Literature Review

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.

Achieving goal-concordant care with goals of care consultations in the Emergency Department American Journal of Hospice and Palliative Medicine; by Stacy Nilsen, PhD, RN, Diane Wintz, MD, Kelly Wright, MSN, MBA, RN, Debra Poeltler, PhD, MPH, RN, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA; 10/24/25 Introduction: Time constraints may be prohibitive to adequate goals of care (GOC) discussions and could delay critical decision making in urgent or emergent situations. ... Method: A retrospective record review was conducted for patients 65 and older at a single community hospital between January and December 2023. Included patients had at least one GOC documented discussion with a nursing team called Advanced Illness Management (AIM) and were admitted or placed in observation. ... 3377 patients met the inclusion criteria. ... Conclusions: There were positive findings in LOS, ICU, and cost with AIM consultation within 24 hours of presenting to the ED, when compared to waiting for a later consultation, supporting consideration of forward-placement of GOC discussion.

Difference-making factors linked to higher reach of Specialist Palliative Care among people with heart failure across a national sample of VA Medical Centers American Journal of Hospice and Palliative Medicine; by Yan Zhan, PhD, RN, MBA, Edward J. Miech, EdD, Erica A. Abel, PhD, MD, and Shelli L. Feder, PhD, APRN, FPCN, FAHA; 11/10/25 Conclusion:  High Specialist Palliative Care (SPC) reach among people with advanced heart failure (aHF) was linked to combinations of several modifiable factors related to staffing, cardiology involvement, and outpatient palliative care. These findings provide actionable insights into improving SPC delivery across VAMCs.Editor's Note: What education or other partnerships do you have with VA Medical Centers in your service areas? Or, what gaps for veterans exist because of a lack of VA Medical Centers? Use these "combinations of modifiable factors related to staffing, cardiology involvement, and outpatient palliative care" for your strategic planning to improve care for veterans struggling with advanced heart failure.

What matters about what matters mostJAMA Network Open; by Mary E. Tinetti, Brenda S. Nettles; 10/25The authors note that “Identifying what matters is essential for providing person-centered care, guiding clinical visits, tailoring care plans, and providing a starting point to foster further patient engagement.” These are lofty expectations of a single, simple question ["what matters most?"]. While the what matters question alone cannot guide care planning or tailor interventions, it can serve as a starting point for ongoing conversations about patient health goals and care preferences. These priorities, in turn, can guide patient-centered decision-making and care. The question also provides an opportunity to get to know the patients we care for as individuals. That, in itself, is an invaluable gift reminiscent of a period when clinicians had more time with patients and cared for them over years.

Effectiveness of a telephonic Aging Brain Care Model for Medicaid Home and Community Services for dementia patients and their caregiversJournal of the American Geriatrics Society; by Malaz A Boustani, Steven R Counsell, Anthony Perkins, Abdelfattah Alhader, Kathryn I Frank, Diana P Summanwar, Karen L Fortuna; 10/25The primary purpose of the present study was the implementation and evaluation of the ABC Community program, a community-based and telephonically administered version of the Aging Brain Care model delivered by Area Agencies on Aging (AAAs) staff. This study employed a ... design with ... the main outcome measure being the total score of the Health Aging Brain Care (HABC) Monitor at 3- and 6-month follow-up. The HABC Monitor has demonstrated excellent reliability and validity in monitoring and measuring the burden of dementia symptoms and the quality of life and stress of the informal caregivers. Approximately 46% of informal caregivers who had at least mild burden at baseline had no such burden at 6 months, and 92% of those who had no stress at baseline remained burden-free at 6 months. Conclusion: The ABC community program might be a scalable collaborative dementia care model targeting socially vulnerable people living with dementia.

State-level variability in location of death of patients with end-stage liver diseaseDigestive Diseases & Sciences; by Julia Meguro, Michael Huber, David Goldberg; 10/25 Although deaths from end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in the United States increasingly occur at home or in hospice, inpatient medical facility deaths remain high. Despite the decrease in in-hospital deaths for all causes, non-White decedents are more likely than White decedents to die in a hospital setting. This study aimed to determine state-level variability in the location of death among patients with ESLD and HCC and to assess racial/ethnic differences in these patterns, focusing on Black, White, and Hispanic/Latino patients. Findings from this study identify states where policies and programs that reduce inpatient deaths for ESLD patients may be most needed. Targeted interventions to improve access to high-quality EOL care for all patients address the national variability of hospice use, especially for those who are Black or African American and in states with high numbers of inpatient deaths and low rates of hospice use, should also be identified and implemented.

