Literature Review

Urban and rural hospital closures in Georgia, 2022-2024JAMA Network Open; by Sara D. Turbow, Kajal Patel, Young-Rock Hong, Jennifer Lom, Mohammed K. Ali; 9/26Hospital closures are a growing concern with a marked increase in both urban and rural hospital closures seen in recent years. These closures, often due to financial strain, decline in patient volumes, and inequities in health care funding, can result in loss of access to critical medical services. The purpose of this study was to examine postclosure changes in discharge volume, charges, and length of stay at hospitals near urban vs rural hospital closures in the state of Georgia. Urban hospital closures are an emerging area that will only become more relevant as policy changes are expected to lead to more urban closures in the coming years.

Current challenges and future innovation in rural heart failure care: A qualitative analysisJournal of Cardiovascular Nursing; by Alexander A. Walkon, Shoshana H. Bardach, Aricca D. Van Citters, Tamar Mosulishvili, Samuel L. Youkilis, Amanda N. Perry, Megan M. Holthoff, Olawale O. Akinola, Amelia M. Cullinan, Melissa Borrows, Katharine A. Manning; 9/26Individuals living with heart failure experience challenges managing frequent hospital admissions and life-altering symptoms, including dyspnea, fatigue, and depression. These challenges are exacerbated by the unique obstacles associated with receiving healthcare in a rural community. Their care partners often do not receive sufficient support to care for someone with heart failure and experience fatigue, social isolation, and anxiety. Interviewees reported challenges related to symptom and care partner burden, fragmented healthcare communication, limited institutional support, and an unclear role for palliative care. Interviewees suggested that integrating personalized care strategies, improving communication and coordination, and expanding specialized support may help address these challenges.

Surrogate decision-making for older adults with and without dementiaJAMA Network Open; by Lauren Hersch Nicholas, Scott D. Halpern, Kenneth M. Langa, Mario Macis; 10/7/26In this survey study of 5965 adults, fewer respondents endorsed life-sustaining treatments (LSTs) when a hypothetical patient had dementia (22% vs 40%). LSTs were more likely to be recommended when the respondent preferred them for their own care, when patient advance directives requested them, and when physicians recommended them. The findings suggest that surrogates’ own values and assumptions about quality of life with dementia, along with documented patient wishes and clinical guidance, may contribute to their recommendations. These findings highlight the importance of preparing patients and surrogates for care decisions through explicit discussions of goals of care and decision-making roles.

Closing the hospice gap: the value of home-based medical care Health Affairs Scholar; by Katherine Ornstein, Bruce Leff, Maggie Salinger, Jennifer M Reckrey, Bian Liu, Zainab Toteh Osakwe, Martha Abshire Saylor, Arushi Arora, Melissa Aldridge, Krista Harrison, Abraham A Brody, Christine S Ritchie; 10/26Home-based medical care (HBMC), longitudinal medical care provided in a patient's home led by physicians or advanced practice providers, addresses complex medical and social needs of seriously ill older adults, particularly those with dementia. We examined whether HBMC use is associated with hospice enrollment and length of stay and whether this varies by dementia status... HBMC users had greater odds of hospice use (odds ratio: 1.34; 95% CI: 1.33-1.35) compared with nonusers, regardless of dementia status. For hospice enrollees, HBMC use minimized both ultra-short (180 days) stays, with a stronger reduction in short stays for patients with dementia. As more older adults age in the community and hospice services expand to support patients with complex illnesses such as dementia, HBMC may offer a valuable strategy for effectively navigating prognosis uncertainty and the complexities of hospice eligibility requirements and enrollment.

Child-specific bioethics: Review of pediatric palliative care ethics guidelines Nursing Ethics; by Christina Lamb and Dimitra V. Pouliopoulou; 10/17/26 ... Care for dying children needs to be consistently grounded in child philosophies. Recommendation: Expanding access to pediatric palliative care requires ethics education research toward pediatric-specific pedagogies and bioethics frameworks to support consistent, ethically robust, holistic, and child-centered care to improve access across clinical, international and interdisciplinary settings. This review study provides a comprehensive ethical analysis of ethical frameworks guiding pediatric palliative care with a focus on end-of-life care. We identified a lack of pediatric specific bioethics originating in pediatric theory and research informing and supporting pediatric palliative care delivery.Guest Editor's Note by Judy Zeringue: This international scholarly research article from the Nursing Ethics Journal reveals the need for a pediatric-specific bioethics framework to guide the care of dying children. This framework should be focused specifically on the unique needs of pediatrics, not taken from the same framework applied to adults at the end of life. A focus on pediatric specific ethics education and research is needed to optimize and provide consistent support in pediatric palliative care including care at the end of life. This ethically robust approach must be promoted to help close the gap to guide the care of dying children everywhere.

