Literature Review

Unique ethical dilemmas occur in long-term care settings: Staff need ethics resources  Medical Ethics Advisor; by Stacey Kusterbeck; online ahead of print 12/1/25 issue ... “The position paper was developed in response to concerns from our members about the ethical challenges of the changing environment in long-term services,” says Jason M. Goldman, MD, MACP, president of the American College of Physicians. ... Discharge disposition, communication issues (either among the clinical team or between clinicians and parents), behavior problems, and goals of care were the top ethical issues reported. Lack of caregiver support was another frequent unique ethical concern. Editor's Note: Your hospice is in a unique role to provide ethics trainings for end-of-life care, and thus building trust, clinical best practices, and referrals. The CMS Hospice Conditions of Participation require: Hospices That Provide Hospice Care to Residents of a SNF/NF or ICF/MR (§ 418.112) (f) Standard: Orientation and training of staff. Finally, this rule requires a hospice to assure the orientation of SNF/NF and ICF/MR staff caring for hospice patients. Staff orientation must address the following topics: hospice philosophy; hospice policies regarding patient comfort methods, pain control, and symptom management; principles about death and dying; individual responses to death; patient rights; appropriate forms; and record keeping requirements.

Consciousness and meaning at life’s end: How the study of dying deepens our understanding of everyday presencePsychology Today; by Alexander Batthyany, PhD; 11/15/25Sergei Rachmaninoff lies dying in his Beverly Hills home. Family and friends surround him, the room suffused with that particular stillness that often accompanies life's final hours. Then something unexpected occurs. The composer opens his eyes and asks those present: "Can you hear this beautiful melody? The enormously beautiful music?" The response from those at his bedside is immediate: "No, there's no music here." ... I share this story with all those who wish to participate in our work as mandatory reading, simply because I want to prevent us from making the same error—saying "No, there's no music" instead of asking "What do you hear?" ...

UofL oncology social work expert leads national effort to transform cancer patient support The Lane Report, Louisville, KY; by Holly Hinson; 11/17/25 ... Tara Schapmire, an associate professor in the University of Louisville (UofL) Department of Medicine, Division of Palliative Medicine, and an associate professor at the UofL Kent School of Social Work and Family Science, has worked decades to help individuals and families impacted by cancer. Schapmire was recently awarded a five-year, $1.6 million grant from NCI to lead a national training initiative aimed at transforming psychosocial and palliative care in oncology. The grant will support an intensive training and mentorship program, and 50 social workers from across the U.S. will be competitively selected each year to receive fully funded palliative oncology training and structured mentorship.

Understanding challenges and barriers to quality end-of-life care for patients with hematologic malignancies: A GIMEMA surveyAnnals of Hematology; by Leonardo Potenza, Fabio Efficace, Eleonora Borelli, Paola Fazi, Thomas Baldi, Francesca Tartaglia, Francesco Sparano, Claudio Cartoni, Pasquale Niscola, Claudia Mucciarini, Oreofe Odejide, Eduardo Bruera, Camilla Zimmermann, Marco Vignetti, Mario Luppi, Elena Bandieri; 10/25Patients with hematologic malignancies often receive aggressive end-of-life (EOL) care, which may be partly related to hematologists' discomfort with discontinuing aggressive treatments at EOL. We assessed a cohort of Italian hematological oncologists through a GIMEMA online survey to explore their attitudes toward standard measures of quality EOL care, their opinions on barriers to providing this care, and potential interventions. In conclusion, Italian hematologists find most standard EOL quality measures acceptable, they identify barriers to quality care, and are open to interventions, including early integration of palliative care, to improve patients' EOL care. However, they lack familiarity with GOC [goals of care] and ACP [advance care planning] discussions, highlighting the need for communication skills training.