Developing medical cannabis competencies-A consensus statementJAMA Network Open; by Yuval Zolotov, Leslie Mendoza Temple, Richard Isralowitz, David A. Gorelick, Rebecca Abraham, Donald I. Abrams, Kyle Barich, Kevin F. Boehnke, Stephen Dahmer, Joseph Friedman, Patricia Frye, Aviad Haramati, Jade Isaac, Mary Lynn Mathre, Marion E. McNabb, Melinda Ring, Ethan B. Russo, Deepika E. Slawek, Brigham R. Temple, Genester S. Wilson-King, Julia H. Arnsten, Mikhail Kogan; 10/25An initial list of 9 competencies was refined and consolidated into 6 core competencies [for the use of medical cannabis]: (1) understand the basics of the endocannabinoid system; (2) describe the main components of the cannabis plant and their biological effects; (3) review the legal and regulatory landscape of cannabis in the US; (4) describe the evidence base for health conditions that are commonly managed with cannabis; (5) understand the potential risks of medical cannabis use; and (6) understand basic clinical management with medical cannabis. Each competency is supported by 2 to 7 subcompetencies, resulting in 26 subcompetencies reflecting granular topics, such as patient safety, vulnerable populations, structural inequities, and interdisciplinary care. These consensus-derived competencies provide a structured, evidence-informed foundation to guide the integration of medical cannabis into undergraduate medical education.

When hospice referrals are placed to improve acute care hospital mortality metricsJournal of Pain & Symptom Management; by Gina M Piscitello, Emily Martin, Gregg A Robbins-Welty, Ryan Baldeo, Joseph Shega, Michael T Huber; 10/25Risk-adjusted inpatient mortality is one way in which the quality of US acute care hospitals is assessed. While the specification of inpatient mortality measurements can vary, patients transitioned to general inpatient hospice (GIP) status are often excluded. GIP is one of four levels of hospice care intended for short-term inpatient management of uncontrolled symptoms that cannot be effectively managed in another setting. This care may be provided in acute care hospitals through partnerships with hospice agencies. As such, a patient may potentially be discharged from the hospital and enrolled in GIP in the same hospital location, even the same bed, and excluded from the hospital’s inpatient mortality measures.

Improving access to inpatient hospice: Implementation and impact of a dedicated comfort care service in a tertiary care hospitalJournal of Palliative Medicine; by Neha Kayastha, Eric Pollak, Yvonne Acker, David Fisher, Noppon Setji, David Casarett; 10/25Many hospitalized patients on comfort care (CC) have a high symptom burden and qualify for General Inpatient Hospice (GIP) care. At our institution, many hospitalized patients who qualified for GIP were unable to discharge to stand-alone hospice facilities due to clinical instability or lack of beds. In July 2022, we created the General Medicine 24 (GM24) Comfort Care and Hospice Team to improve access to high-quality hospice services for hospitalized CC patients. In the three years since the creation of GM24, GIP admissions have increased annually, now 107% higher compared to the year before GM24 was created. Discharges to stand-alone inpatient hospice facilities have increased by 65% in the three years since GM24 was created compared to the year before GM24 was created.

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. 

Clinician and parent perspectives on essential psychosocial care in pediatric cancerJAMA Pediatrics; by Kimberly S. Canter, Anne E. Kazak, Natalie Koskela-Staples, Michele A. Scialla, Kimberly Buff, Emily Pariseau, Victoria A. Sardi-Brown, Julia B. Tager, Lori Wiener; 10/25The Standards for Psychosocial Care for Children With Cancer and Their Families provide guidelines for evidence-based psychosocial care for children with cancer and their families. The Implementing the Standards Together: Engaging Parents and Providers in Psychosocial Care (iSTEPPP) study extends the standards through innovative collaborative research between clinicians and patient and family advocates, with the goal of widespread clinical implementation of standards that clinicians and parents or caregivers agree to be priorities. The 3 standards prioritized by parents and clinicians in this study offer insight into shared priorities for psychosocial care in pediatric cancer. However, misalignment on other priority standards (parental mental health, palliative care, and neurocognitive monitoring) highlights the differences in perception between parents and clinicians. Areas lacking agreement are a stark reminder of potential challenges when working to meet the holistic needs of children with chronic diseases and their families, as clinicians and parents may not agree on which needs are most important.

Compassionate care, measurable impact: Evaluation of embedded physician-led palliative care in a community oncology practiceJCO Oncology Practice; by Haibei Liu, Jillian Hellmann, Jessica Heintz, Geoffrey Daniel Moorer, Karen Miller; 10/25This analysis indicates that embedding palliative care physicians within a community oncology practice significantly increases hospice enrollment and LOS [length of stay] greater than 3 days. These findings support a cooperative care model as a practical strategy for integrating palliative care physicians into community-based oncology practices to improve patients’ EOL outcomes.