Literature Review

Ahead of National Volunteer Week and in celebration of National Volunteer Month, NPHI CEO urges Americans: “Step forward. Be present. Volunteer with your local hospice.” National Partnership for Healthcare and Hospice Innovation (NPHI), Washington, DC; by Matt Wilkinson; 4/16/25 Ahead of National Volunteer Week next week [April 20-26], and in celebration of National Volunteer Month this April, the National Partnership for Healthcare and Hospice Innovation (NPHI) is shining a light on the often-unsung heroes of hospice: volunteers. These compassionate individuals are central to the mission of NPHI’s member providers nationwide, offering their time, energy, and hearts to patients and families during life’s most tender and vulnerable moments. NPHI member organizations rely on nearly 30,000 volunteers to keep their programs running—almost matching the number of full- and part-time staff employed across its national member network. Nationwide, hundreds of thousands of hospice volunteers contribute millions of hours of service annually. This deep tradition of volunteerism isn’t just symbolic—it’s built into the very structure of hospice care. All Medicare-certified hospices are required to have volunteers actively involved in patient and family support, reflecting the core values of compassion and community care that define the field.Editor's note: Throughout the year, find this and more national observances on our newsletters "Healthcare Observances" tab at the top of our website, https://www.hospicepalliativecaretoday.com/resources/healthcare-observances.

Faith is the strength by which a shattered world shall emerge into the light. ~ Helen Keller

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Advance care planning in the inpatient setting: The role of the hospitalistAmerican Journal of Hospice and Palliative Medicine; Nikhil Sood, MD; Rohini Garg, MBBS; Anthony D. Slonim, MD, DrPH, FCCM; 3/25Advance care planning (ACP) is critical to patient-centered health care, particularly in hospital settings where acute and end-of-life decisions often occur. As frontline providers, hospitalists are uniquely positioned to initiate and guide ACP discussions. This article explores the role of hospitalists in ACP, identifies barriers to its implementation, and highlights strategies to overcome these challenges. Key barriers include time constraints, lack of formal training, and uncertainty regarding the appropriate timing of discussions. To address these issues, hospitalists can benefit from structured communication training, integration of ACP prompts into electronic health records, and collaboration with multidisciplinary teams. While ACP has demonstrated benefits, including the alignment of care with patient preferences, reduced unnecessary interventions, and improved satisfaction for patients and families, challenges remain in ensuring consistent and culturally sensitive implementation.

The physical side of grief: Physical symptoms in bereavementIllness, Crisis and Loss; Crystal L. Weeden, Nora P. Reilly; 3/25Both emotional and physiological responses to loss are normal reactions to bereavement. The aim of the study was to examine if the type of loss someone experienced was related to the magnitude of their expressed symptomology in a nonwidowed specific sample. Specifically, to determine if there is a difference in physical symptoms between participants who experienced grief due to an out-of-order loss (a death before the age of 55) versus those who experienced grief after a natural life progression loss (a death that occurs after the age of 80). Results confirmed that those who bereaved an out-of-order loss experienced significantly more symptomology, both emotional and physiological, than those who lost a loved one aged 55 or older. This study highlights the importance of identifying those at the highest risk for increased grief-related symptomology.

Prevention of opioid misuse and abuse through effective pain management in patients with chronic pain: An umbrella systematic reviewCureus: Sana Sultana, Safeera Khan; 3/25Chronic pain is a condition that affects physical well-being as well as emotional well-being, has mental impacts on patients, and diminishes their quality of life. There is also growing evidence that opioids have only limited effectiveness in the management of CNCP [chronic non-cancer pain], and the increased availability of prescription opioids has contributed to an increase in opioid addiction cases and overdose deaths. This review was conducted to determine if adequate pain management would decrease opioid use and prevent misuse. We discussed the different pain management methods in the paper, including the different pharmacotherapy options, nerve blocks, and spinal cord stimulation. We also talk about multidisciplinary treatment with the involvement of various departments (physician, pharmacy for pill counting, physical therapy, psychological care, etc.) in managing pain; good outcomes were observed with improvement in function.

Access to outpatient palliative care: Insights from MichiganAmerican Journal of Hospice & Palliative Care; by Andrew E Russell, Maria J Silveira; 4/25Outpatient palliative care provides supportive care to community-dwelling patients with serious illness who are not eligible or ready for hospice. Little is known about the services these clinics offer and the populations they serve. We conducted a cross-sectional study of outpatient palliative care clinics in Michigan to describe their services and identify gaps in care... There is limited access to outpatient palliative care in Michigan, especially in rural communities. Many clinics do not accept non-cancer or pediatric patients. Additionally, many clinics lack the full interdisciplinary team that is required to provide robust palliative care.