Traumatic bereavement among incarcerated women: Understanding and responding to complex grief after the death of a childMDPI; by Catherine Gallagher, Nena P. Messina; 9/26 Incarcerated women face elevated suicide risk at the intersection of chronic loss, cumulative trauma, and constrained environments. In prison, the death of a child constitutes a profound and overlooked traumatic bereavement. This conceptual manuscript examines how carceral environments restrict privacy, autonomy, family contact, mourning rituals, and social and clinical support, thereby adversely reshaping grief. Restricted information, exclusion from rituals and relational validation, and punishment for grief-related behavior may obstruct narrative reconstruction, continuing bonds, and maternal identity reorganization. The model further considers how acute grief interacts with chronic stress, sustained threat responsivity, sleep disruption, and cumulative allostatic burden to intensify psychological and somatic distress without assuming a uniform neurobiological pathway.

Best case/worst case: A multisite randomized trial of scenario planning for patients with late-stage kidney diseaseJournal of American Geriatrics Society; by Lily N. Stalter, Bret M. Hanlon, Kyle J. Bushaw, Jenna Nitkowski, Anne Buffington, Katharine L. Cheung, Amy B. Zelenski, Kristine Kwekkeboom, Amar D. Bansal, Deidra Candice Crews, Holly M. Koncicki, Daniel Lam, Alvin H. Moss, Maya K. Rao, Dawn Felicity Wolfgram, Jeniann Yi, Carrie Brill, Tamara Isakova, Margaret L. Schwarze; 9/26Best Case/Worst Case (BC/WC) is a communication tool to support nephrologists and older adults with advanced chronic kidney disease with decisions about dialysis. We compared the effectiveness of training nephrologists to use BC/WC versus usual care on receipt of palliative care, quality of life (QOL), quality of communication, dialysis initiation, and death. While we hypothesized that improving prognostic awareness and communication would increase palliative care utilization, the challenges of connecting patients with life-limiting kidney disease to palliative care are multifaceted, well documented, and likely not surmountable with a communication intervention alone. Conclusion: Training nephrologists to use the BC/WC communication tool does not significantly affect receipt of palliative care or other measurable clinical outcomes.

Social work roles and ethics in U.S. medical aid in dying Health & Social Work; Cynthia Helen Nover; 9/26This article fills a gap in the literature by discussing U.S. social work roles and MAiD [medical aid in dying] through an ethical decision-making framework and suggests social work roles, ethics, and risks of MAiD. Mandatory reporting expectations for U.S. social workers may cause confusion with MAiD, so it is important to distinguish between harm to self and MAiD (which is legal in 12 states and the District of Columbia) for hastening death. Relevant ethical expectations include self-determination, social justice, dignity and worth of a person, informed consent, and competence. Terms related to MAiD, including voluntary stopping of eating and drinking, and the current U.S. legal context for social work practice in this area are also described herein.

[Turkey] “Life still has meaning for me!” Exploring sources of meaningful life among palliative care patients: A qualitative studySupportive Care in Cancer; by Hazal Sonbahar Ulu, Güleser Güney Yılmaz, Ayşenur Baysal Yiğit, Elif Merve Cesur, Şeyma Sarışen, Rıfat Bozkuş, Sedef Şahin; 9/26 Palliative care has increasingly shifted from a biomedical model toward holistic approaches that address physical, psychological, social, and spiritual needs. Meaning in life is a key determinant of quality of life in advanced illness, yet patient perspectives on how meaning is constructed within inpatient settings remain underexplored. This study aimed to explore how individuals receiving inpatient palliative care at a tertiary hospital in Turkey construct and sustain meaning in their daily lives. Meaning in palliative care appears to be sustained through social connectedness, spirituality, hope, participation in meaningful occupations, supportive environments, and continuity of identity. Integrating occupation-focused interventions, spiritual care, and environmental modifications within palliative care services may help preserve continuity, dignity, and emotional well-being.

Changes in US life expectancy From 2019 to 2024JAMA Internal Medicine; by Deborah Dowell, Fang Xu, Xinyi Jiang, Gery Guy, Nisha Nataraj, Jean Ko, Grant Baldwin; 10/12/26From 2019 to 2024, there was no overall increasing or decreasing trend in rates for total deaths, poisoning deaths, or leading causes of death, with the exceptions of chronic lower respiratory disease and cancer and COVID-19. Overall life expectancy at birth increased by 0.123 year from 2019 to 2024.