Literature Review

A strategic path forward for hospice & palliative care: Ira Byock, Kristi Newport, Brynn BowmanGeriPal podcast; by Eric Widera, Alex Smith, Ira Byock, Kristi Newport, Brynn Bowman; 11/13/25In June of 2025, hospice and palliative care pioneer Ira Byock published a white paper outlining the urgent challenges facing the field today. In a nutshell, he expressed concerns that the quality of hospice care in the United States has become highly variable, with disturbing frequency of unethical practices and avaricious owners. He also raised concern that the rapid increase in palliative care program growth during the first two decades of this century has stalled, leaving us with understaffed programs that are often inadequately trained. Along with Ira, we’ve invited Kristi Newport, a palliative care doctor and Chief Medical Officer of the American Academy of Hospice and Palliative Medicine, and Brynn Bowman, Chief Executive Officer of the Center to Advance Palliative Care, to discuss these issues and outline a strategic path forward for the field. In particular we talk about Ira’s four-part solution to transform the field and restore its integrity: (1) publishing clear clinical and programmatic standards, (2) making meaningful data publicly available to ensure transparency and accountability, (3) fostering quality-based competition among providers, and (4) embracing the authentic brand of hospice and palliative care—expert care that alleviates suffering and fosters well-being.

End-of-life care and health promotion in Black and African American religious communities: A systematic reviewThe Journal of Aging & Social Change; by Chesney Ward; 10/25Blacks and African Americans have the highest mortality rates of any racial or ethnic group, yet they are less likely to complete advanced directives in the United States.  This systematic review found that faith-based health promotion for end-of-life planning is an effective strategy for engaging Black Americans in discussing end-of-life care despite Black and African Americans’ preference for treatment. By implementing faith-based health promotion in churches, Black Americans are more likely to engage in end-of-life care discussions and complete advanced directives, enhancing their quality of life as they age.Publisher's note: We recognize the correct term "advance directives" was not used in this article.

UofL oncology social work expert leads national effort to transform cancer patient support The Lane Report, Louisville, KY; by Holly Hinson; 11/17/25 ... Tara Schapmire, an associate professor in the University of Louisville (UofL) Department of Medicine, Division of Palliative Medicine, and an associate professor at the UofL Kent School of Social Work and Family Science, has worked decades to help individuals and families impacted by cancer. Schapmire was recently awarded a five-year, $1.6 million grant from NCI to lead a national training initiative aimed at transforming psychosocial and palliative care in oncology. The grant will support an intensive training and mentorship program, and 50 social workers from across the U.S. will be competitively selected each year to receive fully funded palliative oncology training and structured mentorship. 

States’ promising practices to improve care of serious illness National Academy for State Health Policy (NASHP); by Stacie Sinclair (Center to Advance Palliative Care) and Wendy Fox-Grage; 11/17/25 Every state has taken meaningful action in some capacity to improve care for residents facing serious illness, affirms a recent publication from the Center to Advance Palliative Care (CAPC). The report documents how states are using a wide array of policy levers — such as legislation, Medicaid innovation, public education, and workforce development — to improve access to and quality of palliative care. 

Finding their "why": Women in healthcare share their journeys at Alys Smith Symposium The Parthenon; by Abby Ayes; 11/13/25 ...  This year, the [seventh Alys Smith Symposisum on Women Professionals] celebration centered on Melanie Hall, Hospice of Huntington CEO and Marshall University alumna, whose keynote address offered a glimpse into resilience, loss and purpose. ... Hall’s story began with a spark of curiosity. “In early high school, you’re trying to figure out what you’re going to do,” she said. “So, I signed up to be a candy striper.” ... In 2013, Hall’s husband encouraged her to apply for the CEO position at Hospice of Huntington. A few months later, tragedy struck when a house fire destroyed everything her family owned. “Thankfully, all my family made it out,” Hall said. “But life changed in just a few hours.” ... As she wrapped up her keynote, Hall left the audience with a reminder about finding purpose in the unexpected turns of life. [Continue reading.]Editor's Note: Thank you Melanie for your leadership both through Hospice of Huntington and throughout your community. This article ends with, "Students, faculty, and community members were given the chance to ask questions, connect, and learn about nontraditional pathways in healthcare, a fitting close to an evening dedicated to women whose care, courage and conviction define what it means to serve." See "Today's Encouragement" for more.

Sit in nature for twenty minutes a day. Unless you're busy, then sit for an hour.

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!   Also, remember our Job Board to find staff for the new year!

