Literature Review

New tool predicts dementia years before onset Medscape; by Megan Brooks; 11/14/25 A new predictive tool combining amyloid PET data with key clinical factors estimates an individual’s lifetime risk for mild cognitive impairment (MCI) and dementia years before symptoms, potentially transforming the way risk is assessed. The model combines age, sex, APOE-ε4 status and findings on amyloid PET scans, with amyloid PET results having the largest effect on risk. The lifetime and 10-year absolute risk for MCI and dementia in older adults with normal cognition increased continuously with increasing centiloid value for all combinations of sex and APOE-ε4 status.

Respecting the right to refuse: Is decision-making capacity disproportionately challenged in patients declining medical care in order to treat?Journal of Neurosurgery: Case Lessons; by Jacqueline Boyle, Nicholas Comardelle, Alexis Carter, Jeffrey Klopfenstein, Todd McCall; 10/25There is a consensus that withholding aggressive medical care in medically futile situations is ethically sound, even if the patient, surrogate, or family wants everything done. The authors aim to evaluate and discuss the situations in which this request is used as justification for intervention, specifically lifesaving surgery, when a situation is defined by a futile outcome. The authors utilize the illustrative case of an older female who presented with a traumatic brain injury and Duret hemorrhage, an unfortunately common scenario faced by neurosurgeons, to discuss the complex ethical and practical implications of these situations. They seek to define futility, provide an overview of basic medical ethical principles, and evaluate both the motivation to operate and the educational gaps among patients, families, and providers. Review of the basic principles of medical ethics lends to the conclusion that the demands of a patient’s family are not adequate justification for surgical intervention in cases, such as the present one, in which a patient is unlikely to benefit.

Heart failure with reduced ejection fractionMedical Clinics of North America; by Ebrahim Barkoudah, Clyde W Yancy; 11/25Heart failure (HF) is no longer centered on the failing ventricle. Various salutary treatment discoveries now support substantially improved survival with lesser likelihood for urgent care or hospitalization. Advanced care strategies are effective, but not only includes mechanical circulatory assist and heart transplantation, but also clinical trial participation, palliative care, and hospice. At the patient level, longer healthier lives, in concert with expert management of ventricular dysfunction, becomes the contemporary expectation.

Cannabis laws and opioid use among commercially insured patients with cancer diagnosesJAMA Health Forum; by Felipe Lozano-Rojas, Victoria Bethel, Sumedha Gupta, Shelby R. Steuart, W. David Bradford, Amanda J. Abraham; 10/25To date, 39 states and Washington, DC, have enacted medical cannabis laws (MCLs) providing cannabis availability for patients with qualifying conditions, including cancer, while 24 states and Washington, DC, have passed recreational cannabis laws (RCLs) legalizing adult-use cannabis. While opioids remain the recommended treatment for cancer pain, these patients may benefit from cannabis availability for adjuvant therapy. We found significant reductions in all measures of opioid prescription dispensing following MCD and RCD openings. These findings are consistent with prior research suggesting that cannabis may serve as a substitute for opioids in managing pain.

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.

Grateful patient finds strength and support through UConn Health’s ALS Program UConn Today; by Jennifer Walker; 11/17/25 ... ALS, also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that affects the nerve cells in the brain and spinal cord responsible for muscle movement. ... Originally conceptualized by Dr. Amanda Hernandez, division chief of Neuromuscular Medicine, the UConn Health ALS and MD Program provides a “one-stop shop” for patients with progressive neuromuscular diseases that often require coordination across multiple specialties. ... “Our social worker meets every patient,” said Viguera Altolaguirre. “We address caregiver stress, financial barriers, and emotional coping. Palliative care helps patients navigate difficult decisions about feeding tubes, ventilation, and future planning—always at their own pace and comfort level.” 

Trends of palliative care utilization for nontraumatic intracerebral hemorrhage: Analysis of the national inpatient sampleJournal of Clinical Neuroscience; by Andrea Loggini, Victor J Del Brutto, Faddi G Saleh Velez, Jonatan Hornik, Denise Battaglini, Shawn S Wallery, Amber Schwertman, Alejandro Hornik, Christos Lazaridis, Adnan I Qureshi; 10/25We investigated the trends and hospital outcome measures associated with the utilization of consultative palliative care (PC) services among patients with nontraumatic intracerebral hemorrhage (ICH). Of 452,250 ICH cases during the study period, 69,360 (15.3 %) received PC. ... ICH patients receiving PC were older, ...more frequently women, ... White, ... and more likely to be in the highest income quartile ... Conclusions: The use of PC in ICH patients has increased over the past two decades. PC is associated with more efficient healthcare resource utilization and higher odds of discharge to hospice/in-hospital mortality. Disparities in PC utilization persist among underprivileged groups and racial minorities.

