Literature Review

Alliance submits comments in response to CY 2026 Home Health Proposed Rule National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/29/25 As the federal comment period draws to a close, the National Alliance for Care at Home (the Alliance) has joined an unprecedented number of providers and patients in submitting formal feedback to the Centers for Medicare & Medicaid Services (CMS) on the agency’s proposed 9% cut to the home health payment rate for 2026. The unusually high volume of responses collected throughout the comment window underscores broad concern that the $1 billion payment reduction will limit access to care at home, compromise patient safety, and burden the wider healthcare system.  

Autumn shows us how beautiful it is to let things go.

[France] Palliative care for solid organ transplant candidates and recipients: A scoping reviewTransplantation Reviews; by Liesbet Van Bulck, Fiona Ecarnot, Mathilde Giffard; 8/25Solid organ transplant patients experience high morbidity and mortality before and after transplantation. International guidelines recommend integrating palliative care into the management of patients with advanced organ failure, including transplant candidates and recipients, as it supports advance care planning, enhances communication and improves symptom management. This scoping review shows that palliative care for organ transplant has received little attention heretofore.

Can AI simplify surgical instructions as effectively as humans? Enhanced surgical instructions using large language modelsJAMA Network / JAMA Surgery / Research Letter; by Maxwell Sahhar, Joseph E. Nassar, Anne-Emilie Rouffiac, Kaitlyn Crow, Manjot Singh, Michael J. Farias, Bassel G. Diebo, Alan H. Daniels; 8/25Human authors and a chatbot improved documents from a 9th-grade to 6th-grade reading level on most measures. Preoperative instructions showed less improvement by a chatbot. Inconsistencies occurred at rates of 1.1 and 0.6 per document for human authors and a chatbot, respectively. At least 1 inconsistency was found in 20 of 43 human-simplified (47%) and 11 of 43 chatbot-simplified (26%) instructions, with the higher rate of inconsistencies from humans associated with nonclinically significant omissions. Similar rates of critical inconsistencies were observed between human authors and a chatbot.Publisher's note: AI was effective in this study. If AI can simpligy surgical instructions, how would it do with hospice admission and other instructions?

Acceptability and barriers to chronic pain treatment in refugee torture survivorsJAMA Network; by Sargun Kaur Virk, Samantha Tham, Claudia Hatef, Tanzilya Oren, Lola Berger, Adam Tucker, Andrew Robert Milewski, Inmaculada de Melo-Martin, Gunisha Kaur; 8/25Which chronic somatic pain treatment modalities are acceptable to refugee torture survivors, and what factors influence their access to these treatments? Findings suggest that although refugee torture survivors are willing to engage in chronic pain treatment, structural and systemic barriers limit their ability to do so.Publisher's note: How are hospice care plans individualized to reflect unique needs of torture survivors?

Sexuality and intimacy in the context of palliative and end-of-life care: A scoping reviewInternational Journal of Palliative Nursing; by Michelle Traverse, Susan D Mueller, Susan DeSanto-Madeya, Melissa A Sutherland; 8/25This scoping review identifies what is known about patient/partner sexuality and intimacy needs during end-of-life care and how healthcare professionals' (HCPs) approach these needs. A total of 18 articles were included in the review. Four themes were identified: 1) negative impact of serious illness on sexuality and intimacy, 2) barriers and facilitators to addressing sexuality, 3) tension between expansive and genital-focused approaches to sexuality and intimacy, and 4) a disconnect between patient/partner needs and HCP preparation. HCPs require clear and comprehensive training to improve their ability to address sexuality and intimacy during end-of-life care. Taking an expansive view of sexuality and intimacy during this time may facilitate HCP interventions.

Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectivesInterventional Pain Medicine; Sanjeet Narang , Jason Yong , David Hao, 9/25Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination.

Give every day a chance to become the most beautiful day in your life. ~Mark Twain

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. 

Don't hunt trouble. It'll find you on its own. ~ Unknown

This is the one question leaders need to ask themselves: To avoid burnout, leaders need to pay attention to their energy levels Forbes - Work Life; by Tim Jack Adams; 9/1/25 You’ve carried the weight of big decisions, the pressure to perform, to lead and deliver, all despite what’s happening behind the scenes. You’ve navigated through uncertainty and change, providing the space for everyone else to thrive. It’s a feeling that the most capable leaders feel. It’s not quite burnout, but a kind of dullness. A slow drain. A fog that creeps in quietly and makes it harder to stay clear, connected, and grounded. ... It's not about time, it's about energy. ...Editor's Note: Twenty years ago, this concept revolutionized my workday, productivity, outcomes, and overall well-bing, via the book The Power of Full Engagement: Managing Energy, Not Time, Is the Key to High Performance and Personal Renewal, by Jim Loehr, published 2003. This author's content is fresh, dated September 2025.

70% of Americans oppose Medicare home health cuts, national poll finds National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/4/25A new national poll by Fabrizio Ward, commissioned by the National Alliance for Care at Home (the Alliance), finds that seven in ten Americans oppose the Centers for Medicare & Medicaid Services’ (CMS) 2026 Medicare home health proposed rule, which would slash Medicare home health funding by an additional 9%, or $1.1 billion, next year. These cuts would put lifesaving home health care for millions of Americans at risk, particularly seniors and those with disabilities, while doing nothing to address fraud, waste, and abuse occurring in the home health payment system.  

COUNTDOWN: 25 Days Until HOPE Tool Starts, October 1, 2025