Literature Review

Navigating choice: Eating, drinking and decision-making at end of life for individuals with cognitive impairmentJournal of Clinical Practice in Speech-Language Pathology; by Laura Chahdaa, Druvni Pererab, Darcy Longc, Laura Knauerb, Sanora Yonand; 10/25Current clinical guidelines offer limited direction for speech-language pathologists (SLPs) supporting eating and drinking decisions in palliative care (PC), particularly for individuals with dysphagia and co-occurring cognitive impairment. This population presents unique clinical, ethical and interpersonal challenges that often fall outside existing frameworks such as ‘Eating and Drinking with Acknowledged Risk’. This scoping review explores the key considerations for SLPs involved in end-of-life decisionmaking in these complex cases. A qualitative scoping review was conducted and analysed thematically [and] ... six overarching themes were identified: person-centred care; emotional and relational dynamics; ethical decision-making complexity; medical risk; barriers to effective clinical practice; and legal considerations. Findings reveal inconsistencies in practice and limited guidance for SLPs navigating care for individuals with cognitive impairment at the end of life.

Addressing palliative care gaps for rare congenital disease in adults: CM-AVM2 as an exampleJournal of Pain & Symptom Management; by Matthew W Kenaston, Ryan Baldeo, Tyler K Murphy; 10/25Capillary malformation-arteriovenous malformation type 2 (CM-AVM2) is a rare vascular disorder marked by complex, progressive symptoms and limited treatment options. As more individuals with rare diseases reach adulthood, palliative care plays an essential role in supporting quality of life when disease-directed therapies begin to fail. We present a young adult male with EPHB4-positive CM-AVM2, transferred to our tertiary care center for progressive malnutrition, refractory diarrhea, and worsening abdominal pain despite extensive subspecialty care. Through medication optimization, dynamic communication, and consistent interdisciplinary collaboration, the [palliative care] team helped stabilize aspects of his comfort and gradually facilitated GOC [goals of care] discussions. We further discuss how palliative care in this setting differs from standard frameworks, requiring proactive use of disease-specific resources and protracted, anticipatory care planning to optimize quality of life.

Leveraging electronic health record tools and social work to improve advance care planning documentation in older adults with cancerJCO Oncology Practice; by Lauren Reed-Guy, Julianne Ani, Keshav Raghavendran, Charlotte Zuber, Molly Collins, Meghan Kennedy, Noah Goldman, Carolyn Cahill, David Dougherty, Peter Gabriel, Aditi Singh, Leland Boisseau, Ramy Sedhom; 10/25 We conducted a quality improvement pilot in a community oncology practice targeting patients age 65 years and older with a documented geriatric assessment. An electronic health record (EHR) dashboard was used to flag patients without ACP [advance care planning] documents on file. We implemented a default offer of an ACP-focused social work visit during already-scheduled oncology visits. Over 9 months, the proportion of patients with any ACP documents on file increased from 32% to 65%. AD completion increased from 21% to 53%, POLST completion increased from 15% to 31%, and patients with an ACP note on file increased from 17% to 23%. Assistant Editor's note: This study highlights the incredible value of social work interventions in a variety of care settings.

Prevalence and factors associated with receiving a prescription for antithrombotic therapy on hospice admissionJournal of the American Geriatrics Society; by Emily K Short, Phuong Y Duong, Jennifer Tjia, Matthew Alcusky, Mary Lynn McPherson, Jon P Furuno; 10/25This was a cross-sectional study using electronic health record data from adult (age ≥ 18 years) decedents of a large, for-profit hospice chain who died between January 1, 2017, and December 31, 2019. Overall, 11,360 patients (20.8%) had at least one antithrombotic prescription on hospice admission. The most frequently prescribed antithrombotic classes were antiplatelets (15.7%) and direct oral anticoagulants (3.7%). Patients with PPS scores of 20%-30% ... were significantly more likely to receive an antithrombotic prescription compared to patients with a PPS score < 20%. Additionally, patients receiving care in an assisted living facility ... , nursing home ... , or at home ... were more likely to receive an antithrombotic prescription compared to patients receiving care in an inpatient hospice setting.

