Literature Review

Trends in preferred place of death among patients with bladder cancer in the United States, 2000 to 2020Palliative & Supportive Care; by Manas Pustake, Atharva Railkar, Mohammad Arfat Ganiyani, Atulya Aman Khosla, Avi Harisingani, Hanzala Jehangir, Mostafa Eysha, Divya Samat, Taha Hassan, Rohan Garje; 4/26Understanding trends in end-of-life care for bladder cancer patients is essential in improving palliative care planning. This study analyzes trends in preferred place of death among bladder cancer patients in the United States from year 2000 to 2020. Black individuals had significantly lower odds of hospice use than White patients ... and hospice use increased annually by an average of 13.4% ...  Interestingly, younger individuals were more likely to die in hospice compared to those aged 85 years or older, though the odds decreased with age. The results indicate that utilization of hospice care and home-based end-of-life care have risen in prominence though disparities are present across racial and regional groups.

Assessing PA student interest in hospice and palliative medicineThe American Journal of Hospice & Palliative Care; by Ryan Baldeo, Rachael Broder; 4/26While hospice and palliative medicine (HPM) is a critical and growing field, Physician Associates (PAs) are underrepresented. This study sought to assess PA student interest in HPM and identify strategies to increase engagement with the Physician Associates in Hospice and Palliative Medicine (PAHPM) organization. The survey assessed attitudes toward HPM and identified barriers to organizational involvement. Lack of awareness was the primary barrier to involvement (75.8%). Students expressed interest in educational resources (63.6%), job opportunities (57.6%), and mentorship (51.5%). Most respondents (81.8%) do not currently follow PAHPM on social media, but 72.7% indicated they would follow an Instagram account.

The professional guest: Ethical challenges in home-based end-of-life care among interprofessional teamsNursing Ethics; Inbal Halevi Hochwald, Gila Yakov, Moran Weiss, Liron Inchi, Inbal Mayan, Ron Sabar; 4/26Home-based end-of-life palliative care presents unique ethical challenges that differ fundamentally from those in institutional settings. Healthcare professionals navigate the complex role of being both clinical experts and guests in patients' domestic environments, operating in a context where professional authority is continuously negotiated rather than institutionally established. Home-based palliative care places professionals at the intersection of clinical responsibility and domestic sovereignty, a position for which existing frameworks offer insufficient guidance. Addressing these structural and relational challenges requires both individual-level preparation, including training in ethical decision-making in low-control environments, and systemic policy reform.

Enhancing psychosocial care at end of life: A novel simulation training programPalliative & Supportive Care; by Emilia Crnjak, Michelle Kerns, Mariah Stevens, Brianna O'Connell, Lauren Mednick; 4/26Providing psychosocial support to pediatric patients and their families at the end of life represents one of the most challenging yet vital aspects of healthcare practice. This study explored the use of simulation-based training to enhance the self-reported knowledge, skills, and comfort levels of child life specialists in providing psychosocial care during end-of-life situations. Forty-three child life specialists participated in the simulation-based training, which was combined with traditional didactic instruction, and the associated research study. Pre- and post-training surveys were used to assess impact of the training on child life specialists' self-reported knowledge of end-of-life care and comfort in providing this care. A statistically significant increase was seen in all measured aspects of self-reported knowledge and comfort in providing end-of-life care following the training.

Losing a close person to death in ICU: A thematic analysis of bereaved family members' experiences of end-of-life careIntensive and Critical Care Nursing; by Lena Palmryd, Anette Alvariza, Asa Rejno, Tove Godskesen; 6/26This study aims to describe bereaved family members experiences of end-of-life care following the death of a close person in ICU... In ICUs, family members are in great need of compassionate support, characterized by the presence of ICU nurses and their emotionally attuned communication. This support helps family members navigate the complexity in care, fostering trust, meaning-making, and a sense of dignity.

[Canada] Palliative care in multiple sclerosisContinuum; by Penelope Smyth, Janis M. Miyasaki; 4/26This article reviews palliative care concepts valuable to neurologists caring for people with multiple sclerosis (MS), describes the three stages of palliative principles in care delivery, and suggests triggers to refer for specialized palliative care interventions. Advances in disease-modifying therapies have extended life expectancy and reduced disability progression in patients with multiple sclerosis. However, palliative care remains underutilized in addressing persistent symptoms, care partner burden, and psychosocial challenges. Palliative care strategies in MS can be divided into three stages: early-stage palliative care needs and screening after diagnosis; midstage palliative care needs, including symptom management and quality-of-life optimization; and late-stage palliative care needs, including managing severe MS and end-of-life care. Additional foci of specialist palliative care may include end-of-life care, advance care planning, care partner support, and patient consideration of medically assisted death. 

Nursing home ratings and characteristics predict hospice use among decedents with serious illnessesJournal of the American Medical Directors Association; by Ellis C Dillon, Chae Man Lee, Wenqi Gan, Doreek Charles, Germine Soliman, Julie Robison; 4/26Approximately one-third of older Americans experience a nursing home (NH) stay within 3 months of death, but it is unclear how NH characteristics influence end-of-life care.  Short-term (vs long-term) NH stays were associated with increased odds of hospice use and short hospice use. Individuals with long-term stays had lower odds of hospice use with stays at NHs with the highest (vs lowest) CMS ratings for quality measures and staffing ... Those with short-term stays had lower odds of hospice use with stays at NHs with the highest CMS Health Inspection ratings. People with long-term stays at NHs that were part of a chain, had Alzheimer's care units, or had more beds had increased odds of hospice care. Conclusions and implications: Among Connecticut Medicaid-insured decedents with NH stays, people with long-term stays and stays in NHs with better CMS ratings had lower odds of hospice use. Assistant Editor's note: This summary article highlights an important issue and an excellent opportunity for future analysis in a broader context. Intuitively, we'd like to see highly rated NHs have higher hospice utilization. 

Improving advanced practice clinicians' knowledge and comfort of physician orders for life-sustaining treatment form: A homecare quality improvement initiativeGeriatric Nursing; by Jeanette M Ruiz, Yvonne Y Wu, Kristen R Choi, Emily J Martin, Eden R Brauer; 4/26Many advanced practice clinicians (APCs) lack formal training on how to effectively discuss the Physician Orders for Life-Sustaining Treatment (POLST) with chronically ill older adults, often leading to communication gaps and delayed end-of-life decisions. This quality improvement initiative aimed to improve APCs knowledge and comfort in initiating and documenting POLST discussions with community-dwelling geriatric patients. A one-hour online training, incorporating didactic instruction, role-playing, and debriefing, was delivered for APCs providing home-based care. Surveys conducted before and after the training measured ... improvements ...  in POLST completion documentation ... , POLST discussions documentation ... , POLST upload documentation ... , hospice knowledge ... , palliative care knowledge ... , preparedness to discuss POLST ... , comfort with end of life conflict discussions ... , addressing religious/cultural perspectives ... , and use of structured communication frameworks ...