Literature Review

Assumptions and principles for responsible AI development and use in grief and bereavement careDeath Studies; by Melissa Lunardini, Chris Hall, Larissa Hjorth, Phyllis Kosminsky, Val Massdorp, Andy Hau Yan Ho, International Work Group on Death, Dying and Bereavement (IWG); 9/26The rapid integration of artificial intelligence (AI) into grief and bereavement care represents a significant technological shift with therapeutic potential and ethical complexity. This paper establishes evidence-informed assumptions and principles to guide the responsible development and use of AI technologies in grief support, addressing the needs of bereaved individuals, families, communities, professionals, technology developers, and policymakers. We conclude that AI technologies can complement human-centered grief support through responsible development characterized by interdisciplinary collaboration, transparency, cultural sensitivity, and an unwavering commitment to human dignity and welfare over commercial interests.

End-of-life care patterns by transplant eligibility among patients with end stage kidney diseaseJournal of Pain & Symptom Management; by Annie Liu, Jennifer F.N. Kizza-Brown, Ayman Al Jurdi, Ayesha M. Malik, Anushka Dalvi, Sharneet Sandhu, Lina Nurhussien, Nora K. Horick, Onyenma E. Obiejesie, Grace Bizup, Malia Armstrong, Kassem Safa, Sahir Kalim, Samantha Gelfand, Joshua Lakin, James A. Tulsky, Areej El-Jawahri, Nneka N. Ufere; 9/26Adults with end stage kidney disease (ESKD) often spend years awaiting kidney transplantation, during which transplant listing status frequently changes from active to inactive – a phase marked by evolving expectations. In the last year of life, patients had a median of two emergency department visits ... , two hospitalizations ... , and 25 cumulative hospital days ... Overall, 61% died in the hospital and 59% remained full code at death, and 18% were referred to hospice (median stay four days ... ) Conclusion: Adults with ESKD on dialysis experience intensive end-of-life care regardless of transplant eligibility. Switches to inactive status may represent a clinical inflection point to address prognostic understanding and transplant expectations.

Top ten tips palliative care clinicians should know about caring for people with interstitial lung diseasesJournal of Palliative Medicine; by Jyothsna Kuriakose, Jacopo D'Andria Ursoleo, Barney Isaac, Balamugesh Thangakunam, Donald R Sullivan, Kathleen Lindell, Anne-Marie Russell, Rachel Hadler, Matthew Maddocks, Natalia Smirnova, Russell Portenoy, M R Rajagopal, Sarah Mohammed, Anand S Iyer, Smriti Rana, Natasha Smallwood, Christopher A Jones, Jenifer Jeba Sundararaj; 9/26Interstitial lung diseases (ILD) represent a heterogenous group of illnesses with significant multidimensional suffering and varied prognoses. The complex care needs of people with ILD and their caregivers are underrecognized and incompletely addressed. This gap necessitates shared care by a multidisciplinary team along the illness trajectory. PC [palliative care] clinicians need to understand the illness patterns, prognoses, therapeutic options including lung transplant, symptom management, and other supportive interventions in ILD care. This article distills the current evidence into 10 practical tips to assist PC clinicians in delivering comprehensive care to people with ILD. Well-informed PC teams can significantly influence the illness experience of individuals with ILD and their caregivers, thereby reducing serious health-related suffering.

Communication and support needs of dementia care partners at end-of-lifeAmerican Journal of Hospice & Palliative Medicine; by Jordan M. Alpert, Michael B. Rothberg, Michael K. Paasche-Orlow, Ardeshir Z. Hashmi, Silvia Perez-Protto, Jacqueline Fox, Elaine Wittenberg; 9/26Care partners of people with dementia have many responsibilities, including providing care at end-of-life (EOL). Discussions about EOL are often delayed until late in the course of disease, if they occur at all. We found that clinician-initiated discussions and a positive perception of the clinician-care partner relationship contributed to care partners’ willingness to communicate. Care partners usually waited for clinicians to bring up EOL topics and felt apprehensive about these discussions, which hampered their ability to communicate effectively about EOL. Information-seeking was constrained by uncertainty about timing, lack of private discussion opportunities, and perceived limited personalization.

