Literature Review

A workflow initiative to increase the early palliative care referral rate in patients with advanced cancer MDedge - Federal Practitioner - Quality Improvement; by Judy Lim, MD and Linda D. Nguyen, DNP, NP-C, MD; 9/3/25 ... The American Society of Clinical Oncology and the World Health Organization recommend that every patient with advanced cancer should be treated by a multidisciplinary palliative care team early in the course of the disease and in conjunction with anticancer treatment. Despite the documented benefits and the recommendations, early PC is still not often offered in clinical practice. 

Over 240 advocates rally in DC for the future of care at home: National Alliance for Care at Home hosts Inaugural Advocacy Week on Capitol Hill National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 9/12/25 More than 240 care at home care advocates from across the country met with over 275 congressional offices this week to discuss key legislative and regulatory priorities for expanding access to home-based care services. The meetings were part of the 2025 National Alliance for Care at Home’s inaugural Advocacy Week. Alliance Advocacy Week brings together leaders, advocates, and supporters to unite as one voice for care at home, driving positive legislative change and shaping the future of care to ensure broader access to the life-changing home care services for all Americans. 

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.

NGHS breaks ground on philanthropy-funded hospice house Access WDUN, Gainesville, GA; by Caleb Hutchins; 9/9/25 Northeast Georgia Health System held a groundbreaking ceremony Tuesday morning for a philanthropy-funded hospice house near Gainesville. ... The project, which is expected to open in fall of 2026, is the first philanthropy-funded facility in NGHS’ history. Christopher Bray, chief philanthropy officer of the Northeast Georgia Health System Foundation, called the Stephens’ more-than $5 million donation, which kick-started the project, game-changing for the foundation and the health system at large.

Caregiving under the Medicare Hospice Benefit JAMA Internal Medicine - Viewpoint Agind and Health; by Helen P. Knight, MD; Richard E. Leiter, MD, MA; Harry J. Han, MD; 9/8/25 As palliative care physicians, we frequently refer patients to hospice care. When we do so, we often worry about them. How will they and their families manage custodial care—the day in, day out, physical and financial demands of caregiving—on top of navigating the inherent challenges of end of life? We know that high-quality hospice agencies provide patients and their families with invaluable support for symptomatic, emotional, and spiritual needs. But in the US, due to constraints of Medicare reimbursement, hospice agencies provide only limited custodial care support; this lack of assistance often is an unwelcome surprise to our patients and families and profoundly shapes their end-of-life experience.

Keepers of the quiet goodbye: Meet the people who pulled off a hospice miracle by overcoming society’s fear of homelessness and death itself The Oberserver, Sacramento, CA; by Scott Thomas Anderson; 9/3/25 Inside the decade-long struggle to make Joshua’s House a reality in Sacramento: Craig Dresang has lived in the shadow of death since he was 8 years old. Dresang was in third grade when his mother, Joyce, was diagnosed with stage 3 cancer. At almost the same moment, his mom’s best friend was also given a devastating cancer diagnosis. She was gone six months later — an outcome that kept flashing in Dresang’s young mind. ...  ... [Scroll ahead in time.] The child who could never run from death became the professional willing to confront it. ...  [Working with YoloCares in Davis, CA, Dresang met] Marlene von Friedrichs-Fitzwater, a woman on a mission to create the first hospice shelter for unhoused people on the West Coast.

The hidden crisis in serious illness care and how we fix itMedCityNews; by Dr. Mihir Kamdar; 9/7/25 Every year, millions of Americans with serious illnesses find themselves caught in a dangerous limbo: not sick enough to qualify for hospice, but far too ill to be served by our traditional healthcare system. The result is care that’s expensive, fragmented, and often traumatic. These patients are shuffled between a revolving door of emergency rooms and ICUs, enduring a cascade of aggressive interventions that don’t match their goals or improve their quality of life. This approach not only undermines quality, it drives healthcare spending through the roof, particularly in the last year of life. This is the hidden crisis in serious illness care. And it’s getting worse. At the root of the problem is what many in the field call the “hospice cliff.” ...

Training and practice gaps in nursing home palliative care: A cross-sectional study Journal of the American Geriatrics Society (AGS); by Manali Saraiya, Molly A. Nowels, Rose L. Carlson, Jerad H. Moxley, Catherine A. Riffin, Evan Plys, M. Carrington Reid, Isabella Hastings, Taimur Mirza, Ronald D. Adelman, Daniel Shalev; 9/7/25 We conducted a cross-sectional survey of clinical employees (N = 398) at seven NHs within a single integrated health system in New York State to (1) gauge attitudes toward and knowledge about palliative care, (2) estimate the extent of engagement with advance care planning, and (3) elicit perceptions of the most valuable components of palliative care for NH residents. ... Despite support for palliative care, gaps in knowledge and clinical engagement persist and vary by discipline. Discipline-tailored training and program design may improve palliative care delivery in NHs and help ensure more consistent, value-aligned care for residents with serious illness.

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. 

Amarillo VA expands end-of-life care with new hospice unit CBS KFDA-10, Amarillo, TX; by Canion Cvazos; 8/28/25 After years of planning, the Amarillo VA has opened a new chapter in veteran care. The VA held a ribbon-cutting ceremony today to celebrate the opening for its new hospice unit. VA leaders say the goal is to create a home-like environment, where families can gather with comfort and dignity during their loved one’s final days. The hospice unit will provide 10 private rooms, each designed for a single patient, with its own bathroom and shower. 

Hospices nationwide pursue organic growth with new sites Hospice News; by Holly Vossel; 8/28/25 Hospices from across the country have sought organic growth with the recent launches of new facilities.

Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysisThe American Journal of Emergency Medicine; by Satheesh Gunaga, Abe Al-Hage, Alyssa Buchheister, Harish Neelam, Jessica Corcoran, Michael Welchans, Kirby Swan, Mahmoud Awada, Joseph Miller, Fabrice Mowbray; 8/25Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. A total of 8,055 HPC consults were ordered for 6,370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1,355 in 2023 (367 % increase ... ). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023.

Advocate Health investing $3B across rural footprint: 8 things to know Becker's Hospital Review; by Alan Condon; 8/15/25 Charlotte, N.C.-based Advocate Health is investing more than $3 billion across its rural operations to preserve care access, expand services and build a sustainable pipeline of providers for the future. The investment comes at a time when nearly half of rural hospitals are operating at a loss and 800 are at risk of closure, according to an analysis by the Center for Healthcare Quality and Payment Reform. Twenty-one of Advocate Health’s nearly 70 hospitals are located in rural counties across six states, along with more than 320 rural clinics and a network of mobile and virtual programs [including hospice care].