Literature Review

The role of PMHNPs in palliative psychiatry: An ethical framework for care when remission is unattainableJournal of Hospice and Palliative Nursing; by Trae Stewart; 8/23Patients with serious and persistent mental illness may experience intractable suffering despite exhaustive treatment, challenging the dominant curative paradigm in psychiatry. Palliative psychiatry offers an emerging alternative-prioritizing comfort, dignity, and quality of life when remission is no longer attainable. This article presents a comprehensive ethical and clinical framework for integrating palliative psychiatry into psychiatric-mental health nurse practitioner (PMHNP) practice. Drawing parallels with somatic palliative care, the author explores the theoretical foundations, diagnostic complexities, and ethical imperatives guiding palliative psychiatry. Legal challenges, such as hospice eligibility criteria and involuntary treatment statutes, are also examined, with recommendations for practice and policy reform. Assistant Editor's note: As I search for pertinent articles to add to this newsletter, I am delighted to find so many that address a variety of aspects of palliative care. I see articles on palliative care in the ED, palliative care for special populations, palliative care for transplant patients, and as highlighted in this article, palliative care in psychiatry. It makes me think that maybe, just maybe(!), the many benefits of palliative care are finally being recognized and embraced by mainstream health care.

Sexuality and intimacy in the context of palliative and end-of-life care: A scoping reviewInternational Journal of Palliative Nursing; by Michelle Traverse, Susan D Mueller, Susan DeSanto-Madeya, Melissa A Sutherland; 8/25This scoping review identifies what is known about patient/partner sexuality and intimacy needs during end-of-life care and how healthcare professionals' (HCPs) approach these needs. A total of 18 articles were included in the review. Four themes were identified: 1) negative impact of serious illness on sexuality and intimacy, 2) barriers and facilitators to addressing sexuality, 3) tension between expansive and genital-focused approaches to sexuality and intimacy, and 4) a disconnect between patient/partner needs and HCP preparation. HCPs require clear and comprehensive training to improve their ability to address sexuality and intimacy during end-of-life care. Taking an expansive view of sexuality and intimacy during this time may facilitate HCP interventions.

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.

Facing new CMS pressure, providers should audit mental health diagnoses, prescriptions: expert McKnights Long-Term Care News; by Kimberly Marselas; 7/22/25 As reported in McKnight’s Long-Term Care News on July 23, “Nursing homes should be auditing documentation for all residents with mental health disorders to ensure their diagnoses are compliant with new federal guidance, a well-known clinical reimbursement recommended Tuesday. Leigh Ann Frick, president of Care Navigation Consulting, made that suggestion while reviewing updated Long-Term Care Surveyor Guidance that went into effect in late April. At over 900 pages, the new manual and appendixes have left many providers still navigating the changes and how best to respond to them. When it comes to giving antipsychotic medications, diagnosing patients with disorders that require them, or identifying and responding to any other patient needs, the guidance puts new emphasis on the use of professional standards, Frisk explained. Guest Editor’s Note, Judi Lund Person:  For nursing home residents who have elected the Medicare hospice benefit, this information may apply. Diagnosing mental health issues, prescribing, and documenting based on professional standards is an important component in the updated Long-Term Care Surveyor guidance issued in April.

Fireproofing the soul: Navigating fear of the afterlife among palliative care patientsJournal of Palliative Medicine; Ptr Shannon Blower, Jonathan Walker, Lucius Walker, Steven Radwany; 6/25Among palliative care patients, spiritual uncertainty about what may await them after death is a fairly common but often overlooked source of anxiety. Specifically, patients (especially those from orthodox Christian backgrounds that propound the concept of hell as a literal place) may harbor unexpressed fears about being consigned to hell due to the perceived sins they have committed in life. Such fears can be genuinely debilitating and may result in non-responsiveness to traditional palliative therapy. Here, we discuss our experiences with this phenomenon and propose some possible solutions. We offer readers suggestions for how to best identify potential sufferers, broach the subject with such patients, and reassure them.

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.

Cocota's story: Life lessons in aging, resilience, and end-of-life agency from a Brazilian matriarchJournal of the American Geriatrics Society; Thiago J Avelino-Silva, Niousha Moini; 6/25In Cocota's case, a hip fracture in her 80s did not lead to permanent disability; rather, she reclaimed her daily routines, demonstrating the interplay between physical robustness and unwavering determination. Equally telling was her decision to "stop eating and drinking" near life's end, exemplifying resilience as a final expression of agency. We further explore how her experiences align with deeper forms of well-being, marked by purpose and prosocial behavior, and practical wisdom, including emotional regulation and sound moral judgment. By examining her life journey, clinicians and community partners can better appreciate how resilience spans physical, cognitive, psychosocial, and spiritual domains, ultimately guiding more integrated strategies to support older adults. The lessons learned have direct relevance for clinical interventions, community programs, and public health initiatives aimed at fostering autonomy and meaningful engagement in later life.