Developing medical cannabis competencies-A consensus statementJAMA Network Open; by Yuval Zolotov, Leslie Mendoza Temple, Richard Isralowitz, David A. Gorelick, Rebecca Abraham, Donald I. Abrams, Kyle Barich, Kevin F. Boehnke, Stephen Dahmer, Joseph Friedman, Patricia Frye, Aviad Haramati, Jade Isaac, Mary Lynn Mathre, Marion E. McNabb, Melinda Ring, Ethan B. Russo, Deepika E. Slawek, Brigham R. Temple, Genester S. Wilson-King, Julia H. Arnsten, Mikhail Kogan; 10/25An initial list of 9 competencies was refined and consolidated into 6 core competencies [for the use of medical cannabis]: (1) understand the basics of the endocannabinoid system; (2) describe the main components of the cannabis plant and their biological effects; (3) review the legal and regulatory landscape of cannabis in the US; (4) describe the evidence base for health conditions that are commonly managed with cannabis; (5) understand the potential risks of medical cannabis use; and (6) understand basic clinical management with medical cannabis. Each competency is supported by 2 to 7 subcompetencies, resulting in 26 subcompetencies reflecting granular topics, such as patient safety, vulnerable populations, structural inequities, and interdisciplinary care. These consensus-derived competencies provide a structured, evidence-informed foundation to guide the integration of medical cannabis into undergraduate medical education.

VITAS and Miami Dade College partner to shape the next generation of compassionate nurses South Florida Hospital News and Healthcare Report; by Daniel Casciato; 11/1/25 For Miami Dade College (MDC) nursing students Khadijah Norelus and Shanel Cantave, the decision to pursue nursing came from deeply personal experiences. Shanel was inspired after nearly losing her father to a hemorrhagic stroke. Khadijah’s calling was born when she witnessed the care and compassion a hospice nurse gave her cousin in his final moments. Today, both women are VITAS Scholars—recipients of the Miami Dade College LPN Scholarship supported by hospice provider VITAS Healthcare—and represent the next generation of caregivers preparing to serve South Florida’s communities amid a national nursing shortage.

Four nurses in two weeks assaulted at Essentia Hospitals: Nurses say violence is a consequence of unsafe staffing and inaction Minnesota Nurses Association, Brainer, MN; Press Release; 10/28/25Nurses with the Minnesota Nurses Association (MNA) are once again outraged and deeply concerned after two more violent assaults on nurses at Essentia Health. A nurse at Essentia Health St. Joseph’s Medical Center in Brainerd was attacked by a patient last Thursday, followed by another assault at the same facility over the weekend. The latest incidents come less than two weeks after two nurses were injured at Essentia Health St. Mary’s Medical Center in Duluth. Four nurses assaulted in under two weeks reflects a dangerous pattern in Essentia facilities—one that nurses have been warning about for years.Editor's Note: Continue reading for preventable actions and red flags, "True safety comes from care-based prevention." These were hospital settings; the home care settings your staff and volunteers enter provide much higher risks with less control. Ask your direct care staff for examples of professional situations that were unsafe. Office-based leaders, you might be surprised. Examine your workplace violence policies, procedures, trainings, incident reporting, and follow-up.

End-of-life care in the austere military environmentMilitary Medicine; by Jason David, Stevan Fairburn, Hayden Fogle, Nicholas Dulin, Russell Day; 9/25Throughout the Global War on Terror (GWOT), the U.S. military built a revolutionary capacity to deliver life-saving care-even in austere environments-through rapid evacuation, far-forward providers and resources, and advances in prehospital and trauma-critical care. However, the operational reality of future Large Scale Combat Operations (LSCO), as evidenced by wars in Ukraine, Sudan, and Gaza, will be marked by high casualty rates and limited medical resources. [This review] ... explores how medical providers must shift from curative to comfort-focused care, often without formal palliative training, and how end-of-life care protocols must be integrated into doctrine, triage systems, and commander education. We offer pragmatic guidance on clinical decision-making, communication strategies with both medical and non-medical leaders, and the delivery of pain relief, emotional support, and dignity at the end of life-even in forward-deployed, under-resourced settings.

