Literature Review

Palliative care in the intensive care unit: An integrative review of intensive care unit health care professionals' views and experiences Dimensions of Critical Care Nursing (DCCN); by Berit Lindahl and Susan Kirk; May-Jun 2025 ... Our findings suggest there is variation in how palliative care in the ICU is conceptualized and interpreted. Intensive care unit professionals need enhanced competencies and training to develop their confidence in providing palliative care and improve role clarity. Such training should focus on serious illness conversations with patients/families and interdisciplinary teamwork. Integration of palliative consultants into the ICU could be further developed.

Bioethics Artificial Intelligence Advisory (BAIA): An Agentic Artificial Intelligence (AI) framework for bioethical clinical decision support Cureus; by Taposh P. Dutta Roy; 3/12/25 Healthcare professionals face complex ethical dilemmas in clinical settings in cases involving end-of-life care, informed consent, and surrogate decision-making. These nuanced situations often lead to moral distress among care providers. This paper introduces the Bioethics Artificial Intelligence Advisory (BAIA) framework, a novel and innovative approach that leverages artificial intelligence (AI) to support clinical ethical decision-making. The BAIA framework integrates multiple bioethical approaches, including principlism, casuistry, and narrative ethics, with advanced AI capabilities to provide comprehensive decision support. 

Children as living solid organ donors: Ethical discussion and model hospital policy statementThe Journal of Clinical Ethics; Gyan C. Moorthy, Aidan P. Crowley, and Sandra Amaral' Spring 2025In recent years, more attention has been paid to living donation as a means to reduce the suffering of individuals with end-stage kidney or liver disease. Implicated ethical issues include medical risk and risk of coercion, counterbalanced by improved medical outcomes and the benefits of saving a life. Living donation becomes particularly ethically complicated with the prospect of child donation, given the child’s developing autonomy and uniquely dependent status. We outline four broad ethical considerations pertinent to living child organ donation: (1) beneficence, (2) respect for the family as a moral unit, (3) respect for the child as a person, and (4) justice. We conclude that it can be ethical for a healthy child to donate a kidney or liver lobe to a close relative who has exhausted other options provided that certain protections are put into place.

[Canada] Death doulas’ experiences with and perspectives on unusual end-of-life phenomenaOmega-Journal of Death and Dying; Stephen Claxton-Oldfield, Madeleine de Ste-Croix Killoran; 2/25In this article, the term ‘unusual end-of-life phenomena’ (EOLP) is used to refer to extraordinary experiences that can happen when someone is approaching death, at the time of death, and after death. Consistent with the results of previous studies involving people who work with the dying (i.e., doctors, nurses, hospice palliative care volunteers, nursing home staff) death doulas had commonly observed or been told about various EOLP in their work supporting people through the dying process. Deathbed visions were the most witnessed and reported EOLP. Death doulas indicated that they were comfortable talking about EOLP with their clients and clients’ families and most or almost all endorsed spiritual or transpersonal explanations for EOLP over scientific or medical ones. Death doulas have an important role to play in normalizing, validating, and educating their clients and clients’ families about EOLP.

Quality of life in heart failure. The heart of the matter. A scientific statement of the Heart Failure Association and the European Association of Preventive Cardiology of the European Society of CardiologyEuropean Journal of Heart Failure; Maurizio Volterrani, Geza Halasz, Stamatis Adamopoulos, Pier Giuseppe Agostoni, Javed Butler, Andrew J.S. Coats, Alan Cohen-Solal, Wolfram Doehner, Gerasimos Filippatos, Ewa Jankowska, Carolyn S.P. Lam, Ekaterini Lambrinou, Lars H. Lund, Giuseppe Rosano, Marco Metra, Stefania Paolillo, Pasquale Perrone Filardi, Amina Rakisheva, Gianluigi Savarese, Petar Seferovic, Carlo Gabriele Tocchetti, Massimo Piepoli; 3/25 Patients with heart failure (HF) experience much worse QoL [quality of life] and effort intolerance than both the general population and people with other chronic conditions, since they present a range of physical and psychological symptoms, including shortness of breath, chest discomfort, fatigue, fluid congestion, trouble with sleeping, and depression. The importance of QoL for patients with HF is highlighted in a survey showing that 61% attached more weight to QoL over longevity, with 9% and 14% willing to trade 6 and 12 months, respectively, for perfect health and better QoL.It is for these reasons that the Heart Failure Association is developing a new score for QoL in HF, sensitive to mechanism-specific interventions and tailored to be sensitive to changes within individual patients. 

