Literature Review

[Canada] Palliative care is a fundamental human right TroyMedia; by Rebecca Vachon; 7/6/26 ... Despite the fact that everyone dies, and despite the fact that something like 180,000 Canadians and their families interact with some form of end-of-life care in a year, I keep confronting the perception that palliative care is a niche issue, not one of broad interest. But this reaction only underscores the poll's findings: namely that many Canadians continue to misunderstnad what palliative care is and isn't. On a more positive note, however, when Canadians do understand it, palliative care is, in fact, identified as a priority issue.

The hidden cost of cancer's end: how financial strain shapes final months of care Fred Hutch Cancer Center, University of Washingon, Seattle, WA; by D. Moosavi; 6/25/26 ... Previous Fred Hutch research has shown that people with cancer are more than twice as likely to file for bankruptcy, and nearly twice as likely to experience what researchers call an “adverse financial event,” compared with people who don’t have cancer. But most of that earlier work focused on financial hardship as an outcome caused by cancer. This study flips the question: once someone is already dealing with financial strain, what happens to the care they receive as their illness progresses?Publisher's note: This study also notes Fred Hutch researchers are already exploring this idea through an ongoing study called CREDIT, which is testing whether connecting patients with advanced cancer to financial navigation services can improve their care and reduce unnecessary emergency room and hospital use. Could hospices do something similar?

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

Implementation of a serious illness conversation program in a health system: A retrospective observational studyJournal of Palliative Medicine; by Glen Varns, Abbey Sidebottom, Katy Hentges, Sandra Castro-Pearson, Jan Richardson, Emily Downing; 6/26Serious illness conversation (SIC) is a structured conversation framework designed to improve shared decision making and promote goal-concordant care with patients anticipating end-of-life care decisions. Objective: Examine reach, timeliness, and quality of SIC implementation across a health system after implementation of a SIC Program (SICP) [and] examine factors associated with SIC completion for eligible patients. Factors associated with SIC included palliative care visits ... , a primary care provider in the system ... , and an inpatient admission with discharge to home care ... Patients with dementia ... were less likely to have SIC. Conclusion: Systemwide implementation of an SICP engaged [only] half of eligible patients; many of those had multiple documented conversations prior to death.

Impact of specialized pediatric palliative care on bereaved parents' mental and physical healthJournal of Pain & Symptom Management; by Claudia Delgado-Corcoran, Huong D. Meeks, Sarah E. Wawrzynski, Barry P. Markovitz, Brandy Harman, Jasmine R. Masih, Kuan Li, Mark Harousseau, Dominic Moore, Jacob Wilkes, Stefanie G. Ames; 6/26Pediatric death can lead to long-term adverse effects on parents’ health. [In this study] of 776 deceased children linked to 773 mothers and 711 fathers, 36.1% received a SPPC [specialized pediatric palliative care] consultation prior to death. Higher rates of mental and physical health burden were observed in mothers than fathers across all time points. Lack of SPPC was associated with increased risks for new mental and physical health burden for mothers within 12 months after the child’s death ... Conclusions: Bereaved parents, especially mothers, experienced new mental and physical health burden up to 24 months after a child’s death.

Palliative care for older adults with hip fracture: An explanatory sequential mixed-methods studyJournal of Pain & Symptom Management; by Daniel I Hoffman, Sydney Moore, Amanda J Reich, Christina Sheu, Mengyuan Ruan, Masami Tabata-Kelly, Kate Sciacca, Tamryn F Gray, Daniel Dohan, Charlotta Lindvall, Zara Cooper; 6/26After hip fracture, older adults experience burdensome treatments and high mortality; they may therefore benefit from palliative care (PC). Among 1,433 hip fracture admissions, GOCC [goals of care conversations], hospice discussions, and specialty PC were documented in view on their role in GOCC. Conclusion: Limited standardization, role uncertainty, and cultural factors limited PC documentation and delivery, highlighting opportunities to strengthen PC integration in surgical care.

