Literature Review

Hospice enrollment in young adult LGBTQ + decedents with cancer: A multi-site single healthcare system studyBMC Palliative Care; by Sanjna Rajput, Riham Suleiman, Brittany Kimball, Aminah Jatoi, Elizabeth Cathcart-Rake; 11/25Methods [of the study]: A single healthcare system, 4000 + self-reported LGBTQ + database of patients with cancer identified young adult decedents (18-39 years old at death) to report the percentage who died with hospice, the conversations that preceded hospice enrollment, time-on-hospice, and circumstances that surrounded the deaths of those not enrolled. From the database, ... 67% ... were enrolled in hospice ... Conversations that preceded enrollment discussed (1) limited cancer therapeutic options with worsening end-of-life symptoms and how hospice could help ("discussed… decline and how patient would not want to die hooked up to machines"); (2) medical staff's acknowledgement of same sex spouse/life partners ("[She] is here with her wife"); (3) the inclusion of the birth family in end-of-life discussions, especially if the decedent had been single ("Her father met us… this was difficult news for him to hear.").  Conclusions: Most young adult LGBTQ + decedents with cancer receive hospice services with thoughtful and inclusive conversations that precede enrollment.

Hospice and palliative medicine fellows' perspectives on physician-assisted dying education: Hospice and palliative medicine fellows' perspectives on physician-assisted dyingJournal of Pain and Symptom Management; by James Cescon, Antoinette Esce, Melanie Koren, Edith Meyerson, Mollie A Biewald, Robert M Arnold, Anup Bharani, Laura Belland; 11/25Physician-Assisted Dying (PAD) is legal in a growing number of U.S. states, with access expanding nationally due to recent legislative changes. An anonymous nine-item survey was sent to all HPM fellows (N=21) at the Icahn School of Medicine at Mount Sinai. All respondents agreed that learning about PAD in fellowship is important. Topics of interest included ethical considerations (95%), legal criteria (86%), responding to requests in serious illness conversations (86%), navigating requests (76%), and pharmacology/modes of ingestion (71%). While only 10% intended to provide PAD in future practice, 57% were unsure or had not thought about it, and 33% were not considering it. These findings underscore a clear educational need and may guide curriculum development.

[Saudi Arabia] Comparison of end-of-life care between patients with hematological malignancies versus solid tumors: A retrospective analysisJournal of Palliative Care; by Salma Almusaed, Kim Sadler, Walaa Abdulmutaali, Gassan Abudari, Steven Callaghan, Mahmoud Sroor, Muneerah Almutairi, Mohammed AlGhamdi, Muruf Zaid Alshalwah, Sameer Desai, Nessreen Abu Alsalhm, Khloud Alzain; 11/25While specialized palliative care (PC) is well-established for managing STs [solid tumors], its integration into HMs’ [hematological malignancies] care remains less common despite evidence of its benefits. The cohort consisted of 350 adult patients, of whom 86 (24.6%) had HMs and 264 (75.4%) had STs. Overall, HMs patients received more aggressive end-of-life care, including higher rates of Intensive Care Unit (ICU) admissions (81.4% vs 17.8%), intubation (36% vs 8.3%), disease-modifying treatments (23% vs 3.8%), as well as more enteral feeding, dialysis, blood transfusions, and antimicrobial use. Their resuscitation discussions occurred closer to death (3 vs 16 days ... ). Additionally, HMs patients had fewer referrals to PC services (43% vs 79.2% ... ), and most of them died in the ICU (59.3% vs 18.2% ... ).

