Literature Review

[Canada] Simplifying palliative symptom management: Elastomeric infusions in hospice and home careBritish Journal of Nursing; by Vincetic Bozidar, Natalie Wm Hertzman, Daphne Broadhurst; 7/25Palliative care patients often require frequent, resource-intensive, intermittent subcutaneous injections or complex infusion pumps for end-of-life symptom management. Our findings suggest that continuous subcutaneous infusions via elastomeric infusion pumps offer a promising and feasible approach to end-of-life symptom management in hospice and home care. Elastomeric infusions may enhance simplicity, acceptability, safety, efficacy, and efficiency of care, compared to traditional routine subcutaneous injections.

Ethical obligations to inform patients about use of AI toolsJAMA; by Michelle M. Mello, Danton Char, Sonnet H. Xu2; 7/25When a health care organization decides to deploy an AI tool, it should decide whether notification or consent is ethically required. To decide that disclosure is not required at the point of care is not to conclude that organizations have no transparency obligations concerning their use of AI. Two complementary steps can help discharge these obligations. First, health care organizations’ websites and written materials distributed to patients should explain how the organization uses AI to deliver better, safer, more efficient care and protect staff well-being. This kind of transparency honors patients’ desire to know how their care may be affected by AI and may help some make decisions about where to seek care. 

Improved outcomes and cost with palliative care in the Emergency Department: Case-control studyThe Western Journal of Emergency Medicine; Brandon Chalfin, Spencer M Salazar, Regina Laico, Susan Hughes, Patrick J Macmillan; 7/25This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted ... In addition, more cases than controls had a code status of comfort care at discharge ... These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.

Behavioral symptoms in patients with dementia are associated with care partner abusive behaviorsJournal of Elder Abuse & Neglect; by Emily LeRolland, Francesca Falzarano, Karen L. Siedlecki; 8/25Abuse of older adults with dementia is an increasingly prevalent public health concern in the United States. The current study examined whether care recipient behavioral symptoms (e.g. aggressive or agitated behaviors) predicted abusive behaviors by care partners. Results indicate that most participants reported engaging in at least one abusive behavior toward their care recipient. Behavioral symptoms in care recipients were a significant predictor of abusive behavior perpetrated by the care partner, even after controlling for a large number of covariates. Care partner depressive symptoms significantly mediated the relationship between care recipient behavioral symptoms and care partner abusive behavior. Our results suggest that physician screening for depression in care partners and referral to appropriate resources may be one avenue for decreasing the risk of abuse toward care recipients. 

Clinician and caregiver perspectives on managing dementia behaviors in hospiceMedpage Today; by Elethia W. Tillman; 7/25New research reveals a gap in training and resources for managing behavioral and psychological symptoms of dementia (BPSD) in hospice settings, impacting both patient well-being and caregiver burden. Key points include:

[Iceland] Medication causes and treatment of delirium in patients with and without dementiaBrain and Behavior; by Anita Elaine Weidmann, Rut Matthíasdóttir, Guðný Björk Proppé, Ivana Tadić, Pétur Sigurdur Gunnarsson, Freyja Jónsdóttir; 7/25This summary offers the most detailed summary of medication-related information for delirium in patients with and without dementia to support prescribing decisions. While the detailed results can be used to support a multicomponent approach to delirium care, they also support the call for categorizing delirium into distinct etiological subgroups. The effect of medication on gut microbiome diversity and composition should be considered.

[Canada] Palliative care access and use among homeless individuals: A scoping reviewBMC Palliative Care; by Ashley Rodericks-Schulwach, Ravi Gokani, Lynn Martin; 7/25Homeless individuals experience unique needs and challenges when PC. Many of the challenges experienced are related to the stigma of homelessness– it negatively impacts the relationship people have with PC professionals as well as creates barriers to access. Implementation of integrated and intersectoral PC programs that employ harm reduction approaches is needed to ensure that people experiencing homelessness receive PC that promotes dignity and comfort. Specialized staff training to work with this population is also needed to improve quality of PC care provided. Future research that employs an intersectional lens to better understand the needs of sub-groups within the homeless population is needed, as is use of consistent terminology related to PC services to ensure both understanding and generalizability of findings. 

