Literature Review

Nursing home residents, family members, and staff members views about a good death and preferred place of death for a nursing home residentOmega-Journal of Death and Dying; Janet Sopcheck, Ruth M. Tappen; 2/25Our study ... revealed that residents, like family members and staff members, had mixed opinions of the place of death for the NH resident, highlighting the importance of having advance care planning sessions with residents and their families to gain an understanding regarding their choices. Our study found the predominant and common qualities across the three participant groups of a good death include painless or pain-free, without suffering, peaceful, quiet, and dying in my sleep. Interestingly, almost one-fifth of the participants disagreed with the term good death, offering that death is not good as the person is no longer alive. Based on this study’s finding, using the term a good death in research and in advance care planning sessions may not be relevant or appropriate and instead focus on what care is necessary to promote a natural death, as mentioned by a few participants.

Hastening death by stopping eating and drinking: Hope Wechkin, Thaddeus Pope, and Josh Briscoe GeriPal Podcasts; by Hope Wechkin, Thaddeus Pope, and Josh Briscoe Eric and Alex have featured discussions about complex bioethical concepts around caring for people at the end of life, including voluntarily stopping eating and drinking (VSED), and multiple episodes about the ethical issues surrounding medical aid in dying (MAID). Recently, discussion has emerged about how these issues intertwine in caring for patients with advancing dementia who have stated that they would not want to continue living in that condition: for those with an advanced directive to stop eating and drinking, how do we balance caring for their rational past self and their experiential current self? Should these patients qualify for medical aid in dying medications? And is there a middle path to provide some degree of comfort while also hastening the end of life?

[Australia] Advance care planning has brought 'comfort and peace' to Annaliese Holland ABC News; by Eva Blandis and Daniel Keane; 3/19/25Young South Australian woman Annaliese Holland, who is preparing for major high-risk surgery, has spoken about the importance of advance care planning. The 25-year-old was diagnosed with a rare autoimmune disease and terminal illness several years ago. Ms. Holland wants young people to have more open conversations about death and end-of-life care. ... "I say my life is like walking on a field of landmines, not knowing when it will go off,"  she said. While it is a harrowing statement, she is harnessing her situation to help others — Ms. Holland is a strong supporter of advance care planning.

Impacting end-of-life care with new healthcare legislation: Patient-Directed Medical Orders (PDMO) in advance care planningAmerican Nurse - State Nurses Associations - Florida News Journal; by Meredith Fischer, BSN, RN, CHPN; 3/19/25 Over the summer, a friend’s elderly father underwent resuscitation and intubation because his nursing facility could not locate his Do Not Resuscitate Order (DNRO) or Advanced Directive (AD). ... New legislation is being filed for a Patient-Directed Medical Order (PDMO) document designed to address the shortcomings of the ADs and DNRO forms—currently the primary tools for addressing end-of-life care preferences in Florida. The PDMO form originates from the POLST paradigm, which has been adopted by most states since its inception in Oregon in the early 1990s (National POLST, 2022). Healthcare professionals recognized that many individuals were not receiving the end-of-life care outlined in their ADs and DNROs due to accessibility, clarity, and practicality (National POLST, 2022).

Why aging parents make DNR choices before crisis strikes Rolling Out 25; by Khalil Best; 3/17/25The conversation typically begins quietly. ... An aging parent mentions their desire for a Do Not Resuscitate order—commonly known as a DNR—and the atmosphere in the room shifts. For many adult children, this moment arrives unexpectedly, triggering complex emotions ranging from denial to grief. Yet these discussions, uncomfortable as they may be, represent one of the most meaningful exchanges families can share. Understanding why many elderly parents choose to sign DNR orders in advance illuminates not just practical healthcare concerns, but deeper values about dignity, autonomy, and what constitutes a meaningful life.

[UK] RCGP shifts to position of neither supporting nor opposing assisted dying RCGP - Royal College of General Pracitioners, London, UK; Press Release; 3/14/25 The Royal College of General Practitioners' Council has voted to move to a position of neither supporting nor opposing assisted dying being legal. The RCGP UK governing Council - elected representatives of the wider College membership – today voted to determine what the College’s stance should be on whether or not assisted dying should be legal:

How Houston Methodist’s ACO reduced its end-of-life spending by nearly 20% MedCity News - Hospitals; by Katie Adams; March 10, 2025 Houston Methodist Coordinate Care is reducing costs through a partnership with Koda Health, a digital platform that guides patients through their end-of-life choices. Preliminary findings show the technology resulted in a 19% reduction in the total cost of care for patients at the end of their life, which equals nearly $9,000 in savings per patient. ... The ACO has been working with Koda Health for more than three years — and it is saving money by getting patients more involved in their end-of-life care plan.

