Literature Review

Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-Hispanic White surrogate decision makersEquity Neuroscience; by Imadeddin Hijazi, Lewis B Morgenstern, Robert Michael Miller, Erin Case, Madeline Kwicklis, Darin B Zahuranec; 10/25 Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Contrary to our original hypothesis, we did not identify an ethnic difference in surrogate reports of the quality of death and end-of-life care after stroke between MA patients and NHW [non-Hispanic White] patients after adjusting for demographic and clinical factors. This result is encouraging, as it implies that in this community, ethnic disparities in end-of-life care may not be as pronounced as reported in other populations. Furthermore, the high scores on both surveys indicate overall satisfaction with care regardless of ethnicity. 

Trends in hospice use among older adults with dementia and cancer by race and ethnicity 2011–2021Journal of the American Geriatrics Society; by Inbal Mayan, Siqi Gan, John Boscardin, Krista L. Harrison, Jennifer E. James, Alexander Smith, Lauren J. Hunt; 11/25Hospice use among older adults has expanded substantially, with more than 1.7 million Medicare beneficiaries enrolled annually. Yet, disparities by race and ethnicity in hospice remain. It is unknown whether these disparities have narrowed over time or whether trends differ by clinical condition. We examined changes in hospice use by race and ethnicity among decedents with dementia and cancer, two common terminal diagnoses with different trajectories and implications for hospice eligibility.

GUIDE and beyond: Strategies for comprehensive dementia care integrationJournal of the American Geriatrics Society; by Kristin Lees Haggerty, David B Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R Lee, Madelyn Johnson, Morgan J Minyo, Katherine L Possin, Quincy M Samus, Lynn Spragens, Lee A Jennings, Gary Epstein-Lubow; 10/25The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach.  Drawing from the experiences of six previously tested programs ... we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.

Hospice, palliative care, and care experiences among Medicare beneficiaries with cancerJournal of Geriatric Oncology; by Lisa M Lines, Miku Fujita, Kim N Danforth, Daniel H Barch, Michael T Halpern, Michelle A Mollica, David T Eton, Ashley Wilder Smith; 11/25Among 37,025 Medicare beneficiaries with cancer, 11.1 % received hospice (with or without PC) and 7.4 % received PC only. Nearly 30 % of the sample died within five years of diagnosis; fewer than one-third of decedents received hospice. Factors associated with receiving hospice included increasing age, non-Hispanic ethnicity, American Indian/Alaska Native and multiracial identities, living in higher-income neighborhoods, survey-completion proxy assistance, fair/poor general health, advanced stage at diagnosis, and more illness burden. Independent predictors of PC encounters included age 75-79, female identification, no dual enrollment, no proxy assistance, and more illness burden. Differences in care experience associated with hospice or PC use were shown for two care experience measures: doctor communication scores and doctor rating scores were higher among beneficiaries who received neither hospice nor PC relative to beneficiaries who received hospice.

How clinicians prenatally discuss management options and outcomes for congenital heart disease Journal of Pain and Symptom Management; by Samantha Syme, Kelsey Schweiberger, Judy C Chang, Ann Kavanaugh-McHugh, Nadine A Kasparian, Robert M Arnold, Kelly W Harris; 11/27/25 Online ahead of printA prenatal diagnosis of complex congenital heart disease (cCHD) introduces significant emotional, social, and financial stress for families. ... Fetal cardiology consultations offer an important opportunity to support families navigating uncertainty following a prenatal diagnosis of CHD. Clinicians approached these conversations with empathy and a focus on long-term outcomes, though discussions about management options varied. There is an opportunity for increased presentation and integration of palliative care consultants as a longitudinal, family-centered resource, regardless of mortality risk, which may enhance supports available to families during this highly emotional period.

S41 Delayed palliative care consultation among veterans with pancreatic cancer: An analysis of patterns and outcomesThe American Journal of Gastroenterology; by Adla, Akhil; Walker, Hayes; Whitwell, Samantha; Yn, Louis; Tombazzi, Claudio; 10/25Pancreatic cancer is characterized by a rapid disease progression, and poor overall prognosis, necessitating a comprehensive approach to care. The American Society of Clinical Oncology strongly recommends early palliative care consultation for all advanced pancreatic cancer patients, at the time of diagnosis or within the 8-12 weeks of diagnosis. Timely palliative care involvement has been shown to improve symptom management, mood, and improved survival. Despite these benefits, palliative care referrals are often delayed, limiting the potential impact on patient outcomes. This study reveals a dramatic percentage of patients who did not have palliative care consultations in a timely fashion as recommended by American Society of Clinical Oncology. 

5.2 consultation-Liaison perspectivesJournal of the American Academy of Child & Adolescent Psychiatry; by Julia A. Kearney;10/25Parents suffer loss and anticipatory grief, struggle with complex medical decision-making, and bear the primary burden of talking to their children about illness, death, and loss. Clinical intervention can: 1) improve communication around child prognosis and medical decision-making; 2) support parents in having open conversations with their children; and 3) directly assess and address parent mental health. Parents and caregivers appreciate resources to address their mental health in pediatric settings, need expertise from clinicians experienced in pediatric illness and palliative care, and need programs to overcome barriers such as parents’ unwillingness or inability to leave their child and the unpredictability of the child’s illness. While nothing can eliminate the suffering and grief of families facing a child’s terminal illness, clinicians can increase hope by helping enhance meaning, connection, trust, and love while reducing guilt and regret.  

[Norway] Intensive care of the very old - questioning the relationship between illness severity and the moral imperative to deliver life-saving carePhilosophy, Ethics, & Humanities in Medicine; by Gabriele Leonie Schwarz; 10/25Intensive care provision to very old patients is rapidly growing owing to demographic changes and increasing treatment intensity. However, intensive care carries only questionable benefit for the oldest patients, and many of them die after prolonged organ support. Departing from a clinical perspective, this study aims to explore the drivers for the expansion of critical care in advanced age, despite widespread awareness of its potential harms to patients, their families, healthcare professionals, and society. 

[Canada] Examining compassion satisfaction and work-related stress within a hospice for the homeless (H4H) organization: Results from a multi-method surveyAmerican Journal of Hospice & Palliative Care; by Celina Carter, Mary Anne Olalia, Justine Giosa; 10/25Communities in Canada have created targeted hospice palliative care strategies such as facility-based hospices for the homeless (H4H) to promote equitable access to care. We developed and administered an anonymous 26-item survey to 104 providers including both staff (eg, nurses, administrators) and volunteers at a facility-based H4H in Ontario. Requests for additional resources to foster workplace wellbeing included educational, process-related, spiritual/psychological, and social supports. Respondents storied that positive workplace wellbeing includes being able to provide quality care, and having supportive relationships, personal fulfillment, and a respectful culture within the workplace. Provider participants were satisfied with their ability to be effective carers, yet chronic multi-level work-related stressors can erode a sense of meaning in H4H work.

Bridging the gap: A scoping review of clinical decision support systems in end-of-life care for older adults Journal of Palliative Medicine; by Susanny J Beltran, Lainey Dorris, Marie Hamel, Shanelle Harvey, Mustafa Ozkaynak, Kenan Sualp; 11/17/25 online ahead of print Background: ...  This scoping review maps the current landscape of clinical decision support (CDS) systems in EOL care, identifies key system types, and examines their effectiveness in guiding clinical decisions. ... Results: A total of 31 studies were included, categorizing CDS systems into prognostic tools, referral tools, and care informing tools. ...