Literature Review

Small but mighty: 5 lessons from smaller teams delivering high-quality palliative care CAPC; by Megan Hesketh; 12/16/25 ... High-quality palliative care isn’t defined by program size or budget—it’s defined by consistency, collaboration, and a shared commitment to patients and families. Across the country, smaller palliative care programs are demonstrating what’s possible when teams focus on training, teamwork, and outcomes that matter. In summer 2025, CAPC spoke with twenty smaller organizations—community hospitals, critical access hospitals, independent hospices, and small practice groups serving fewer than 150 beds—to understand how they sustain their commitment to high-quality palliative care. Their experiences highlight what makes these programs effective: clear structures, intentional learning, and a deep sense of accountability to their communities.

My patient was gone. I had to help his family see it: The art of medicine means sitting with families’ grief and hope Stat10 - First Opinion; by Raya Elfadel Kheirbek; 12/15/25 Bullets tore through Michael Thompson’s car at a stop sign, ending the life of a 35-year-old father in an instant. Just minutes earlier, he had dropped his 8-year-old daughter, Emma, at dance class, her pink tutu bouncing as she waved goodbye. Now, in the ICU, his young body lay tethered to machines — ... a ventilator’s hiss forcing his chest to rise. ... His family’s grief filled the room, raw and heavy, as I prepared to document our meeting. On the screen, a pop-up appeared: “Patient is deceased; do you want to continue?” Its cold bluntness paled against their pain. Michael looked alive. His chest rose and fell with the ventilator. ... Medicine isn’t just tests or machines. It is presence — sitting with families in their grief, faith, and love. Our tools should support that presence, not interrupt it with cold prompts. ... Most U.S. hospitals lack clear guidelines for these situations, leaving families and clinicians alike in limbo. They also worried about organ donation — a decision fewer than 1% of families consent to after brain death, often because the body still looks alive.Editor's Note: We thank the palliative care physicians, nurses, social workers, and chaplains who provide sensitive presence with families in the unbearable spaces between hope and loss, especially when life support decisions arise. In this season, may we pause to honor those who carry this sacred work—and remember the families who have had to accept harsh truths while machines still “breathe.”

The ethical challenge of negative compassion: How excessive empathy in end-of-life care affects decision-making and patient autonomy Journal of Hospice and Palliative Nursing; by Victoria Pérez-Rugosa, Gina Lladó-Jordan, Pablo de Lorena-Quintal, Esther Domínguez-Valdés, Antonia Rodríguez-Rodríguez, Carmen Sarabia-Cobo; 12/11/25 Online ahead of print ... 3 key themes emerged: decision paralysis and emotional overload, conflicts between personal beliefs and professional responsibilities, and institutional barriers to ethical practice. Findings reveal that excessive emotional involvement can hinder the implementation of patients' documented wishes, potentially compromising patient autonomy and increasing caregiver distress. The study highlights the need for institutional policies that support emotional resilience, structured debriefing, and ethics training. ... These insights are highly relevant for palliative nursing practice, offering guidance for supporting staff and upholding patient-centered care in end-of-life settings.

Ask Sheri: Overcoming fear and expressing thanks Lovin' Life; by Sheri Simpson; 12/7/25Dear Sheri, When my mother’s health began to decline, our family found ourselves standing at the edge of something we couldn’t quite prepare for. ... From the very first visit, the hospice team wrapped my mother — and our entire family — in comfort, dignity and compassion. They didn’t just care for her; they cared about her. They learned her favorite songs, listened to her stories, and treated her as the vibrant, funny, loving woman she’d always been. The nurses would hum along when she sang softly, and one even brought her a small, crocheted blanket because she noticed how much mom loved the color lavender. Hospice is not about giving up, it’s about giving more: more peace, more presence, more love. Azorna Hospice helped us see that. ...

Holidays can be celebrated even during illness SNJ Today, Cumberland County, NJ; 11/30/25 The holidays often bring warmth, tradition, and togetherness, but when a loved one is facing a terminal diagnosis, the season can also bring intense emotion, uncertainty, and sadness. The joyful anticipation of the season may now feel solemn and bittersweet. Yet, according to NJ Health Hospice and Palliative Care, observing the holidays, gently and intentionally, can foster comfort, connection, and cherished memories.

