Literature Review

"Ask us anything": A framework for understanding bereaved children's questions about illness, dying, and griefPalliative Care & Social Practice; by Ceilidh Eaton Russell, Liana Bailey, Ashwini Pugazhendhi, Karleigh Sutton, Sandra Twiner Ross, Joanna Humphreys; 7/26Grieving children may wonder about questions of illness, dying, and death as they navigate the death of, or grief for, someone who matters to them. Parents and caregivers, as well as health and psychosocial clinicians frequently report feeling uncertain and unprepared to engage in these conversations even if they are aware of their helpfulness. Interested in examining the questions bereaved children wonder about, this study analyzed 710 anonymous questions submitted by children aged 5-17 during Ask Us Anything sessions at a bereavement camp in Ontario, Canada between 2009 and 2024. Question focuses (i.e., what it says about the core topic) spanned across: Body, Condition, Dying and Death, Grief, while question functions (i.e., what it says about what the person seeks to understand about the topic) spanned: How it Works, Catch, Cause, Cure, Care, Connect. Children's questions can be helpful windows into what their grief experiences are like and what their emotional, existential, and/or informational needs are within this experience.

Aging and end-of-life care planning among transgender and nonbinary individuals: A systematic reviewLGBT Health; by Ginger H Kwak, G Nic Rider, Emily A Paine, Walter O Bockting, Steven A John; 7/26The objective of this review was to identify perceptions of end-of-life (EOL) care needs among transgender and nonbinary (TNB) individuals. We identified five major themes during thematic analysis: fear of discrimination in long-term care facilities, fear of loss of independence, maintaining social circles with aging, obstacles to EOL logistics, and what defines successful aging. Additional subthemes included fear about loss of identity, preference for euthanasia versus loss of identity, participation in EOL planning, and advance care plan/will completion. Psychosocial aspects were the most substantial barriers to successful EOL planning.

[Greece] Patient-reported outcome measures in palliative care: A systematic review to inform health policy and health system performanceHealth Policy; by Maria Katharaki, Christos Triantafyllou, Julie Ling, Joao Breda; 7/26Health systems increasingly recognise palliative care as an essential component of universal health coverage. Assessing palliative care quality and value remains challenging, as key outcomes are often missed by routine indicators. Patient-reported outcome measures (PROMs) can address this gap, but their use remains fragmented. Seventy studies were included. The most commonly used PROMs were the Integrated Palliative Care Outcome Scale (IPOS), Edmonton Symptom Assessment Scale (ESAS), and the EORTC QLQ-C15-PAL instrument. Implementation challenges included patient frailty, workload and time constraints, limited standardisation, and poor integration into clinical workflows and health information systems.

"It felt like throwing in the towel": Family caregiver perspectives on end-of-life decision making in chronic obstructive pulmonary diseaseJournal of Palliative Medicine; by Natalia Smirnova, Tivona Batieste, Sarah H Cross, Samir Jamdar, Catherine S Peterson, Camille P Vaughan, Dio Kavalieratos; 7/26Chronic obstructive pulmonary disease (COPD) has an unpredictable trajectory and high symptom burden, complicating end-of-life (EOL) decisions around place of death and hospice use. We conducted semi-structured interviews with bereaved caregivers of people with COPD who received pulmonary care at a U.S. academic center and died within 12 months. Fifty-six percent of decedents received hospice; 33% died at home. Caregivers described five themes: missed prognostic cues and poor communication; hospice as both loss and relief; home as ideal but hospital as default; financial influences on decisions; and mismatch between hospice and COPD needs. Caregivers identified a readiness gap driven by prognostic uncertainty, communication challenges, and financial constraints.

One clinician, every conversation: Palliative care delivery by solo APRN hospitalists in Critical Access HospitalsJournal of Hospice & Palliative Nursing; by Melissa Skoff; 7/26Advanced practice registered nurses (APRN) who practice as solo hospitalists in critical access hospitals are often underrecognized in their role in providing palliative and end-of-life care. This article describes the full scope of the solo APRN hospitalist in a critical access hospital setting with close attention to how complex patient demands contribute to the challenges in providing high-quality end-of-life communications. This article examines clinical, educational, and ethical dimensions of this work, and presents a case example that illustrates how these pressures present during a shift. Strategies to strengthen rural palliative care capacity are discussed, including tele-palliative care, remote ethics support, and APRN-centered education. As rural workforce shortages persist and continue to rise, alongside rising patient acuity, naming and addressing these structural gaps is essential in improving quality of care and protecting the well-being of a solo APRN hospitalist.

[Canada] Listening to young people on childhood death: a youth-focused participatory approach to children's palliative and end-of-life research and policymaking Children & Society; by Sydney Campbell, Nika Rovensky, Ryan Kent, Lauren Delaney, Franco A. Carnevale, Mary Ellen Macdonald; 6/23/26 Conclusion: Our study is one of the first to investigate the perspectives of young people in Canada regarding children's palliative and end-of-life (P-EOL) care, and the first in Canada to employ a participatory approach with young people in research about childhood death and dying. ... To date, the lessons we have learned can help researchers from diverse contexts aiming to carry out similar projects related to children's P-EOL care, based in the belief that the only way to truly shift current practices that overlook young people's voices and engagements as meaningful is through continuous advocacy, development, and application of engagement practices in all matters affecting young people.

Adopting the fourth pillar of acute care surgery: the current state of palliative medicine in trauma care Current Trauma Reports; by Alison Haruta and Kathleen O'Connell; 7/30/26Although most older trauma patients survive hospitalization, many deaths occur within six months after discharge, making early goals-of-care (GOC) discussions essential. However, palliative care consultation remains significantly underused, occurring in only 2–4% of severely injured trauma cases. ... Primary palliative care skills are essential for trauma surgeons, though effective integration into the trauma system has been variable. As the need grows, the specialty palliative care work force cannot keep up with demand, highlighting the need for surgeons to learn and perfect their primary palliative care skills, including communication skills and holistic symptom management. Palliative care should function as a core pillar of trauma care, ensuring dignity, reducing non-beneficial treatments, and improving end-of-life experiences for patients and families.