Provider MiraSol Health launches new Behavioral Health Program Hospice News; by Jim Parker; 6/3/25 MiraSol Health has launched a new behavioral health program designed to amplify emotional and psychological support for its hospice and palliative care patients. Branded as Rays of Hope Behavioral Health, the program offers individual and group therapy sessions, both in person and via a secure telehealth platform. Through Rays of Hope, MiraSol’s licensed therapists will help address anticipatory grief, caregiver stress, loss and other struggles that patients and families face during a time of chronic, serious or terminal illness.

CMS releases HOPE Guidance Manual (V. 1.01) and TablesCenters for Medicare and Medicaid Services (CMS); by CMS; 4/22/25On April 22, 2025, CMS released the HOPE Guidance Manual (V. 1.01) and connected tables. Providers can use v1.01 for HOPE planning, as this is considered final before HOPE implementation. Also note that earlier this month, the final HOPE data specs have also been released, helping software developers to finalize their HOPE software for testing in the coming months.

Increasing awareness and access to integrated behavioral health and palliative care: An introduction to the American Journal of Hospice and Palliative Medicine'sAmerican Journal of Hospice and Palliative Care; James Gerhart, Michael Hoerger, Stacie Levine, Sean O'Mahony; 2/25Mental health symptoms are common in the general population and are overrepresented in patients receiving palliative care and hospice services. This introduction to the special issue on Mental Health in Palliative Care and Hospice highlights the ongoing need for research and training to prepare our palliative care workforce to address the concerns of patients experiencing serious illness and mental health concerns. Multilevel approaches are needed to enhance understanding of mental health needs among people with serious illness. Public health outreach is needed within our communities, targeted support is needed for family caregivers, and structured training for palliative care and hospice clinicians is needed to enhance competent mental health in these settings.

Medically recommended vs nonmedical cannabis use among US adultsJAMA Psychiatry; Beth Han, MD, PhD, MPH; Wilson M. Compton, MD, MPE; Emily B. Einstein, PhD; Nora D. Volkow, MD; 1/25With increases in cannabis use for medical purposes and its perceived benefits, patients and clinicians need to be aware of its potential risks. Results showed that adults aged 18 to 49 years reporting medical-only or medical-nonmedical cannabis use vs nonmedical-only use had higher prevalence of CUD [cannabis use disorder] at all severity levels and reported more frequent cannabis use. These findings suggest that medically recommended cannabis is not associated with reduced addiction risk compared with nonmedical use. Clinicians should consider addiction risk before recommending medical cannabis and, if they do, should monitor for CUD emergence.

What the experiences of young persons can teach us about medical aid in dying for psychiatric illnessJAMA Psychiatry; Brent Kious, MD, PhD; 1/25Medical aid in dying (MAID) is becoming ever more available. While it is most often used by persons with terminal illnesses, it is also becoming more accessible to those with a primary psychiatric illness. Some countries, including the Netherlands, have long allowed MAID for persons experiencing unbearable and irremediable suffering due to a mental illness. In Canada, Quebec’s Superior Court ruled in 2019 that restricting MAID to persons with a “reasonable foreseeable natural death” violates key sections of the Canadian Charter, implying that MAID must be made available to persons with nonterminal conditions, including psychiatric illness. Meanwhile, while only persons with terminal illness can access MAID in those parts of the US that have legalized it, some physicians have argued that certain psychiatric illnesses, especially anorexia nervosa, can be terminal, opening the door to MAID for persons with a primary psychiatric illness. 

[Australia] Why mental health clinicians are not engaging in advance care planning with older people with schizophrenia and other psychotic illnessesPsychology Research and Behavior Management; Anne P F Wand, Aspasia Karageorge, Yucheng Zeng, Roisin Browne, Megan B Sands, Daniella Kanareck, Vasi Naganathan, Anne Meller, Carolyn M Smith, Carmelle Peisah; 12/24These clinician-identified attitudes, experiences, and barriers to engagement in ACP [advance care planning] with older people with psychotic illnesses highlight avenues of potential intervention to facilitate ACP in this cohort. Given the complexity of issues, clinicians need education and training in ACP combined with clear processes and policies to support practice. Clinician insights should be combined with the perspectives of older consumers with psychotic illnesses and their families to inform implementation of ACP.