Literature Review

Discontinuation of medications with limited benefit at end of life in community-dwelling older veteransJournal of the American Geriatrics Society; by Joshua M Thorpe, Kelvin A Tran, Sherrie L Aspinall, Shelli L Feder, Brystana G Kaufman, Ann Kutney-Lee, Maria K Mor, Loren J Schleiden, Florentina E Sileanu, Carolyn T Thorpe, Courtney H Van Houtven; 4/26Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life prescribing has focused on nursing homes or hospice settings. [This study setting was] community-residing, non-hospice older veterans. Among community-dwelling older veterans in their final year of life, 73% were receiving at least one LBM at the start of that year, and 78% of these individuals continued LBM use until death. These rates parallel those reported in long-term care populations and underscore the need for community-based healthcare providers to routinely screen for LBMs and support appropriate medication discontinuation in older patients with advanced illnesses and limited life expectancy.

Engaging bereaved parent educators in pediatric end-of-life workshops: A trauma-informed onboardingJournal of Pain & Symptom Management; by Kayla Solstad, Dannell Shu, Kelly McManimon, Stacy Remke, Susan O'Conner-Von, Anne Woll, Joseph M Miller, Miriam C Shapiro, Johannah M Scheurer; 3/26Recognizing that pediatric end-of-life (EOL) scenarios occur infrequently and are distressing for trainees and other healthcare team members, our group created pediatric end-of-life care skills (PECS) simulation-based workshops to improve trainee competence for these skills. We  ... provide interprofessional workshops, including trainees from the pediatric residency program, graduate school of nursing, and graduate school of social work. Since creation of the workshops, the group and curricula have benefited immensely from including the expertise of bereaved parent educators (BPEs), who have experienced the death of their own infant or child and have been integral team members ... from workshop creation through facilitation. Research shows that families who have experienced the death of a child appreciate an interdisciplinary approach to their care and communication at the EOL. When parents of pediatric patients were asked about priorities in EOL care, they highlighted the importance of communication, emotional expression and support by staff, and ready access to multi-disciplinary staff.

Introducing palliative care: Family caregivers’ knowledge, exposure, and preferred messagingAmerican Journal of Hospice & Palliative Medicine; by Elaine Wittenberg, Joy V. Goldsmith, Sierra Forrest, Hanna G. Lee, Eva YN Yuen; 3/26Most family caregivers have never heard of palliative care, making it challenging for clinicians to introduce the subspecialty. Semi-structured phone interviews with family caregivers of patients eligible to receive palliative care were conducted. Knowledge of palliative care was significantly associated with having heard about and being offered palliative care. Caregiver exposure to palliative care was associated with age and race, with older, White caregivers significantly more likely to have heard about palliative care compared to Hispanic caregivers. Caregivers positively endorsed all message strategies designed for introducing palliative care.

Expanding access to palliative care for patients with advanced liver diseaseAAAS - EurekAlerts!, Philadelphia, PA; describes JAMA Internal Medicine at doi: 10.1001/jamainternmed.2026.0571; 4/13/26 A new multicenter trial led by Manisha Verma, MD, and Victor Navarro, MD, at Jefferson Einstein Philadelphi Hospital demonstrates a new approach that could potentially transform access to palliative care for patients with ALD and address a major care gap. In the PAL LIVER trial, a large cluster-randomized study conducted across 19 U.S. centers, researchers evaluated whether hepatologists trained in primary palliative care could match the effectiveness of palliative care specialists in delivering quality-of-life benefits to patients with ALD, including those with decompensated cirrhosis and liver cancer. With 935 patients enrolled, this is one of the largest trials to date in liver disease palliative care.

A scoping review of breakthrough cancer pain: Mapping the evidence landscapeSupportive Care in Cancer; Mellar Davis, Russell Portenoy, Andrew Davies, Sebastiano Mercadante, Akhila Reddy, M R Rajagopal, Eduardo Bruera; 3/26Breakthrough pain (BTP) in cancer populations is characterized by heterogeneous definitions, assessment approaches, and management strategies. This scoping review mapped the available evidence to characterize BTP concepts, describe the evidence base, and identify knowledge gaps. This scoping review maps heterogeneous evidence characterized by inconsistent definitions, selected populations, short-term outcomes, and geographic concentration. Key knowledge gaps include: standardized operational definitions, patient-centered functional outcomes, long-term efficacy and safety data, evidence from diverse settings and populations, and integration of pharmacological and non-pharmacological approaches. The review provides a descriptive landscape but does not assess evidence quality or support treatment recommendations.    

Spiritual distress screening by nurses to increase comprehensive spiritual support of patientsJournal of Hospice & Palliative Nursing; by Nair, Archana; Patterson, Dorothy; Hauver, Bethany; Labadie, Chelsey; 4/26This project aimed to address a gap in nurses’ awareness of spiritual care and comprehensive spiritual support of patients in a breast oncology clinic at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center through interdisciplinary collaboration with chaplaincy. Following education, nurses screened patients during their initial visit to the breast surgical oncology clinic who were experiencing moderate to severe distress for related existential themes of distress using an assessment tool and referred them to chaplaincy or social work based on the screening results. Nurse-initiated chaplain referrals increased significantly during the study period, with the most common distress themes being stress, hopes/fears, and assistance/help. Patient acceptance of referrals averaged 18.7% for chaplaincy and 33.1% for social work. By enhancing nurses’ understanding of spiritual care and the role of chaplaincy, the clinic was able to improve the provision of comprehensive spiritual support, contributing to holistic patient care.