Literature Review

[Korea] Earlier palliative cancer care cuts end-of-life ED visits Medscape; ed. by Gargi Mukherjee; 7/23/25 A recent retrospective study found that earlier outpatient palliative care referrals for patients with advanced cancer were associated with a small increase in overall emergency department (ED) visits but significantly fewer end-of-life ED visits and improved advance care planning. ... A substantial proportion of patients with advanced cancer visited the ED, including during the final month of life. Earlier palliative care referrals were associated with fewer end-of-life ED visits, “emphasizing the importance of timely integration of [palliative care] to reduce unnecessary interventions and ensure goal-concordant care,” the authors wrote. The researchers also noted that the findings underscore the need for structured advance care planning discussions across care settings to enhance the quality of end-of-life care.

Exploring a collective grief experience in the U.S.: Qualitative findings from older parents whose only child has diedOmega; Yongqiang Zheng, Leslie G Wuest, Jeongah Kim, Rebecca A Rodriguez; 6/25Despite its profound physical and mental health impacts, research on the loss of an only child in later life among older U.S. adults remains scarce. This phenomenological qualitative study explores the lived experiences and meanings older bereaved parents attribute to their loss. Inductive thematic analysis revealed 6 themes: the enduring intensity of grief, significant secondary losses, feelings of isolation and alienation, the role of social support in coping, and spirituality and religion's influence on their journey. By amplifying these parents' voices, the study lays a foundation for understanding their unique grief and underscores the gaps in U.S. policy and mental health services. These findings deepen insight into an understudied population, highlighting the need for enhanced resources for older bereaved parents.

Effectiveness of an educational intervention in enhancing end-of-life care understanding and decision-making in African AmericansPalliative & Supportive Care; Delicia Pruitt, Megan Reilly, Stephen Zyzanski, Neli Ragina; 7/25AA [African American] patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL [end of life] care options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Palliative video consultation and symptom distress among rural inpatients-A randomized clinical trialCritical Care Medicine; Marie A. Bakitas, DNSc, RN; Shena Gazaway, PhD, RN; Felicia Underwood, MSW, MPS, LICSW-S; Christiana Ekelem, BS; Vantrice T. Heard, PhD; Richard Kennedy, MD, PhD; Andres Azuero, PhD; Rodney Tucker, MD, MMM; Susan McCammon, MD, PhD; Joshua M. Hauser, MD; Lucas McElwain, MD; Ronit Elk, PhD; 7/25The triple threat of rural geography, racial inequities, and older age has hindered access to high-quality palliative care for many people in the US. Only 70% of the deep South vs 85% to 94% of the rest of the US has palliative care despite the deep South having the greatest needs due to suboptimal health care access and elevated morbidity and mortality. In this RCT [randomized clinical trial] among Black or African American and White chronically ill hospitalized adults, culturally based specialist palliative care video consultation was not associated with statistically significant reduced symptom distress compared with usual care, but there was a clinically meaningful difference ... between groups. Contrary to our hypotheses, intervention participants’ QOL [quality of life] and resource use (secondary outcomes) also were not improved. Assistant Editor's note: This study reminds us that palliative care delivered virtually, as opposed to in-person, may not be of benefit to some individuals. It also reminds us that palliative care, at its best, is delivered on an ongoing basis by a known, trusted professional, as opposed to a one-time session with a consultant. 

Collective leadership in home-based palliative care: Advancing APRN roles to enhance successHome Health Care Management & Practice; Nicole DePace, MS, APRN, GNP-BC, ACHPN; Rebecca Souza, DNP, ANP-BC, ACHPN; Therese Rochon, MA, MS, FNP-C; Paula Rego, DNP, AGPCNP-BC; Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; 6/25Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.

End-of-life symptoms in persons dying with advanced dementia in the community setting: Findings from IN-PEACEJournal of Pain and Symptom Management; by Kurt Kroenke, Sujuan Gao, Susan E. Hickman, Alexia M. Torke, Nina M. Johnson, Amy Pemberton, Andrea Vrobel, Minmin Pan, Laura R. Holtz, Greg A. Sachs; 8/25This article characterizes symptom burden in persons with advanced dementia dying in the community who were enrolled in a 2-year trial of home-based palliative care. Symptoms did not generally worsen from enrollment to time of death and symptom severity was similar to persons with dementia dying in a nursing home.

[Norway] iLIVE volunteer study: Volunteer and healthcare professional perceptions of newly developed hospital end-of-life-care volunteer services, in five countriesPalliative Medicine; Tamsin McGlinchey, Stephen Mason, Grethe Skorpen Iversen, Dagny Faksvåg Haugen, Inmaculada Ruiz Torreras, Pilar Barnestein Fonseca, Miša Bakan, Berivan Yildiz, Ruthmarijke Smeding, Anne Goossensen, Agnes van der Heide, John Ellershaw; 5/25Volunteer services that provide direct support to patients receiving palliative and end-of-life care in hospitals are new and developing, but little is known about the use and experience of such services from key stakeholders. 20 Volunteers and 20 healthcare professionals were recruited. Three overall themes were generated: (1) Volunteers provided 'unique, distinct, 'community' support' bringing familiarity to an unfamiliar, medically focussed environment. (2) Volunteers were able to 'establish a connection centred on 'being there' within the acute hospital environment' despite the fast paced and highly changeable environment. (3) Through 'relational interactions adapted to the individual person' volunteers attended to patients' existential and emotional needs. These services confer benefits that are transferrable across cultures and countries, 'fusing' formal care with the informal visiting of family or friends, attending to patients' existential needs.

