Literature Review

P4s are either unhelpful or unnecessary. Proposing a better AI-powered solution to predict patients' preferencesBioethics; by Beatrice Marchegiani; 5/26The Personalized Patient Preference Predictor (P4) has been proposed as an AI tool to aid surrogate decision-making when incapacitated patients lack advance directives. This paper argues that P4s face a fundamental dilemma: they are either unnecessary or unhelpful. To address  ... [its] limitations, I propose a better AI-powered alternative: the Patient Preference Retriever (PPR). Rather than generating new text, the PPR uses vector search techniques to retrieve relevant statements from a patient's digital footprint, presenting them verbatim alongside metadata such as date, context, and source. This approach offers greater transparency, respects autonomy more reliably, and supports surrogate decision-makers in weighing authentic evidence. I conclude that while advance directives remain the gold standard, retrieval-based approaches like the PPR provide a more reliable and ethically defensible use of AI in surrogate decision-making than generative approaches like P4s.

Stakeholder perspectives on integrating ADEPT into end-of-life care for nursing home residents with dementia: A qualitative descriptive studyInternational Journal of Older People Nursing; by Susanny J Beltran, Latarsha Chisholm, Emily Jaijairam; 5/26Nursing homes care for a significant proportion of individuals with advanced dementia, yet timely hospice referrals remain a challenge. The Advanced Dementia Prognostic Tool (ADEPT) is a mortality risk score instrument that holds promise for improving care planning by providing a standardised, accessible method for identifying residents at risk of death within 6 months. Current processes for identifying hospice-eligible residents rely on regular assessments and interdisciplinary collaboration but reveal significant gaps, including delays in referrals and inconsistent practices. Participants viewed ADEPT as a promising tool to complement goals-of-care conversations and enhance care planning, rather than exclusively triggering hospice initiation. Implementation barriers included the need for electronic system integration, regulatory compliance and staff education, while facilitators encompassed strong leadership support, interdisciplinary coordination and alignment with existing workflows.

The clinical relevance of sleep disturbance ("insomnia") in patients with advanced cancer receiving palliative care: A scoping reviewSupportive Care in Cancer; by Shauna Munir, Eva Jones, Faith Precious Omeokwe, Andrew Neil Davies; 5/26Sleep disturbance ("insomnia") is common in patients with advanced cancer receiving specialist palliative care. The studies highlight that sleep disturbance is associated with a range of physical symptoms (e.g. fatigue, drowsiness), a variety of psychological problems (e.g. anxiety, depression), impaired quality of life, and reduced overall survival. Sleep disturbance is an "orphan" symptom, and the results of this scoping review suggest that it deserves much greater attention. Indeed, healthcare professionals should screen all palliative care patients for the problem and, when identified, perform a thorough assessment and initiate an appropriate treatment.

 The impact of assisted dying legislation on nursing practice in palliative care: a scoping review Journal of Advanced Nursing; by Marlene Werner, Christiane Kreyer, Sabine Pleschberger; 6/5/26 Aim: To review the literature on the state of research on the impacts of assisted dying on nursing practice within specialised palliative care. Results: Fifteen studies published between 2019 and 2024, all from Canada or the United States, met the inclusion criteria. Three themes were identified: (1) positioning and meaning, describing how nurses are required to position themselves and to renegotiate their values; (2) impact on core competencies, capturing changes in key nursing responsibilities; and (3) challenges in interpersonal relationships, referring to increased team conflicts and shifts in relationships with patients and their families. 

[Italy] Understanding the evolving role of early palliative care in myelodysplastic syndromes: A 2026 narrative reviewAnnals of Hematology; by Pasquale Niscola, Valentina Gianfelici, Marco Giovannini, Carla Mazzone, Maria Ilaria Del Principe; 5/26Myelodysplastic Syndromes/Neoplasms (MDS) are a heterogeneous group of blood cancers characterized by a broad spectrum of symptoms and varying impacts on quality of life (QoL). Although the integration of early PC care has long been recognized as an essential part of comprehensive management for patients with solid tumors, experience in the context of MDS is still limited. However, symptom control, QoL, advanced care planning goals, the reduction of aggressive therapies, intensive care use, including intubation before death, and resource use in the end-of-life (EOL) phase are critical issues that are enhanced through early PC in MDS management. Additionally, integrating standard hematological measures with early PC leads to fewer visits and hospital admissions near the EOL, particularly during the last 30 days. Moreover, patients with early PC die at home or in hospice care at a rate nearly in line with their preferences.

Hospice enrollments from the Emergency Department feature short admissions and high-acuity hospice care Health Affairs; by Helen P. Knight, Kourosh Ravvaz, Alexander Fiksdal, Lin Shen, Isaac S. Chua, Claire K. Ankuda, Haiden A. Huskamp, Hojjat Salmasian, Joan M. Teno, and David W. Bates; 6/1/26 ... The 10 percent of hospice agencies with the highest proportion of ED-to-hospice enrollments were less often for-profit than agencies ranked below the fiftieth percentile in respect to proportion of ED-to-hospice enrollments. Further research is needed to increase understanding of how much patients benefit from ED-to-hospice transfers when their hospice stays before death are very short, and what drivers lead to these ED-to-hospice transfers.

First do no harm: communication surrounding non-beneficial treatments American Journal of Hospice and Palliative Medicine; by Cassie Stanzler, MD, Adam Marks, MD, MPH, and Laura Taylor, MD, MSc; 5/21/26 Despite a consensus in the medical community that clinicians should not offer non-beneficial treatments (NBTs) to their patients, little guidance exists on the particular communication needs around this fraught topic. While intended in the spirit of non-maleficence, setting limits around NBTs can be seen by patients and families as abandonment, resulting in conflict. In this paper, we propose a framework to guide Palliative Care clinicians in communicating about these complex issues with patients and families. ... Our framework emphasizes proactive relationship building with patients and families, close attention to their values, and compassionate limit-setting when medically appropriate.