Literature Review

Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United StatesCancer; Shriya K. Garg BS; Khushi Kohli BA; Isha K. Garg BS; Yash K. Garg BS; Lilac G. Nguyen BS; Isabella S. Nguyen BS; Erin Jay G. Feliciano MD, MBA; Yefri A. Baez MD; Brandon A. Mahal MD; Puneeth Iyengar MD, PhD; Daniel R. Gomez MD, MBA; Kaitlyn Lapen MD; Edward Christopher Dee MD; 5/25 This study examines disparities in the receipt of palliative-intent interventions among Hispanic subgroups with advanced lung, breast, and prostate cancer. Among 945,894 total patients, disaggregated analyses revealed reduced receipt of palliative-intent interventions for patients with lung, breast, and prostate cancer of Mexican descent ... compared to non-Hispanic White patients. Receipt for patients of South or Central American descent was reduced in comparison to non-Hispanic White patients for lung and breast cancer ... Uptake of palliative interventions for metastatic lung and breast cancer was reduced for patients of Cuban descent ..., and was lower for patients of Dominican descent with breast cancer, compared to non-Hispanic White patients ... These findings demonstrate disparities in the receipt of palliative-intent interventions among disaggregated Hispanic subgroups. This study highlights the need for disaggregated research to further characterize these disparities and their drivers.

Antibiotics at end of life: Where are we now and where are we going? A narrative reviewAmerican Journal of Hospice and Palliative Medicine; by Patrick D Crowley, Francis X Whalen, Leslie R Siegel, Douglas W Challener; 8/25Antibiotics are frequently prescribed at the end of life, though the benefits and harms are not well understood. Prescribing practices vary based on individual situation and geographic location. Patients with cancer and those hospitalized receive more antibiotics than those enrolled in outpatient hospice. Urinary tract infections and pulmonary infections are the most common conditions treated with antibiotics at the end of life -most often with penicillin derivatives and vancomycin in the hospital, fluoroquinolones in outpatient, and cephalosporins in both settings. When asked, patients most often prefer limiting antibiotics to symptom management at the end of life. Physicians’ over-estimation of patient preference for antibiotics and the increased probability of misdiagnosis increases antibiotic prescription rates. Antibiotics can improve symptoms when used for specific diseases at the cost of drug reactions, resistant organisms, and delayed discharge. Antibiotic use has variable results on survival duration.

Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settingsJournal of Palliative Care; Mona Ibrahim Hebeshy, PhD, RN; Darcy Copeland, PhD, RN; 6/25With the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. [Conclusions:] Nurses generally feel competent; however, they often lack confidence in addressing patients’ social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.

Fireproofing the soul: Navigating fear of the afterlife among palliative care patientsJournal of Palliative Medicine; Ptr Shannon Blower, Jonathan Walker, Lucius Walker, Steven Radwany; 6/25Among palliative care patients, spiritual uncertainty about what may await them after death is a fairly common but often overlooked source of anxiety. Specifically, patients (especially those from orthodox Christian backgrounds that propound the concept of hell as a literal place) may harbor unexpressed fears about being consigned to hell due to the perceived sins they have committed in life. Such fears can be genuinely debilitating and may result in non-responsiveness to traditional palliative therapy. Here, we discuss our experiences with this phenomenon and propose some possible solutions. We offer readers suggestions for how to best identify potential sufferers, broach the subject with such patients, and reassure them.

[Spain] “The good death”: Experience of parents who have suffered the loss of a child in a pediatric intensive care unit. A phenomenological studyJournal of Pediatric Nursing; by Sara Alcón-Nájera, Rosa Blanca Ortiz-Pizarro, Elena Peña-Meléndez, Alberto Sánchez-Gallego, María Teresa González-GilThe ‘good death’ condenses experiences of parents into a constructive interpretation. It is characterised by the fact that it is participated, accompanied and honoured. It requires exquisite holistic care (emotional/social/relational and spiritual). It promotes a family-centered approach and emotional wellbeing of parents. The family's perception of a ‘good death’ is a powerful facilitator of bereavement. The experience of the death of a child in a Pediatric Intensive Care Unit must ensure a peaceful, dignified, and respectful death, accompanied and participated in by the family to achieve a “Good Death”. Evidence-based palliative and end-of-life care is essential for developing protocols and resources that ensure excellent support for families and their adaptation to the loss.

[Italy] Palliative Performance Scale predicts mortality in cardiac intensive care unitOpen Heart; by Laura Sofia Cardelli, Lorenzo Gamberini, Beatrice Dal Passo, Silvia Zagnoni, Francesca Sciarra, Federica Frascaro, Alice Vitagliano, Valeria Carinci, Maria Laura Canale, Gianni Casella; 6/25Patients with PPS ≤70 had significantly higher 1-year all-cause mortality and in-hospital all-cause mortality. The PPS is a reliable and independent predictor of mortality in CICU patients. Incorporating PPS into clinical practice may enhance risk stratification, guide decision-making and optimise resource allocation in this high-risk population.

