Literature Review

Evasiveness in everyday hospital palliative care practice: a focused ethnography Journal of Clinical Nursing; by Carolien van Leussen, Evelien Kuip, Renske Kruizinga, Els van Wijngaarden; 9/2/26 Conclusion: This study shows how evasiveness in hospital-based palliative care is produced and sustained through biomedical routines, organizational pressures and professional and personal orientations. These factors make it difficult to realize the holistic ideals of palliative care in everyday practice. As a result, patients' fears, uncertainties and end-of-life wishes often remain insufficiently explored, whereas organizational routines shape what is considered appropriate and possible in clinical interactions.

Patient and caregiver perspectives on communication quality in tele-palliative care Journal of Palliative Medicine; by Julia I. Bandini, PhD, Elaine Li, BA, Dio Kavalieratos, PhD, FAAHPM, Natalie C. Ernecoff, PhD, Kimberly Curseen, MD, and Jordan Harrison, PhD; 8/27/26 Objective: To qualitatively explore patient and family caregiver experiences with telehealth and in-person visits for outpatient palliative care, including preferences related to mode of care and any perceived differences in communication quality by mode in a post-pandemic context. Results: Three themes emerged: (1) participants weighed convenience, symptom burden, and visit reason in choosing mode of care; (2) opinions differed on the authenticity of communication via telehealth; and (3) comfort and privacy shaped communication quality. Some patients and family caregivers perceived communication via telehealth as comparable to in-person care, while others felt in-person visits allowed for more authentic interactions. Many found that the convenience of telehealth outweighed any perceived differences in communication quality. In addition, some patients noted that without the option for telehealth, the benefits of an in-person palliative care visit may not have outweighed the travel burden.

Can I get a witness? The ethical dimensions of family presence in patient sufferingThe Hastings Center Report: by Jennifer Blumenthal-Barby, Trevor M Bibler, Holland Kaplan, Adam Omelianchuk, Joanna Smolenski; July-August 2026For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing the patient's actual or perceived suffering while the family escapes this burden and therefore appears to fail to uphold a duty to the patient. Is it morally defensible to request or require family members to be present with an unresponsive patient to bear witness to their actual or perceived suffering?

An exploration of gratitude on well-being in hospice and palliative care familial caregiversJournal of Palliative Medicine; by Kathryn Levy, Pei C Grant, Hannah Rachiele, Gina Schuster, Jonathan L Rossi, Sheila Conboy, Andrew Gasper, Christopher W Kerr; 7/26Familial caregivers (FCGs) play a critical role in health care by providing unpaid care to loved ones with serious illness. Although caregiving is often associated with emotional and physical burden, increasing attention has been directed toward potential sources of meaning and psychological growth, including gratitude. Higher levels of gratitude were associated with greater flourishing and recognition of positive caregiving experiences and were inversely associated with caregiver strain among FCGs of hospice and palliative care patients. Future longitudinal and intervention-based research is needed to determine whether gratitude-focused approaches can improve resilience, psychological well-being, and relational connection in end-of-life caregiving.

Spirituality and religiosity in end-of-life decision-making in intensive care units: a systematic review of preferences, ethical framing, and meaning-making Cureus; by Dimitrios G. Apostolakis, Nikiforos V. Angelopoulos, Spiros Georgakis, Fotios Tatsis, Foteini Veroniki, Konstantinos Stamatis, Georgios Papathanakos, Mary Gouva, Vasilios Koulouras; 8/25/26 End-of-life decision-making in intensive care units (ICUs) is a complex and ethically challenging process shaped not only by clinical factors but also by patients' values, cultural contexts, and spiritual or religious beliefs. ...  [Spirituality] demonstrated a multidimensional role, facilitating acceptance of death, promoting support for palliative care in some contexts, and contributing to meaning-making during the end-of-life process. Cultural and contextual factors moderated these relationships, and the provision of spiritual care by healthcare professionals was associated with less aggressive end-of-life care. ... Integrating spiritual assessment and culturally sensitive spiritual care into routine clinical practice may enhance shared decision-making and improve alignment between treatment decisions and patients' values, preferences, and goals of care.

A retrospective mixed-methods analysis of falls among patients in a social model hospice residential care home American Journal of Hospice and Palliative Medicine; by Carol S. Weisse, PhD, Kelly Melekis, MSW, PhD, Lam Nguyen, Cort Collier, BS, and Nadia Kelley, MPH; 8/9/26 ... In the 24-hour period prior to patients’ falls, opiates were shown to be the most frequently administered medication followed by benzodiazepines, with higher rates of falls among patients who consumed both of these medications in combination. Most falls occurred in the bedroom or bathroom and were related to toileting needs. Results suggest that informal caregivers may benefit from additional training when supporting hospice patients’ toileting needs, especially when they have received opiates and benzodiazepines. Results illustrate caregivers’ efforts to balance fall risk with patients’ desire for autonomy as a central element of home hospice care. Editor's Note: What systems do you have in place for reporting, responding to, and reducing patient falls, especially in homes? At a minimum, you need to have these in place:

Empowering elderly Chinese Americans: Advance care planning educational workshopGeriatric Nursing; by Mengyao Zhao, Tammy Tyree; 7/26Advance care planning (ACP) is important to ensure an individual's values and preferences are followed at the end-of-life (EOL). However, elderly Chinese Americans have a much lower advance directive (AD) completion rate than the national average. This quality improvement project aimed to improve ACP engagement and AD completion rates among elderly Chinese Americans at a local senior center in Arizona. Three monthly culturally tailored educational workshops were conducted, and ... data analysis showed a significant increase in ACP engagement scores over time ...  Additionally, AD completion rates rose by 220% after the intervention. These findings indicate that culturally tailored educational workshops can effectively improve ACP engagement and AD completion rates in elderly Chinese Americans.

Goal-concordant care for older adults with advanced heart failure: A retrospective cohort studyPalliative Medicine; by Sarah Godfrey, Maryjane Farr; 7/26Older adults with advanced heart failure experience significant morbidity and mortality and face higher complication rates from advanced therapies. Of 212 patients, 91 (42.9%) underwent evaluation for advanced therapies, though few received a heart transplant (16, 7.5%) or left ventricular assist device (32, 15.1%). Most (148, 69.8%) had only one palliative physician visit. One hundred thirty-nine (65.6%) died, often in the hospital (55, 40%) and with life-sustaining therapy in the last 24 h (73, 52.5%). Most (167, 78.8%) received goal-concordant care, with the main reasons for discordance being the desire for advanced therapy (33, 15.6%) and complications post-implantation affecting quality of life (9, 4.2%). Conclusions: Few older adults received advanced therapies, and palliative care was underutilized, with many patients seeing palliative care only once. Most received goal-concordant care, but decisions were often made late, highlighting the need for earlier, longitudinal palliative care for these vulnerable patients.