Outcomes for hospitalized patients with comfort measures only ordersJournal of Palliative Medicine; by Gina Piscitello, Donna Durant, Tami Minnier, Marika Haranis, Robert M Arnold, Jane Schell; 6/26Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur. Our primary aim was to assess the associations of specialty palliative consults (SPC) or documented goals of care conversations (GOCC) with in-hospital mortality among patients with CMO orders. Of 6,789 hospitalized patients with CMO orders ... seventy-three percent died in-hospital, and 22% were discharged with hospice. SPC placed anytime during hospital admission were associated with lower in-hospital mortality ... and higher discharge with hospice ... In contrast, documented GOCC anytime during admission were associated with higher in-hospital mortality ...  and lower discharge with hospice ...

Survival variation and predictors of length of stay in US hospice patientsInternational Perspectives and Future Directions for Practice, Research, and Policy; by Ian Duncan, Xiyue Liao, Terri Maxwell; 6/26End-of-life (EOL) patients in the US Medicare program represent a large and growing population, as well as a disproportionate share of Medicare’s costs. Survival of patients in hospice is, however, highly variable, implying an opportunity for improved management by enhancing the prediction of survival. Actuaries, health economists, policy analysts, and health services researchers have studied expenditures at the EOL for Medicare decedents for many years, finding that survival at EOL is highly variable. We discuss the utilization of hospice benefits for patients at the EOL in the United States.

An end-of-life care approach defining a new standard of careJAMDA; by David N. Hoffman; 6/26The Institute for Healthcare Improvement (IHI) Leadership Alliance established an End-of-Life Care/Ending-Life Care Accelerator to define a continuum of care for patients as they progress from curative care, to palliative care, to hospice care, to final care planning, including ending life care interventions such as Medical Aid in Dying (MAiD), Voluntarily stopping eating and drinking (VSED), and palliative sedation. This accelerator defined as its goal the task of breaking down barriers between care providers which has been illuminated by research recently conducted by the Completed Life Initiative (CLI). CLI’s research efforts in this area started with an ongoing examination of nationwide hospice organization policies to provide referral for active intervention at the end of life. That effort was refocused on the widespread noncompliance of California and Washington state hospice organizations with a state law requirement to post on the organizations website a list of interventions made available by the hospice organization.

Saturday newsletters focus on headlines and research - enjoy!

Reynolds creates Iowa Medicaid fraud task force Insurance Newsnet; by Marissa Payne; 7/9/26 Gov. Kim Reynolds signed an executive order Wednesday [7/8] creating a new task force geared toward eliminating Medicaid fraud, waste and abuse, joining in the federal government's crackdown on potential misuse of public assistance programs. Reynolds signed the order establishing the Iowa Medicaid Fraud Elimination Task Force, which the Republican governor's office says will seek to ensure funds are used to support Iowans who qualify for benefits. "Safeguarding federal programs like Medicaid from bad actors requires accountability at every point in the process, from member eligibility verification to provider enrollment and billing," Reynolds said in a statement. 

'Labor of love:' Longtime Hospice of Dubuque leader retires Telegraph Herald, Dubuque, IA; by Elizabeth Kelsey; 7/8/26 When Lavonne Noel was hired as financial coordinator for Hospice of Dubuque in 1990, she was simply looking for a part-time job while she raised her young children. Little did the Dubuque resident know that she would spend the next 36 years working for the local nonprofit, including 15 as its executive director. Noel retired recently from Hospice of Dubuque after a career she described as “the greatest privilege of my professional life.” ... Hospice of Dubuque Financial Director Jackie Brehm is currently serving as interim executive director while officials conduct a search for Noel’s permanent replacement. Noel has every confidence Hospice of Dubuque will continue to thrive under new leadership.

Deep summer is when laziness finds respectability. ~ Sam Keen