Literature Review

Surgeon perspectives on palliative care: Are we the barrier to better care?The Journal of Clinical Ethics; Sean J Donohue, Baddr A Shakhsheer, Peter Phung, Anthony W Kim, Monica Zell, Sean C Wightman; Fall 25Surgeons face numerous perioperative challenges when caring for patients with life-threatening or chronic diseases. Palliative care has been associated with an average reduction of $3,237 per admission, as well as reduction in emergency department visits, hospital admissions, and hospital length of stay. For patients within the intensive care setting, palliative interventions have shown a 26 percent relative risk reduction in intensive care unit length of stay and overall alignment of patients' and families' goals of care. It remains pervasive in surgical culture that operative intervention and palliation are mutually exclusive and occur sequentially, rather than concurrently. Preoperative palliative care consultations in surgical patients occur less than 1 percent of the time. Preoperative palliative care may serve to help explore, clarify, and document quality-of-life values and preferences, in hopes of better promoting goal-concordant care.

Communication surrounding treatment preferences for older adults with dementia during emergency medical services responseJournal of the American Geriatrics Society; by Lauren R. Pollack, Danae G. Dotolo, Anna L. Condella, Whitney A. Kiker, Jamie T. Nomitch, Elizabeth Dzeng, Nicholas J. Johnson, Thomas D. Rea, May J. Reed, Michael R. Sayre, Erin K. Kross; 9/25Emergency Medical Services (EMS) providers, capable of rapidly delivering life-prolonging interventions, are often first to respond to acute health concerns for older adults in the United States. Prior work has shown a preference among many people with dementia for comfort-focused care near end-of-life. EMS providers treating critically ill older adults with dementia face challenges that may hinder their ability to elicit treatment preferences, in particular when responding to calls from professional caregivers. Direct communication with surrogate decision-makers may facilitate goal-concordant care.Assistant Editor's note: Being an RN for over 40 years, I have seen many changes in health care, especially in what is expected now of patients/families. I remember the day when nurses were not permitted to share with the patient his/her own BP reading; instead, we were to tell patients to "ask the doctor". Back then the doctor controlled almost all aspects of the patient's care, as well as the sharing of information with the patient about his/her own medical condition. I am glad those days are gone. Now, patients are expected to engage in ongoing discussions regarding advance care planning, execute written advance directives, and are expected to share their care preferences with health providers and loved ones and/or caregivers. It would be an ideal world where health care providers were continuously aware of evolving patient preferences and could always deliver goal concordant care. I believe we need to keep working toward this goal, but I also understand that this expectation can add burden to patients who are already extremely burdened with the many difficult aspects of serious illness. I believe that, as health care providers, we need to appreciate that some people simply cannot or will not share their preferences; it is simply too scary, too foreign, too difficult to do so.

Instilling hope: A comprehensive model of cancer care for younger adults Targeted Oncology; by Andrea Eleazar, MHS and Shane Dormady, MD, PhD; 9/29/25 In the past decade, the incidence of numerous cancer types has increased, particularly among younger adults under age 50. For younger adults, many of whom are primary breadwinners of their households or in the height of their educational or professional careers, a cancer diagnosis at this life stage can be unexpected and jarring. ... In an interview with Targeted Oncology, Shane Dormady, MD, PhD, medical director of El Camino Health Cancer Center, describes the unique needs and challenges of younger adults, outlines El Camino Health’s comprehensive care strategy, and offers insights and considerations for treating and interacting with this patient population.

Rehab and death: Improving end-of-life care for Medicare skilled nursing facility beneficiariesJournal of the American Geriatrics Society; by Sarguni Singh, Christian Davis Furman, Lynn A. Flint, Joan Teno; 8/25Hospitalized older adults with serious illness may be discharged to a skilled nursing facility (SNF) [and] ... for those that do not improve, discharge to a SNF can begin a cycle of costly care transitions between hospital, home with home health care, SNFs, and long-term care facilities, leading to fragmented care and missed opportunities for discussions about preferences for care, illness understanding, and to address distressing symptoms. In this article, we describe key policies that contribute to high-cost, low-value care near the end of life for older adults using the Medicare SNF benefit.

