Literature Review

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The potential of music as a nonpharmacologic intervention for the ICU—Sound medicineJAMA Internal Medicine; by Farah Acher Kaiksow, Eduard Eric Vasilevskis; 10/25The intensive care unit (ICU) offers lifesaving interventions, but it is also associated with considerable patient pain, anxiety, and high rates of delirium. Delirium in patients in the ICU is a highly prevalent condition associated with increased inpatient mortality and long-term cognitive impairment. Unfortunately, the medications used to treat pain and anxiety in the ICU may simultaneously trigger delirium. This conundrum has motivated researchers to investigate alternative, nonpharmacologic therapies for pain and anxiety that have the potential to be less delirium inducing.Assistant Editor's note: Perhaps this is an area where palliative care practitioners could lend expertise. Maybe a Music Therapist could be involved in designing a "sound medicine" program for ICU patients, as described in the article. And this could be a great research project-evaluating outcomes using music therapy as an intervention for suffering patients in the ICU, or in any setting, for that matter.

Cannabis laws and opioid use among commercially insured patients with cancer diagnosesJAMA Health Forum; by Felipe Lozano-Rojas, Victoria Bethel, Sumedha Gupta, Shelby R. Steuart, W. David Bradford, Amanda J. Abraham; 10/25To date, 39 states and Washington, DC, have enacted medical cannabis laws (MCLs) providing cannabis availability for patients with qualifying conditions, including cancer, while 24 states and Washington, DC, have passed recreational cannabis laws (RCLs) legalizing adult-use cannabis. While opioids remain the recommended treatment for cancer pain, these patients may benefit from cannabis availability for adjuvant therapy. We found significant reductions in all measures of opioid prescription dispensing following MCD and RCD openings. These findings are consistent with prior research suggesting that cannabis may serve as a substitute for opioids in managing pain.

Evaluation and treatment of malignant neuropathic painAmerican Journal of Hospice and Palliative Medicine; by Lillian Boehmer, Belal Dakroub, Glenn Pebanco; 10/25Cancer-related neuropathic pain (CRNP) is difficult to identify, assess, and treat, often requiring higher analgesic needs and resulting in poorer outcomes. Objectives: To evaluate the effectiveness of guideline-directed therapy for CRNP in veterans treated at the West Palm Beach VA Healthcare System (WPB VAHCS) Hematology/Oncology Center and managed as outpatients by a pain and palliative care clinical pharmacy practitioner (CPP). Following CPP intervention, pain scores improved ... and PEG [Pain, Enjoyment, and General Activity] scores improved ... CPP-guided use of guideline-directed therapies significantly improved pain intensity and function in veterans with CRNP. Buprenorphine may reduce medication burden in geriatric patients with multimodal pain, reinforcing its value in structured palliative care models.    

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.

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.

Saturday newsletters focus on headlines and research - enjoy!

Agape Care Group acquires Community Hospice of Alabama Hospice News; by Jim Parker; 11/19/25 Agape Care Group Hospice (ACG Hospice) has acquired Community Hospice of Alabama. Financial terms of the transaction are undisclosed. Community Hospice operates three locations in the Foley, Bay Minette and Mobile communities in Alabama. Post-transaction, Agape will now provide services in 41 Alabama counties with a total of 11 locations in the state. 

Rowan and Bayada Home Health Care to strengthen nursing workforce with innovative partnership Rowan University, Glassboro, NJ; Press Release; 11/18/25 “More. Great. Nurses”: That was the chant echoing through the room as BAYADA founder and chairman of the board Mark Baiada energized the crowd during a ceremonial signing event on Nov. 17 at Rowan University. The celebration launched a new agreement between Rowan and BAYADA Home Health Care, the nation’s largest independent nonprofit home health care provider. The partnership creates a debt-free pathway for aspiring nurses and expands access to high-quality home health care in the region.

Mercy Hospice House temporarily closes; parent company to assume outpatient care The Durango Herald, Durango, CO; by Elizabeth Pond; 11/17/25 The Mercy Hospice House, an end of life care wing of Mercy Hospital, has temporarily closed because of a change in outpatient service ownership and a required licensing review. A reopening date has not been determined. The facility, owned and operated by CommonSpirit Health, will transfer leadership of outpatient services to its national entity, CommonSpirit Health at Home, said Kevin Massey, a spokesman. Inpatient hospice care will continue under CommonSpirit Health and Mercy Hospital, he said.

The hidden value of thrift stores in hospice care Teleios Collaborative Network (TCN); hosted by Chris Comeaux with Mark Cohen and Lin Sue Flood; 11/19/25 This TCNtalks episode explores the multifaceted role of thrift stores in Hospice Care, highlighting their impact on community engagement, grief support, and economic sustainability. Our guests, Lin Sue Flood, Director of Community Engagement at Hospice of the Valley, and Mark Cohen, retired Editor & Publisher of Hospice News Today, and Principal, Cohen-Fyfe Communications, discuss how thrift stores serve as vital assets for Hospices, providing not only financial support but also fostering community connections and environmental sustainability.

Unique ethical dilemmas occur in long-term care settings: Staff need ethics resources  Medical Ethics Advisor; by Stacey Kusterbeck; online ahead of print 12/1/25 issue ... “The position paper was developed in response to concerns from our members about the ethical challenges of the changing environment in long-term services,” says Jason M. Goldman, MD, MACP, president of the American College of Physicians. ... Discharge disposition, communication issues (either among the clinical team or between clinicians and parents), behavior problems, and goals of care were the top ethical issues reported. Lack of caregiver support was another frequent unique ethical concern. Editor's Note: Your hospice is in a unique role to provide ethics trainings for end-of-life care, and thus building trust, clinical best practices, and referrals. The CMS Hospice Conditions of Participation require: Hospices That Provide Hospice Care to Residents of a SNF/NF or ICF/MR (§ 418.112) (f) Standard: Orientation and training of staff. Finally, this rule requires a hospice to assure the orientation of SNF/NF and ICF/MR staff caring for hospice patients. Staff orientation must address the following topics: hospice philosophy; hospice policies regarding patient comfort methods, pain control, and symptom management; principles about death and dying; individual responses to death; patient rights; appropriate forms; and record keeping requirements.