Literature Review

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.

[Australia] The unmet needs of parents in pediatric palliative care: A qualitative systematic reviewJournal of Palliative Medicine; by Piyumi Senanayake, John Oldroyd; 8/25The goal of pediatric palliative care is to improve the quality of life of children with life-limiting or life-threatening disease and their families through a holistic care approach. Thirteen studies were included [in this analysis]. Five major themes emerged: (1) pediatric palliative care services delivery and care coordination, (2) emotional, psychological, and spiritual support, (3) end-of-life care and bereavement support, (4) practical and daily living support, and (5) communication and information. Parents reported unmet needs in multiple dimensions and wished for more support in caring for their children. Given that all of the unmet needs align with already established pediatric palliative care standards, this review highlights the need for revised health care policies and practices that will lead to better implementation of these standards in practice.

Training and practice gaps in nursing home palliative care: A cross-sectional study Journal of the American Geriatrics Society (AGS); by Manali Saraiya, Molly A. Nowels, Rose L. Carlson, Jerad H. Moxley, Catherine A. Riffin, Evan Plys, M. Carrington Reid, Isabella Hastings, Taimur Mirza, Ronald D. Adelman, Daniel Shalev; 9/7/25 We conducted a cross-sectional survey of clinical employees (N = 398) at seven NHs within a single integrated health system in New York State to (1) gauge attitudes toward and knowledge about palliative care, (2) estimate the extent of engagement with advance care planning, and (3) elicit perceptions of the most valuable components of palliative care for NH residents. ... Despite support for palliative care, gaps in knowledge and clinical engagement persist and vary by discipline. Discipline-tailored training and program design may improve palliative care delivery in NHs and help ensure more consistent, value-aligned care for residents with serious illness.

Estimating the predictability of questionable open-access journalsScience Advances; by Han Zhuang, Lizhen Liang, Daniel E. Acuna; 8/25Questionable journals threaten global research integrity, yet manual vetting can be slow and inflexible. Here, we explore the potential of artificial intelligence (AI) to systematically identify such venues by analyzing website design, content, and publication metadata. Evaluated against extensive human-annotated datasets, our method achieves practical accuracy and uncovers previously overlooked indicators of journal legitimacy... Our study defines “questionable open-access journals” as journals violating the best practices outlined by the Directory of Open Access Journals (DOAJ) and showing indicators of low editorial standards.Publisher's note: The authors use AI to evaluate open-access journals adherence to best publishing practices - an interesting use of AI that could be applied to many other settings. The list of open-access journals can be found here.

Understanding trauma in the context of direct care work in nursing homesJournal of Applied Gerontology; by Alfred Boakye, Jennifer Craft Morgan, Candace L. Kemp, Antonius D. Skipper; 8/25Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents’ care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.

A digital therapeutic intervention for inpatients with elevated suicide risk: A randomized clinical trialJAMA Network; by Craig J. Bryan, Patricia Simon, Samuel T. Wilkinson, Michael H. Allen, Jeremiah Perez, Caleb Adler, Khatiya Moon, Lauren Astorino, Kristen M. Carpenter, Luke Misquitta, Katherine Brownlowe, Lauren R. Khazem, Jarrod Hay, Austin G. Starkey, Julia Tartaglia, Helena Winston, Scott Simpson, Alecia D. Dager, Seth Feuerstein; 8/25Does a smartphone-based digital therapeutic intervention designed to deliver suicide-focused cognitive behavior therapy (CBT) reduce future suicide attempts among patients hospitalized with acutely elevated suicide risk? In this randomized clinical trial of 339 inpatients in psychiatric hospitals, no difference was found in time to first actual suicide attempt between those who used the digital therapeutic intervention and those who used the control application. The digital therapeutic intervention did not impact time to first suicide attempt after discharge among patients admitted for suicidal ideation and/or suicide attempts.Publisher's note: As AI is studied in healthcare, it's interesting to explore both what works and what doesn't.

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Top ten tips palliative care clinicians should know about intensive care unit consultationJournal of Palliative Medicine; by Ankita Mehta, Karen Bullock, Jillian L. Gustin, Rachel A. Hadler, Judith E. Nelson, William E. Rosa, Jennifer B. Seaman, Shelley E. Varner-Perez, Douglas B. White; 8/25Critical illness and ICU stays can be extremely distressing for patients and their loved ones. Providing palliative care in the ICU, although a standard component of comprehensive care delivery, involves understanding the individual culture of each specific ICU, collaboration with multiple providers, and interfacing with surrogate decision makers while patients may not be able to communicate and are undergoing interventions that are unfamiliar to them and loved ones. These top ten tips aim to support palliative care clinicians providing consultation in ICUs. Specifically, these tips address initial relationship building with ICU clinicians and teams to foster effective collaboration, establishing goals of care by assessing health-related values, explaining treatment options, individualizing prognostic discussions, and managing end-of-life symptoms for patients while in the ICU and throughout ICU discharge transition.

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. 

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.

Physician billing for advance care planning among Medicare fee-for-service beneficiaries, 2016-2021The Permanente Journal; by Nan Wang, Changchuan Jiang, Elizabeth Paulk, Tianci Wang, Xin Hu; 8/25In 2016, the Centers for Medicare & Medicaid Services started reimbursing practitioners for their time spent providing advance care planning (ACP) with patients. Results: The percentage of practitioners billing ACP visits tripled from 1.76% in 2016 to 4.56% in 2021, with the highest percentage among hospice and palliative medicine practitioners (36.94%) in 2021. ACP service volume was similar by metropolitan status for hospice and palliative medicine, but it was higher in nonmetropolitan regions for cancer-related specialties, non-cancer terminal disease specialties, and primary and geriatrics care. This nationwide analysis showed low adoption of ACP billing by 2021, and it varied widely across specialties. This may reflect practical challenges of ACP related to comfort level with ACP discussion and documentation burden among the professional communities.

AI in palliative care: A scoping review of foundational gaps and future directions for responsible innovationJournal of Pain and Symptom Management; by Selen Bozkurt, Soraya Fereydooni, Irem Kar, Catherine Diop Chalmers, Sharon L Leslie, Ravi Pathak, Anne M Walling, Charlotta Lindvall, Karl Lorenz, Ravi Parikh, Tammie Quest, Karleen Giannitrapani, Dio Kavalieratos; 8/25AI holds increasing promise for enhancing palliative care through applications in prognostication, symptom management, and decision support. However, the utilization of real-world data, the rigor of validation, and the transparency and reproducibility of these AI tools remain largely unexamined, posing critical considerations for their safe and ethical integration in sensitive end-of-life settings... AI in palliative care remains in early development, showing promise in areas such as prognosis and documentation support. However, limited validation, insufficient cross-site testing, and lack of transparency currently limit clinical applicability. Future research should emphasize external validation, inclusion of broader patient data, and adoption of open science practices to ensure these tools are reliable, safe, and trustworthy.