How some people are using playlists to prepare for dyingBBC News; by Alex Taylor; 9/21/25  For years, local DJ Dave Gilmore soundtracked other people's nights out in pubs and clubs. But now he's curating a uniquely personal playlist - the songs of his own life to carry him through terminal illness. The list includes both November Rain and Sweet Child O' Mine by Guns and Roses, The Shadows by Apache - which inspired Dave to play guitar - and Pink Floyd's Comfortably Numb. ... Moments like this emphasise the power of music to forge everlasting connection. ... The impact is neurological as well as emotional, explains Sarah Metcalfe, managing director of the Utley Foundation's Music for Dementia campaign. Brain activity scans show music "lights up" multiple parts of our brain, simultaneously touching physical and emotional sense centres. "Even if one part of the brain is damaged, those other parts can still be accessed," Sarah says.

AI can aid in end-of-life care decisions, but can't replace human teams MarylandToday; by Fid Thompson; 9/19/25 “Would I be surprised if this person were not alive 12 months from now?”  This so-called “surprise question,” combined with clinical risk calculators, helps doctors make decisions about care for patients near the end of life. Increasingly, clinicians also use artificial intelligence (AI) models to predict remaining life expectancy and better inform palliative care decisions. In a recent study out in the Journal of Palliative Medicine, a University of Maryland researcher sought to understand what palliative care teams think about these AI tools that give an estimated life expectancy or prognosis in end-of-life care, and found mixed reactions. 

A rapid review of states' Portable Medical Order forms and the National POLST Paradigm for Advanced Care PlanningJournal of Hospice and Palliative Nursing; by Tracy Fasolino, Megan Pate, Nancy Dias, Rikki Hooper, Lena Burgess, Megan Golden, Savannah Horvick, Jamie Rouse, Elizabeth Snyder; 8/25Hospice and palliative care nurses initiate goals of care conversations with patients and family members while advocating for the completion of advance directives. As leaders in these conversations, nurses must have a working knowledge of the various forms, such as portable medical orders. The National Physician Orders for Life-Sustaining Treatment (POLST) Paradigm calls for the standardization of portable medical orders to ensure goal-concordant care that can cross all healthcare settings. This rapid review provides an overview of state-level portable medical order forms, compares and contrasts them with the National POLST form, and proposes policy recommendations for hospice and palliative care nurses to advocate within their state, territory, or tribal nation. 

“I know you didn’t want to stay”: Emergency Department conversations about disposition for people living with dementia The Gerontologist; Justine Seidenfeld, Matthew Tucker, Melissa Harris-Gersten, Gemmae M Fix, Nina R Sperber, Susan N Hastings; 8/25When people living with dementia present to the emergency department (ED), the disposition decision- to admit them to the hospital or discharge them home- can be difficult for providers. Major themes included 1) disposition conversations had significant variation in depth and content, 2) patient and care partner participation varied with disposition, and 3) satisfaction was driven by alignment of disposition preferences. Our study suggests that there are no consistent formats of disposition conversations for people living with dementia. Improving quality may be most needed when preferences are misaligned, and this should be identified early in the encounter.

Patient-and caregiver-identified goals for advance care planning in patients with dementia or cognitive impairmentDementia; by Kristin L Rising, Angela M Gerolamo, Nazanin Sarpoulaki, Venise J Salcedo, Grace Amadio, Robin Casten, Anna Marie Chang, Alexzandra T Gentsch, C Virginia O'Hayer, Barry Rovner, Brooke Worster; 8/25Despite an aging population and acknowledged importance of advance care planning (ACP) for persons living with cognitive impairment, few engage in ACP. Most existing tools to facilitate ACP discussions focus on medical outcomes, despite research documenting that persons with cognitive impairment often have quality of life outcomes as primary goals. This qualitative study engaged persons with mild cognitive impairment (MCI) or dementia and their carers to identify outcomes that are most important to inform development of a tool to guide ACP interventions with this population. Participants identified 23 outcome categories for ACP interventions within the following six domains: social life, family involvement, current lifestyle, physical independence, financial independence and healthcare goals. Of the 23 outcome categories, the majority (86%) were quality of life goals and only a small fraction (14%) were healthcare specific.