Human-AI collaborative content analysis: Investigating the efficacy and challenges of LLM-assisted content analysis for TikTok videos on palliative careProceedings of the Association for Information Science & Technology; by Souvick Ghosh, Ketan Malempati, Camille Charette; 10/25Palliative care is frequently misunderstood, yet short videos on social media can help disseminate useful information and build supportive communities. In this study, we propose an iterative LLM-LLM agentic conversational approach to identify palliative care themes from 56 TikTok videos. Our approach identified themes such as Policy, Advocacy, and Access, as well as Emotional Support and Coping while highlighting omissions like Humor and Saying Goodbye, underlining the need for human oversight. The contributions of this work include a new annotated dataset of 242 TikTok videos, a validated LLM-based thematic analysis pipeline, and evidence that combining automated and human-in-the-loop methods enhances reliability and accuracy in short-form video analysis.

Enhancing palliative care integration in the Cardiac Surgical Intensive Care Unit: A multidisciplinary quality improvement projectAmerican Journal of Hospice and Palliative Medicine; by Crystal Hope Bennett Schiano; 10/25The rate of unmet palliative care (PC) needs is high in critical care areas, especially in the surgical patient population, where PC involvement is notoriously late in the patient’s clinical progression. This quality improvement project aimed to evaluate the ability of education, workflow delineation, and an evidence-based assessment tool to improve the integration of PC in a cardiac surgical intensive care unit (TICU). The intervention included education, workflow delineation, and an evidence-based frailty assessment (FA) implementation. The outcomes of this project were similar to those of the existing literature, further revealing that ICUs are challenging care settings in which to connect patients with PC for the first time. Future studies on the effects of FA in the cardiac surgical patient population are warranted to find the most appropriate settings for assessment and associated interventions based on identifying a patient’s frailty.

Allowing natural death in end-of-life decision-makingGeriatric Nursing; by Jodi Erickson, Mary Ann Cantrell, Meredith MacKenzie Greenle; Nov-Dec 2025To act in concordance with the wishes of people who are dying, the healthcare system must empower patients and healthcare professionals to communicate effectively and in a way that minimizes distress for all involved. More specifically, the use of negation in the term “Do Not Resuscitate” (DNR) in EOL decision-making conversations may contribute to the confusion regarding the meaning of the terms in actual clinical practice. The terminology of DNR and sometimes “Do Not Attempt Resuscitation” (DNAR) is utilized in most healthcare settings and is also incorporated into most portable medical orders, such as POLST forms. “Allow Natural Death” (AND) is a term that has been suggested as an alternate to DNR in EOL situations and does appear in some portable medical orders. This quantitative study indicates that healthy adults may prefer the use of AND instead of DNR when having EOL decision making discussions.

An explicit live discharge protocol for hospice-initiated live dischargesJournal of the American Medical Directors Association; by Stephanie P. Wladkowski, Susan Enguidanos, Tracy A. Schroepfer;1/26Hospice-initiated discharges, or those not requested by patients or caregivers, are distinct from voluntary disenrollment from hospice because they often occur without adequate preparation. Hospice patients who have stabilized and been deemed no longer terminal can disrupt continuity of care, leaving patients and their caregivers unprepared for the complex medical, emotional, and logistical needs posthospice. Currently, no standardized guidelines exist to support hospice clinicians in planning for and conducting these live discharges. To address this gap, an explicit live discharge protocol (LDP) was developed to guide hospice clinicians in supporting patients who are no longer eligible to receive hospice and are discharged alive and their caregivers.

[Indonesia] A systematic review of spiritual distress and needs among patients with cancerJournal of Holistic Nursing Science; by Erna Rochmawati, Novita Kurnia Sari, Juan Manuel Leyva Moral, Maria Dolors Bernabeu-Tamayo, Sarah Amalia, Eny Hernani; 10/25This systematic review reveals that patients' spiritual distress is associated with younger age, religious affiliation, and various burdens. Moreover, spiritual needs exhibit geographical variability that influenced by factors such as gender, length of cancer diagnosis, and anxiety. To effectively address spiritual distress, care provision should incorporate spiritual assessments that consider demographic, psychological, and illness-related factors. Additionally, spiritual care shouldencompass religious rituals as well as aspects of inner peace and generativity. Future studies should focus on developing and utilizing valid and reliable instruments to measure spiritual needs and distress among cancer patients in both hospital and community settings.

Benzodiazepine or antipsychotic use and mortality risk among patients with dementia in hospice careJAMA Network Open; by Lauren B. Gerlach, Lan Zhang, Hyungjin Myra Kim, Joan Teno, Donovan T. Maust; 10/25Benzodiazepines and antipsychotics are commonly used in hospice to manage symptoms such as agitation, anxiety, and terminal delirium in people with ADRD [Alzheimer disease and related dementias], often in response to behaviors that are distressing not only to the patient but also to family caregivers and staff. While these medications can offer symptom relief, they carry risks, including falls, sedation, and confusion. In this national case-control study of nursing home residents with ADRD receiving hospice care, initiation of benzodiazepine or antipsychotic use was associated with increased 180-day mortality. While these medications may provide symptom relief in appropriate clinical scenarios, their use is associated with substantial risks. These findings highlight the need for careful prescribing decisions and the development of dementia-specific hospice prescribing guidelines.