Literature Review

Developing competencies to advance health care access and quality for Latino, Hispanic, and Spanish origin populations-A consensus statementJAMA Network Open; by Débora H. Silva, John A. Davis Rodríguez, Hector Rasgado-Flores, Pilar Ortega, Deion Ellis, Fernando Sánchez Mendoza, Victor Cueto, Fabiola Quintero-Rivera, Norma Iris Poll-Hunter, Minerva Romero Arenas, Kenneth Lee Dominguez, Juan Emilio Carrillo, José E. Rodríguez, John Paul Sánchez; 8/25Question: What competencies and milestones are essential for advancing health equity for Latina, Latino, Latinx, Latine, Hispanic, and Spanish Origin (LHS+) populations? Since the 1970s, the LHS+ population has increased 6-fold and grown to be the largest ethnic or racial group in the US and accounts for approximately 20% of the US population. The LHS+ health equity competencies and milestones resulting from this study add to prior work by creating a blueprint for standardization and broader application of such educational experiences on a national level. As a tool to enhance CBME [competency-based medical education ] efforts aligned with care for LHS+ populations, the competencies may aid educators and institutions through an LHS+–informed lens in conducting gap analyses for the development of local curricula, developing teaching and assessment materials, supporting the professional development of learners and faculty, and facilitating educational scholarship. 

Medicare Advantage plan spending and payments under the hospice carve-outJAMA Network Open; by Meghan Bellerose, Andrew M Ryan, Claire K Ankuda, David J Meyers; 8/25In 2021, the Centers for Medicare & Medicaid Services implemented a Value-Based Insurance Design (VBID) model to test the impact of including hospice services in the Medicare Advantage (MA) benefits package. In December 2024, the VBID was ended following widespread dissatisfaction ... Under the carve-out model, after an MA enrollee elects hospice, health care related to their terminal illness is paid for by fee-for-service (FFS) Medicare. MA plans stop receiving the inpatient and outpatient portions of that enrollee's capitated payment but continue to receive premium and rebate payments. In this cross-sectional study, MA plans received high premium and rebate payments for beneficiaries enrolled in hospice despite low health care spending after enrollees elected hospice. To reduce excess payments, the Centers for Medicare & Medicaid Services could require MA plans to submit information on enrollees' use of supplemental benefits and adjust payments made after election of hospice to align with spending.

Improving community-based palliative care explanations: Insights from persons declining servicesAmerican Journal of Hospice & Palliative Care; by Kira G Sheldon, Kathryn H Bowles, Elizabeth A Luth; 8/25Beneficiaries and caregivers had mixed understandings of palliative care, including: no knowledge, belief that it was the same as or pre-hospice, and accurate, but often one-dimensional understandings of it. Participants recommended providing individualized, tailored explanations focused on the person's health concerns in simple language with follow-up materials to improve engagement with palliative care. Small adjustments to how palliative care is explained may increase understanding among older adults and caregivers, particularly among those with limited or inaccurate knowledge. Among those familiar with palliative care, providing accessible and clear explanations customized to the person's specific care needs can further broaden understanding and increase perceived relevance.

Implementing education for community adult hospice nurses to expand pediatric hospice and palliative careJournal of Hospice and Palliative Nursing; by Shelly C Wenzel; 8/25Pediatric hospice and palliative patients require specially-trained clinicians to provide holistic support in areas such as disease progression, illness trajectory, and goals of care. An asynchronous online educational module, including a pre- and postmodule survey, was developed to provide education on timely pediatric quality-of-life conversations and skills for nurses who work with the adult population. Following the education module, participants reported an increase in comfort from 25% to 93.3% and willingness from 59% to 93.3%. Additionally, postmodule confidence level increased to 94%. These findings suggest an asynchronous educational module approach benefits the needs of community-based adult hospice and palliative nurses and gains learned from this module may enhance nurse skill and improve access to care.

[UK] Does non-beneficial nasogastric tube feeding occur during end-of-life care? An audit of outcomes for those with a malnutrition universal screening tool score of 2Journal of Palliative Medicine; by Ross Andrew James Webster, Moitree Banerjee, Rachel King, Rosana Pacella, Antonina Pereira; 8/25The consideration of artificial nutrition and hydration (ANH) is recommended for individuals with reduced nutritional intake. However, placing long-term nonoral feeding tubes is not appropriate in those with advanced dementia or if the individual is likely to die imminently—“within hours or days”. In some instances, the provision of ANH in the weeks leading up to death may be considered a “Non-Beneficial Treatment.” In [this study a] total [of] 40 (47.6%) of 84 NGT [nasogastric tube]-flagged individuals were deceased within six months. Conclusions: NGT insertions in this cohort have a high likelihood of being considered “non-beneficial.”

Benefits and burdens of research participation: A mixed methods systematic review in palliative and end-of-life careJournal of Hospice and Palliative Nursing; by Cara L Wallace, Stephanie P Wladkowski, Ruaa Al-Juboori, Anna Wingo, Kathryn W Coccia, Rebecca Hyde, Verna Hendricks-Ferguson; 8/25Research participation of hospice and palliative care patients and family caregivers is essential to develop and test best practices. Yet, healthcare professionals are often hesitant to ask patients and caregivers to participate in research, fearing it is too intrusive or unethical during a sensitive time. This review focused on the motivating factors, benefits, and burdens of research participation for patients with serious illness and their family caregivers. For clinicians and researchers, connecting patients and caregivers to palliative and end-of-life research may be both beneficial as a contribution to scientific literature and as an additional source of ongoing support.