Mindfulness and tai chi improve mood in cancer survivors Medscape, reposted in AAHPM; ed. by Gargi Mukherjee; 6/25/25 Both Mindfulness-Based Cancer Recovery (MBCR) and Tai Chi/Qigong (TCQ) significantly improved mood in survivors of cancer, whether participants selected their preferred program or were randomly assigned to either type of program. MBCR had greater benefits in reducing tension and anger, while TCQ was particularly effective in reducing depression and boosting vigor.

Artificial intelligence and health care waste—Promise or peril?JAMA Health Forum; William H. Shrank, MD, MSHS; Suhas Gondi, MD, MBA; David J. Brailer, MD, PhD; 6/25One obvious target of AI [artificial intelligence] tools in health care is the reduction of waste. While LLM [large language model] applications to health care are still nascent—many still make errors, and more rigorous evaluations are needed—most agree that the long-term opportunity for AI in health care is tremendous. A recent study estimated that widespread adoption of AI could lead to savings of 5% to 10% of total US health care spending. Realizing even a fraction of this potential would increase the affordability of care for people in the US and free substantial societal resources to make other valuable investments. But getting there will require deliberate choices from leaders and policymakers and careful attention to risks that could set back progress.

Zuranolone in palliative care: Promise and practicality for the rapid treatment of depressionThe American Journal of Hospice & Palliative Care; Eric Prommer; 6/25Zuranolone is an orally available antidepressant classified as a neuroactive steroid. Neuroactive steroids act as positive allosteric modulators for both synaptic and extrasynaptic GABA, making them distinct from currently available drugs targeting major depression and insomnia. By modulating GABA binding sites, neuroactive steroids enhance the function of GABA, which is depressed in major depression. The drug has a rapid onset of action, which differs from currently available antidepressants that are used in palliative care. [This] ... paper will review the pharmacology, pharmacodynamics, safety profile, and clinical studies showing its effectiveness in major depression and how it can potentially be helpful in the palliative care population.

Unanswered questions on private equity in gastroenterologyJAMA Network; by Jane M. Zhu; 6/25A growing literature on private equity (PE) acquisitions of physician practices has found associated increases in health care prices and utilization, but evidence specific to gastroenterology remains relatively new despite the specialty being a popular target for PE. More than 1 in 8 gastroenterology practices are now owned by PE, with practice fragmentation, lucrative procedural reimbursements, and an aging population factoring into continuing investor interest... Taken together with observations of increased utilization, there may be 2 interpretations of the data presented by Arnold and colleagues. One interpretation of the findings may be that PE acquisition may focus on reducing inefficiencies, improving access by expanding practice capacity, and increasing throughput. Another interpretation may be that PE acquisition is focused on the strategic exploitation of market and pricing power. The latter may have less of an impact on clinical measures like quality of care, but potentially, both strategies could be at play.Publisher's note: Similar questions being asked across hospice, gastroenterology, physician practices, and other areas of healthcare.

Physicians' preferences for their own end of life: A comparison across North America, Europe, and AustraliaJournal of Medical Ethics; Sarah Mroz, Sigrid Dierickx, Kenneth Chambaere, Freddy Mortier, Ludovica De Panfilis, James Downar, Julie Lapenskie, Koby Anderson, Anna Skold, Courtney Campbell, Toby C Campbell, Rachel Feeney, Lindy Willmott, Ben P White, Luc Deliens; 6/25Setting: Eight jurisdictions: Belgium, Italy, Canada, USA (Oregon, Wisconsin, and Georgia), Australia (Victoria and Queensland). Participants: Three physician types: general practitioners, palliative care physicians, and other medical specialists. Conclusion: Physicians largely prefer to intensify alleviation of symptoms at the end of life and avoid life-sustaining techniques. In a scenario of advanced cancer or Alzheimer's disease, over half of physicians prefer assisted dying. Considerable preference variation exists across jurisdictions, and preferences for assisted dying seem to be impacted by the legalisation of assisted dying within jurisdictions.

Serious illness conversations in the Emergency Department for older adults with advanced illnesses - A randomized clinical trialJAMA Network; by Kei Ouchi, Susan D. Block, Dorene M. Rentz, Donna L. Berry, Hannah Oelschlager, Youkie Shiozawa, Sarah Rossmassler, Amanda L. Berger, Mohammad A. Hasdianda, Wei Wang, Edward Boyer, Rebecca L. Sudore, James A. Tulsky, Mara A. Schonberg; 6/25Does an emergency department (ED)–based intervention to discuss serious illness care goals improve advance care planning outcomes for older adults with advanced illnesses? In this randomized clinical trial including 141 patients in the ED, a nurse-led intervention to discuss serious illness care goals did not significantly improve patient-reported engagement in advance care planning but did increase subsequent clinician-documented serious illness conversations in the medical records. These findings suggest that ED visits may serve as a critical access point for serious illness conversations in clinically stable older adults with advanced illnesses.