[Austria] Influence of prior knowledge and experience on willingness to pay for home hospice services: a contingent valuation study International Journal of Health Economics and Management; Caroline Steigenberger, Andrea M Leiter, Uwe Siebert, Claudia Schusterschitz, Magdalena Flatscher-Thoeni; 3/25/25 Home hospice services contribute to dying in dignity by addressing medical and social needs at the end of life. ... We aim to quantify the benefits of home hospice services to society using society's monetary valuation and examine the influence of prior knowledge and experience on willingness to pay for home hospice services. A nationwide cross-sectional contingent valuation study was conducted in Austria. ... The two-part regression analysis showed a statistically significant positive impact on the probability of having a positive willingness to pay by prior knowledge of home hospice services, prior donations, and the wish of not dying alone. [Continue reading ...]Editor's note: Pair this research from Austria with today's USA post, "Medicare and 24-hour in-home hospice care: Is it covered?" Too often, we take for granted our Hospice Medicare payment system. Some choose to misuse it in ways that lead to fraud. This research reinforces openess to hospice services per "prior knowledge of home hospice services, prior donations, and the wish of not dying alone."

Community health workers and technology interventions' impact on palliative support globally Journal of Palliative Medicine; by Alekhya Gunturi, Margarita Pertierra, Irma Elizabeth Huayanay Espinoza, Maya Kavita Ramachandran, Mpho Ratshikana Moloko, Karl A Lorenz; 3/20/25Background: Palliative care has the potential to relieve burdened global health systems but is in short supply in many low-resource settings. Community health workers (CHWs) and digital health tools/telephonic support have the potential to scale scarce palliative care resources and improve outcomes for seriously ill adults in home/community settings.  Conclusions: CHWs and digital health/telephony can improve quality of life, health care use, and caregiver support. Most research focuses on physical and psychological aspects of care instead of cultural aspects of care. Future research is needed to explore culturally tailored interventions in minority populations and low- and middle-income countries, as well as investigate emerging remote technologies to allow for scaling palliative care into home/community settings.Editor's note: Pair this with Hospice community responds to proposed DEA telehealth prescribing rule, posted 3/21/25.

[UK] Why we need to consider frailty in the assisted dying debateAge and Aging; Sarah A Hopkins, Annabel Price, Simon N Etkind; 2/25Assisted dying/assisted suicide (AD/AS) is legal or decriminalised in several countries and Bills to legalise it are currently being considered by the UK and Scottish Parliaments. Older adults living with frailty make up an increasing proportion of those who die, yet the possible implications of AD/AS for these individuals are relatively unexplored. Frailty complicates AD/AS in relation to eligibility because of ambiguity over whether frailty constitutes a terminal illness, challenges in accurately predicting prognosis, and difficulty determining reversibility of suffering. Frailty also blurs the distinction between terminal illness and disability, in contrast to the clear-cut language of current proposed legislation where those with a terminal illness are eligible, but those with disability are not. Further consideration is needed regarding eligibility, safeguards in the context of relational autonomy and for those who already feel a burden, and how to mitigate risks of further entrenching ableist and ageist attitudes.

