Literature Review

Grieving the living: How Hospice of St. Lawrence Valley helps caregivers cope North Country Now, St. Lawrence County, NY; by Kate Favaro, Hospice of St. Lawrence Valley; 7/10/25 With caregiving comes grief, there’s no way around it. You will grieve two important things that you’ve lost: who the person you’re caring for used to be, and the things that will never be. Take the time to explore the grief you’re experiencing so you can provide the best care possible. If you’re not taking care of yourself, you won’t be able to take care of anyone else. Hospice of St. Lawrence Valley offers the following on the grief of caregiving:

When less is more: Addressing polypharmacy in high-risk populations Pharmacy Times; by Andrew E. Esch, MD, MBA and Alain Hipensteele; 7/7/25 As digital health tools and artificial intelligence (AI)–powered clinical decision support systems become increasingly embedded in pharmacy workflows, pharmacists are gaining new opportunities to identify and address the risks of polypharmacy—particularly in high-risk populations such as older adults and those receiving palliative care. At the same time, evolving deprescribing guidelines and ongoing drug shortages have underscored the need for coordinated, patient-centered medication management strategies. In this interview with Pharmacy Times®, Andrew E. Esch, MD, MBA, director of the Palliative Care Program Development at the Center to Advance Palliative Care, discusses how pharmacists are using emerging technologies to streamline medication reviews, reduce therapeutic duplication, and engage caregivers in deprescribing conversations. 

From burnout to belonging: Creating space for grief in clinical education American Academy of Pediatrics (AAP) Journals Blog; by Rachita Gupta; 6/16/25 ... While significant progress has been made in addressing burnout and emotional distress in medicine, and in incorporating these topics into medical education, many clinicians remain hesitant and uncertain about how to address grief and distress from patient care in day-to-day clinical practice. This uncertainty exists both in terms of their own experiences and, even more so, in supporting trainees. A lack of emotional processing in these difficult situations can accelerate burnout and further disconnect clinicians from the humanism and vulnerability that are intrinsic to the privilege of practicing medicine. ... The recently published Hospital Pediatrics article by Bloomhardt et al, “Good Grief? Introducing the TEARS Framework for Educator to Support Learners Experiencing Grief,” (10.1542/hpeds.2024-008096) addresses the hesitancy many clinicians experience when assessing learners’ emotional processing during or after distressing patient cases by introducing the TEARS framework. ...Editor's Note: See a related post in today's newsletter, "“Her toes fell off into my hand”: 50 moments that changed healthcare workers forever."

Short notice, long love: A hospice wedding full of heart Citrus County Chronicle, Inverness, FL; by Mike Arnold; 6/16/25 Brendan Malone and Vanessa Rodriguez made a snap decision that would change their lives – and touch the hearts of everyone around them. The couple were driving up from Estero in the early afternoon of June 5 to visit Malone’s father, Michael “Big Mike” Malone, who had recently moved into Citrus Health and Rehab in Inverness and was also receiving care from Vitas Hospice. [Already engaged,] ... they made the decision to get married the next morning, at Citrus Health and Rehab. There were no tuxedo fittings, no cake tastings, no invitations sent. There was no time. There were flowers, guests, toasts, bubbles – and love. And “Big Mike” had a front row seat. Brendan Malone didn’t want to get married without the man who had been his biggest supporter by his side. ... What followed was a whirlwind of compassion, planning, and action from the staff at the nursing facility and the local hospice team. Within hours, they coordinated decorations, arranged courtyard seating, and made sure Michael could be present in his wheelchair for the ceremony.

Empath revamping physical, digital workspace for improved employee experience Hospice News; by Jim Parker; 6/16/25 ... [Empath is updating] its physical locations to enhance the workspace for employees. “Some of this workspace design that we’re doing is innovative. We’ve invested in common workplace environments. We have quiet rooms, where people can go and focus on rest, relaxation and ease in the middle of the day. We leave your laptops, leave your phones out of that room,” Fleece told Hospice News. “We’ve invested in common kitchen areas and gathering places that are like a workplace cafe, with coffee, lounge chairs, TVs and things like that, so people can get together and socialize while they are in the office.” Florida-based Empath Health is the parent company of 17 affiliates and four philanthropic foundations. The organization provides care to more than 81,000 patients annually. 

Couple marry in ICU an hour before bride’s father takes his last breath Our Community Now, North Providence, RI; by OCN staff; 8/22/24, published in our newsletter 9/1/24A Rhode Island hospital held an emergency wedding that had to be performed before the bride’s father died from muscular dystrophy. Sabrina Silveira-DaCosta says her father, 58-year-old Frank Silveira, was Portuguese-born and raised, a serious chef and a five-star dad. ... With Silveira’s health rapidly declining, his family realized he wasn’t going to make it his daughter’s wedding on Sep. 7, so plans changed. “Everyone was able to bring the wedding to him in the hospital, and he got to walk me down the aisle,” Silveira-DaCosta said. From his intensive care unit bed, Silveira escorted his daughter down the hospital hallway Monday into the hands of her fiancé, Sam DaCosta. ... Silveira-DaCosta’s father died about an hour after he walked her down the aisle. “It’s very complex. It’s a lot of emotion. Our community hospitals don’t get enough credit because any big hospital couldn’t have done this for us,” she said.

Hospice staff at UVM Home Health and Hospice vote to form union Vermont Biz - Vermont Business Magazine; by Tim, The University of Vermont Health Network - Home Health & Hospice; 6/6/25 After six months of organizing, a majority of the roughly 85 Hospice staff at UVM Home Health and Hospice voted Thursday to formalize their union. Hospice United will represent Nurses, LNAs, Social Workers, Chaplains, Bereavement Coordinators, Volunteers Coordinators, Cooks, and Admin Support in both the McClure Miller Respite House and the community-based team. ... With a 88% voting yes, this victory marks the establishment of union representation at every one of UVM Health Network’s seven locations. Once the votes are certified, staff will begin the process of bargaining their first contract with the UVMHN administration.  

Provider MiraSol Health launches new Behavioral Health Program Hospice News; by Jim Parker; 6/3/25 MiraSol Health has launched a new behavioral health program designed to amplify emotional and psychological support for its hospice and palliative care patients. Branded as Rays of Hope Behavioral Health, the program offers individual and group therapy sessions, both in person and via a secure telehealth platform. Through Rays of Hope, MiraSol’s licensed therapists will help address anticipatory grief, caregiver stress, loss and other struggles that patients and families face during a time of chronic, serious or terminal illness.

MLN Fact Sheet: Creating an efffective Hospice Plan of CareCenters for Medicare & Medicaid Services, Medicare Learning Network (MLN); 5/10/25 The hospice plan of care (POC) maps out needs and services given to a Medicare patient facing a terminal illness, as well as the patient’s family or caregiver. CMS data shows that some hospice POCs are incomplete or not followed correctly. This fact sheet educates on creating and coordinating successful hospice POCs. The primary goal of hospice care is to meet the holistic needs of an individual and their caregiver and family when curative care is no longer an option. To support this goal:

Primary mental health competencies for hospice and palliative medicine physicians: A Delphi studyJournal of Pain and Symptom Management; by Lisa Podgurski, Danielle Chammas, Keri O Brenner, Leah B Rosenberg, Neha G Goyal, Maria I Lapid, Sue E Morris, William F Pirl, Bridget Sumser, Benjamin W Thompson, Lindsey Wright, and Daniel Shalev; 5/20/25  Objectives: To establish and prioritize 'primary mental health competencies' for specialist hospice and palliative medicine physicians using expert consensus methods. Results: The expert panel proposed 68 competencies divided into: (A) psychological foundations of serious illness care, (B) diagnosis and management of mental health disorders in serious illness, and (C) systems-based practice. After first-round voting, 23 competencies were recirculated for a second vote. Following second-round voting, 32 competencies were included in the final list: 7 from part A, 20 from part B, and 5 from part C.

What is it like to die? University of Minnesota’s VR experience offers some answers. The Minnesota Star Tribune; by Richard Chin; 5/2/25 Our reporter returned from the Embodied Labs experience with some thoughts on what he’d like his last hours to look like. When the University of Minnesota offered to let me experience what it’s like to die, naturally I said yes. Aren’t we all morbidly curious about the undiscovered country, as Hamlet put it, from which no traveler returns? Except this time, happily, I would get to return because it would be a virtual death, an experience in a VR studio that’s part of the university’s Health Sciences Library system.

Exploring overlooked collaborative opportunities during end-of-life care Medical Xpress; by Institute of Science Tokyo; 5/14/25 [This study's researchers describe:] "Bereaved family members broadly recollected the mixed regretful actions and decisions that should have been taken during the end-of-life care process. Coordination and cooperation challenges that existed between health care professionals and family caregivers emerged as factors that impeded these actions at the time." [They identified three types of] unintended, percolated work (UPW). ...

Palliative and end-of-life care during critical cardiovascular illness: A scientific statement from the American Heart Association American Heart Association; by Erin A. Bohula, MD, DPhil, Michael J. Landzberg, MD, Venu Menon, MD, FAHA, Carlos L. Alviar, MD, Gregory W. Barsness, MD, FAHA, Daniela R. Crousillat, MD, Nelia Jain, MD, MA, Robert Page II, PharmD, MSPH, FAHA, Rachel Wells, PhD, MSN, and Abdulla A. Damluji, MD, PhD, MBA, FAHA on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology; and Council on Cardiovascular and Stroke Nursing; 5/15/25 Abstract: Cardiac intensive care units are witnessing a demographic shift, characterized by patients with increasingly complex or end-stage cardiovascular disease with a greater burden of concomitant comorbid noncardiovascular disease. Despite technical advances in care that may be offered, many critically ill cardiovascular patients will nevertheless experience significant morbidity and mortality during the acute decompensation, including physical and psychological suffering. Palliative care, with its specialized focus on alleviating suffering, aligns treatments with patient and caregiver values and improves overall care planning. Integrating palliative care into cardiovascular disease management extends the therapeutic approach beyond life-sustaining measures to encompass life-enhancing goals, addressing the physical, emotional, psychosocial, and spiritual needs of critically ill patients. This American Heart Association scientific statement aims to explore the definitions and conceptual framework of palliative care and to suggest strategies to integrate palliative care principles into the management of patients with critical cardiovascular illness.