Literature Review

When end-of-life becomes the beginning of new life: Application of the Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU to the setting of donation after circulatory deathCritical Care Explorations; by Ian M. Oppenheim, Rita N. Bakhru, Carolina B. Maciel, Katharina M. Busl, on behalf of the Donor Care Unit Network for Optimizing Recovery (DONOR) GroupThe recently published Society of Critical Care Medicine Guidelines on Adult End-of-Life Care in the ICU provide a detailed and well-thought-out approach to a vital component of critical care, although they explicitly refrain from discussing how they may apply to organ donation. As representatives of the Donor Care Unit Network for Optimizing Recovery (DONOR), a group of intensivists experienced in managing donation after circulatory death (DCD), we wish to endorse equal delivery of high-quality end-of-life (EOL) care for organ donors. Although some logistical differences must be addressed, the EOL recommendations outlined in the Guidelines are still applicable to patients being evaluated for or undergoing DCD. Recent accounts of unacceptable patient care in the setting of DCD highlight a critical threat to patient welfare and public trust. Our mandate is clear: implement and audit protocols that guarantee dignity and symptom control while demonstrating that DCD remains wholly consistent with a compassionate, honorable, and fulfilling EOL.

Using case studies to bridge the undergraduate nursing education gap in palliative and hospice careJournal of Hospice & Palliative Nursing; by Katherine Adams, Lisa Cross; 8/26Undergraduate nursing students struggle with understanding pharmacological pain management, especially in palliative care. New nurses indicate needing more experience with pain management and ethical dilemmas surrounding pain management. This project aimed to develop real-life case scenarios aligned with palliative competencies for use in undergraduate courses. Traditionally, palliative and hospice content is delivered with community courses, possibly limiting student competency across settings. These case studies present an opportunity for formative student assessment in pharmacological and other palliative management over 4 settings. Facilitation requires reflective techniques, and nurse faculty may need support in guiding discussions.

Nearly half of veterans with stage IV cancer die without hospice: a national VHA analysis of 45,397 decedents Medscape; by Sasmith Menakuru, MD; Alexander Quattlebaum, MD; Chance Bloomer, MD; Lara Khoury, MD; Abdulsabur Sanni, MD; Michael Goodman, MD; 9/3/26  Results: Of 45,937 veterans, 20,338 ... had no hospice admission or consultation.  ... Conclusions: Hospice access for veterans with Stage IV cancer deteriorated during COVID-19 and shows no meaningful recovery; ... These findings identify Stage IV hospice access as an underrecognized national VHA quality priority warranting Stage IV—triggered automated palliative care consultation, embedded outpatient palliative care in oncology clinics, standardized referral protocols at documented progression, and veteran/family-facing hospice education. This analysis establishes a statistically rigorous national baseline for benchmarking interventions–and a call to action for the VHA oncology community to restore hospice as a core element of veteran-centered end-of-life care.

Patient and caregiver perspectives on communication quality in tele-palliative care Journal of Palliative Medicine; by Julia I. Bandini, PhD, Elaine Li, BA, Dio Kavalieratos, PhD, FAAHPM, Natalie C. Ernecoff, PhD, Kimberly Curseen, MD, and Jordan Harrison, PhD; 8/27/26 Objective: To qualitatively explore patient and family caregiver experiences with telehealth and in-person visits for outpatient palliative care, including preferences related to mode of care and any perceived differences in communication quality by mode in a post-pandemic context. Results: Three themes emerged: (1) participants weighed convenience, symptom burden, and visit reason in choosing mode of care; (2) opinions differed on the authenticity of communication via telehealth; and (3) comfort and privacy shaped communication quality. Some patients and family caregivers perceived communication via telehealth as comparable to in-person care, while others felt in-person visits allowed for more authentic interactions. Many found that the convenience of telehealth outweighed any perceived differences in communication quality. In addition, some patients noted that without the option for telehealth, the benefits of an in-person palliative care visit may not have outweighed the travel burden.

An exploration of gratitude on well-being in hospice and palliative care familial caregiversJournal of Palliative Medicine; by Kathryn Levy, Pei C Grant, Hannah Rachiele, Gina Schuster, Jonathan L Rossi, Sheila Conboy, Andrew Gasper, Christopher W Kerr; 7/26Familial caregivers (FCGs) play a critical role in health care by providing unpaid care to loved ones with serious illness. Although caregiving is often associated with emotional and physical burden, increasing attention has been directed toward potential sources of meaning and psychological growth, including gratitude. Higher levels of gratitude were associated with greater flourishing and recognition of positive caregiving experiences and were inversely associated with caregiver strain among FCGs of hospice and palliative care patients. Future longitudinal and intervention-based research is needed to determine whether gratitude-focused approaches can improve resilience, psychological well-being, and relational connection in end-of-life caregiving.

Spirituality and religiosity in end-of-life decision-making in intensive care units: a systematic review of preferences, ethical framing, and meaning-making Cureus; by Dimitrios G. Apostolakis, Nikiforos V. Angelopoulos, Spiros Georgakis, Fotios Tatsis, Foteini Veroniki, Konstantinos Stamatis, Georgios Papathanakos, Mary Gouva, Vasilios Koulouras; 8/25/26 End-of-life decision-making in intensive care units (ICUs) is a complex and ethically challenging process shaped not only by clinical factors but also by patients' values, cultural contexts, and spiritual or religious beliefs. ...  [Spirituality] demonstrated a multidimensional role, facilitating acceptance of death, promoting support for palliative care in some contexts, and contributing to meaning-making during the end-of-life process. Cultural and contextual factors moderated these relationships, and the provision of spiritual care by healthcare professionals was associated with less aggressive end-of-life care. ... Integrating spiritual assessment and culturally sensitive spiritual care into routine clinical practice may enhance shared decision-making and improve alignment between treatment decisions and patients' values, preferences, and goals of care.