Literature Review

Restarting medications after deprescribing in adults discharged from hospital to skilled nursingJAMA Network Open; by Thomas J. Reese, Sandra F. Simmons, Eduard E. Vasilevskis, Emily K. Hollingsworth, Matthew S. Shotwell, Amanda S. Mixon; 6/26Question: Among older adults discharged to skilled nursing facilities (SNFs) after hospital-initiated deprescribing, what is the frequency and timing of medication restarts ...? In this cohort study analyzing data from 2 randomized trials with a total of 598 participants, 15.9% of deprescribed medications were restarted. Higher health literacy and longer intervention exposure were associated with fewer restarts, whereas more prescribers, higher number of baseline medications, and fewer pharmacies were associated with medication restarts; restart during the SNF stay was associated with greater 90-day hospital readmissions. Conclusions: In this cohort study, approximately 1 in 6 deprescribed medications were restarted within 90 days, with nearly half occurring soon after SNF discharge. Patient factors and markers of care fragmentation were associated with restart, suggesting that enhancing transitional care and postdischarge support may improve the durability of hospital-initiated deprescribing.

When technology meets its limits: Integrating Medical Aid in Dying with withdrawal of a left ventricular assist deviceCureus; by Yvette Vieira, Paola Reveco; 6/26As outcomes improve and patients [with advanced heart failure] live longer with [surgically implanted left ventricular assist devices], ... clinicians across disciplines are increasingly confronted with the complex clinical, ethical, and practical challenges that arise when life-sustaining therapy is dependent on implanted technology, particularly in the context of end-of-life decision-making. We present a case report of a 76-year-old man with advanced heart failure supported by an implanted cardiac pump [who wanted to pursue] ... medical aid in dying ... [in his own home] ... Deactivating a cardiac assist pump typically occurs in a hospital with intravenous sedation for the abrupt heart failure symptoms that can occur when the pump is turned off. An end-of-life care navigator and a carefully assembled interdisciplinary team providing medical aid in dying in conjunction with pump deactivation achieved the patient’s home death at his selected date. Coordinating implanted cardiac device withdrawal with medical aid in dying is clinically achievable, ethically defensible, and legally sound. Healthcare systems must develop written protocols, train hospice providers, provide anticipatory counseling, fund necessary infrastructure, and support this end-of-life care.

Implementing the PAR scale in a pediatric concurrent care setting: A quality improvement projectJournal of Hospice & Palliative Nursing; by Taylor Ronne, Andrea Cahill, Kassidy Horst, Leeza Struwe, Kelly Gonzales; 6/26Pediatric patients in concurrent hospice and palliative care often face fragmented communication regarding family goals of care during acute hospitalizations. This quality improvement project evaluated clinician and care coordinator experiences with the implementation of the Preference for Acute Rehospitalization Scale at Children's Nebraska. A pre- and postimplementation survey design ...  assessed awareness of family goals, confidence in decision-making, and perceptions of the tool among an interdisciplinary team. While clinicians expressed general openness to standardized communication tools, results showed no statistically significant differences in survey items, highlighting that successful adoption in complex pediatric settings requires sustained education, seamless workflow integration, and robust interdisciplinary engagement to ensure treatment remains aligned with family preferences.

The effect of palliative care involvement in vascular patients at the end-of-lifeJournal of Vascular Surgery; by Angela McCarthy, Kristy Wrana, Emma Triantafyllou, Ya-Huei Li, Carol Strycharz, Lindsay Lynch, Edward D Gifford; 6/26Vascular surgeons frequently manage critically ill patients and support complex end-of-life decision-making. Despite well-documented benefits of palliative care in serious illness, prior studies report that only 25% of vascular patients near the end of life received such support. Those without a palliative consult were more likely to undergo a code (18.0% vs. 6.6% ... ). After palliative consultation, the proportion of patients with a code status of do-not-resuscitate increased from 50.0% to 77.4%, and the proportion with a full code designation decreased from 50% to 22.6%  ... Patients with the goal of care to allow natural death increased to more than half of the patients from 18.4% after the palliative consultation ... These findings highlight an opportunity for vascular surgeons to proactively integrate palliative care, improving alignment between clinical interventions and patient preferences.