Home-based psilocybin-assisted therapy for a patient with advanced cancer: A case reportPalliative & Supportive Care; by Houman Farzin, Benjamin Koren, Héléna Ferrier, Justin J Sanders, Nicolas Garel; 10/25 Psychospiritual distress affects many patients with cancer, contributing to diminished quality of life, decreased survival and a desire for hastened death. The current standard of care, which primarily consists of antidepressants and psychotherapy, has demonstrated only modest benefits. Psilocybin-assisted therapy (PAT) has shown evidence of rapid, durable, and significant effects on measures of both depression and anxiety in this patient population. A 51-year-old man diagnosed with metastatic lung cancer, referred to palliative care (PC) with a prognosis of less than 6 months, experienced depression and anxiety in the context of demoralization and existential distress. PAT was well tolerated, with significant decreases in both anxiety and depression [and] the patient subjectively reported a sustained reduction in suffering and improved well-being at 2 months post-intervention. 

[France] End-of-life sedation and spousal grief: Exploring bereavement narratives with and without continuous deep sedationPalliative Care & Social Practice; by Livia Sani, Yasmine Chemrouk, Marthe Ducos, Pascal Gauthier, Marie-Frédérique Bacqué; 10/25This study explored how bereavement experiences differ based on the use of CDSUD [Continuous Deep Sedation Until Death]. Spouses whose partners received CDSUD often reported emotional disruption and unresolved grief, while those without CDSUD described greater relational continuity and a more gradual farewell. Across both groups, the quality of communication, emotional preparedness, and involvement in end-of-life decisions shaped the grieving process. These findings emphasize the emotional complexity of CDSUD, particularly when implemented suddenly or without sufficient explanation. Palliative care teams should prioritize transparent, timely discussions about sedation options and provide tailored emotional support throughout the dying process.

Reducing moral distress through interdisciplinary collaboration: the impact of a weekly palliative care and neonatology conference BMC Palliative Care; by Kirthi Devireddy, Riddhi Shukla, Rachel Boren, James E Slaven, Rebecca A Baker, Jayme D Allen, Karen M Moody; 11/11/25 Conclusion: A neonatal intensive care unit (NICU) and palliative care-weekly-collaborative conference resulted in significantly decreased moral distress among NICU staff. Qualitative data revealed that both prolonging life with life-sustaining medical therapies (LSMTs) and ending it by withdrawing LSMTs in the context of prognostic uncertainty and institutional constraints creates significant moral distress among staff. Palliative care and NICU programs should consider implementing regular interdisciplinary collaborative conferences to address this distress.

Difference-making factors linked to higher reach of Specialist Palliative Care among people with heart failure across a national sample of VA Medical Centers American Journal of Hospice and Palliative Medicine; by Yan Zhan, PhD, RN, MBA, Edward J. Miech, EdD, Erica A. Abel, PhD, MD, and Shelli L. Feder, PhD, APRN, FPCN, FAHA; 11/10/25 Conclusion:  High Specialist Palliative Care (SPC) reach among people with advanced heart failure (aHF) was linked to combinations of several modifiable factors related to staffing, cardiology involvement, and outpatient palliative care. These findings provide actionable insights into improving SPC delivery across VAMCs.Editor's Note: What education or other partnerships do you have with VA Medical Centers in your service areas? Or, what gaps for veterans exist because of a lack of VA Medical Centers? Use these "combinations of modifiable factors related to staffing, cardiology involvement, and outpatient palliative care" for your strategic planning to improve care for veterans struggling with advanced heart failure.

