Literature Review

Deprescribing at the End of Life: Jennifer Tjia, Jon Furuno, Simon MooijaartGeriPal podcast; by Eric Widera, Alex Smith, Jennifer Tjia, Jon Furuno, Simon Mooijaart; 2/26/26In this episode of the GeriPal Podcast, we tackle the pressing topic of deprescribing at the end of life with expert guests Jennifer Tjia, Jon Furuno, and Simon Mooijaart. The conversation focuses on identifying medications that should almost always be discontinued—such as statins, osteoporosis meds, finasteride, and vitamins, which offer minimal benefit for patients with limited life expectancy. We also delve into more nuanced cases, such as antithrombotics, which present complex decisions that challenge clinicians, particularly when prognosis spans the many weeks to months range. Finally, we explore practical strategies for engaging patients and families in deprescribing conversations.

Granite VNA names James Culhane President and CEO Granite VNA, Concord, NH; Press Release; 3/5/26 After a rigorous and comprehensive executive search, Granite VNA, New Hampshire’s largest not-for-profit home health and hospice agency, has named James Culhane as its next President and CEO. He will succeed Beth Slepian, who has served in that role since 2015, upon her retirement in June 2026. Culhane has served as President and CEO of Lake Sunapee Region VNA & Hospice in New London, New Hampshire, since 2015. 

Demystifying the end: Hospice care impact on the Black community Word In Black | Houston Defender; by Laura Onyeneho; 3/2/26 ... For African American, Afro-Caribbean and African immigrant families, generational trauma and a lack of trust in the healthcare system often lead to delayed decisions about hospice care. “There’s been a historical gap in access and trust,” said [Monica James, Community Engagement Coordinator for Houston Hospice]. “Our goal is to show up consistently, to listen and to let these communities know they have options and that they’re not alone.” ... “For communities of color, we have to meet people where they are. That means understanding family dynamics, faith and what dignity means to different people,” she said. 

C-TAC report: From metrics to momentum - accelerating the spread of community-based palliative care The John A. Hartford Foundation, Washginton, DC; 3/4/26 The Coalition to Transform Advanced Care (C-TAC) and and The John A. Hartford Foundation (JAHF) have released a report, "From Metrics to Momentum: Accelerating the Spread of Community-Based Palliative Care." The report summarizes discussion from a September 2025 C-TAC national convening of clinical, policy, payer, and delivery system leaders that was focused on accelerating the spread of community-based palliative care and identifying meaningful approaches to measuring access. 

Beware the ides of March! ~Shakespeare's Julius Caesar

How wonderful it is that nobody need wait a single moment before starting to improve the world. ~Anne Frank

Religion and spirituality in pediatric end-of-life: A systematic reviewJournal of Pediatric Psychology; by Kara Jackson, Alyssa Marchetta, Barry Nierenberg, Jessica M Valenzuela; 2/26Spirituality is a recognized element of palliative care, with documented benefits for adult patients. However, limited research exists on how religion and spirituality affect children at end-of-life (EOL) and their parents. Findings revealed diverse religious and spiritual practices among families, including faith stability, spiritual care use, and prayer. Key outcomes associated with spirituality included enhanced coping, acceptance, meaning-making, hope, caregiver spiritual well-being, decision-making, and improved parent-child communication. Across studies, spiritual support emerged as a vital component of the pediatric EOL experience.

Burden and well-being among dementia caregivers in Puerto Rico: The role of behavioral and psychological symptoms of dementiaThe Journals of Gerontology; by Junyub Lim, Ross Andel, Frank Puga, María P Aranda, Maricruz Rivera-Hernandez, Ana Luisa Dávila-Roman, Michael Crowe; 2/26Dementia is more prevalent in Puerto Rico than in the U.S. mainland, increasing demands for caregiving. We examined caregiver burden and depressive symptoms among Puerto Rican dementia caregivers while also considering behavioral and psychological symptoms of dementia (BPSD). Caregivers were 63 ± 10 years of age on average, and 77% were women. In this Puerto Rico-based sample, perceptual disturbances/apathy, and appetite/eating symptoms specifically, were most likely to magnify the caregiver burden-depressive symptoms link.

Physicians are not providers: The ethical significance of names in health care: A policy paper from the American College of PhysiciansAnnals of Internal Medicine; by Lois Snyder Sulmasy, Jan K. Carney, for the ACP Ethics, Professionalism and Human Rights CommitteeMore than 25 years ago, Pellegrino and Relman noted the increasing commercialization of the learned professions, anticipating what many physicians are increasingly experiencing today: an impairment of their ability to practice in accordance with standards of medical ethics and professionalism. These hurdles to the physician’s ability to do right by the patient contribute to what leaders in medicine and the American College of Physicians have called deprofessionalization. An example is the use of the term provider to describe physicians and other health professionals. The use of this terminology has been reviewed in medical journal articles but has not been adequately explored as a matter of ethics and professionalism. Through that lens, this paper examines the trends, significance, and implications for patients, physicians, and health care of the use of the term provider.

What does moral agency mean for nurses in the era of artificial intelligence?Hastings Center Report; by Connie M Ulrich, Oonjee Oh, Sang Bin You, Maxim Topaz, Zahra Rahemi, Liz Stokes, Lisiane Pruinelli, George Demiris, Patricia Flatley Brennan; 2/26Being a moral agent was once thought to be an irreplaceable, uniquely human role for nurses and other health care professionals who care for patients and their families during illness and hospitalization. Today, however, artificial intelligence systems are often referred to as “artificial moral agents,” “agentic,” and “autonomous agents.” As these systems begin to function in various capacities within health care organizations and to perform specialized duties, the question arises as to whether the next step will be to replace nurses and other health care professionals as moral agents. Focusing primarily on nurses, this essay explores the concept of moral agency, asking whether it remains exclusive to humans or can be conferred on AI systems. We argue that AI systems should not supplant nurses’ moral agency, as patients come to hospitals or any other health care setting to be heard, seen, and valued by skilled professionals, not to seek care from machines.

MedPAC: March 2026 Report to CongressMedPAC Reports; 3/12/26Medicare Benefit: National health care spending grew rapidly in 2023 and 2024, by 7 percent in each of these years. By 2024, national health care spending totaled $5.3 trillion. Health care spending has made up an increasing share of the country’s gross domestic product (GDP) over time, rising from about 13 percent of GDP in 2000 to 18 percent in 2024. Medicare spending grew more rapidly than national health care spending in 2023 and 2024 (by 9 percent and 8 percent, respectively), in part due to changes in Part D financing that shifted more of the cost of prescription drug coverage from beneficiaries to the federal government. By 2024, Medicare spending totaled $1.1 trillion—equivalent to 21 percent of national health care spending and 3.8 percent of GDP. (Please see the full report here for additional detail.)Hospice Chapter:

Call for applications: Investigator in Residence ProgramASCENT press release; 3/2/26The Advancing the Science of Palliative Care Research Across the Lifespan (ASCENT) Consortium invites applications for its 2026 Investigator in Residence Program. The goal of this program is to increase the number of palliative care investigators, expand the range of institutions where palliative care research is performed, and develop scientific and leadership capabilities leading to future successful grant proposals, both through ASCENT and extramurally. Applications due Thursday, March 26 at 5:00 pm PT.