Literature Review

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.

AI, health, and health care today and tomorrow-The JAMA Summit Report on artificial intelligenceJAMA; Derek C. Angus, Rohan Khera, Tracy Lieu, Vincent Liu, Faraz S. Ahmad, Brian Anderson, Sivasubramanium V. Bhavani, Andrew Bindman, Troyen Brennan, Leo Anthony Celi, Frederick Chen, I. Glenn Cohen, Alastair Denniston, Sanjay Desai, Peter Embí, Aldo Faisal, Kadija Ferryman, Jackie Gerhart, Marielle Gross, Tina Hernandez-Boussard, Michael Howell, Kevin Johnson, Kristine Lee, Xiaoxuan Liu, Kimberly Lomis, Alex John London, Christopher A. Longhurst, Ken Mandl, Elizabeth McGlynn, Michelle M. Mello, Fatima Munoz, Lucila Ohno-Machado, David Ouyang, Roy Perlis, Adam Phillips, David Rhew, Joseph S. Ross, Suchi Saria, Lee Schwamm, Christopher W. Seymour, Nigam H. Shah, Rashmee Shah, Karandeep Singh, Matthew Solomon, Kathryn Spates, Kayte Spector-Bagdady, Tommy Wang, Judy Wawira Gichoya, James Weinstein, Jenna Wiens, Kirsten Bibbins-Domingo, for the JAMA Summit on AI; 10/25AI will disrupt every part of health and health care delivery in the coming years. Given the many long-standing problems in health care, this disruption represents an incredible opportunity. However, the odds that this disruption will improve health for all will depend heavily on the creation of an ecosystem capable of rapid, efficient, robust, and generalizable knowledge about the consequences of these tools on health. AI is changing how and when individuals seek care and how clinicians interact with patients, establish diagnoses, and implement and monitor treatments. In contrast to drugs or more traditional medical devices, there is little consensus or structure to ensure robust, safe, transparent, and standardized evaluation, regulation, implementation, and monitoring of new AI tools and technologies.

[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.

Evaluation and treatment of malignant neuropathic painAmerican Journal of Hospice and Palliative Medicine; by Lillian Boehmer, Belal Dakroub, Glenn Pebanco; 10/25Cancer-related neuropathic pain (CRNP) is difficult to identify, assess, and treat, often requiring higher analgesic needs and resulting in poorer outcomes. Objectives: To evaluate the effectiveness of guideline-directed therapy for CRNP in veterans treated at the West Palm Beach VA Healthcare System (WPB VAHCS) Hematology/Oncology Center and managed as outpatients by a pain and palliative care clinical pharmacy practitioner (CPP). Following CPP intervention, pain scores improved ... and PEG [Pain, Enjoyment, and General Activity] scores improved ... CPP-guided use of guideline-directed therapies significantly improved pain intensity and function in veterans with CRNP. Buprenorphine may reduce medication burden in geriatric patients with multimodal pain, reinforcing its value in structured palliative care models.    

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.

Benzodiazepine or antipsychotic use and mortality risk among patients with dementia in hospice careJAMA Network Open; by Lauren B. Gerlach, Lan Zhang, Hyungjin Myra Kim, Joan Teno, Donovan T. Maust; 10/25Benzodiazepines and antipsychotics are commonly used in hospice to manage symptoms such as agitation, anxiety, and terminal delirium in people with ADRD [Alzheimer disease and related dementias], often in response to behaviors that are distressing not only to the patient but also to family caregivers and staff. While these medications can offer symptom relief, they carry risks, including falls, sedation, and confusion. In this national case-control study of nursing home residents with ADRD receiving hospice care, initiation of benzodiazepine or antipsychotic use was associated with increased 180-day mortality. While these medications may provide symptom relief in appropriate clinical scenarios, their use is associated with substantial risks. These findings highlight the need for careful prescribing decisions and the development of dementia-specific hospice prescribing guidelines.

Study shows over 90% of older adults with dementia undergo burdensome interventions in their final year Today Headline - Medical Research; by Duke-NUS Medical School; 11/17/25 A new study by researchers from Duke-NUS Medical School has revealed that almost all community-dwelling older adults with advanced dementia in Singapore experience at least one potentially burdensome intervention in their last year of life. The findings highlight an urgent need for new strategies to support families and reduce unnecessary interventions at the end of life.

Navigating choice: Eating, drinking and decision-making at end of life for individuals with cognitive impairmentJournal of Clinical Practice in Speech-Language Pathology; by Laura Chahdaa, Druvni Pererab, Darcy Longc, Laura Knauerb, Sanora Yonand; 10/25Current clinical guidelines offer limited direction for speech-language pathologists (SLPs) supporting eating and drinking decisions in palliative care (PC), particularly for individuals with dysphagia and co-occurring cognitive impairment. This population presents unique clinical, ethical and interpersonal challenges that often fall outside existing frameworks such as ‘Eating and Drinking with Acknowledged Risk’. This scoping review explores the key considerations for SLPs involved in end-of-life decisionmaking in these complex cases. A qualitative scoping review was conducted and analysed thematically [and] ... six overarching themes were identified: person-centred care; emotional and relational dynamics; ethical decision-making complexity; medical risk; barriers to effective clinical practice; and legal considerations. Findings reveal inconsistencies in practice and limited guidance for SLPs navigating care for individuals with cognitive impairment at the end of life.

Addressing palliative care gaps for rare congenital disease in adults: CM-AVM2 as an exampleJournal of Pain & Symptom Management; by Matthew W Kenaston, Ryan Baldeo, Tyler K Murphy; 10/25Capillary malformation-arteriovenous malformation type 2 (CM-AVM2) is a rare vascular disorder marked by complex, progressive symptoms and limited treatment options. As more individuals with rare diseases reach adulthood, palliative care plays an essential role in supporting quality of life when disease-directed therapies begin to fail. We present a young adult male with EPHB4-positive CM-AVM2, transferred to our tertiary care center for progressive malnutrition, refractory diarrhea, and worsening abdominal pain despite extensive subspecialty care. Through medication optimization, dynamic communication, and consistent interdisciplinary collaboration, the [palliative care] team helped stabilize aspects of his comfort and gradually facilitated GOC [goals of care] discussions. We further discuss how palliative care in this setting differs from standard frameworks, requiring proactive use of disease-specific resources and protracted, anticipatory care planning to optimize quality of life.