Literature Review

"Being ill defines your daily life": Social wellbeing of patients residing at home facing an incurable illness and their primary family caregivers BMC Palliative Care; by Trudy Schutter, Ian Koper, Marieke Groot, Kris Vissers, Jeroen Hasselaar; 11/28/25 Online ahead of print This study demonstrates that meaningful relationships, acknowledgement of one's situation and the ability to determine one's own level of involvement in society are essential for the social wellbeing of patients and family caregivers confronted with incurable illness. ... Furthermore, the quality of communication and relationships with healthcare providers, employers, and institutions, along with the prevailing societal attitudes towards incurable illness, caregiving, death, and dying, is of considerable significance and should be given careful attention.

Respecting the right to refuse: Is decision-making capacity disproportionately challenged in patients declining medical care in order to treat?Journal of Neurosurgery: Case Lessons; by Jacqueline Boyle, Nicholas Comardelle, Alexis Carter, Jeffrey Klopfenstein, Todd McCall; 10/25There is a consensus that withholding aggressive medical care in medically futile situations is ethically sound, even if the patient, surrogate, or family wants everything done. The authors aim to evaluate and discuss the situations in which this request is used as justification for intervention, specifically lifesaving surgery, when a situation is defined by a futile outcome. The authors utilize the illustrative case of an older female who presented with a traumatic brain injury and Duret hemorrhage, an unfortunately common scenario faced by neurosurgeons, to discuss the complex ethical and practical implications of these situations. They seek to define futility, provide an overview of basic medical ethical principles, and evaluate both the motivation to operate and the educational gaps among patients, families, and providers. Review of the basic principles of medical ethics lends to the conclusion that the demands of a patient’s family are not adequate justification for surgical intervention in cases, such as the present one, in which a patient is unlikely to benefit.

Slow-tempo music and delirium/coma-free days among older adults undergoing mechanical ventilation-A randomized clinical trialJAMA Internal Medicine; by Babar A. Khan, Sikandar H. Khan, Anthony J. Perkins, Annie Heiderscheit, Frederick W. Unverzagt, Sophia Wang, J. Hunter Downs III, Sujuan Gao, Linda L. Chlan; 10/25Objective: To determine if a slow-tempo music (60-80 beats/min) listening intervention decreases delirium duration, delirium severity, pain, or anxiety in older adults undergoing mechanical ventilation. In this randomized clinical trial of 158 mechanically ventilated older adults, a twice-daily music intervention delivered via noise-canceling headphones and tablets for up to 7 days did not demonstrate a statistically significant decrease in delirium duration, delirium severity, pain, or anxiety.

Heart failure with reduced ejection fractionMedical Clinics of North America; by Ebrahim Barkoudah, Clyde W Yancy; 11/25Heart failure (HF) is no longer centered on the failing ventricle. Various salutary treatment discoveries now support substantially improved survival with lesser likelihood for urgent care or hospitalization. Advanced care strategies are effective, but not only includes mechanical circulatory assist and heart transplantation, but also clinical trial participation, palliative care, and hospice. At the patient level, longer healthier lives, in concert with expert management of ventricular dysfunction, becomes the contemporary expectation.

Errors in electronic health record advance care planning documentation: It's a patient safety issueJournal of Palliative Medicine; by Seth N Randa, Sarah Nouri, Anne M Walling, Kanan Patel, Mike K W Cheng, Christine S Ritchie, Brookelle Li, Gabriela Vanegas, Elle Cardoso, Rebecca L Sudore; 11/25Centralized locations in the electronic health record (EHR) improve access to advance care planning (ACP) information; however, the prevalence of documentation errors in these locations is unknown... Among 10,767 patients, 5374 (49.9%) had ACP in their EHR, and 495 (9.2%) of those had a verified error; 32.9% were Patient Safety Errors. Patients with errors were more likely to self-identify as from a minoritized population, be non-English speaking, and have a serious illness.

AI, health, and health care today and tomorrow-The JAMA Summit Report on artificial intelligenceJAMA; Derek C. Angus, Rohan Khera, Tracy Lieu, Vincent Liu, Faraz S. Ahmad, Brian Anderson, Sivasubramanium V. Bhavani, Andrew Bindman, Troyen Brennan, Leo Anthony Celi, Frederick Chen, I. Glenn Cohen, Alastair Denniston, Sanjay Desai, Peter Embí, Aldo Faisal, Kadija Ferryman, Jackie Gerhart, Marielle Gross, Tina Hernandez-Boussard, Michael Howell, Kevin Johnson, Kristine Lee, Xiaoxuan Liu, Kimberly Lomis, Alex John London, Christopher A. Longhurst, Ken Mandl, Elizabeth McGlynn, Michelle M. Mello, Fatima Munoz, Lucila Ohno-Machado, David Ouyang, Roy Perlis, Adam Phillips, David Rhew, Joseph S. Ross, Suchi Saria, Lee Schwamm, Christopher W. Seymour, Nigam H. Shah, Rashmee Shah, Karandeep Singh, Matthew Solomon, Kathryn Spates, Kayte Spector-Bagdady, Tommy Wang, Judy Wawira Gichoya, James Weinstein, Jenna Wiens, Kirsten Bibbins-Domingo, for the JAMA Summit on AI; 10/25AI will disrupt every part of health and health care delivery in the coming years. Given the many long-standing problems in health care, this disruption represents an incredible opportunity. However, the odds that this disruption will improve health for all will depend heavily on the creation of an ecosystem capable of rapid, efficient, robust, and generalizable knowledge about the consequences of these tools on health. AI is changing how and when individuals seek care and how clinicians interact with patients, establish diagnoses, and implement and monitor treatments. In contrast to drugs or more traditional medical devices, there is little consensus or structure to ensure robust, safe, transparent, and standardized evaluation, regulation, implementation, and monitoring of new AI tools and technologies.