CDC reports rise in unintentional fall deaths among older adults JAMA; by Samantha Anderer; 7/11/25 The US Centers for Disease Control and Prevention (CDC) reported that deaths from unintentional falls among adults aged 65 years or older increased over the past 2 decades. Falls are currently the leading cause of injury for older adults, reaching 70 per 100 000 in 2023. As age increases, so does the likelihood of death due to a fall. And data from the National Vital Statistics System indicate that from 2003 to 2023, adults aged 85 years or older experienced the greatest increase in fall deaths. Rates for men, who are more likely to die from an unintentional fall, doubled from 178 to 373 per 100 000 people among those 85 years or older. For women in the same age group, deaths from falls increased 2.5 times, from 129 to 320 per 100 000. 

Mapping the final journey: End-of-life frailty trajectories and cause of deathJournal of the American Geriatrics Society; Jianhong Xu, Jonathan Ka-Long Mak, Qian-Li Xue, Chenkai Wu; 6/25Frailty trajectories at the end of life varied by cause of death, with neurodegenerative disease decedents exhibiting more severe frailty. Among 37,465 decedents, 2,895 (7.7%) died from neurodegenerative diseases [and] three distinct frailty trajectories were identified among these decedents: rapidly progressive frailty (6.9%), moderate progression of frailty (21.1%), and advanced and stable frailty (72.0%). These patterns differed significantly from those observed in decedents with other causes of death, who exhibited persistently low frailty (24.7%), intermediate and progressive frailty (46.5%), and advanced and progressive frailty (28.8%). Compared to cancer decedents, individuals with neurodegenerative diseases had higher baseline frailty and a dominant trajectory of advanced and stable frailty. Older age, lower education, and greater chronic disease burden were associated with the advanced and progressive frailty trajectory.

Facilitating advance care planning conversations among patients with cancer and their care partners utilizing a conversation game: A pilot studyCancer Reports; Kylee Kimbel, Michael Hayes, Morgan Bucher, William A Calo, Tullika Garg, Monika Joshi, Hannah Kuntz, Terrence E Murphy, Erika VanDyke, Emily Wasserman, Lauren J Van Scoy; 6/25Current guidelines [for patients with cancer] recommend early, frequent advance care planning (ACP) conversations among clinicians, patients, and care partners (CPs) and advance directive (AD) completion. However, only 55% of patients with cancer have completed such directives, suggesting the need for interventions to increase rates of ACP. The Hello game has been shown to be effective in promoting ACP in several populations but has not been tested in patients with cancer or their CP. Three themes emerged from both patient and CP focus groups ...: (1) Participants enjoyed the group dynamics and relating to peers when playing Hello; (2) Hello serves as a helpful conversation starter; (3) modifications could help tailor Hello for use in cancer context-particularly adding more questions about quality of life and mental health. Hello was well-received by dyads, and their feedback was used to tailor Hello for patients with cancer and their CPs.

Addressing the underutilization of hospice care in Asian American communities: A scoping reviewAmerican Journal of Hospice and Palliative Medicine; Tuzhen Xu, PhD, APRN, FNP-C; Dan Song, PhD, RN; Gloria M. Rose, PhD, NP-C; 6/25Despite national improvements in hospice care, utilization remains low among Asian American (AA) communities. Identified barriers to hospice utilization included language and communication challenges; cultural values and beliefs surrounding death; family-centered decision-making and filial piety; religious influences such as beliefs in karma and suffering; and broader issues like low acculturation and mistrust of the healthcare system. Comprehensive cultural competence training is needed for healthcare providers, especially physicians, nurse practitioners, registered nurses, and social workers involved in hospice and palliative care.

[UK] Caring for a patient with inoperable hip fractureBMJ Supportive and Palliative Care; Arouba Imtiaz, Amelia Collins, Fiona Rawlinson, Antony Johansen; 6/25Hip fractures pose significant challenges, particularly in managing severe incident pain in people who are not fit for surgery. We present the case of an older man with multiple comorbidities who was managed non-operatively. Standard opioids caused sedation with limited pain relief. Patient-controlled analgesia (PCA) with intravenous fentanyl provided effective, short-acting relief, allowing the patient to remain alert and engage in care. This case highlights PCA as a practical option for managing incident pain in selected palliative patients.

[India] Enhancing palliative care through university-community partnerships: A systematic review of models, impacts, and challengesBMC Palliative Care; Alaka Chandak, Priyadarshini Bhalchandra Kulkarni; 6/25This systematic review highlights the deep potential of university–community partnerships (UCPs) to act as agents of change in palliative care education and service provision. Such collaborations complementarily improve the quality of life of the elderly while availing healthcare students with essential experiential learning opportunities. Exceptional models, such as the CARE program, illustrate the double benefit of improved community welfare and the creation of effective empathetic professionals with the capability to cater to the complex demands of caring.