Unique ethical dilemmas occur in long-term care settings: Staff need ethics resources  Medical Ethics Advisor; by Stacey Kusterbeck; online ahead of print 12/1/25 issue ... “The position paper was developed in response to concerns from our members about the ethical challenges of the changing environment in long-term services,” says Jason M. Goldman, MD, MACP, president of the American College of Physicians. ... Discharge disposition, communication issues (either among the clinical team or between clinicians and parents), behavior problems, and goals of care were the top ethical issues reported. Lack of caregiver support was another frequent unique ethical concern. Editor's Note: Your hospice is in a unique role to provide ethics trainings for end-of-life care, and thus building trust, clinical best practices, and referrals. The CMS Hospice Conditions of Participation require: Hospices That Provide Hospice Care to Residents of a SNF/NF or ICF/MR (§ 418.112) (f) Standard: Orientation and training of staff. Finally, this rule requires a hospice to assure the orientation of SNF/NF and ICF/MR staff caring for hospice patients. Staff orientation must address the following topics: hospice philosophy; hospice policies regarding patient comfort methods, pain control, and symptom management; principles about death and dying; individual responses to death; patient rights; appropriate forms; and record keeping requirements.

Providing specialised palliative care to families with ethnic minority background: Perspectives, experiences, and approaches Omega (Westport); by Josefine Maria Bruun, Mikkel Rytter, Jahan Shabnam, Morten Sodemann, Mogens Grønvold, Merete Paludan, Mathilde Adsersen, Jesper Grau Eriksen, Mette Asbjoern Neergaard; 11/17/25 online ahead of print ... While some participants employed informal strategies of cross-cultural palliative care, these were rarely grounded in formal training or guidelines. We therefore recommend the integration of ongoing cultural humility training into the education of palliative care professionals to better support equitable and responsive care in diverse clinical settings.

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.

Reducing moral distress through interdisciplinary collaboration: the impact of a weekly palliative care and neonatology conference BMC Palliative Care; by Kirthi Devireddy, Riddhi Shukla, Rachel Boren, James E Slaven, Rebecca A Baker, Jayme D Allen, Karen M Moody; 11/11/25 Conclusion: A neonatal intensive care unit (NICU) and palliative care-weekly-collaborative conference resulted in significantly decreased moral distress among NICU staff. Qualitative data revealed that both prolonging life with life-sustaining medical therapies (LSMTs) and ending it by withdrawing LSMTs in the context of prognostic uncertainty and institutional constraints creates significant moral distress among staff. Palliative care and NICU programs should consider implementing regular interdisciplinary collaborative conferences to address this distress.

The human cost of health care automation MedPageToday's KevinMD.com; by Christie Mulholland; 11/8/25 AI is rolling out in medicine faster than most of us can process. Ambient scribes documenting visits. Clinical decision support algorithms. Automated prior authorizations. The promises are compelling: reduced clerical burden, more face-time with patients, less burnout. I wanted this. As a palliative care doctor and director of physician well-being at my institution, ... [when] AI tools promised relief, I advocated for them. ... 

Living with dementia report emphasizes that even those with advanced disease have stories to share JAMA Medical News; by Rita Rubin, MA; 10/31/25 As the average age of the US population has risen, so has the number of people living with Alzheimer disease and related dementias. And yet, dementia is still a highly stigmatized condition, a new collection of essays published by the Hastings Center for Bioethics points out. Clinicians, caregivers, and loved ones could improve the lives of the more than 7 million people in the US who are living with dementia if they only recognized that such individuals still have their own stories to tell, even when they can’t express themselves the same way they did before their symptoms appeared. 

Love, loss and last wishes fulfilled at Duke HomeCare & Hospice: Staff members regularly make miracles happen Duke Today, Durham, NC; by Working@Duke; 10/29/25 The bell chimed three times at Hock Family Pavilion, and everyone knew what it meant. Duke HomeCare & Hospice nurses and workers stepped into the hallway of Duke’s 12-person inpatient hospice facility, solemnly waiting in silence. Anthony Wilkie, a Duke Clinical Nurse, had been bracing himself for the moment with a mixture of sorrow and humility. When a bell rings three times at Hock Family Pavilion, a patient has just died and a ritual is about to begin. ...