Literature Review

[Portugal] Ketamine for cancer-related pain in palliative care: A systematic review of clinical use and safetyJournal of Pain & Palliative Care Pharmacotherapy; by Catarina Vitorino-Afonso, Paulo Reis-Pina; 7/26Ketamine has emerged as an adjuvant for opioid-refractory cancer-related pain in palliative care, but evidence remains limited. [This study found that] ketamine was used mainly as an adjuvant. Many reports described reduced pain and/or lower opioid use, although certainty was very low and attribution was limited by polypharmacy and regimen changes. Intravenous infusions were most common, but subcutaneous, oral, and intranasal routes were also used. Intranasal ketamine showed pragmatic utility for breakthrough pain, while oral ketamine was described in ambulatory palliative care settings.

Where hospice fails us: A qualitative study of facilitators and barriers in transitions to hospice according to palliative care cliniciansJournal of Palliative Medicine; by Morgan M Nakatani, Julia G Cohn, Kris W Herring, Thomas W LeBlanc; 7/26Transitions to hospice are challenging for patients, caregivers, and health care teams, yet few studies have examined gaps in care from the perspectives of referring palliative care (PC) clinicians. PC clinicians identify substantial barriers to hospice transitions, underscoring the need to improve access to comprehensive end-of-life care. Clinicians emphasized the value of hospice and the Medicare benefit, while identifying barriers to hospice transitions [including] ... inadequate caregiving support, limited reimbursement, uncertainty around eligibility and prognostication, and differences between for-profit and non-profit hospice agencies. These barriers contributed to inequitable access to hospice and gaps in care.

Palliative care consults for the oldest-old: A retrospective study of referral patterns, patient characteristics, and clinical outcomes Geriatric Nursing; by John Cameron, Kalli Stilos, Anita Chakraborty; 8/11/26Objective: This study describes the characteristics and outcomes of patients aged 90 and older (the oldest-old) receiving inpatient palliative care consultation at a tertiary care hospital, to identify gaps and opportunities to improve care. ... Conclusion: Referrals for specialist palliative care in the oldest-old occur late in hospitalization, predominantly among those with non-cancer illnesses and poor functional status. Systemic changes, including the use of prognostication tools and enhanced collaboration between geriatric and palliative care services, are needed. Nurses are pivotal in advocating for earlier advance care planning (ACP) and identifying patients who would benefit from timely palliative integration to ensure goal-concordant care.

Spiritual aspects of palliative and end-of-life care: highlights - compiled by by Barry R. Ashpole ehospice; by The International Association for Hospice & Palliative Care; 8/10/26 The International Association for Hospice & Palliative Care's literature search is intended as an advocacy, research, and teaching resource for colleagues who have a special interest in palliative and end-of-life care. Its goal is to keep its readers abreast of “current thinking” and also of emerging or related issues. ... The current posting focusses on the spiritual aspects of palliative and end-of-life care.

Ethical implementation of organ donation following medical assistance in dying: Recommendations of the ethics committee of the Transplantation SocietyTransplantation; by Kristof Van Assche, Johannes Mulder, Curie Ahn, Richard D M Allen, Jan Bollen, Katrina A Bramstedt, Patrizia Burra, Patrick Cras, Kumud Dhital, Ian Dittmer, Beatriz Domínguez-Gil, James Downar, Riadh A S Fadhil, Patrick Ferdinande, John L R Forsythe, Marie-Chantal Fortin, Michael A Freeman, Rik T Gerritsen, Kim E Grayson, Andrew Healey, Alex Kazemi, Vivek B Kute, Dominique E Martin, Diethard Monbaliu, Elmi Muller, Alejandro Nino-Murcia, Gert Olthuis, Helen I Opdam, Brendan Parent, Alicia Pérez Blanco, Sam D Shemie, Marion Siebelink, Amina Silva, Vanessa Silva E Silva, Hans P Sonneveld, Peter G Stock, Rankie Ten Hoopen, Carrie Thiessen, Walther van Mook, Dirk Van Raemdonck, Anji E Wall, Matthew J Weiss, Larna Woodyatt, Dirk Ysebaert, David Thomson; 7/26Medical assistance in dying (MAiD) is legally permitted in a growing number of jurisdictions ... Organ donation following MAiD offers patients an opportunity to address transplant needs as a final act of altruism, but it also raises complex ethical questions that require strong safeguards to protect patients, professionals, and public trust.We identified key ethical issues and safeguards by analyzing guidelines and protocols from the 6 countries where organ donation following MAiD is performed: Australia, Belgium, Canada, the Netherlands, New Zealand, and Spain. Three domains of ethical concern emerged: (1) safeguarding the integrity of patients' decision-making (voluntariness, informed consent, and how and when information is presented); (2) ethical governance of donation following MAiD (adherence to the Dead Donor Rule, death determination, and consent for premortem interventions); and (3) implications for care relationships and professional practice (end-of-life impacts, recipient information and donor anonymity, and professional support, including conscientious objection). Key recommendations include clear and consistent policies; a patient-centered, nondirective approach; rigorous eligibility and voluntariness assessments; and strict separation between MAiD and donation/transplantation teams.

Mandatory mortality surprise question screening in the ED: Identification and associations with end-of-life care outcomesJournal of Palliative Medicine; by Nancy Kim, Karen Jubanyik, Peiyuan Liu, Giselle O'Connor, Ling Han, Rohit B Sangal, R Lynn Fiellin, Jennifer Kapo, Elizabeth Prsic, Shelli Feder; 7/26Early identification of patients with serious illness remains challenging in the emergency department (ED), where clinical decisions are made under time constraints. The mortality surprise question (MSQ) is a brief prognostic screen that may help identify patients needing end-of-life services. Results: Among 113,397 admissions (74,816 patients), MSQ completion was 100%; 7.8% received a "No" response. A "No" response was strongly associated with increased palliative care consultation ... , ACP documentation ... , hospice referral ... , comfort-measures-only orders ... , hospice disposition ... , higher inpatient mortality ... , and increased 30-day readmission ... Palliative care consultation occurred earlier among MSQ "No" than MSQ "Yes" encounters.

Private equity ownership in hospice care:  a systematic review (2012-2026) American Journal of Hospice and Palliative Medicine; by Denise D. Quigley, PhD, MA, Shannon Walsh, MPP, Cordt T. Kassner, PhD, Lara Dhingra, PhD, and Andrew W. Dick, PhD; 7/28/26 Hospice care is associated with improved end-of-life outcomes. Recent shifts in hospice utilization highlight several key trends. Alzheimer’s disease and related dementias (ADRD) (25%) have surpassed cancer (23%) as the leading primary diagnosis. Concurrently, industry ownership has transitioned from predominantly nonprofit to for-profit (70%) and private equity (PE) ownership has grown dramatically from 3% to 15%. To date, no study has synthesized evidence on PE ownership in hospice care.  We conducted a systematic review of English-language, peer-reviewed studies published 2012-2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Private equity ownership in hospice care:  a systematic review (2012-2026) American Journal of Hospice and Palliative Medicine; by Denise D. Quigley, PhD, MA, Shannon Walsh, MPP, Cordt T. Kassner, PhD, Lara Dhingra, PhD, and Andrew W. Dick, PhD; 7/28/26 Hospice care is associated with improved end-of-life outcomes. Recent shifts in hospice utilization highlight several key trends. Alzheimer’s disease and related dementias (ADRD) (25%) have surpassed cancer (23%) as the leading primary diagnosis. Concurrently, industry ownership has transitioned from predominantly nonprofit to for-profit (70%) and private equity (PE) ownership has grown dramatically from 3% to 15%. To date, no study has synthesized evidence on PE ownership in hospice care.  We conducted a systematic review of English-language, peer-reviewed studies published 2012-2026, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Quality domains in home-based pediatric hospice and palliative care: Adolescent and young adult perspectivesBMC Palliative Care; by Daniel H Grossoehme, Claire A Crawford, Jhansi Chandra Ellakula, Toluwalase Ajayi, Justin N Baker, Sarah Friebert, Lisa Humphrey, JillAnn Jarrell, Rachel Thienprayoon, Pamela S Hinds; 7/26Previous research with pediatric providers and caregivers concluded that pediatric hospice and palliative care have unique attributes. Not known is how adolescent hospice and palliative care patients understand quality palliative care. Methods: Semi-structured interviews with 10-26 year-olds who received home-based hospice and/or palliative care visits in the prior three years at six diverse sites in the United States. The results address an important gap by including adolescent/young adult patients' voices regarding delivery of home-based hospice and palliative care. Clinical implications include prioritizing and making time to build trusting relationships directly with the AYA, empowering them to participate in their care to the extent appropriate and prepare for transition to adult care when needed, providing support for family members, and training for all providers in generalist spiritual care.