Literature Review

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

From burnout to belonging: Creating space for grief in clinical education American Academy of Pediatrics (AAP) Journals Blog; by Rachita Gupta; 6/16/25 ... While significant progress has been made in addressing burnout and emotional distress in medicine, and in incorporating these topics into medical education, many clinicians remain hesitant and uncertain about how to address grief and distress from patient care in day-to-day clinical practice. This uncertainty exists both in terms of their own experiences and, even more so, in supporting trainees. A lack of emotional processing in these difficult situations can accelerate burnout and further disconnect clinicians from the humanism and vulnerability that are intrinsic to the privilege of practicing medicine. ... The recently published Hospital Pediatrics article by Bloomhardt et al, “Good Grief? Introducing the TEARS Framework for Educator to Support Learners Experiencing Grief,” (10.1542/hpeds.2024-008096) addresses the hesitancy many clinicians experience when assessing learners’ emotional processing during or after distressing patient cases by introducing the TEARS framework. ...Editor's Note: See a related post in today's newsletter, "“Her toes fell off into my hand”: 50 moments that changed healthcare workers forever."

Artificial intelligence and health care waste—Promise or peril?JAMA Health Forum; William H. Shrank, MD, MSHS; Suhas Gondi, MD, MBA; David J. Brailer, MD, PhD; 6/25One obvious target of AI [artificial intelligence] tools in health care is the reduction of waste. While LLM [large language model] applications to health care are still nascent—many still make errors, and more rigorous evaluations are needed—most agree that the long-term opportunity for AI in health care is tremendous. A recent study estimated that widespread adoption of AI could lead to savings of 5% to 10% of total US health care spending. Realizing even a fraction of this potential would increase the affordability of care for people in the US and free substantial societal resources to make other valuable investments. But getting there will require deliberate choices from leaders and policymakers and careful attention to risks that could set back progress.

Zuranolone in palliative care: Promise and practicality for the rapid treatment of depressionThe American Journal of Hospice & Palliative Care; Eric Prommer; 6/25Zuranolone is an orally available antidepressant classified as a neuroactive steroid. Neuroactive steroids act as positive allosteric modulators for both synaptic and extrasynaptic GABA, making them distinct from currently available drugs targeting major depression and insomnia. By modulating GABA binding sites, neuroactive steroids enhance the function of GABA, which is depressed in major depression. The drug has a rapid onset of action, which differs from currently available antidepressants that are used in palliative care. [This] ... paper will review the pharmacology, pharmacodynamics, safety profile, and clinical studies showing its effectiveness in major depression and how it can potentially be helpful in the palliative care population.

Unanswered questions on private equity in gastroenterologyJAMA Network; by Jane M. Zhu; 6/25A growing literature on private equity (PE) acquisitions of physician practices has found associated increases in health care prices and utilization, but evidence specific to gastroenterology remains relatively new despite the specialty being a popular target for PE. More than 1 in 8 gastroenterology practices are now owned by PE, with practice fragmentation, lucrative procedural reimbursements, and an aging population factoring into continuing investor interest... Taken together with observations of increased utilization, there may be 2 interpretations of the data presented by Arnold and colleagues. One interpretation of the findings may be that PE acquisition may focus on reducing inefficiencies, improving access by expanding practice capacity, and increasing throughput. Another interpretation may be that PE acquisition is focused on the strategic exploitation of market and pricing power. The latter may have less of an impact on clinical measures like quality of care, but potentially, both strategies could be at play.Publisher's note: Similar questions being asked across hospice, gastroenterology, physician practices, and other areas of healthcare.

Physicians' preferences for their own end of life: A comparison across North America, Europe, and AustraliaJournal of Medical Ethics; Sarah Mroz, Sigrid Dierickx, Kenneth Chambaere, Freddy Mortier, Ludovica De Panfilis, James Downar, Julie Lapenskie, Koby Anderson, Anna Skold, Courtney Campbell, Toby C Campbell, Rachel Feeney, Lindy Willmott, Ben P White, Luc Deliens; 6/25Setting: Eight jurisdictions: Belgium, Italy, Canada, USA (Oregon, Wisconsin, and Georgia), Australia (Victoria and Queensland). Participants: Three physician types: general practitioners, palliative care physicians, and other medical specialists. Conclusion: Physicians largely prefer to intensify alleviation of symptoms at the end of life and avoid life-sustaining techniques. In a scenario of advanced cancer or Alzheimer's disease, over half of physicians prefer assisted dying. Considerable preference variation exists across jurisdictions, and preferences for assisted dying seem to be impacted by the legalisation of assisted dying within jurisdictions.

