Literature Review

GUIDE and beyond: Strategies for comprehensive dementia care integrationJournal of the American Geriatrics Society; by Kristin Lees Haggerty, David B Reuben, Rebecca Stoeckle, David Bass, Malaz Boustani, Carolyn Clevenger, Ian Kremer, David R Lee, Madelyn Johnson, Morgan J Minyo, Katherine L Possin, Quincy M Samus, Lynn Spragens, Lee A Jennings, Gary Epstein-Lubow; 10/25The Centers for Medicare & Medicaid Services' (CMS) Guiding an Improved Dementia Experience (GUIDE) Model represents a landmark opportunity to improve outcomes for persons with dementia and their caregivers and scale comprehensive dementia care through a structured service delivery and alternative payment approach.  Drawing from the experiences of six previously tested programs ... we describe a four-step approach to enable successful adoption and implementation: identifying key leaders and partners, preparing a tailored value proposition, initiating program start-up, and ensuring sustainable implementation. We highlight practical tools and resources to address operational challenges, including electronic health record integration, reimbursement strategies, and staff training. By focusing on evidence-based models, health systems and other providers can accelerate implementation, reduce costly emergency and institutional care, and deliver high-quality, person-centered support. This approach can help to empower GUIDE participants and others to build effective, durable, scalable comprehensive dementia care systems, ultimately advancing the goal of establishing such care as a permanent Medicare benefit.

Hospice, palliative care, and care experiences among Medicare beneficiaries with cancerJournal of Geriatric Oncology; by Lisa M Lines, Miku Fujita, Kim N Danforth, Daniel H Barch, Michael T Halpern, Michelle A Mollica, David T Eton, Ashley Wilder Smith; 11/25Among 37,025 Medicare beneficiaries with cancer, 11.1 % received hospice (with or without PC) and 7.4 % received PC only. Nearly 30 % of the sample died within five years of diagnosis; fewer than one-third of decedents received hospice. Factors associated with receiving hospice included increasing age, non-Hispanic ethnicity, American Indian/Alaska Native and multiracial identities, living in higher-income neighborhoods, survey-completion proxy assistance, fair/poor general health, advanced stage at diagnosis, and more illness burden. Independent predictors of PC encounters included age 75-79, female identification, no dual enrollment, no proxy assistance, and more illness burden. Differences in care experience associated with hospice or PC use were shown for two care experience measures: doctor communication scores and doctor rating scores were higher among beneficiaries who received neither hospice nor PC relative to beneficiaries who received hospice.

How clinicians prenatally discuss management options and outcomes for congenital heart disease Journal of Pain and Symptom Management; by Samantha Syme, Kelsey Schweiberger, Judy C Chang, Ann Kavanaugh-McHugh, Nadine A Kasparian, Robert M Arnold, Kelly W Harris; 11/27/25 Online ahead of printA prenatal diagnosis of complex congenital heart disease (cCHD) introduces significant emotional, social, and financial stress for families. ... Fetal cardiology consultations offer an important opportunity to support families navigating uncertainty following a prenatal diagnosis of CHD. Clinicians approached these conversations with empathy and a focus on long-term outcomes, though discussions about management options varied. There is an opportunity for increased presentation and integration of palliative care consultants as a longitudinal, family-centered resource, regardless of mortality risk, which may enhance supports available to families during this highly emotional period.

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.

[Norway] Intensive care of the very old - questioning the relationship between illness severity and the moral imperative to deliver life-saving carePhilosophy, Ethics, & Humanities in Medicine; by Gabriele Leonie Schwarz; 10/25Intensive care provision to very old patients is rapidly growing owing to demographic changes and increasing treatment intensity. However, intensive care carries only questionable benefit for the oldest patients, and many of them die after prolonged organ support. Departing from a clinical perspective, this study aims to explore the drivers for the expansion of critical care in advanced age, despite widespread awareness of its potential harms to patients, their families, healthcare professionals, and society. 

[Canada] Examining compassion satisfaction and work-related stress within a hospice for the homeless (H4H) organization: Results from a multi-method surveyAmerican Journal of Hospice & Palliative Care; by Celina Carter, Mary Anne Olalia, Justine Giosa; 10/25Communities in Canada have created targeted hospice palliative care strategies such as facility-based hospices for the homeless (H4H) to promote equitable access to care. We developed and administered an anonymous 26-item survey to 104 providers including both staff (eg, nurses, administrators) and volunteers at a facility-based H4H in Ontario. Requests for additional resources to foster workplace wellbeing included educational, process-related, spiritual/psychological, and social supports. Respondents storied that positive workplace wellbeing includes being able to provide quality care, and having supportive relationships, personal fulfillment, and a respectful culture within the workplace. Provider participants were satisfied with their ability to be effective carers, yet chronic multi-level work-related stressors can erode a sense of meaning in H4H work.

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.