Feasibility study of using electronic patient-reported outcomes to screen patients with advanced solid cancers for palliative care needsJournal of Palliative Medicine; Tara L Kaufmann, Matthew Kearney, Dagoberto Cortez, John W Saxton, Katie Goodfellow, Carolyn Smith, Patrick Chang, Katherine Sebastian, Aaron Galaznik, Julie Scott, Elizabeth Ann Kvale, Arif H Kamal, Antonia V Bennett, Angela M Stover, Ashley M Henneghan, Michael Pignone, Gabrielle Betty Rocque; 3/25Standardized, needs-based screening and triage systems are essential to more effectively address patients' palliative care needs. We developed a 13-item ePRO [electronic patient-reported outcomes] palliative care survey to assess multidimensional palliative care needs and conducted a pilot study (n = 25) of a palliative care screening intervention using ePRO monitoring and presentation of ePRO reports to a multidisciplinary care team. Patients found the ePRO palliative survey acceptable and appropriate. Screening patients for unmet palliative needs using ePRO monitoring is feasible, acceptable, and appropriate among patients, but more work is needed to understand the perspectives of diverse patients and how to integrate ePRO palliative care screening into clinical workflows.

Inpatient use of valproic acid in agitated delirium by palliative medicineAmerican Journal of Hospice and Palliative Medicine; Sarah Jacobs, DO; Leah Herbst, DO; Carlos Fernandez, MD; Zankhana Y. Mehta, MD; Amanda Young, MS; Mellar P. Davis, MD; 2/25Valproic acid (VPA), an anti-epileptic medication available in intravenous and parenteral forms, has recently been used to treat agitation associated with delirium. VPA as an adjunct in treating delirium has been reported to be opioid, antipsychotic and benzodiazepine sparing. ... this study did show that 50% of patients did not require benzodiazepines or antipsychotics at all, and that VPA might have a role in sparing the use of medications such as antipsychotics and benzodiazepines which have poor evidence in the management of agitation in delirium.

Prevalence of depression and anxiety among adults with chronic pain-A systematic review and meta-analysisJAMA Network Open; Rachel V. Aaron, PhD; Scott G. Ravyts, PhD; Nicolette D. Carnahan, PhD; Kavya Bhattiprolu, BS; Nicole Harte, MClinPsychol; Claire C. McCaulley, BA; Lauren Vitalicia; Alexandria B. Rogers, PhD; Stephen T. Wegener, PhD; Joanne Dudeney, PhD; 3/25Chronic pain, defined as pain that persists for more than 3 months, is a prevalent and disabling condition affecting 21% of adults. In this systematic review and meta-analysis of depression and anxiety among individuals with chronic pain, approximately 40% of adults had clinically significant depression and anxiety. Women, younger people, and people with nociplastic pain were most likely to have depression and anxiety. The co-occurrence of chronic pain with depression and anxiety is a significant public health concern necessitating routine screening in clinical settings, equitable access to specialty care, and innovative treatment development. 

Medical interpreters’ experiences with patients who are near end-of-life and their family membersJournal of Pain and Symptom Management; Joycelyn Howard DNP, RN, AGCNS, ACHPN ; Alexia M. Torke MD, MS; Susan E. Hickman PhD; Greg Sachs MD; Sylk Sotto-Santiago EdD, MBA, MPS; James E. Slaven MS, MA; Denise Robinson PhD, RN, FNP; 3/25In 2019 the United States Census Bureau reported 8% of the United States Population “speak English less than very well”. Ensuring individuals with a non-English language preference (NELP), previously referred to as limited English proficiency, have equitable access to healthcare includes providing high quality interpreter services. Although self-efficacy for interpreting EOL [end of life]conversations is generally high, interpreters desire education about EOL care. Interventions are also needed to address the high emotional toll of interpreting EOL conversations. Education and training about EOL care may help them to not only convey information accurately but also cope with emotional nuances characteristic of these significant conversations, ultimately elevating the quality of care for patients and family members in vulnerable and important moments.

Sarcopenia in terminally ill patients with cancer: Clinical implications, diagnostic challenges, and management strategies Journal of Hospice & Palliative Care; by Se-Il Go, Myoung Hee Kang, and Hoon-Gu Kim; 3/1/25 Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration.