Literature Review

Antibiotics in hospice: Applying the four-quadrant approach to improve patient-centered care Oxford Academic | Clinical Infectious Diseases; by Patrick D. Crowley, Karen M. Meagher, Amelia K. Barwise; 3/5/26The use of antibiotics in the hospice setting is complicated by differing patient goals, elevated side effects, and limited information regarding effectiveness. Here, we describe a case and apply the four-quadrant approach (4QA). This includes analyzing the case through the lenses of (1) medical indications related to improving function and reducing symptoms; (2) patient preferences ...; (3) quality-of-life factors that include managing infectious symptoms versus antibiotic side effects; and (4) contextual features, which include antimicrobial resistance concerns and cost considerations. Antibiotics may be beneficial in some cases and should not be denied to patients enrolled in hospice care. More robust evidence-based information about outcomes is needed to inform discussions at the time of enrollment. Applying the 4QA to a case can help determine the best approach for each individual patient.

2025 Facts and Figures Report now available to Alliance members The National Alliance for Care at Home; Alexandria, VA and Washington, DC; Press Release; 3/3/26 The National Alliance for Care at Home (the Alliance) published the 2025 edition of Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, hospice provider characteristics, and quality of care. Facts and Figures – the leading resource for hospice providers and others interested in understanding the work of the community – has been published annually for over two decades. The findings in this report reflect patients who received care in 2024, provided by hospices certified by the Centers for Medicare & Medicaid Services (CMS) and reimbursed under the Medicare Hospice Benefit. ... The full 2025 Facts and Figures report is available for Alliance members online. The Executive Summary is available to the public.  Editor's Note: Pair this national data with the The Alliance and the Research Institute for Home Care release 2025 Hospice Chartbook that we posted on 2/20/26. The RIHC Hospice Chartbook mainly provides state views with some national treands, whereas this Facts and Figures report is mainly a national view with time trends.

The measure isn’t wrong. The story is incomplete. McKnights Long-Term Care News; by Steven Littlehale; 2/27/26 Not long ago, I was sitting across from a nursing home leadership team as they stared at a quality measure report that didn’t make sense to them. ... So we did what more facilities should do when a QM score feels off: We stopped looking at the rating and started looking at the math. That’s where the real story surfaced. It wasn’t about poor care, but about exclusions not captured, covariates not fully coded, and pieces of the clinical picture that never made it into the structured data fields the Centers for Medicare & Medicaid Services reads. 

Hospice spending, care quality scores by state Becker's Hospital Review; by Elizabeth Gregerson; 2/18/26 California and Nevada hospice providers had the lowest care-quality scores despite spending the most per beneficiary to provide care between Jan. 1, 2023, and Dec. 31, 2024, according to CMS data released Feb. 18. Rhode Island and West Virginia had the highest hospice care quality scores during the data collection period. CMS’ Hospice Quality Reporting Program includes data submitted directly by hospice providers, from Medicare hospice claims, and from the Hospice Consumer Assessment of Healthcare Providers and Systems survey. Here are the hospice care quality scores and per-beneficiary spending amounts by state between Jan. 1, 2023, and Dec. 31, 2024, according to CMS: ...

Integrating compassion and policy: Highlights from IAHPC Advocacy, 2025Palliative Medicine in Practice: by Katherine Irene PettusIn 2025, the International Association for Hospice and Palliative Care (IAHPC) advanced advocacy for palliative care as an ethical, clinical, and human rights imperative. As a non-state actor in official relations with the World Health Organization (WHO), the association worked across policy, faith, and professional domains to integrate palliative care into universal health coverage frameworks. This report summarizes IAHPC’s global activities from February to November 2025, including engagement at the 78th World Health Assembly (WHA), collaboration with WHO and the International Narcotics Control Board (INCB), the launch of the Leadership and Advocacy Development (LEAD2) program, and new interfaith and educational initiatives.Assistant Editor's note: As I peruse peer reviewed journals to bring you relevant and current summaries of research, I am amazed at the large number of articles published now about palliative care. It wasn't this way just a few years ago. As a long-time hospice and palliative care nurse, I am delighted to see the ground swell of interest in the principles, the need, the value, and the effectiveness of palliative care. I feel like 'We Have Arrived' (finally!). Kudos to all of you who have worked tirelessly over many years to educate professionals and the public at large, about palliative care and its virtues. I know we are not done; there is more to do. But we've come a long way baby!

How nurses assess care goals to boost patient satisfaction informa; by Sara Heath; 1/21/26 Nurses at New Jersey's Valley Hospital boosted patient satisfaction by 14% by soliciting and understanding patient care goals. Krystal LaNeve, a nurse at Valley Hospital in Paramus, New Jersey, often finds herself talking a lot with her patients. ... [Dialogue is] key to patient-centered care but operationalizing that can be an uphill battle. Healthcare teams are strapped for time, and it can be difficult to discuss care preferences with patients ...  Editor's Note: While most of this article is behind a paywall, a similar article is posted on the ANA Nursing Resources Hub, "Ways Nurses Can Improve Patient Care."

Hospice enrollment in young adult LGBTQ + decedents with cancer: A multi-site single healthcare system studyBMC Palliative Care; by Sanjna Rajput, Riham Suleiman, Brittany Kimball, Aminah Jatoi, Elizabeth Cathcart-Rake; 11/25Methods [of the study]: A single healthcare system, 4000 + self-reported LGBTQ + database of patients with cancer identified young adult decedents (18-39 years old at death) to report the percentage who died with hospice, the conversations that preceded hospice enrollment, time-on-hospice, and circumstances that surrounded the deaths of those not enrolled. From the database, ... 67% ... were enrolled in hospice ... Conversations that preceded enrollment discussed (1) limited cancer therapeutic options with worsening end-of-life symptoms and how hospice could help ("discussed… decline and how patient would not want to die hooked up to machines"); (2) medical staff's acknowledgement of same sex spouse/life partners ("[She] is here with her wife"); (3) the inclusion of the birth family in end-of-life discussions, especially if the decedent had been single ("Her father met us… this was difficult news for him to hear.").  Conclusions: Most young adult LGBTQ + decedents with cancer receive hospice services with thoughtful and inclusive conversations that precede enrollment.

Canadian woman approved for assisted suicide instead of getting surgery LifeNews.com; by Steven Ertelt; 12/8/25 A Canadian woman suffering from parathyroid disease has revealed that she is considering assisted suicide because she cannot get the surgery she needs. Jolene Van Alstine, from Saskatchewan, suffers from a rare form of parathyroid disease, which results in extreme bone pain, nausea and vomiting. She requires surgery to remove a remaining parathyroid, but no surgeons in Saskatchewan are able to perform the operation. In order to be referred to another province for the operation, Van Alstine must first be seen by an endocrinologist, yet no Saskatchewan endocrinologists are currently accepting new patients. Van Alstine commented that the pain has become so unbearable that she has applied and been approved for Canada’s euthanasia and assisted suicide programme, with the ending of her life scheduled to take place on 7 January 2026.

Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-Hispanic White surrogate decision makersEquity Neuroscience; by Imadeddin Hijazi, Lewis B Morgenstern, Robert Michael Miller, Erin Case, Madeline Kwicklis, Darin B Zahuranec; 10/25 Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Contrary to our original hypothesis, we did not identify an ethnic difference in surrogate reports of the quality of death and end-of-life care after stroke between MA patients and NHW [non-Hispanic White] patients after adjusting for demographic and clinical factors. This result is encouraging, as it implies that in this community, ethnic disparities in end-of-life care may not be as pronounced as reported in other populations. Furthermore, the high scores on both surveys indicate overall satisfaction with care regardless of ethnicity. 

Not just a ‘soft skill’: How academic hospitals are embedding professionalism into strategy Becker's Hospital Review; by Kelly Gooch; 11/18/25 Hospitals and health systems are formalizing leadership roles focused on clinical excellence and professionalism — particularly at academic medical centers. Leaders say their institutions see the value in this approach to improve patient safety, strengthen workplace culture and support clinician well-being. ... Becker’s connected with these leaders to discuss the drivers that led their organizations to elevate this focus, how they link it to strategic goals, and examples of meaningful success. 

Hospice: Track errors, payment caps to avoid facing costly penalties Home Health Line, DecisionHealth; by MaryKent Wolff; 11/13/25 Keep a close eye on possible claim and billing mistakes that could lead to issues related to your payment cap. While increased revenue may seem like a good thing for providers, overpayments could lead to heightened scrutiny and financial hardships for your agency. [May require subscription for additional information]

Integrated clinical-social care and boundaries of health careJAMA Health Forum; by Vincent Guilamo-Ramos, Marco Thimm-Kaiser, Adam Benzekri, Kody H. Kinsley; 10/25After a decade of growing momentum, the future role of health care in addressing patients’ health-related social needs (HRSNs) through integrated clinical-social care is uncertain. There is agreement that increasing health care expenditures are a significant burden on the national budget, but there is disagreement over remedies to reduce costs while improving outcomes. We argue that a constructive debate over the role of integrated clinical-social care within health care reforms requires a shared vision for its implementation. We advance this debate by delineating the boundaries of what the health care system, social welfare system, and bridging infrastructure between them can deliver in an integrated clinical-social care paradigm.