Software as a medical practitioner—Is it time to license artificial intelligence?JAMA Internal Medicine; by Eric Bressman, Carmel Shachar, Ariel D. Stern, Ateev Mehrotra; 11/25The Healthy Technology Act of 2025, a bill being considered by Congress, would permit artificial intelligence (AI) systems to prescribe medications without human sign-off. While allowing AI to practice independently may still be a stretch, large language models are already being used to support diagnosis and treatment. These applications challenge the current regulatory framework for clinical AI, which has focused on software as a medical device (SaMD). The US Food and Drug Administration (FDA) has cleared more than 1000 AI tools using this framework, mostly for narrow, well-defined tasks. However, generative models can be applied across domains, straining the SaMD framework. In this Viewpoint, we explore the application of a licensure paradigm to clinical AI systems, arguing that this offers a more reliable regulatory framework.

Navigating loss: An in-depth exploration of grief and spiritual resilience in Hispanic and Latino culturesUrban Social Work; by Angelica Olivo; 11/25This was a phenomenological study that highlighted how culture, spirituality, and coping mechanisms influenced Hispanic and Latino community grief.  ... [The study] identified themes on death beliefs, traditional grieving practices, cultural taboos, family roles, and religious faith, providing rich data on cultural and spiritual factors in grief. The themes that emerged from the analysis were related to death beliefs, traditional grieving practices, cultural taboos, family roles, and religious faith. Findings supported a second line of evidence that diverse subgroups and the longitudinal grief experience may better inform understandings of, and improve cultural competency in, bereavement support.

Home Health Aides caring for adults with heart failure-A pilot randomized clinical trialJAMA Network Open; by Madeline R. Sterling, Cisco G. Espinosa, Sasha Vergez, Margaret V. McDonald, Joanna Ringel, Jonathan N. Tobin, Samprit Banerjee, Nicola Dell, Lisa M. Kern, Monika M. Safford; 11/25Objective: To examine the effectiveness of an education- and communication-based intervention among HHAs caring for patients with HF.  In this pilot randomized clinical trial including 102 agency-employed HHAs randomized to training alone or in addition to an application that allowed HHAs to exchange text messages with nurse supervisors, training improved HHAs’ HF knowledge and HF caregiving self-efficacy. The addition of the application did not improve these primary outcomes, but it significantly reduced HHAs’ self-reported preventable 911 calls, a secondary outcome.

Palliative care specialist use among Medicare decedents who had poor-prognosis cancersJAMA Network; by Isaac S. Chua, Haiden A. Huskamp, Ateev Mehrotra, Andrew D. Wilcock; 7/25Has specialty palliative care (PC) use among Medicare decedents who had cancers with poor prognoses changed in the context of greater telehealth use and more advanced practice clinicians in the field? In this cohort study..., the proportion with specialty PC use increased 24% from 2018 to 2023 [from 30% to 37%], largely driven by outpatient encounters and care by advanced practice clinicians. Decedents who were older, had lower incomes, and were living in nonmetropolitan areas remained less likely to receive any PC... These findings suggest that different strategies are needed to increase PC use among some disadvantaged subpopulations.Publisher's Note: Similar to Hua's article (Validation of a claims-based algorithm for specialist palliative care delivery in metastatic cancer), palliative care specialists were defined as those with NPI provider specialty code 17 or those who  included an ICD-10 Z51.5 code on at least 80% of their evaluation and management encounters.

Validation of a claims-based algorithm for specialist palliative care delivery in metastatic cancerJournal of Pain and Symptom Management; by May Hua, Zhixin Yang, Ling Guo, J Brian Cassel, R Sean Morrison, Guohua Li; 11/25The lack of valid methods to identify specialist palliative care (PC) delivery in population-level data impedes comprehensive understanding of its use... We developed a claims-based algorithm to identify specialist PC, using a physician billing claim from a known PC clinician as the gold standard, retaining candidate variables with a positive predictive value (PPV) >60%... A simple algorithm can identify receipt of specialist PC care in Medicare claims for patients with metastatic cancer with reasonable accuracy.Publisher's Note: While this is a statistically sophisticated article, findings support use of the palliative care provider specialty code (Provider Specialty Code 17) and encounter for palliative care code (ICD-10 Z51.5) to identify specialist palliative care delivery in a specific population (Medicare beneficiaries with metastatic cancer claims).