Advance Care Planning for Black and White older adults with serious illnessJAMA Network; by Kimberly S. Johnson, Deborah Ejem, Alyssa Platt, Maren Olsen, Tammie Quest, Nadine Barrett, Ramona Rhodes, Anupama Gangavati, Ronit Elk, Marie Bakitas, Marisette Hasan, Kenisha Bethea, Sherone N. Williams-Bryant, Felicia Underwood, Jane Lowers, Karen Steinhauser, Rowena Dolor, Raegan W. Durant; 10/7/26The EQUAL ACP Randomized Trial. Is a facilitated advance care planning (ACP) approach more effective than a self-guided ACP approach among Black and White adults 65 years or older with a serious illness? In this cluster randomized clinical trial of 789 participants, ACP completion (advance directive, clinician note, or family discussion about end-of-life care preferences) at 1 year did not differ significantly by intervention. Among Black participants, completion was 71% with the facilitated approach and 62% with the self-guided approach. Among White participants, it was 68% and 78%, respectively.

Ethics and professionalism in artificial intelligence and medical practice: A position paper from the American College of PhysiciansAnnals of Internal Medicine; by Matthew DeCamp, Lois Snyder Sulmasy, Kyle E. Karches, for the Ethics, Professionalism and Human Rights Committee of the American College of PhysiciansArtificial intelligence (AI) in health care is being rapidly adopted in perhaps one of the most rapid implementations of technology in medicine to date. Better thought of as augmented intelligence, as a tool that provides assistance to physicians and patients, many guidelines for its use have been issued, but consensus has not yet been achieved on issues such as privacy, disclosure, and fairness. Patients and physicians need ethical guidance at the point of care. Three guideposts described in this American College of Physicians position paper and rooted in the patient–physician relationship—principles of medical ethics, clinical integrity, and physician-independent practical reasoning—can inform the ethical use of AI: relationality, self-governance, and competence. This paper examines the implications of AI for patients, physicians, and health care and provides guidance for its ethical use.

Do not play: Recognizing spiritual distress in serious illnessJournal of Hospice & Palliative Nursing; by Jeanna A Ford; 9/26Spiritual distress is a significant yet frequently underrecognized component of serious illness and palliative care. Although spirituality is recognized as a core domain of quality palliative care, patients often express spiritual suffering through grief, mistrust, anger, identity, trauma, or existential concerns rather than explicitly religious language. This article explores the role of spiritual assessment and open-ended inquiry in recognizing spiritual distress through the case of an 86-year-old Black male with metastatic prostate cancer who repeatedly refused to answer standardized questions regarding spiritual distress. Although he identified as agnostic, broader conversations revealed profound sources of meaning, suffering, dignity, and peace shaped by experiences of racism, institutional mistrust, family, music, and legacy. The case illustrates how spiritual distress may emerge indirectly and highlights the limitations of relying solely on structured screening tools.

[Germany] Organ donation and brain preservation after assisted dying: Case report and considerations for a potential pathwayBMC Medical Ethics; by Alexander German, Alexander Grotemeyer, Katharina Koller, Markus Eckstein, Hannes Wolff, Stefan Rampp, Patrick Süß, Vincent C Müller, Dieter Birnbacher, Jürgen Winkler, Martin Regensburger; 9/26Protecting life and restoring health have been at the core of the conception of medical care since antiquity, for health professionals and the public alike. Assisted dying represents a practice that appears to challenge this traditional conception. In jurisdictions where assisted dying is condoned, the question remains as to whether the practice should be medicalized or deferred to non-medical actors. Irrespective of the divisive controversy surrounding assisted dying and its medicalization per se, the practice gives rise to high-stakes ethical, legal and organizational challenges when intersecting with organ transplantation, tissue banking, and Structural Brain Preservation or cryonics. In this narrative account, we describe the contextual framework and outline our experience and operational scope for addressing them at a university hospital in Germany. Based on this description we propose a structured pathway for increasing donation and preservation options for terminal patients while retaining ethical integrity and professional accountability.

Evaluation of palliative care technical skills in an acute care setting: A simulation-based, qualitative assessmentAmerican Journal of Hospice & Palliative Care; by Daniel Boron-Brenner, Alexzandra Gentsch, Jenna Campolieto, Sepehr Sedigh-Haghighat, John Liantonio; 8/26Emergency physicians frequently encounter patients with serious illness, yet training in palliative care competencies remains inconsistent during emergency medicine (EM) residency. The objective of this study was to qualitatively examine EM residents' perceptions of the intersection between palliative care and emergency medicine following participation in palliative care-focused simulation scenarios. Residents reported uncertainty regarding core palliative care competencies, including interpretation of advance directives, documentation of do-not-resuscitate/do-not-intubate orders, and clinical decision-making during peri-arrest and resuscitation scenarios. Emotional responses included hesitancy and discomfort during high-stakes decision-making, particularly in the setting of limited information. Palliative-focused simulation elicited perceived knowledge gaps and emotional responses relevant to emergency care delivery. Simulation-based education may offer a structured approach to integrating palliative care competencies into EM training.