What matters about what matters mostJAMA Network Open; by Mary E. Tinetti, Brenda S. Nettles; 10/25The authors note that “Identifying what matters is essential for providing person-centered care, guiding clinical visits, tailoring care plans, and providing a starting point to foster further patient engagement.” These are lofty expectations of a single, simple question ["what matters most?"]. While the what matters question alone cannot guide care planning or tailor interventions, it can serve as a starting point for ongoing conversations about patient health goals and care preferences. These priorities, in turn, can guide patient-centered decision-making and care. The question also provides an opportunity to get to know the patients we care for as individuals. That, in itself, is an invaluable gift reminiscent of a period when clinicians had more time with patients and cared for them over years.

Effectiveness of a telephonic Aging Brain Care Model for Medicaid Home and Community Services for dementia patients and their caregiversJournal of the American Geriatrics Society; by Malaz A Boustani, Steven R Counsell, Anthony Perkins, Abdelfattah Alhader, Kathryn I Frank, Diana P Summanwar, Karen L Fortuna; 10/25The primary purpose of the present study was the implementation and evaluation of the ABC Community program, a community-based and telephonically administered version of the Aging Brain Care model delivered by Area Agencies on Aging (AAAs) staff. This study employed a ... design with ... the main outcome measure being the total score of the Health Aging Brain Care (HABC) Monitor at 3- and 6-month follow-up. The HABC Monitor has demonstrated excellent reliability and validity in monitoring and measuring the burden of dementia symptoms and the quality of life and stress of the informal caregivers. Approximately 46% of informal caregivers who had at least mild burden at baseline had no such burden at 6 months, and 92% of those who had no stress at baseline remained burden-free at 6 months. Conclusion: The ABC community program might be a scalable collaborative dementia care model targeting socially vulnerable people living with dementia.

State-level variability in location of death of patients with end-stage liver diseaseDigestive Diseases & Sciences; by Julia Meguro, Michael Huber, David Goldberg; 10/25 Although deaths from end-stage liver disease (ESLD) and hepatocellular carcinoma (HCC) in the United States increasingly occur at home or in hospice, inpatient medical facility deaths remain high. Despite the decrease in in-hospital deaths for all causes, non-White decedents are more likely than White decedents to die in a hospital setting. This study aimed to determine state-level variability in the location of death among patients with ESLD and HCC and to assess racial/ethnic differences in these patterns, focusing on Black, White, and Hispanic/Latino patients. Findings from this study identify states where policies and programs that reduce inpatient deaths for ESLD patients may be most needed. Targeted interventions to improve access to high-quality EOL care for all patients address the national variability of hospice use, especially for those who are Black or African American and in states with high numbers of inpatient deaths and low rates of hospice use, should also be identified and implemented.

Developing medical cannabis competencies-A consensus statementJAMA Network Open; by Yuval Zolotov, Leslie Mendoza Temple, Richard Isralowitz, David A. Gorelick, Rebecca Abraham, Donald I. Abrams, Kyle Barich, Kevin F. Boehnke, Stephen Dahmer, Joseph Friedman, Patricia Frye, Aviad Haramati, Jade Isaac, Mary Lynn Mathre, Marion E. McNabb, Melinda Ring, Ethan B. Russo, Deepika E. Slawek, Brigham R. Temple, Genester S. Wilson-King, Julia H. Arnsten, Mikhail Kogan; 10/25An initial list of 9 competencies was refined and consolidated into 6 core competencies [for the use of medical cannabis]: (1) understand the basics of the endocannabinoid system; (2) describe the main components of the cannabis plant and their biological effects; (3) review the legal and regulatory landscape of cannabis in the US; (4) describe the evidence base for health conditions that are commonly managed with cannabis; (5) understand the potential risks of medical cannabis use; and (6) understand basic clinical management with medical cannabis. Each competency is supported by 2 to 7 subcompetencies, resulting in 26 subcompetencies reflecting granular topics, such as patient safety, vulnerable populations, structural inequities, and interdisciplinary care. These consensus-derived competencies provide a structured, evidence-informed foundation to guide the integration of medical cannabis into undergraduate medical education.