Why palliative care is more than just end-of-life support MedPageToday's KevinMD.com; by Dr. Vishal Parackal; 9/1/25 ... Palliative care as a system requires strong interpersonal and cross-specialty communication for smooth functioning, as patients may require expert opinions from different fields to optimize their treatment plan. Patient education for systemic follow-ups and establishing a baseline of knowledge regarding their diagnosis and potential danger signs helps create a better environment for holistic care. While we focus on the physical aspects of care and diagnosis, we often fail to realize the psychological and mental impact that such conditions can have on the patient and their family. ... The opportunity to make a meaningful difference in patients’ lives by easing their suffering and enhancing their quality of life is profoundly fulfilling. ... Editor's Note: Excellent descriptions of palliative care.

Physician billing for advance care planning among Medicare fee-for-service beneficiaries, 2016-2021The Permanente Journal; by Nan Wang, Changchuan Jiang, Elizabeth Paulk, Tianci Wang, Xin Hu; 8/25In 2016, the Centers for Medicare & Medicaid Services started reimbursing practitioners for their time spent providing advance care planning (ACP) with patients. Results: The percentage of practitioners billing ACP visits tripled from 1.76% in 2016 to 4.56% in 2021, with the highest percentage among hospice and palliative medicine practitioners (36.94%) in 2021. ACP service volume was similar by metropolitan status for hospice and palliative medicine, but it was higher in nonmetropolitan regions for cancer-related specialties, non-cancer terminal disease specialties, and primary and geriatrics care. This nationwide analysis showed low adoption of ACP billing by 2021, and it varied widely across specialties. This may reflect practical challenges of ACP related to comfort level with ACP discussion and documentation burden among the professional communities.

Integrating advance care planning into end-of-life education: Nursing students’ reflections on advance health care directive and Five Wishes assignmentsNursing Reports; by Therese Doan, Sumiyo Brennan; 7/25Advance care planning tools, such as the Advance Health Care Directive (AHCD) and Five Wishes, provide experiential learning opportunities [for prelicensure nursing students] that bridge theoretical knowledge with real-world patient advocacy. In this study, students were asked to complete either the AHCD or Five Wishes document as though planning for their own end-of-life care, encouraging personal reflection and professional insight. Students developed critical insights into their personal values, envisioned themselves in EOL scenarios, and reflected on their responsibility as future nurses. The assignment fostered both professional development and personal growth, making it a meaningful experience within the nursing curriculum. By encouraging students to engage personally with end-of-life decisions, the assignment cultivates empathy, ethical reflection, and a readiness to initiate sensitive conversations.

Palliative delays associated with increased length of stay in older traumatic brain injury patientsThe Journal of Trauma & Acute Care Surgery; by Sarah A Hatfield, Parima Safe, Cleo Siderides, Anjile An, Cassandra V Villegas, Nicole Goulet, Robert J Winchell, Elizabeth Gorman; 7/25Trauma Quality Improvement Program guidelines recommend early goals of care discussions (≤72 hours) for older patients with severe injuries. Patients (55 years or older) with moderate to severe TBI [traumatic brain injury] ... were retrospectively identified at a level I trauma center (2020-2022). Conclusions: Delayed PI [palliative intervention] is associated with increased LOS [length of stay] in older TBI patients, with no survival difference compared with early PI. Palliative interventions should be introduced early to reduce morbidity in patients with potential poor prognosis.