering cancer care for incarcerated individuals, participants identified pragmatic strategies to improve cancer screening and treatment that address most identified barriers to care in US prisons. Application of these strategies may be associated with mitigation of disparities in cancer survival for incarcerated individuals. Participants identified strategies to improve care addressing nearly all previously identified barrier themes, including strategies for (1) conducting screening in prisons; (2) bringing cancer treatment into prisons and centralizing care; (3) using telehealth, navigators, and early oncologist involvement to improve care coordination; (4) improving communication and social support; (5) improving symptom management, access to palliative medicine, and end-of-life care; and (6) delivering patient-centered care. Strategies require implementation by prisons, prison clinicians, oncologists, oncology practices, and policymakers.

Incarceration and quality of cancer careJAMA Network Open; by Oluwadamilola T. Oladeru, Ilana B. Richman, Jenerius A. Aminawung, Jason Weinstein, Lisa B. Puglisi, Rajni Mehta, Hsiu-Ju Lin, Emily A. Wang, Cary P. Gross; 10/25The incarcerated population in the US is aging, and an estimated 15% of incarcerated adults, or approximately 175,000 individuals, are now 55 years or older. With this demographic shift, diseases of aging have become more prevalent, and cancer now ranks as the most common cause of death among people who are incarcerated in the US. Despite the growing prevalence, cancer outcomes among those incarcerated lag behind those with no history of incarceration. Individuals diagnosed with cancer while incarcerated or immediately following release have an approximate 2-fold increase in cancer-related mortality compared with the general population, even after adjusting for stage at diagnosis. Along with other published literature, this work suggests that gaps in quality of care may contribute to observed disparities in outcomes.Assistant Editor's note: Most of us cannot imagine what it would be like to be in prison. With cancer. And perhaps even dying there. Steven Garner knows. He spent many decades as an inmate at a state penitentiary. While there, he became a hospice volunteer supporting dying inmates, training other volunteers, and he served to pioneer Hospice in Corrections programs throughout the US. Steven is out of prison now, living his best life in Colorado and consulting around the nation about ways to improve end of life care for incarcerated persons. Oprah Winfrey was involved in sharing Steven's story in a Netflix documentary called Serving Life. NPR published an article about Steven in February 2024. Additionally, Hospice Analytics has posted a link to a 20-minute video about Steven's life and work in prison: Angola Prison Hospice: Opening the Door. And finally, if you'd like more information, Steven Garner has a website. 

Poverty, food insecurity, and housing instability among US health care workersJAMA Network; by Anthony Zhong, Chloe Gao, Donald Szlosek, Dang Nguyen, Maelys J. Amat, Russell S. Phillips; 10/22/25The US health workforce faces projected shortages of more than 180 000 physicians and 200 000 registered nurses in the next decade. Burnout, poor working conditions, and inadequate wages have been cited as key drivers of these shortages. However, the prevalence of financial hardship can affect worker retention and job performance. This study evaluated rates of poverty, food insecurity, and housing instability among US health care workers... Rates of financial hardship varied by occupational group. Direct care/support workers reported the highest rates of financial hardship across all measures, including poverty (9.63%), food insecurity (24.50%), and housing instability (13.64%).Publisher's note: An interesting question - do we know these rates among hospice workers?

New Affinity Hospice CEO seeks to take company national Hospice News; by Jim Parker; 10/16/25Newly appointed Affinity Hospice CEO Chris Smith wants to build the company as a national player, extending beyond its current regional footprint. Affinity Hospice serves more than 1,300 patients daily through 23 locations across Georgia, Alabama, Virginia, South Carolina and Arkansas. Now, Smith seeks to build density in this current service region before branching out into new and contiguous markets.

Executive Personnel Changes - 10/24/25

Hospice & Palliative Care Network of Maryland calls for action on short hospice stays: New issue paper highlights urgent need for earlier access to careHospice & Palliative Care Network of Maryland press release; by Peggy Shimoda; 10/23/25The Hospice & Palliative Care Network of Maryland (HPCNM) has released a new issue paper, “Short Hospice Stays in Maryland: Ensuring Patient-Centered Care at End-of-Life,” revealing that Maryland ranks 46th nationally for hospice length of stay. With a median of just 18 days in 2024, patients and families miss the full benefit of hospice services that promote comfort, dignity, and peace at the end of life... “Short hospice stays are not just a clinical problem—they’re a systems challenge,” said Dr. Jennifer Kennedy, HPCNM Board Member and Chair of the Short Length of Stay Workgroup. “Earlier conversations, coordinated care, and improved discharge practices can help patients receive the care they deserve sooner.”

Health care in the USA: money has become the missionThe Lancet; by Adam Gaffney, Steffie Woolhandler, David U Himmelstein, Danny McCormick; 10/21/25Despite extraordinary scientific and medical resources, the US health-care system underperforms. In this Review we consider the damage wrought by decades of market-based policies that have stimulated profit-seeking by insurers and health-care providers.