How would hospice use differ if every Medicare beneficiary were in Medicare Advantage?Journal of Palliative Medicine; by Claire K Ankuda, Karen McKendrick, Melissa Aldridge; 6/26Hospice use is higher in the growing Medicare Advantage (MA) program compared to Traditional Medicare (TM). It is uncertain if this is due to different hospice referral patterns. Among 5153 decedents, 35.3% were in MA at death. Compared to TM decedents, MA decedents were younger, more likely to be Hispanic, less likely to reside in a facility, and less likely to report serious illnesses (dementia, cancer, stroke, heart disease, and lung disease). We estimated that if TM decedents had been enrolled in MA, hospice use would have been 6.1% higher ... This difference was pronounced among those with higher education and serious illnesses in TM: for example, 10.1% higher for those with dementia ... versus without dementia ...

Only one in five U.S. young adults with advanced cancer receive palliative care as part of treatment, study shows American Cancer Society, Atlanta, GA; Press Release; 7/23/26 Young adults with advanced cancer face unique challenges that make palliative care especially important. This population often experiences physical, emotional, and social needs while undergoing treatment, related to their developmental and life-stage transitions. However, a new study by researchers at the American Cancer Society (ACS) reveals that despite a small increase in use over time, only 18.3% of young adults in the United States with advanced cancer received palliative care as part of treatment in 2023. The study is published today in the Journal of the American Medical Association (JAMA) Network Open. 

An updated analysis of serious health-related suffering from 2021 to 2023 Journal of Pain and Symptom Management; by Afsan Bhadelia, Xiaoxiao Jiang Kwete, Tania Pastrana, Héctor Arreola-Ornelas, Jinfeng Ding, Oscar Méndez-Carniado, Lukas Radbruch, William E Rosa, Hongliang Tao, Valentina Vargas Enciso, Felicia Marie Knaul; 7/15/26 Results: Between 2021 and 2023, global serious health-related suffering (SHS) grew by 3.9% - outpacing population growth (1.8%) - driven by sharp increases in upper-middle-income countries (UMICs) (5.5%) and high-income countries (HICs) (5.2%) and notable condition-specific increases in SHS associated with lung disease (18.2%), inflammatory disease of the central nervous system (11.4%), and dementia (7.9%). Moreover, increases in SHS due to cancer were particularly stark in LICs (17.8%), while injuries markedly rose in HICs (15.9%).

Restarting medications after deprescribing in adults discharged from hospital to skilled nursingJAMA Network Open; by Thomas J. Reese, Sandra F. Simmons, Eduard E. Vasilevskis, Emily K. Hollingsworth, Matthew S. Shotwell, Amanda S. Mixon; 6/26Question: Among older adults discharged to skilled nursing facilities (SNFs) after hospital-initiated deprescribing, what is the frequency and timing of medication restarts ...?  In this cohort study analyzing data from 2 randomized trials with a total of 598 participants, 15.9% of deprescribed medications were restarted. Higher health literacy and longer intervention exposure were associated with fewer restarts, whereas more prescribers, higher number of baseline medications, and fewer pharmacies were associated with medication restarts; restart during the SNF stay was associated with greater 90-day hospital readmissions. Conclusions: In this cohort study, approximately 1 in 6 deprescribed medications were restarted within 90 days, with nearly half occurring soon after SNF discharge. Patient factors and markers of care fragmentation were associated with restart, suggesting that enhancing transitional care and postdischarge support may improve the durability of hospital-initiated deprescribing.

"Reconciling"- conceptualising the grieving process of family members involved in assisted dying: A grounded formal theoryBMC Palliative Care; by Jonathan Bayuo, Prince Kyei Baffour, Elisha Baafi Oduro, Deborah Adedibu; 6/26While theoretical frameworks for understanding the grieving process are well-established, the advent of assisted dying presents a novel and under-examined context for grief and bereavement. Thus, this study sought to generate a theory explaining the grieving process of family members involved in assisted dying. Reconciling, as a mid-range theory, extends existing grief models by demonstrating that bereavement in assisted dying involves a proactive, ethically charged negotiation of autonomy, suffering, and relational responsibility; dimensions not accounted for in stage-based or oscillation models. The grieving process in assisted dying is best understood as Reconciling, a dynamic, iterative negotiation of autonomy, suffering, love, and loss. Families move through ambivalence, anticipation, transition, and aftermath in ways that blend emotional complexity with profound meaning-making.