Teaching end-of-life care: Q&A with professor of medicine Medical Xpress; by Mahima Samraik, Yale University, edited by Sadie Harley; 10/20/25 Every year, thousands of families sit in hospital rooms hearing words no one wants to hear: "We have done everything we can." What happens next, whether doctors stay engaged or step away, can transform one of life's most difficult moments for patients and their families. Unfortunately, for too many patients, the shift from curative care to end-of-life care leaves them feeling stranded. ... "But it doesn't have to be this way," says Matthew Ellman, MD, professor of medicine (general medicine) at Yale School of Medicine (YSM) and director of Medical Student Palliative and End-of-Life Care Education. Ellman has spent decades at patients' bedsides and now teaches medical students about death and dying. In his recent essay in Academic Medicine, he draws from his personal experiences as a physician and encourages fellow doctors to embrace difficult conversations around end-of-life care.

The essential role of Speech-Language Pathologists in end-of-life swallowing intervention: A narrative reviewASHA Perspectives; by Sanora Yonan; 9/25Speech-language pathologists (SLPs) are essential in the intervention of dysphagia, particularly at the end of life (EoL), where their guidance can significantly improve patients' comfort and quality of life. However, despite a growing recognition of their importance in this palliative setting, SLPs continue to face obstacles for consistent involvement on the palliative care team. Three primary themes emerged [from this study]: diet texture adjustment, compensatory swallowing strategies, and patient and caregiver education. The review also identified significant barriers to SLP involvement, including inconsistent practices, limited resources, legal concerns, and a lack of interdisciplinary integration.Assistant Editor's note: In my experience, SLPs were rarely, if ever, utilized with hospice patients. However, this article clearly describes ways that SLPs could be helpful for patients with swallowing difficulties. SLPs can also be very useful for patients with speech difficulties. I think the IDT simply does not think of it-does not think of how a SLP could be helpful. Maybe it is also partly due to lack of knowledge of their value. Perhaps, both hospice and palliative care teams might consider arranging for an inservice from a SLP so that team members can learn more about how such therapy could be helpful in improving the quality of life of patients.

Decoding code status: Assessing end of life care knowledge in high-risk ED populationsThe Journal of Emergency Medicine; by Shreyans Sanghvi, Jacqueline Furbacher, Thaddeus Puzio, Caroline Ha, Deena Abdelhalim, Mariah Arneson, Alaina Sturkie, Erika Richey, Benjamin Cooper, Samuel Luber; 9/25The National Institute on Aging projects that the U.S. population over age 65 will nearly double by 2050, placing further strain on an already burdened healthcare system. The emergency department (ED) plays a critical role in caring for this vulnerable population, initiating intensive care for approximately 2,000 older adults daily. However, such care often conflicts with the treatment preferences of most Americans; 80% of older adults report a desire to avoid intensive care and repeated hospitalizations at the end of life (EOL). Among 187 patients [surveyed], 84% reported never having heard of code status options (of those who had, 73% were primarily English-speaking) and 83% were unaware of their current code status. Additionally, 74% lacked any ACDs [advance care directives]. Regarding CPR, 80% believed it successfully restarts the heart of sick patients more than 50% of the time, while 83% and 84% had never been informed about what CPR entails or its associated risks, respectively. 

Bayada receives $1m grant for nursing scholarships HomeCare, Philadelphia, PA; Press Release; 10/2/25 BAYADA Home Health Care, a nonprofit home health care provider, announced it has been awarded $1 million from the Regina Charitable Fund of the Philadelphia Foundation to sponsor 75 caregivers in Montgomery County, Pennsylvania on their path to becoming nurses.  The Regina Charitable Fund is a nonprofit established to support organizations that provide care for chronically ill and indigent aged, and to train individuals to provide such care. ... While providing paid personal care and companionship services to BAYADA clients, program participants will receive scholarships of $10,000 each to attend the nursing school of their choice.