[Korea] Alzheimer Disease in Breast Cancer survivorsJAMA Network; by Su-Min Jeong, Wonyoung Jung, Hyeonjin Cho, Hea Lim Choi, Keun Hye Jeon, Ki-Woong Nam, Yun-Gyoo Lee, Bongseong Kim, Kyungdo Han, Dong Wook Shin; 6/20Is breast cancer survivorship associated with the risk of Alzheimer dementia (AD), and how are cancer treatments associated with this risk? Breast cancer survivors may have a slightly lower risk of AD compared with cancer-free individuals, potentially influenced by cancer treatments, underscoring the need for further research on long-term neurocognitive outcomes in this population.

[Bogota, Columbia] Anxiety, depression, and quality of life of caregivers of palliative care patients with cancerRevista Cuidarte; by Alejandra María Alvarado García, Lina María Vargas-Escobar, Mauricio Arias-Rojas, Carlos Javier Avendaño-Vásquez, Cesar Antonio Consuegra-Pareja; 2/25Caregivers with moderate or severe depression were more likely to report symptoms of sadness, punishment feelings, self-dislike, suicidal thoughts or wishes, indecisiveness, irritability, changes in appetite, concentration difficulty, and tiredness or fatigue. Among caregivers with mild depression, loss of interest in sex, agitation, and past failure were identified. Strategies for psycho-emotional counseling, education, and support for caregivers are needed.

Re-examining early in early palliative care: Precedent, reality, and future research prioritiesJCO Oncology Practice; by Laura A. Petrillo, Julia L. Agne; 6/25Nearly 700,000 people in the United States are living with metastatic solid tumor malignancies in 2025, a number that continues to grow because of advances in survival-extending therapy. Even with therapeutic advances, however, metastatic cancer continues to negatively affect patients' quality of life because of bothersome symptoms and psychological, social, and spiritual distress. Palliative care is specialized medical care focused on alleviating suffering for individuals with serious illness, including those with advanced cancer. On the basis of on substantial evidence demonstrating its efficacy in improving quality of life, ASCO and other organizations now recommend the early integration of palliative care with oncology care for all individuals living with advanced cancer. [Also see accompanying article: Early Integration of Outpatient Palliative Care Among Adults With Advanced Cancer in a Safety-Net Health System: A Patterns of Care Analysis; by Lisa DiMartino, Vincent Merrill, Celette Sugg Skinner, Timothy P. Hogan, Navid Sadeghi, Alva Roche-Green, Winnie Wang, Arthur S. Hong]

‘It takes a village’: The need to expand community-based pediatric palliative careHospice News; by Holly Vossel; 6/25/25Similar to adults, many seriously ill children prefer to die in the home versus in facility-based care settings. But several barriers are preventing greater access to goal-concordant, community-based pediatric palliative care delivery. The challenges in some ways mirror issues among adult populations such as insufficient clinical resources, caregiver burden or lagging family support in the home, as well as financial and logistical constraints. However, in the pediatric space, these obstacles are much more complex and nuanced to navigate, according to Allison Grady, pediatric oncology nurse practitioner and chair of the National Association of Pediatric Nurse Practitioners’ (NAPNAP) Pediatric Palliative Care Special Interest Group.

Avow selected to provide hospice care in Lee, Glades, and Hendry CountiesSouth Florida Hospital News; 6/25/25Avow is proud to announce that the Florida Agency for Health Care Administration (AHCA) has notified Avow of its intent to select the organization to provide hospice services in Lee, Glades and Hendry counties, following AHCA’s preliminary approval of Avow’s Certificate of Need (CON) application. This important decision will expand Avow’s compassionate, high-quality hospice care for residents throughout Southwest Florida.

Measuring what matters: The untapped power of resident experienceMcKnight's Long-Term Care News; by Charles de Vilmorin; 6/25/25In today’s senior living and long-term care environment, doing well financially depends on doing good — truly good. Communities that thrive are the ones that deliver on the promise of person-directed living, where residents are not passive care recipients but active participants in a life of dignity, purpose and connection. This isn’t just a moral imperative — it’s a strategic one. The industry has long recognized the importance of resident quality of life, but often fails to define or measure it with the same rigor applied to occupancy or staffing ratios. This is a missed opportunity. Resident experience remains one of the most powerful, untapped levers for operational improvement, competitive differentiation and financial growth. It’s time we treat it like the performance driver it is.Publisher's note: The balance of "mission and money" is equally true in hospice.