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.

Home-based psilocybin-assisted therapy for a patient with advanced cancer: A case reportPalliative & Supportive Care; by Houman Farzin, Benjamin Koren, Héléna Ferrier, Justin J Sanders, Nicolas Garel; 10/25 Psychospiritual distress affects many patients with cancer, contributing to diminished quality of life, decreased survival and a desire for hastened death. The current standard of care, which primarily consists of antidepressants and psychotherapy, has demonstrated only modest benefits. Psilocybin-assisted therapy (PAT) has shown evidence of rapid, durable, and significant effects on measures of both depression and anxiety in this patient population. A 51-year-old man diagnosed with metastatic lung cancer, referred to palliative care (PC) with a prognosis of less than 6 months, experienced depression and anxiety in the context of demoralization and existential distress. PAT was well tolerated, with significant decreases in both anxiety and depression [and] the patient subjectively reported a sustained reduction in suffering and improved well-being at 2 months post-intervention. 

Using natural language processing to assess goals-of-care conversations for patients with cancerJCO Clinical Cancer Informatics; by Melissa K Greene, Gloria Broadwater, Donna Niedzwiecki, Thomas W LeBlanc, Jessica E Ma, David J Casarett, Brittany A Davidson; 10/25This is a retrospective review of patients at a single US center who died with cancer between 2018 and 2022, and had documented GOC [goals of care] notes in the last 12 months of life. Eight GOC components were identified: current understanding of illness, information preferences, prognostic disclosure, goals, fears, acceptable function, trade-offs, and family involvement. The most common GOC component addressed was family involvement (75.0%) and the least common was fears (21.1%). Only 5.4% had all eight components documented. More comprehensive GOC notes were associated with lower rates of aggressive EOL care; 73.2% received aggressive care when 0/8 components were documented, compared with 56.8% and 50.3% with six or seven components discussed, respectively.

New guidance offered for responsible AI use in health care - American Heart Association Science Advisory American Heart Association; by Newsroom; 11/10/25 Published in the Association’s flagship journal, Circulation, the advisory, “Pragmatic Approaches to the Evaluation and Monitoring of Artificial Intelligence in Healthcare,” introduces a pragmatic, risk-based framework for evaluating and monitoring artificial intelligence (AI) tools in cardiovascular and stroke care. It builds on prior published AI frameworks to identify critical gaps in current practices. 

Evaluating the frequency, quality, and timing of advance care planning among patients with metastatic breast cancerJCO Oncology Practice; by Charlotte Linton Early, KyungSu Kim, Xianming Tan, Emily Miller Ray; 10/25We identified a cohort of 1,112 patients with MBC [metastatic breast cancer] with a median age of 62 years and time since MBC diagnosis of 1.4 years. ACP [advance care planning] was generally low ... and only 11% of patients ... had an ACP note. Within ACP notes, documentation of key elements of serious illness communication was low: 23% for prognosis, 41% for metastatic diagnosis, 18% for non-curative treatment goals, 51% for patient values, 50% for treatment options, and 69% for treatment decisions. Notes by inpatient clinicians had higher quality (44%) when compared to outpatient oncologists (14%), outpatient palliative care providers (3%), and primary care providers (5%...). The low frequency, poor quality, and late delivery of advance care planning and documentation among patients with metastatic breast cancer represent a gap in cancer care quality. 

Living with dementia report emphasizes that even those with advanced disease have stories to share JAMA Medical News; by Rita Rubin, MA; 10/31/25 As the average age of the US population has risen, so has the number of people living with Alzheimer disease and related dementias. And yet, dementia is still a highly stigmatized condition, a new collection of essays published by the Hastings Center for Bioethics points out. Clinicians, caregivers, and loved ones could improve the lives of the more than 7 million people in the US who are living with dementia if they only recognized that such individuals still have their own stories to tell, even when they can’t express themselves the same way they did before their symptoms appeared.