Tellable and untellable stories in suffering and palliative careMortality; by Maxxine Rattner; 3/19The relief of patients’ suffering – both physical and non-physical – is a primary aim of palliative care, and has been described as an obligation and ethical duty for palliative care providers. This paper suggests that common approaches to relieving patients’ non-physical suffering – such as creating opportunities to make meaning, achieve personal growth, and hone one’s resiliencies – comprise the larger, more tellable part of the palliative care discourse. A more marginal, less tellable part of the discourse acknowledges that some non-physical suffering cannot necessarily be relieved.Publisher's note: Though dated, this article offers an honest perspective on the profound challenge of alleviating suffering, and the essential lesson of humble grace when relief is not possible.

Shifting to online and telephone bereavement support provision during the COVID-19 pandemic: A mixed methods study of bereavement service provider perspectives and lessons learnt for current practice Palliative Medicine; by Lucy E Selman, Jenny Birchall, Eileen J Sutton, Tracey Stone, Renata Medeiros Mirra, Emma Gilbert, Mirella Longo, Kathy Seddon, Anne M Finucane, Alison Penny, Anthony Byrne, Emily Harrop; 11/24/25, online ahead of print Background: Provision of remote (online/telephone) bereavement support accelerated during the COVID-19 pandemic. However, the extent and impact of this change and lessons learnt are unknown. ...Conclusions: Remote delivery of bereavement support increased support capacity and can potentially reduce inequities in access. However, it needs to be carefully tailored, and is not appropriate for everyone. Staff and volunteers providing remote services require training and support.

The potential of music as a nonpharmacologic intervention for the ICU—Sound medicineJAMA Internal Medicine; by Farah Acher Kaiksow, Eduard Eric Vasilevskis; 10/25The intensive care unit (ICU) offers lifesaving interventions, but it is also associated with considerable patient pain, anxiety, and high rates of delirium. Delirium in patients in the ICU is a highly prevalent condition associated with increased inpatient mortality and long-term cognitive impairment. Unfortunately, the medications used to treat pain and anxiety in the ICU may simultaneously trigger delirium. This conundrum has motivated researchers to investigate alternative, nonpharmacologic therapies for pain and anxiety that have the potential to be less delirium inducing.Assistant Editor's note: Perhaps this is an area where palliative care practitioners could lend expertise. Maybe a Music Therapist could be involved in designing a "sound medicine" program for ICU patients, as described in the article. And this could be a great research project-evaluating outcomes using music therapy as an intervention for suffering patients in the ICU, or in any setting, for that matter.

Cannabis laws and opioid use among commercially insured patients with cancer diagnosesJAMA Health Forum; by Felipe Lozano-Rojas, Victoria Bethel, Sumedha Gupta, Shelby R. Steuart, W. David Bradford, Amanda J. Abraham; 10/25To date, 39 states and Washington, DC, have enacted medical cannabis laws (MCLs) providing cannabis availability for patients with qualifying conditions, including cancer, while 24 states and Washington, DC, have passed recreational cannabis laws (RCLs) legalizing adult-use cannabis. While opioids remain the recommended treatment for cancer pain, these patients may benefit from cannabis availability for adjuvant therapy. We found significant reductions in all measures of opioid prescription dispensing following MCD and RCD openings. These findings are consistent with prior research suggesting that cannabis may serve as a substitute for opioids in managing pain.

Evaluation and treatment of malignant neuropathic painAmerican Journal of Hospice and Palliative Medicine; by Lillian Boehmer, Belal Dakroub, Glenn Pebanco; 10/25Cancer-related neuropathic pain (CRNP) is difficult to identify, assess, and treat, often requiring higher analgesic needs and resulting in poorer outcomes. Objectives: To evaluate the effectiveness of guideline-directed therapy for CRNP in veterans treated at the West Palm Beach VA Healthcare System (WPB VAHCS) Hematology/Oncology Center and managed as outpatients by a pain and palliative care clinical pharmacy practitioner (CPP). Following CPP intervention, pain scores improved ... and PEG [Pain, Enjoyment, and General Activity] scores improved ... CPP-guided use of guideline-directed therapies significantly improved pain intensity and function in veterans with CRNP. Buprenorphine may reduce medication burden in geriatric patients with multimodal pain, reinforcing its value in structured palliative care models.    

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.