At the end of life, doctors’ actions and patients’ wishes may be misaligned, according to a Rutgers Health study Rutgers; by Greg Bruno; 2/28/25 For terminally ill cancer patients, the final days of life are immensely personal, having the choice to continue cancer treatments, or to stop treatments and prioritize a more comfortable passing. What a patient wants, however, isn’t always what they receive, according to a Rutgers Health study published in the journal Cancer. “A patient's end of life is often not a reflection of what they want, but rather, who their oncologist happens to be,” said Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, and lead author of the national study. “The data doesn’t indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients,” says George, who is also a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, the state’s only National Cancer Institute-designated Comprehensive Cancer Center. ... [Click on the title's link for more statistics, insights, and recommendations.]

[UK] Coming to terms with dying: Advance care planning as a conduit between clinicians, patients, and conversations about death and dying - A qualitative interview studyPalliative Medicine; Rowena Jane Eason, Lisa Jane Brighton, Jonathan Koffman, Katherine Bristowe; 2/25Advance care planning elicits multiple complex thoughts, emotions, and behaviours, with responses ranging from the procedural to the profound. Discussions empowered and instilled confidence, promoted openness with relatives, encouraged people to make the most of their time remaining, and sometimes contributed to coming to terms with their mortality. Factors influencing experiences of discussions reflected the complexity and diversity in participants' lives, personalities, and life experiences, with discussions exposing the realities of living with terminal illness. 

Explaining racial and ethnic disparities in advance care planning: A decomposition analysisJournal of Pain and Symptom Management; Yifan Lou, Emma Zang, Qianqian Li; 2/25The ACP [advance care planning] disparities between White and Hispanic populations were nearly twice as large as the disparity between White and Black populations. Interventions targeting less educated older Black and Hispanic individuals should be prioritized to narrow the ACP disparity. Negative healthcare experiences in previous care and household dynamics should be addressed while working with Black and Hispanic older adults, respectively.

Central Coast VNA & Hospice expands registered nursing services in Monterey Buzz; 3/5/25 Central Coast VNA & Hospice is significantly expanding its registered nursing care services in Monterey, providing residents with increased access to high-quality, personalized healthcare delivered directly in their homes. … Key expanded services include advanced care planning, which helps patients and families make informed medical decisions, and a palliative care program focused on relieving symptoms and reducing stress for patients with serious illnesses. The organization also offers specialty programs targeting specific health conditions such as cardiac care, diabetic care, and orthopedic support. 

Patient put in hospice at 52 celebrates life years after admission, thanks to heart surgery KCTV-5, Kansas City, MO; by Morgan Riddell; 2/27/25 A local man with heart failure who was told numerous times he only had months to live now has a new outlook on life two years later. ... It started in 2023. Sam Edwards, who was diagnosed with ALS after serving in the military, started experiencing new pains. He went to doctors who all determined Sam was just experiencing issues related to ALS. Then, a doctor at the VA Hospital noticed some tests were off and found Sam was experiencing heart failure. What he needed was open heart surgery, but doctors determined the risk of putting Sam on the operation table was too high. Not only was he at risk of having a stroke and dying on the operating table, but his recovery would also be months long and painful. They declined to do the surgery at the VA and suggested Sam go get a second opinion. This is when he was connected with Dr. Michael Gibson.Editor's note: While we in the palliative and hospice field promote earlier admissions to care and elimination of overtreatment, another side of the coin exists. Click on the title's link to read more about this hospice patient who sought out a second opinion. Imagine: the hospice patient is you (at age 52); or a family member; or a best friend. Especially as AI becomes more prevalent in assessing palliative and hospice referrals, we must see the bigger picture and retain human element. 

45% of end-of-life cancer patients potentially overtreated: 5 study notes Becker's Hospital Review; by Elizabeth Gregerson; 2/28/25 Almost half of all Medicare enrollees with cancer nearing end of life receive aggressive overtreatment as opposed to supportive palliative or hospice care, according to a study published Feb. 21 in JAMA Health Forum. Here are five things to know from the study: