Literature Review

Creating user personas to represent the needs of dementia caregivers who support medication management at home: Persona development and qualitative studyJMIR Aging; by Anna Jolliff, Priya Loganathar, Richard J Holden, Anna Linden, Himalaya Patel, Jessica R Lee, Aaron Ganci, Noll Campbell, Malaz Boustani, Nicole E Werner; 7/25Caregiver-assisted medication management plays a critical role in promoting medication adherence and quality of life for people living with Alzheimer disease or related dementias (ADRD). Caregivers in this study demonstrated a range of characteristics and values that informed their approach to medication management. They used a combination of technology-based strategies and strategies situated in their physical environments to manage medications. The personas created can be used to inform interventions, such as digital tools, that address caregivers' unmet needs.

Working through grief: Exploring the relationship between organizational support on employee engagement, satisfaction, and loyaltyTransdisciplinary Journal of Management; Katie N. Hansen; 7/25For most people, work and grief are unavoidable, meaning the majority of employees will work while grieving. Over the past several decades, employer grief responses have been more strategic than human-focused, leaving the bereaved under-supported. The most significant finding [of this study] is a decline in how engaged, loyal, and satisfied employees feel post-loss. Statistical analysis confirms that bereavement leave, reintegration accommodations, and provided support impact employee engagement, loyalty, and satisfaction, with positive and moderate to high associations existing between several variables. Finally, the results suggest the quality of an employer’s response and support for grieving employees remains insufficient, as the majority of respondents felt the need to take leave in excess of the bereavement leave provided, were not granted flexible work accommodations, and post-loss workloads did not meet their needs.

Demystifying dying in end-of-life-care: A phenomenological perspective Death Studies; by Elisabet Sernbo, Magnus Weber, Charlotta Öhrling, Stina Nyblom; 8/26/25 This article focuses on experiences of the process of dying. The empirical material consists of interviews with patients in palliative care and their significant others. The analysis draws attention to the lived experiences of the participants - embedded in time, identities, social relations, and everyday lives - and to how the possibility of sense-making is conditioned by the lifeworld. ... [This] needs to be understood as reorienting work: supporting people when their lines become disrupted or need to be altered. This requires a display of radical empathy ...

The treatment of chemotherapy-induced peripheral neuropathy: A review of current management options and a potential role for scrambler therapyFrontiers in Pain Research; by Hassan Aboumerhi, Henry Vucetic, Andrew Gruenzel, Bahar Moftakhar, Mona Gupta, Santosh K Rao, Michael D Staudt; 7/25Chemotherapy-induced peripheral neuropathy (CIPN) presents a growing medical and financial burden on patients and the healthcare system alike. This has been treated with conservative and interventional care limited by efficacy, side effects, and lack of coverage. As such, there is an unmet treatment need for effective non-invasive or minimally invasive therapies for the treatment of CIPN. Scrambler therapy (ST) is a peripheral, non-invasive neuromodulation technique, which uses transcutaneous electrical stimulation to modulate pain signals. ST has shown mixed results in clinical trials; while some patients report symptom relief, more robust evidence is required before it can be widely recommended.

Expanding the conceptualization of bereavement in the perinatal periodThe Journal of Obstetric, Gynecologic & Neonatal Nursing; by Rana Limbo, Natasha Nurse-Clarke; 7/25Contemporary definitions of perinatal loss encompass a range of involuntary and unintended pregnancy outcomes, including miscarriage (loss of pregnancy before 20 weeks gestation; Mayo Clinic, 2023), ectopic pregnancy (fertilized egg implanted outside the uterus), stillbirth (the birth of a fetus who shows no signs of life at or after 20 weeks gestation; Gregory et al., 2022), and neonatal death (the death of a live-born fetus within the first 28 days of life; National Center for Health Statistics, 2024). The loss of a pregnancy or fetus or the death of a newborn is an event, and perinatal bereavement is the emotional response to that event. The need for perinatal palliative care, which refers to care provided to families who receive a life-limiting fetal diagnosis, has also emerged as a critical component in supporting families through these losses (Limbo & Wool, 2016).

Evaluating the role of palliative care in emergency department opioid use among advanced cancer patientsSupportive Care in Cancer; by Joel Nortey, Shiyun Zhu, Andrew Lynch, Hannah Whitehead, Nirmala Ramalingam, Raymond Liu; 7/25 Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department [ED] visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens.

Effect of a multi-component palliative care intervention on goals of care discussions for critical patients in the emergency departmentInternal & Emergency Medicine; by Julia Murray, Zacharia Grami, Katherine Benson, Christopher Hritz, Samantha Lawson, Corita Reilley Grudzen, Allison Cuthel, Lauren Talanda-Fath Southerland; 7/25Goals of care (GOC) discussions are vital to understanding patients' values and preferences during serious illness, but they occur infrequently during Emergency Department (ED) care. We report a single site sub-study of a stepped wedge pragmatic trial of a multi-component intervention of primary palliative care in the ED (PRIM-ER), focused on GOC conversations. The intervention did not change the proportion of patients receiving a GOC conversation in the ED ... [however patients] presenting with a cancer-related complaint ... or a respiratory emergency ... were associated with increased odds of a GOC conversation occurring. Of the 60 GOC conversations that occurred, 76.7% ... resulted in a change in code status, patient care plans, hospice, or updated advance care planning documents. While the intervention did not increase this secondary outcome of GOC conversations, the discussions that did occur frequently impacted ED care.Assistant Editor's note: This study concluded that the intervention employed in the ED did not increase the proportion of patients receiving GOC conversations. Yet the study also concluded that almost 77% of the patients who DID receive the conversation had a change in code status, care plan, hospice or advance care planning documents. This study clearly reminds us that GOC conversations, employed even in the ED, can help patients embrace a palliative approach to care when faced with serious illness.

Financial performance of rural and urban nursing homes: A comparative analysisThe Journal of Rural Health; by Gregory N. Orewa, Rohit Pradhan, Akbar Ghiasi, Shivani Gupta, Robert Weech-Maldonado; 7/25The financial sustainability of nursing homes is increasingly critical as the aging US population continues to grow. Rural facilities often encounter more significant economic challenges than urban counterparts. This study investigates the disparities in financial performance between rural and urban nursing homes in the United States, emphasizing the influence of organizational and environmental factors. A comprehensive understanding of these differences is necessary for the implementation of effective policy and management interventions... Rural nursing homes had lower operating margins than urban facilities in unadjusted models. However, after adjusting for organizational factors such as size, occupancy, and payer mix, the rural–urban difference was no longer significant. Environmental factors, including population demographics and income levels, contributed to financial disparities. COVID-19 exacerbated financial challenges, disproportionately affecting rural facilities... Financial disparities between rural and urban nursing homes are not solely due to geographical location, but also stem from structural challenges. These insights have significant policy implications suggesting that addressing reimbursement rates, operational efficiency, and resource allocation is crucial to ensure the financial sustainability and quality care for aging populations.

[India] Challenges and ethical considerations of palliative care in Indian prisonsJournal of Pain and Symptom Management; by Swapnil Kumar Barasker, Pankaj Singhai, Maya Nair, Deepali Kumar; 8/25The landscape of palliative care (PC) in India is still nascent, and when applied to the prison setting, it becomes a terrain fraught with unique challenges. There is a dearth of region-specific perspectives on end-of-life care (EOLC) and PC in Indian prisons. In Indian prisons, EOLC is complicated by issues such as overcrowding, inadequate medical facilities, and the societal neglect of incarcerated individuals, yet the need for it remains largely unrecognized... Prison deaths are frequently associated with brutality or neglect, but statistics reveal that most deaths occur due to natural causes such as ischemic heart disease, pneumonia, cancer, and liver and kidney disorders. Despite many prisoners having chronic illnesses, they often lack regular follow-ups and access to appropriate care due to insufficient medical staff and infrastructure.

System wide goals of care implementation: A podcast with Ira Byock, Chris Dale, and Matt GonzalesGeriPal podcast; by Eric Widera, Alex Smith, Ira Byock, Chris Dale, Matt Gonzales; 7/24/25Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don’t happen or at least don’t get documented. How can we do better? In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative [found] an increase from 7% to 85% in goals of care conversation documentation for patients who were in an ICU for 5 or more days. How did they achieve this? Our guests will share insights into the project’s inception and the strategies that drove its success, including:

Evaluating a large language model in translating patient instructions to Spanish using a standardized frameworkJAMA Pediatrics; Mondira Ray, MD, MBI; Daniel J. Kats, MD, MBI; Joss Moorkens, PhD; Dinesh Rai, MD; Nate Shaar, BA; Diane Quinones, MS, RN, CPNP; Alejandro Vermeulen, BFA, CMI; Camila M. Mateo, MD, MPH; Ryan C. L. Brewster, MD; Alisa Khan, MD, MPH; Benjamin Rader, PhD; John S. Brownstein, PhD; Jonathan D. Hron, MD; 7/25Patients and caregivers who use languages other than English in the US encounter barriers to accessing language-concordant written instructions after clinical visits. Large language models (LLMs), such as OpenAI’s GPT-4o ... can translate Spanish translations of real-world personalized written patient instructions that are comparable in quality to those generated by professional human translators. Independent professional medical translators preferred the GPT-4o–generated translations over the human translations, and error analysis revealed a higher rate of mistranslation errors in the human translations. These findings demonstrate GPT-4o’s ability to produce quality translations in Spanish ...

How health care systems shape end-of-life care—A step toward transparencyJAMA Network Open; by Jacqueline M. Kruser, Gordon D. Rubenfeld; 7/25Our health care systems, in all their multifaceted complexities, are more influential in shaping the delivery of care than individual human effort or error. Influential system-level factors span many different domains: how we are paid, the buildings we work in, the technology around us, who and how many we have on the team caring for patients, our workload, and our local social networks of influence. One pragmatic first step in addressing the problem of invisible, inaccessible, and/or inflexible patterns of end-of-life care is to build awareness of and foster transparency about the current patterns and their default orientation. Building from this deeper understanding of how our everyday routines and practice patterns influence care, we can then take the bigger step of intentionally designing our routine clinical practice patterns to be systematic yet flexible in their support of patients with serious illnesses.