Literature Review

Perceptions of telemedicine use for specialist care in skilled nursing facilitiesJAMA Network Open; by Gillian K. SteelFisher, Mary G. Findling, Eran N. Ben-Porath, Andrew D. Wilcock, Ateev Mehrotra, David C. Grabowski, Michael L. Barnett; 10/26More than one million people live as long-term residents in US skilled nursing facilities (SNFs). Quality of care in these settings is often suboptimal, and among the key challenges is insufficient use of specialist care. In this national survey of 379 directors of nursing at SNFs, most of those whose residents used telemedicine confirmed the advantages of telemedicine, although they also reported additional time burdens on nursing staff. The top reasons for not using telemedicine among less-frequent users and nonusers were that specialists offered telemedicine only infrequently and there were limited improvements in quality of care over normal practices. The findings suggest that specialist telemedicine care is seen as a useful tool for SNFs, but incentives for specialists to offer telemedicine and reimbursement for nursing staff time are needed.

End-of-life care for people who are incarcerated—ReplyJAMA; by Nicole Mushero, Brie Williams; 10/26We appreciate the response to our article by Ms Ofori-Darko and Dr McClelland and agree wholeheartedly that the definition of palliative care for incarcerated patients should be comprehensive and match the community standard. This standard includes all evidence-based interventions that palliate symptoms during serious, life-limiting illness. We also agree that short-course or single-fraction regimens of radiation therapy may be indicated for incarcerated patients with serious illness who may face additional barriers to longer-duration treatments. Other palliative treatments may also include some forms of chemotherapy, immunotherapy, antibiotics, blood transfusions, and diuresis. Some treatments may lose palliative effectiveness over time and thus be stopped as a person transitions to hospice care.

Palliative care trigger process in the pediatric intensive care unit: A quality improvement project available to purchaseCritical Care Nurse; by Cynthia Myo, Beth Nachtsheim Bolick, Julie Reed, Kimberly A. Pyke-Grimm; 10/26Early integration of palliative care for pediatric intensive care unit patients and their families is beneficial for establishing goals of care and complex decision-making. Trigger criteria were developed through a literature review and interprofessional work group discussions. The pediatric palliative care trigger criteria process was integrated into 3 areas of the pediatric intensive care unit workflow. Staff members identified patients meeting the trigger criteria and initiated team discussion on the appropriateness of palliative care. Conclusion: Implementation of a trigger criteria process to identify patients with high needs for palliative care was successful and effective in the pediatric intensive care unit in the setting of limited palliative care availability.

Medical debt and advanced cancer stage at diagnosisJAMA Network Open; by Jiazhang Xing, Xuesong Han, Xin Hu, Lingbin Meng, Lang Qu, Ryan D. Nipp, K. Robin Yabroff, Changchuan Jiang; 10/26Medical debt is a pervasive challenge for US households and has emerged as a key social determinant of health. Approximately 1 in 6 individuals in the US report medical debt, with millions facing debt in collections, and this situation disproportionately impacts low-income, uninsured, and racially and ethnically minoritized and socially deprived populations. At the community level, medical debt reflects broader structural and policy-related factors, including local insurance market characteristics, state Medicaid policies, hospital billing and collection practices, and regional socioeconomic conditions. In this cross-sectional study of US counties, higher medical debt burden was associated with higher incidence rates of late-stage and overall cancer across multiple cancer types.

Home transfusions feasible for hospice patients with blood cancer: first-of-its-kind research could help inform efforts to reimburse hospice agencies for providing blood and platelet transfusions The University of Oklahoma, Oklahoma City, OK; by April Wilkerson; 11/3/26 ... [For patients with blood cancers who are no longer pursuing aggressive treatment:] The approach allowed patients to receive transfusions for symptom relief without repeated trips to a hospital or clinic, giving them more opportunity to spend time with loved ones. ... The study was a collaboration with Our Blood Institute, based in Oklahoma City, which provided the blood, lab testing and nursing staff to perform transfusions, as well as two local hospices, Integris Hospice and Apex Home Health and Hospice, which oversaw care and collected data.

Medicare spending rises after private equity buys hospices Harvard Medical School; by Harvard Medical School with byline, Jake Miller; 11/2/26 At a Glance 

Bereaved parents' experiences of virtual Storytelling Through Music: A qualitative analysisJournal of Pain & Symptom Management; by Carolyn S Phillips, Sue E Morris, Erin Rodriguez, Megan Hebdon, Jason Morris, Rev Brandon Morgan, Meera Singh, Amanda Maestro, Claudia Gruber; 9/26Bereaved parents whose child died from cancer are at risk for prolonged and complicated grief, yet accessible, engaging bereavement interventions remain limited. Storytelling Through Music (STM) is a virtual, group-delivered expressive arts intervention that integrates reflective writing, psychoeducation, and therapeutic songwriting. Five interrelated themes characterized the STM experience: (1) connecting with peers and music, (2) benefits of coping through sharing, (3) expansive emotional experience ... , (4) graded exposure through the sequenced writing-storytelling-songwriting process, and (5) enduring legacy, with the final song functioning as a lasting keepsake and ongoing coping resource. STM appears to support multidimensional grief processing by combining social connection, narrative meaning-making, and music-based emotional engagement in a virtual format.

Palliative care utilization in mesothelioma: Insights from the National Inpatient Sample (2016-2020)Journal of Palliative Care; by Sangam Sangam, Tripti Jain, Pulkit Jain, Shorabh Sharma; 9/26Mesothelioma is a rare and fatal cancer with a median survival of about 1 year after diagnosis. Palliative care (PC) becomes important in improving symptom control and quality of life in cancer patients. However, there is no literature regarding specific determinants of PC utilization in hospitalized mesothelioma patients. We studied the trends and determinants in utilization of PC, and its impact on hospital costs using the National Inpatient Sample. Inpatient PC use in mesothelioma remains low but is associated with lower hospitalization costs. These findings support the need for systematic early PC integration in Mesothelioma management in a hospital setting.

Spirituality in end-of-life care: Tips and tools for all physiciansAmerican Journal of Hospice & Palliative Medicine; by Derek Ross Soled, Sheila Cavanaugh, Anne Vandenhoeck, Michael Balboni; 9/26Many physicians find themselves with patients when life’s final horizon is approaching but feel ill-equipped when they cannot take the suffering away. If a patient has no discernible chance of recovery, praying for healing seems disingenuous, and yet expressing condolences seems premature. Family and friends sometimes similarly grapple with how best to convey sincere emotion without amplifying any awkwardness. End-of-life situations are often protracted and can weary clinicians and families alike with the challenge of what to say. This article discusses practical tools for physicians navigating these situations with a focus on spirituality and the role of chaplains.

[Canada] Medical assistance in dying in patients with destination-therapy left ventricular assist devicesJACC Case Reports; by Jacqueline Carverhill, Michele Bertelli, Omid Kiamanesh; 9/26Case summary: Two male patients with destination-therapy LVADs [left ventricular assist devices] received clinician-administered MAiD [medical assistance in dying]. One had refractory transfusion-dependent gastrointestinal bleeding and died in a community hospice; the other had refractory pain, anxiety, and existential suffering and died on an acute care ward. In both cases, intravenous medications were administered while the LVAD remained active, and the device was deactivated after unconsciousness and apnea were confirmed. These cases describe a practical approach to coordinating MAiD with LVAD deactivation in hospital and hospice settings. The process required advance agreement among the LVAD team, MAiD provider, and palliative care team regarding medication sequencing, responsibility for device deactivation, and anticipated alarms.