Literature Review

Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategyJournal of Pain & Symptom Management; by Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev; 3/26Depression in serious illness is common, disabling, and often requires rapid improvement. In the psychiatric literature, SGA [second-generation antipsychotics] augmentation improves response and remission rates ... , with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No RCTs have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.

Kelly, DelBene introduce Concurrent Care for Comfort Act U.S. Representative Mike Kelly, Washington, DC; Press Release; 4/20/26 Today, U.S. Representatives Mike Kelly (R-PA), a member of the Ways & Means Subcommittee on Health, and Suzan DelBene (D-WA) introduced the Concurrent Care for Comfort Act, legislation that seeks to improve patient care and outcomes for Americans on Medicare who receive dialysis treatment. Currently, Americans living with end stage renal disease (ESRD) are not permitted to continue their dialysis treatment under Medicare to enter palliative hospice care. This legislation would amend Medicare policy to allow for Americans to continue their treatment, enter hospice, and be with their family pain-free.

Sovereign Hospice: addressing late-stage renal condition care gaps in Fort Worth MyCarrollCountyNews.com, Dallas, TX; by Sovereign Hospice; 4/16/26 End-stage kidney disease affects hundreds of thousands of Americans each year. When kidneys can no longer sustain life without dialysis or a transplant, families are left to make decisions that few feel prepared for. Sovereign Hospice ... is drawing attention to a gap many families face: not knowing that hospice care services exist as a legitimate, fully supported option at this stage of illness. ... For patients with end-stage kidney disease, the shift away from aggressive treatment means that symptom management becomes the priority. Common symptoms at this stage include fatigue, pain, restlessness, and fluid retention. The interdisciplinary team is trained to address all of these through individualized care plans.

Racial disparities in non-stigmatized supportive care medication use in pancreatic cancerJournal of Pain & Symptom Management; by Olga Monika Trejos Kweyete, Chardaé Whitner, David L. Deremer, Yi Guo, Jiang Bian, Lisa Scarton, Sherise C. Rogers, Diana J. Wilkie, Xiwei Lou, John M. Allen; 3/26Pancreatic cancer (PC) is associated with a high symptom burden that contributes to reduced health-related quality of life (HRQoL) and adverse clinical outcomes. This study examined racial and ethnic differences in the use of non-stigmatized SCMs [supportive care medications] during end-of-life care among patients with PC. SCM use was defined as at least one outpatient prescription claim for antiemetics, appetite stimulants, cognitive aids, headache aids, or sleep aids. Racial and ethnic disparities persist in the use of non-stigmatized SCMs among patients with PC at the end of life. These findings extend prior evidence on inequities in cancer symptom management and underscore the need for interventions that promote equitable access to supportive care medications across diverse populations.

Spiritual distress screening by nurses to increase comprehensive spiritual support of patientsJournal of Hospice & Palliative Nursing; by Nair, Archana; Patterson, Dorothy; Hauver, Bethany; Labadie, Chelsey; 4/26This project aimed to address a gap in nurses’ awareness of spiritual care and comprehensive spiritual support of patients in a breast oncology clinic at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center through interdisciplinary collaboration with chaplaincy. Following education, nurses screened patients during their initial visit to the breast surgical oncology clinic who were experiencing moderate to severe distress for related existential themes of distress using an assessment tool and referred them to chaplaincy or social work based on the screening results. Nurse-initiated chaplain referrals increased significantly during the study period, with the most common distress themes being stress, hopes/fears, and assistance/help. Patient acceptance of referrals averaged 18.7% for chaplaincy and 33.1% for social work. By enhancing nurses’ understanding of spiritual care and the role of chaplaincy, the clinic was able to improve the provision of comprehensive spiritual support, contributing to holistic patient care. 

‘Startling’: Palliative care services often not provided for severe brain metastases Healio; by Josh Friedman; 3/3/26 Half of patients with the most severe brain metastases may not be receiving palliative care consultations. Those who do have a significantly higher likelihood of filling out advance directive documentation and getting hospice care, and they have similar OS as those who did not receive consultations. ... “We have to rephrase the word fighting,” [Rohit Singh, MD, medical oncologist and assistant profess at University of Vermont] said. “I tell my patients, you’re not giving up fighting [getting palliative care]. You’re fighting for what’s better for you. You’re fighting for your quality of life. That’s you making it better. You’re not giving up anything. You are making sure whatever time we have aligns with your goals.”Editor's Note: Powerful communication from Dr. Singh. Reframing “fighting” can serve as a catalyst for alignment—across patients, families, and care teams. Palliative care isn’t surrender; it’s a deliberate choice to prioritize what matters most.

Top ten tips palliative care clinicians should know about wound care Journal of Palliative Medicine; by Nicole Dussault, Jared Morphew, Veronica Nwagwu, Brittany Gatta, Angela Richardson, Nancy Payne, E Foy White-Chu, Lidiette Wilson, Heather Dalton, Christopher E Winstead-Derlega, Katherine Ramos, Christopher A Jones; 3/30/26 ... In this article, we outline key tips for assessing and managing wounds, including understanding prognosis and goals of care, evaluating care settings, tailoring management to the underlying disease process, and addressing symptoms such as pain, odor, and psychosocial distress. A thoughtful, interdisciplinary approach is essential to reduce the physical and emotional burden wounds place on patients and caregivers.Editor's Note: As CMS implements the HOPE (Hospice Outcomes & Patient Evaluation) Tool as of October 1, 2025, skin and wound assessment becomes a visible quality marker in hospice—requiring structured documentation, ongoing reassessment, and clear alignment with patient goals. 

Feasibility and acceptability of a self-written, tele-delivered, LGBTQ+-affirming adaptation of dignity therapy for LGBTQ+ women with advanced cancerAmerican Journal of Hospice & Palliative Medicine; by Lexie Wille, Kristie A. Wood, Mike C. Parent; 2/26Dignity therapy (DT) is effective in addressing dignity-related existential distress in people with advanced cancer, but the traditional protocol assumes supportive family structures, uses heteronormative language, and requires synchronous clinician facilitation. These features may limit accessibility for LGBTQ+ individuals. This pilot demonstrated that a self-written, tele-delivered LGBTQ+-affirming DT adaptation was feasible and acceptable for LGBTQ+ women with advanced cancer.

Building excellence: The journey to American Heart Association Certification Journal of Hospice & Palliative Nursing; by Fahey, Donna M. MSN, MFA, RN, AHN-BC, CHPN, CNL; 3/24/26 Heart failure patients often arrive at hospice with advanced symptoms, variable care plans, and limited coordination across settings. To address this, Samaritan Healthcare and Hospice pursued the American Heart Association Palliative/Hospice–Heart Failure Certification. The initiative required a full system redesign focused on standardizing education, documentation, care coordination, and performance measurements. This article outlines the challenges encountered ... and describes the process used to achieve certification in October 2025. 

Hearing on “Improving kidney health through better prevention and innovative treatment” U.S. House Committee on Ways and Means Subcommittee on Health; written testimony fo Dr. Robert Taylor; 3/18/26

MedPAC debates hospice payment updates via outlier, add-on payments Inside Health Policy; by Sigi Ris; 3/17/26 When it comes to addressing hospice provider’s high-cost treatments for patients with end-stage renal disease or cancer, Congress’ Medicare advisors seemed to support updating the hospice payment system with outlier payments rather than an add-on payment and commissioners debated the merits of creating a transitional care model for those patients that would reduce barriers to these support services. [Full access requires subscription, with option for 30 days free access.]