Training and practice gaps in nursing home palliative care: A cross-sectional study Journal of the American Geriatrics Society (AGS); by Manali Saraiya, Molly A. Nowels, Rose L. Carlson, Jerad H. Moxley, Catherine A. Riffin, Evan Plys, M. Carrington Reid, Isabella Hastings, Taimur Mirza, Ronald D. Adelman, Daniel Shalev; 9/7/25 We conducted a cross-sectional survey of clinical employees (N = 398) at seven NHs within a single integrated health system in New York State to (1) gauge attitudes toward and knowledge about palliative care, (2) estimate the extent of engagement with advance care planning, and (3) elicit perceptions of the most valuable components of palliative care for NH residents. ... Despite support for palliative care, gaps in knowledge and clinical engagement persist and vary by discipline. Discipline-tailored training and program design may improve palliative care delivery in NHs and help ensure more consistent, value-aligned care for residents with serious illness.

Estimating the predictability of questionable open-access journalsScience Advances; by Han Zhuang, Lizhen Liang, Daniel E. Acuna; 8/25Questionable journals threaten global research integrity, yet manual vetting can be slow and inflexible. Here, we explore the potential of artificial intelligence (AI) to systematically identify such venues by analyzing website design, content, and publication metadata. Evaluated against extensive human-annotated datasets, our method achieves practical accuracy and uncovers previously overlooked indicators of journal legitimacy... Our study defines “questionable open-access journals” as journals violating the best practices outlined by the Directory of Open Access Journals (DOAJ) and showing indicators of low editorial standards.Publisher's note: The authors use AI to evaluate open-access journals adherence to best publishing practices - an interesting use of AI that could be applied to many other settings. The list of open-access journals can be found here.

Understanding trauma in the context of direct care work in nursing homesJournal of Applied Gerontology; by Alfred Boakye, Jennifer Craft Morgan, Candace L. Kemp, Antonius D. Skipper; 8/25Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents’ care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.

A digital therapeutic intervention for inpatients with elevated suicide risk: A randomized clinical trialJAMA Network; by Craig J. Bryan, Patricia Simon, Samuel T. Wilkinson, Michael H. Allen, Jeremiah Perez, Caleb Adler, Khatiya Moon, Lauren Astorino, Kristen M. Carpenter, Luke Misquitta, Katherine Brownlowe, Lauren R. Khazem, Jarrod Hay, Austin G. Starkey, Julia Tartaglia, Helena Winston, Scott Simpson, Alecia D. Dager, Seth Feuerstein; 8/25Does a smartphone-based digital therapeutic intervention designed to deliver suicide-focused cognitive behavior therapy (CBT) reduce future suicide attempts among patients hospitalized with acutely elevated suicide risk? In this randomized clinical trial of 339 inpatients in psychiatric hospitals, no difference was found in time to first actual suicide attempt between those who used the digital therapeutic intervention and those who used the control application. The digital therapeutic intervention did not impact time to first suicide attempt after discharge among patients admitted for suicidal ideation and/or suicide attempts.Publisher's note: As AI is studied in healthcare, it's interesting to explore both what works and what doesn't.

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Top ten tips palliative care clinicians should know about intensive care unit consultationJournal of Palliative Medicine; by Ankita Mehta, Karen Bullock, Jillian L. Gustin, Rachel A. Hadler, Judith E. Nelson, William E. Rosa, Jennifer B. Seaman, Shelley E. Varner-Perez, Douglas B. White; 8/25Critical illness and ICU stays can be extremely distressing for patients and their loved ones. Providing palliative care in the ICU, although a standard component of comprehensive care delivery, involves understanding the individual culture of each specific ICU, collaboration with multiple providers, and interfacing with surrogate decision makers while patients may not be able to communicate and are undergoing interventions that are unfamiliar to them and loved ones. These top ten tips aim to support palliative care clinicians providing consultation in ICUs. Specifically, these tips address initial relationship building with ICU clinicians and teams to foster effective collaboration, establishing goals of care by assessing health-related values, explaining treatment options, individualizing prognostic discussions, and managing end-of-life symptoms for patients while in the ICU and throughout ICU discharge transition.

[Japan] Clinical and communication factors associated with family conflict in palliative care units: A survey of bereaved families in JapanCancer Medicine; by Jun Hamano, Kento Masukawa, Masanori Mori, Takashi Yamaguchi, Hiroyuki Otani, Hiroto Ishiki, Yutaka Hatano, Isseki Maeda, Satoru Tsuneto, Yasuo Shima, Tatsuya Morita, Yoshiyuki Kizawa, Mitsunori Miyashita; 9/25Family conflict is a common problem in palliative care and has been identified as a potential barrier to providing appropriate care... Our findings suggest that abrupt clinical deterioration is associated with family conflict. Confirming patients' and families' wishes regarding CPR during hospitalization may help reduce family conflict in PCUs.