Literature Review

Difficult encounters: How to set boundaries in the context of structural inequitiesJournal of Pain & Symptom Management; by Carrie C. Wu, Erik K. Fromme; 1/26Difficult encounters between patients and clinicians impact all areas of medical care, yet how to manage them is not routinely taught in medical training. This paper presents a case of a patient with cancer who struggled with emotional outbursts and impulsive behaviors. In the context of the racial trauma and socioeconomic challenges that the patient also experienced, the team struggled with boundary setting. We will review both traditional and contemporary approaches to the management of difficult clinician-patient interactions, while also addressing some of the limitations of existing frameworks. We will explore the role of bias in boundary setting and make suggestions for individual-, team-, and system-level approaches.

Direct care nursing as a career destination-A qualitative exploration of why nurses stayNursing Management; by Leach, Catherine T.; Whade, Jill J.; Horvick, Savannah G.; 1/26Intent to stay (ITS) is the best predictor of nurse turnover. Interventions aimed at combating turnover may be ineffective if they're developed without getting input from nurses to understand why they stay. A total of 18 clinical nurses were interviewed, and four major themes were identified: organizational culture, sense of belonging, leadership in action, and sustainability of bedside nursing. Conclusions: Integrating organizational culture, sense of belonging, leadership in action, and resources for direct care nursing will strengthen nurses' ITS and encourage nurses to pursue direct care nursing as a career destination.

Understanding advance care planning among young adults: A theory-based examination using the Integrated Behavioral Model and Precaution Adoption Process ModelJournal of Social Work in End-of-Life & Palliative Care; by Colette A. McAfee, Derek Cegelka, Victoria R. Wagner-Greene, Amy Wotring; 1/26This study examined predictors of ACP [advance care planning] behaviors among U.S. adults aged 18–35 (N = 614) using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model (PAPM). ACP engagement was defined as completing a living will, designating a durable power of attorney for health care (DPAHC), and discussing wishes with a loved one. Most participants (68.6%) had not fully engaged in ACP. Regression analyses revealed that direct perceived norms, attitudes, and life experience with serious illness were significant predictors of intention to engage in ACP.  Personal or family experiences with life-threatening illness emerged as key motivators.

Advance care planning for patients with hematologic malignancies: A narrative reviewAmerican Journal of Hospice & Palliative Medicine; by Olivia M. Seecof; 1/26Advance care planning (ACP) completion rates are higher in patients with serious illness compared to the general population, however, ACP is overall under-utilized and sub-optimal, especially for patients with hematologic malignancies. This patient population can experience unique and significant physical and psychological symptoms due to their illness and the treatment, resulting in high rates of aggressive end of life care. This high healthcare utilization pattern often triggers ACP conversations and documentation, often facilitated by specialty palliative care clinicians. This review article examines existing literature about ACP for patients with hematologic malignancies with the intent to inform future prospective research to improve values-based patient care.

[Republic of Korea] P-1080. Multidrug-resistant organism status and its association with hospice use and end-of-life care patterns in patients with advanced cancer referred palliative careOpen Forum Infectious Diseases; by Jeong-Han Kim, Jiwon Yu, Ye Sul Jeung, Shin Hye Yoo, Jin-ah Sim, Bhumsuk Keam; 1/26Multidrug-resistant organisms (MDRO) are increasingly prevalent and may contribute to more aggressive healthcare utilization near the end-of-life, particularly among patients with advanced cancer receiving palliative care (PC). MDRO status was associated with significantly lower use of community-based hospice care, including inpatient hospice ... and home hospice ... It was also linked to more frequent deaths in tertiary hospitals ... and higher intensive care unit admissions ... and renal replacement therapy ... Medical costs were consistently higher in the MDRO group across all end-of-life trajectory before death.

From the iron lung to artificial intelligence: Integrating new technology into critical care American Journal of Critical Care; by Seo Yoon Lee, Alvin D. Jeffery; 1/26Artificial intelligence technology has emerged rapidly and is being incorporated into the health care delivery system as a new bedside tool. It is vital to maintain a human-centered approach, in which artificial intelligence serves as a tool to augment, not replace, the nuanced judgment of health care professionals. It is crucial to cultivate a critical mindset, continuously validating artificial intelligence outputs against clinical judgment. Integrating artificial intelligence into team workflows, developing clear ethical guidelines, and fostering collaboration between clinicians and data scientists are essential for successful implementation. By proactively preparing for the transition, the critical care community can harness artificial intelligence’s power to improve patient recovery and survival while ensuring that technology remains guided by human expertise and compassion.Assistant Editor's note: All of us in health care, not just those working in critical care, will be faced with decisions about how to incorporate AI into our work. It will likely become an invaluable tool in our day-to-day lives. But AI can only give us ideas, suggestions and enhanced knowledge. It cannot hold the hand of a dying patient or comfort the loved ones who bear witness. Only we can offer the CARE in health care. Empathy, humanness and critical thinking can come only from us.