Pacemaker and defibrillator deactivation in competent hospice patients: an ethical considerationAmerican Journal of Hospice and Palliative Care; by Jennifer M Ballentine; 1/05In 2003, a Colorado hospice provider asked the DCBC for assistance in developing a policy on deactivation of pacemakers and defibrillators in competent hospice patients. The hospice had encountered concerns from some physicians and cardiac care clinicians that deactivating such devices treads the fine line between legitimate withdrawal of burdensome treatment and assisted death... This article summarizes contributions from the committee's discussion, as well as independent research undertaken by the author.Publisher's note: This older, yet still relevant and helpful, article recently came across my desk.

Concordance of 30-day mortality and in-hospital mortality or hospice discharge after sepsisJAMA Network; by Hallie C. Prescott, Megan Heath, Namita Jayaprakash, Raymund B. Dantes, Chanu Rhee, Patricia J. Posa, Scott A. Flanders; 4/9/25In this all-payer, multihospital cohort of patients with community-onset sepsis, the proportion of hospitalizations ending in death or hospice discharge was similar to 30-day mortality and substantially higher than in-hospital mortality alone. Concordance between this composite outcome and 30-day mortality was high and greater than in-hospital mortality alone at the encounter level. These data suggest that the composite outcome of in-hospital mortality or hospice discharge may be a useful measure for national benchmarking of sepsis outcomes. While not identical to 30-day mortality, this composite outcome is available in real time for all patients and appears to have minimal systematic bias from variable hospital discharge practices.Publisher's note: An interesting study that includes "hospital discharge to hospice" as an important variable for consideration.

[Netherlands] A care ethical perspective on family caregiver burden and supportNursing Ethics; Maaike Haan, Jelle van Gurp, Marianne Boenink, Gert Olthuis; 3/25Family care-when partners, relatives, or other proxies care for each other in case of illness, disability, or frailty-is increasingly considered an important pillar for the sustainability of care systems. Especially in a palliative care context, however, family care can be challenging. Witnessing caregivers' challenges may prompt compassionate nurses to undertake actions to reduce burden by adjusting tasks or activities. The question is then whether self-sacrifice is a problem that nurses should immediately solve. Therefore, we suggest that caregiver experiences should always be interpreted in an explorative dialogue, focused on what caring means to a particular family caregiver. Nurses do not have to liberate family caregivers from the situation but should support them in whatever overwhelms or drives them in standing-by their loved ones until the end.

Without support, seniors aging in place may elect facility-based care, study finds McKnights Home Care; by Adam Healy; 4/16/25 Older adults aging in place may rethink whether they want to receive care at home if they do not receive certain aging-in-place supports from their care providers and loved ones, according to a new study published in the Journal of the American Geriatrics Society. The researchers interviewed nearly 300 older adults receiving care at home and in long-term care facilities. ... The first theme was participants’ personal health experiences. ... Similarly, loss of health of loved ones and friends may also influence where patients want to receive care. ... The final factor influencing older adults’ aging preferences was time, the study found. 

Cybersecurity contracts at risk as HHS cuts 150 IT workers: Report Becker's Health IT; by Naomi Diaz; 4/15/25 The Department of Health and Human Services could face a critical breakdown in its IT and cybersecurity systems after a sweeping reduction in force that eliminated key staff and leadership, Wired reported April 14, citing four current and former agency employees. More than 150 workers in HHS’ Office of the Chief Information Officer were among hundreds of administrative staff laid off April 1, according to the report. These employees were responsible for contract renewals and cybersecurity licenses and oversaw operations at the department’s Computer Security Incident Response Center — the hub for detecting and responding to cyberthreats across the department. Sources told Wired the cuts left no one in place to renew critical cybersecurity contracts, some of which are set to expire as soon as June.

This weekend: Passover and Easter with hospice patients and familiesHospice & Palliative Care Today; by Joy Berger, DMA, FT, BCC, MT-BC, editor in chief; 4/17/25 This weekend brings a confluence of the Jewish Passover and Christian Easter holy days. Whatever your faith system, understanding at least a bit about the diverse faith systems of those you serve matters. We provide these hospice-specific resources as references: