Literature Review

[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.

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.

Physician billing for advance care planning among Medicare fee-for-service beneficiaries, 2016-2021The Permanente Journal; by Nan Wang, Changchuan Jiang, Elizabeth Paulk, Tianci Wang, Xin Hu; 8/25In 2016, the Centers for Medicare & Medicaid Services started reimbursing practitioners for their time spent providing advance care planning (ACP) with patients. Results: The percentage of practitioners billing ACP visits tripled from 1.76% in 2016 to 4.56% in 2021, with the highest percentage among hospice and palliative medicine practitioners (36.94%) in 2021. ACP service volume was similar by metropolitan status for hospice and palliative medicine, but it was higher in nonmetropolitan regions for cancer-related specialties, non-cancer terminal disease specialties, and primary and geriatrics care. This nationwide analysis showed low adoption of ACP billing by 2021, and it varied widely across specialties. This may reflect practical challenges of ACP related to comfort level with ACP discussion and documentation burden among the professional communities.

AI in palliative care: A scoping review of foundational gaps and future directions for responsible innovationJournal of Pain and Symptom Management; by Selen Bozkurt, Soraya Fereydooni, Irem Kar, Catherine Diop Chalmers, Sharon L Leslie, Ravi Pathak, Anne M Walling, Charlotta Lindvall, Karl Lorenz, Ravi Parikh, Tammie Quest, Karleen Giannitrapani, Dio Kavalieratos; 8/25AI holds increasing promise for enhancing palliative care through applications in prognostication, symptom management, and decision support. However, the utilization of real-world data, the rigor of validation, and the transparency and reproducibility of these AI tools remain largely unexamined, posing critical considerations for their safe and ethical integration in sensitive end-of-life settings... AI in palliative care remains in early development, showing promise in areas such as prognosis and documentation support. However, limited validation, insufficient cross-site testing, and lack of transparency currently limit clinical applicability. Future research should emphasize external validation, inclusion of broader patient data, and adoption of open science practices to ensure these tools are reliable, safe, and trustworthy.

Top ten tips palliative care clinicians should know about the future of generative intelligenceJournal of Palliative Medicine; by Pragat Patel, Raj Patel, Gilad Kuperman, Monica Consolandi, David Collett, Shunichi Nakagawa, Nicolas Burry, Karl B Bezak, Jake Strand, Mihir Kamdar, Judith E Nelson, William E Rosa, Craig D Blinderman; 8/25Artificial intelligence (AI) is transforming health care and has implications for palliative care (PC) and serious illness communication (SIC). This article integrates interdisciplinary and interprofessional expertise, providing key tips for PC clinicians to best leverage AI-driven tools to enhance PC practices, care efficiency, and patient- and family-centered outcomes. AI-driven tools range from predictive analytics to improve intervention delivery to AI-assisted communication and documentation of goals of care. Beyond these potential benefits are important ethical, logistical, and equity considerations that must be carefully addressed.

Exploring virtual reality as an intervention to improve symptom severity in hospice-eligible patientsAmerican Journal of Hospice and Palliative Care; by Hannah Maciejewski, Kathryn Levy, Catherine M Mann, Suzanne S Sullivan, Gina Schuster, Christopher W Kerr; 7/25Virtual reality (VR) as an intervention has appeared in the literature and in clinical settings across many different populations. To expand the use of this care option, it is worth considering the ways in which a VR application may benefit individuals with life-limiting illness in hospice and palliative care settings. The incorporation of VR as a therapy option may aid in symptom management and support people nearing the end of life in focusing on aspects of their overall well-being.

Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysisThe American Journal of Emergency Medicine; by Satheesh Gunaga, Abe Al-Hage, Alyssa Buchheister, Harish Neelam, Jessica Corcoran, Michael Welchans, Kirby Swan, Mahmoud Awada, Joseph Miller, Fabrice Mowbray; 8/25Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. A total of 8,055 HPC consults were ordered for 6,370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1,355 in 2023 (367 % increase ... ). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023.

The Faith Care Family Project: A pilot intervention for African American dementia family caregiversAmerican Journal of Alzheimer's Disease and Other Dementias; Noelle L Fields, Ling Xu, Ishan C Williams, Fayron Epps, Samantha Tinker; 8/25The Faith Care Family (FCF) Project was a telephone based, volunteer-led intervention for African American Alzheimer’s disease and related dementias (AD/ADRD) family caregivers that was piloted in one predominantly African American church. Church volunteers indicated overall significant improvements knowledge of AD/ADRD after the training as well as after the intervention. Quantitative results indicated that caregivers increased their knowledge of dementia, reported improved coping skills, and reported increased positive aspects of caregiving. Feeling a connection, normalizing the challenges of caregiving, gaining or reinforcing knowledge, and sharing community resources were themes from qualitative interviews with the family caregivers.

Proportional sedation for persistent agitated delirium in palliative care-A randomized clinical trialJAMA Oncology; David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing Chen, Patricia Bramati, Sanjay Shete, Eduardo Bruera; 7/25Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. 

"It may cost you your money, it costs you your life": A framework for financial hardship in dementiaGerontologist; by Krista L Harrison, Emily R Adrion, Juliana Friend, Sarah B Garrett, Madina Halim, Michael Terranova, Alissa B Sideman, Nicole D Boyd, Georges Naasan, Joni Gilissen, Pei Chen, Melissa D Aldridge, Daniel Dohan, Michael D Geschwind, Alexander K Smith, Christine S Ritchie; 7/25Care for persons with dementia costs ∼ $500 billion annually in the United States. Few qualitative studies or conceptual frameworks of the financial experiences of people impacted by dementia exist. This study examined how patients and caregivers impacted by different types of dementia and at different points in the disease journey described financial issues within a palliative care context... Even in a well-resourced population, the financial toll of dementia can be substantial. The Direct-Emotional-Logistical framework of dementia financial hardship can be used to assess financial impacts in palliative care settings.

Process & outcome evaluation of a rural health network to assess effectivenessJournal of Evaluation in Clinical Practice; by Sarah Mollman, Kelly Boyd, Charlene Berke, Mari Perrenoud, Vonda Reed, Carol Stewart; 8/19/25Background: Rural residents face many health disparities and challenges. Rural health networks form to address the specific needs of a community by bringing together multiple individuals and organisations; however, there is limited literature on the evaluation of these networks. Objective: To evaluate a network's effectiveness in three areas: (1) capacity to achieve change in palliative care education, (2) key results of collaborative efforts, and (3) extent to which grant activities were implemented.Results: The network was proficient or excelling in all 15 areas of a Network Organisational Assessment and represented all 38 key sectors representing the focus of network (palliative care). 

35 years of palliative care progress: What lies ahead for society engagement? Journal of Pain & Symptom Management; by Vilma A Tripodoro, Marie-Charlotte Bouësseau, Stephen Connor, Carlos Centeno; 8/14/25This special article presents a narrative synthesis of key policy milestones, conceptual transitions, and global indicators in the development of palliative care. It contrasts two WHO-endorsed public health models: the 2007 "Umbrella" strategy and the 2021 "House" framework, analysing their complementarities and global relevance. ... The future of global palliative care depends on political will, fair allocation of resources, robust monitoring, and meaningful community participation. ...

[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.