Later-life friendship in advance care planning: Variation by marital status and genderResearch on Aging; Zheng Lian, Lucie Kalousová; 1/26Friendship is an understudied social context in research on advance care planning (ACP).  Multivariable logistic regressions show that having any friends is associated with greater odds of AD [advance directives] and EOL [end-of-life] discussions. The positive association between emotional support from friends and EOL discussions is more pronounced among never married men, compared to both married individuals and never married women. These findings highlight friendship as a salient social context associated with ACP engagement, particularly among never married men.

A scoping review on aphasia and technology: Exploring mechanisms enhancing quality of lifeQuality of Life Research; by Grace E. Terry, Cassondra Wilson, Gillian Anderson, Stacy M. Harnish; 1/26 People with aphasia are at an increased risk for reduced quality of life (QoL) because of their change in communication abilities. The present study aims to review the current evidence supporting assistive technology as a tool to improve QoL for people with aphasia, while investigating the various mechanisms technology may impact that lead to increased QoL for people with aphasia. This review emphasizes the role mechanisms such as self-management, social interaction, and virtual communication play in improving QoL for people with aphasia, while emphasizing the role technology plays in impacting the function of these mechanisms.  However, for this assistive technology to be impactful, it must be person centered and thoroughly trained based on the current body of evidence.

EV0034 Palliative pain relief: A case study of high-frequency spinal cord stimulation in an end-of-life cancer patientNeuromodulation: Technology at the Neural Interface; P. Majedi, Dominic Bailey; 1/26A significant proportion of patients with cancer will experience cancer-related pain at some point during their illness. The treatment approach for cancer-related pain is often multifaceted and may necessitate the use of advanced interventional methods, including spinal cord stimulation (SCS). Recent studies have demonstrated the utility and efficacy of SCS techniques in the treatment of cancer-related pain and chemotherapy induced neuropathy. Here, we present a case report on a patient receiving high frequency SCS at 10 kHz for end-stage cancer-related pain.

Effectiveness and impact of telehealth-integrated palliative care for persons living with dementia and their caregiversTelemedicine & e-Health; by Brooke Worster, Lizabeth Kaminoff, Amina Mason, Laura Pontiggia, Kayla Madden, Mackenzie Kemp, Amanda Guth, Nina Diamond, Allison Herens, Kristin Rising, Jeannette Kates; 12/25 In 2024, an estimated 6.9 million Americans aged 65 and older were living with Alzheimer’s disease (AD), the most common form of dementia. Palliative care (PC) can improve quality of life (QOL) and reduce nonbeneficial care, yet persons living with dementia (PLWD) remain underserved. The intervention group [in this study] received up to two telehealth visits with a PC specialist, the patient (if able), and a caregiver (if participating). The intervention group had significantly fewer emergency department visits and hospitalizations but no differences in QOL or caregiver burden.

[Austria] Hospice nurses' views about the necessity for palliative sedation in existential sufferingPain Management Nursing; Dana Hagmann, Susanne Fleckinger, Piret Paal; 1/26Disagreements between nurses and doctors regarding the assessment and management of existential suffering in terminally ill patients represent a critical challenge in palliative care, particularly in the context of inpatient adult hospices. The study highlights the limited involvement of nurses in decision-making processes regarding palliative sedation despite their critical insights into patients' existential suffering. The findings emphasize the need for interdisciplinary collaboration and the integration of nurses' perspectives to achieve more holistic and ethically sound care in inpatient hospices.

[Australia] The Palliative Aged Care Outcomes Program (PACOP): establishing a national framework to improve palliative care in long-term care facilities for older people BMC Geriatrics; by Johnson, C.E., Dai, Y., Bryce, L. et al; 1/31/26 Background: With an aging population worldwide, many countries face increasing challenges in delivering quality palliative care in long-term care facilities for older people (LTCFs). In Australia, a Royal Commission into Quality and safety of Aged Care in 2021 highlighted significant gaps in this field. In response, the Palliative Aged Care Outcomes Program (PACOP), a person-centred outcomes framework, was developed to address gaps in identification, assessment and management of palliative care needs in LTCFs.Conclusion: PACOP has achieved substantial uptake and early signs of successful implementation in Australian LTCFs. ...

Critical illness versus end-of-life conversations: A novel curriculum for enhancing resident physician communication skillsJournal of Pain & Symptom Management; by Kristin A Juhasz, Luke Rosielle, Sohale Shakoor, Kristina Damisch, Brad King, Troy King, Megan Kammerer; 12/25End-of-life (EOL) discussions are of utmost importance to emergency medicine physicians, and residency programs vary in their training on this subject, despite being an Accreditation Council for Graduate Medical Education (ACGME) requirement. During two yearly sessions, emergency medicine residents received training on end-of-life discussions. Each session included a seminar on how to approach the delivery of difficult news to patients and families and how to engage them in conversation. Our novel curriculum increased self-reported confidence in discussing EOL issues, especially among first- and second-year emergency medicine resident physicians. Training and experience with EOL conversations not only helps residents, but ultimately benefits patients and their families.