Literature Review

The persons behind our patients - Individualized assessment tools for personalized careJAMA Internal Medicine; by Ruchi Bhatia; 6/2/25In clinical medicine, we rely heavily on bulleted templates to conduct and document care. These templates help capture the complexity of the medical problems we treat... However, the checklists we use often fail to provide a holistic narrative of the patient’s story... Reviewing the details of these checklists during the visit may aid decision-making but limits face-to-face interactions and can distract from understanding the unique person in the patient... Relying exclusively on checklists can unintentionally prevent patients from sharing their personhood and will not elicit complex concerns, such as fears of getting older, dying, or being written off.Publisher's note: Several recent stories we've covered extol the benefits of AI in healthcare; this story articulates some of the risks.

Hospices facing a US caregiving ‘crisis’ Hospice News; by Holly Vossel; 6/2/25 Family caregivers in the United States are being challenged by a swelling aging population inneed of greater support and stronger policy infrastructures. Much room for improvement exists at both state and federal levels when it comes to recognizing the important roles that family caregivers play, according to Steven Lee, co-founder and CEO of ianacare, a Boston-based patient and caregiver resource company. More innovative care models and disease-specific reimbursement options have widened pathways for hospice providers to improve family caregiver support, Lee said in a recent Hospice News Elevate podcast. But these fall short of addressing the diverse scope of practical, emotional and financial needs, he stated. Editor's note: This article has an excellent map of US states with caregiver categories for "Well-Supported," "Safe for Now," "High Risk," and "Critical" (courtesy of Otsuka America Pharmaceutical). Additionally, our sponsor Hospice Analytics provides the National Hospice Locator, for caregivers/families to find hospices that serve in each US county, and sorted by their quality scores. And, our sponsor Composing Life equips hospice organizations with caregiver/family video libraries that span the continuum of serious illness, hospice, and grief care. 

How do you comfort a dying parent? U.S. News & World Report - WTOP News; 6/1/25 Caring for a parent who is dying can be emotionally taxing. ... Here are ten tips for how to conduct a caring conversation with someone who is dying — and how to know when to sit in silence too.

Is the life I’m living the life that wants to live in me? ~ Parker J. Palmer

Ethics talk: Are private equity investments really different from other ownership structures in health care?AMA Journal of Ethics, Podcast May 2025; by Robert I. Field, PhD, JD, MPH; 5/30/25Dr. Robert I. Field joins Ethics Talk to discuss whether and to what extent private equity firms’ increasing presence in health care deserves our scrutiny and what policy makers, clinicians, and patients should know about responding to private equity ownership stakes in the organizations where they work and where they go for health services. 

Empathetic AI policy example: A framework for the human impact on AI Solutions Review; by Tim King; 5/30/25 ... Empathetic AI is our organizational pledge to place people at the center of our AI strategy. It means prioritizing the dignity of work, the stability of our workforce, and the fair treatment of all individuals impacted by automated systems. It means actively supporting those whose roles may be transformed or displaced and investing in their future through retraining, redeployment, and transparent communication. Our core principles are as follows:

The importance of humanity in internal medicine I.M. Matters from the American College of Physicians; President's Message by Jason M. Goldman, MD, MACP; June 2025I recently attended the funeral of one of my long-time patients, who had required hospice care after a long battle with heart disease. Many of us have had the experience of telling a patient and their family that their disease has progressed and we have reached the limits of medical science. In training, we are taught to be compassionate but professional, maintaining a certain level of emotional detachment ... As internal medicine specialists, we have the awesome responsibility and privilege to be the doctor for our patients through decades of their life experiences and to offer them not just medical science, but also humanity and comfort. ... One of the greatest acts of charity a person can perform is to attend someone's funeral, as it is the only act of kindness that cannot be reciprocated. This patient had been in my practice for almost two decades, and I had the privilege of taking care of both her and her husband.Editor's note: Re-read this powerful statement, "One of the greatest acts of charity a person can perform is to attend someone's funeral, as it is the only act of kindness that cannot be reciprocated." 

[United Kingdom] Hospice cuts 19 jobs to save £1.7m amid ‘worst financial crisis’ in its history LSE - The London School of Economics and Political Science; by Emily Moss; 5/29/25 A Yorkshire-based hospice charity has cut 19 jobs in the hope of reducing its annual costs by £1.7m as it faces what it has previously described as “the worst financial crisis” in its almost 40-year history. The Kirkwood, which provides palliative and end-of-life care for people living in and around Kirklees, West Yorkshire, said that an additional nine employees had agreed to reduce their hours or adjust their roles to enable the hospice to save money. The hospice opened its redundancy consultation in February. The initial plans placed 33 roles at risk of redundancy. At the time, the Kirkwood said it was facing the “worst financial crisis” in its history, citing a “perfect storm” of an increasing demand for hospice services versus rises in the prices of essential equipment, energy and food.Editor's note: This represents just one of many ongoing reports of financial crises, extreme fund-raising, closures and staff layoffs throughout the UK's hospices. Themes and patterns pair with trends we're seeing throughout the US.

HOPE Tool Anxiety: What are we forgetting in the rush to prepare?Teleios Collaborative Network (TCN); by Melissa Calkins and Ashley Espy; 5/30/25 Panic is in the air.  With the HOPE assessment tool set to replace HIS, hospice teams are racing to prepare—scrubbing workflows, updating systems, and trying to wrap their heads around new clinical documentation demands.  But amid the rush, it's easy to overlook critical gaps: non-clinical staff being left out of planning, unclear timelines, poor communication, or the complete absence of a project lead.  HOPE isn't just about compliance—it's about execution. If we don't step back and ask what's missing, we risk rolling out a system that nobody is truly ready for.Steps to Operationalize the HOPE Tool:

US trends from 1999 to 2020: Mortality and location of deaths in ischemic stroke Neurology Advisor; by Meghna Rao; 6/2/25 Patterns of ischemic stroke mortality have varied over the last 2 decades in the United States, according to study findings published in PLOS One. Stroke is one of the leading causes of mortality in the US. Researchers studied the trends in location of ischemic stroke deaths to improve end-of-life care and address health care inequities.The Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database was used to examine trends in ischemic stroke mortality between 1999 and 2020. 

OP-ED: How hospice care falls short for people living with dementia Being Patient - Alzheimer's News, Advice, Stories & Support; by Maria J. Silveira; 5/30/25Only 12 percent of Americans with dementia ever enroll in hospice. This may be due to how hospice is structured and paid for in the U.S., explains University of Michigan associate professor of internal medicine Maria J Silveira. ... In contrast to the former president [Jimmy Carter's extended hospice care], his wife, who had dementia, lived only nine days under hospice care. Palliative care physicians like myself who treat both conditions are not surprised at all by this disparity. ... Strikingly, only 12 percent of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70 percent of the time.

French lawmakers approve assisted dying bill Le Monde with AP and AFP; 5/27/25France's Assemblée Nationale adopted a bill on Tuesday, May 27, to allow adults with incurable illnesses to take lethal medication, the initial step in a lengthy process that could grant patients medical assistance to end their lives in clearly defined circumstances. The bill received 305 votes in favor and 199 against, after all parties in parliament allowed their lawmakers a free vote on the issue. It will now be sent to the Sénat for further debate. A definitive vote on the bill could take months to be scheduled. In parallel, another bill on palliative care, meant to reinforce measures to relieve pain and preserve patients' dignity, was also adopted on Tuesday, unanimously. 

June is the time for being in the world in new ways, for throwing off the cold and dark spots of life. ~ Joan D. Chittister