Asking older adults with impaired cognition and care partners about serious illness experiences can elicit goals of care during advance care planning Americn Journal of Hospice and Palliative Medicine; by Glory H. Thai, BS, Valecia Hanna, MS, Peiyuan Zhang, MSW, Chase Mulholland Green, MPH, John Cagle, PhD, MSW, Jennifer L. Wolff, PhD, and Martha Abshire Saylor, PhD, RN; 8/13/25 Older adults with cognitive impairment and their care partners were able to respond to serious illness experience questions, with responses eliciting a spectrum of goals of care. Integrating such questions into advanced care planning (ACP) for older adults with cognitive impairment may clarify goals of care and improve decision-making for patients and families. 

[UK] 'Dementia has got two faces': grief as an experience of holding on and letting go for people living with primary progressive aphasia and posterior cortical atrophyAging and Mental Health; Claire Waddington, Henry Clements, Sebastian Crutch, Martina Davis, Jonathan Glenister, Emma Harding, Erin Hope Thompson, Jill Walton, Joshua Stott; 8/25Research on grief in people with primary progressive aphasia (PPA) and posterior cortical atrophy (PCA), is limited, despite the unique challenges these individuals face due to lack of understanding of their condition, younger age at onset and atypical symptom profile. The current study explores the losses people living with PPA or PCA experience and what helps to navigate these losses. The impact and navigation of loss is reflected across five interconnecting themes: what I have lost, am losing and will lose, shared and unique sense of loss, balance between what is lost and what remains, changes in relationships and what helps in navigating loss. These findings will be used alongside existing grief theory and interventional frameworks to develop a psychosocial intervention for people living with dementia.

Standardized assessment of patient experience in pediatric palliative care: A national collaborationJournal of Pain & Symptom Management; by Ashley K Autrey, Stacey Rifkin-Zenenberg, Tracy Hills, Jennifer Salant, Rachna May, Elliot Rabinowitz, Chelsea Heneghan, Laura Drach, Emma Jones, Rachel Thienprayoon; 7/25Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC [pediatric palliative care] services. Results: Patients/ families felt heard and understood and would recommend PPC. Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.

Social relationships and end-of-life quality among older adults in the United States: The impacts of marital, kinship, and network ties The Journals of Gerontology; by Kafayat Mahmoud, Deborah Carr; 7/25We examine marital status differences in recent decedents’ end-of-life care and gender differences therein, and the role of other social ties (children, siblings, network members) in influencing the quality of end-of-life care. Divorced decedents fared poorly on multiple outcomes, being less likely than married or widowed persons to receive excellent care and to have personal care needs met. Divorced and widowed decedents were less likely to receive respectful treatment relative to married decedents. We found no significant gender differences in these patterns. Persons with more siblings and network members had superior pain management. Hospital patient advocates could also aid those who lack close kin at the end of life.

Do not resuscitate (DNR) emergency medical services (EMS) protocol variation in the United StatesThe American Journal of Emergency Medicine; by Amelia M Breyre, E Jane Merkle-Scotland, David H Yang, Kenneth Hanson, Sameer Jagani, Abe Tolkoff, Satheesh Gunaga; 7/25Do Not Resuscitate (DNR) orders are essential for ensuring that critically ill patients receive care from Emergency Medical Service (EMS) aligned with their preferences. However, significant variations exist in EMS protocols regarding acceptable DNR documentation leading to discordant care, moral distress, and ethical dilemmas. Although most EMS protocols have dedicated DNR protocols, this is not universal and there is significant variability in types of documentation recognized as valid. Documentation that is concise, portable, and designed for EMS use, such as the POLST is preferred. Assistant Editor's note: It is this variability in protocols that personally scares many of us who work in the EOL field. It is not uncommon to hear a hospice/palliative worker joke that they want a "DNR tatoo on their chest"! Perhaps it would be easier (and less painful) to continue to promote POLST, or something similar, in each of our respective workplaces.

Issues in developing multilingual graphics-based digital caregiver guides for dementia careDiscourse, Context & Media; by Boyd H. Davis, Margaret Maclagan, Meredith Troutman-Jordan; 8/25To increase the opportunity to educate caregivers for persons with dementia, particularly the nearly 40% of migrant healthcare workers emigrating to the US, we have chosen an adaptation of graphic medicine as a means of presenting these workers with conversations about dementia care in two formats of ‘mini-comics’: photo-based and cartoon. Our graphic Caregiver Guides are a form of mediated digital discourse that incorporate both words and pictures, and thereby support caregivers as they draw immediately useful guidance from online materials when offering daily off-line care. Each guide covers a situation that occurs commonly as caregivers care for people living with dementia.