Literature Review

Who should palliative care see? Diane Meier, Bob Arnold, and Justin Sanders GeriPal; by Alex Smith; 8/13/26 As Diane Meier remarks to start today’s podcast, palliative care has come a long way from the days when we were the “brink of death” consult. We’re seeing patients earlier and earlier in the course of illness.  In fact, the evidence base for specialist palliative care is arguably stronger in the outpatient setting than the inpatient setting.  In some ways, as Eric remarked, we are a victim of our own success. We’ve pushed on the boundaries of seeing patients earlier in the course of illness, we’ve demonstrated remarkable value to our colleagues and health systems: now they want us to see more and more patients, with conditions we would not have previously considered core to palliative care practice. Our guests modeled respectful disagreement, and we were somewhat surprised that there was more agreement than we expected.  

Medical aid in dying: Bridging ethical guidance and bedside communication in nursing practiceJournal of Hospice & Palliative Nursing; by Jeanna Ford, Phyllis Whitehead; 7/26As MAiD [Medical aid in dying] becomes more integrated into serious illness care, nurses, particularly those in hospice and palliative care, are increasingly the first clinicians to receive patient questions about this option. These inquiries are often embedded in broader concerns related to suffering, loss of autonomy, fear of prolonged dying, and desire for control rather than solely requests for hastened death. The Hospice and Palliative Nurses Association’s recent position statement on medical aid in dying emphasizes compassionate, nonjudgmental care, respect for autonomy, professional integrity, and the ethical obligation of nonabandonment while recognizing the complexities of conscientious objection. This manuscript examines the evolving legal and ethical landscape of MAiD, explores the professional implications for nursing practice, and introduces the EXPLORE (Elicit, Explore, Probe Suffering, Learn Values, Observe Pressures, Review Support, Evaluate Next Steps) communication framework, a practice-based model developed to provide nurses with a structured, evidence-informed approach for responding to patient-initiated MAiD discussions. 

[Portugal] Ketamine for cancer-related pain in palliative care: A systematic review of clinical use and safetyJournal of Pain & Palliative Care Pharmacotherapy; by Catarina Vitorino-Afonso, Paulo Reis-Pina; 7/26Ketamine has emerged as an adjuvant for opioid-refractory cancer-related pain in palliative care, but evidence remains limited. [This study found that] ketamine was used mainly as an adjuvant. Many reports described reduced pain and/or lower opioid use, although certainty was very low and attribution was limited by polypharmacy and regimen changes. Intravenous infusions were most common, but subcutaneous, oral, and intranasal routes were also used. Intranasal ketamine showed pragmatic utility for breakthrough pain, while oral ketamine was described in ambulatory palliative care settings.

Palliative care consults for the oldest-old: A retrospective study of referral patterns, patient characteristics, and clinical outcomes Geriatric Nursing; by John Cameron, Kalli Stilos, Anita Chakraborty; 8/11/26Objective: This study describes the characteristics and outcomes of patients aged 90 and older (the oldest-old) receiving inpatient palliative care consultation at a tertiary care hospital, to identify gaps and opportunities to improve care. ... Conclusion: Referrals for specialist palliative care in the oldest-old occur late in hospitalization, predominantly among those with non-cancer illnesses and poor functional status. Systemic changes, including the use of prognostication tools and enhanced collaboration between geriatric and palliative care services, are needed. Nurses are pivotal in advocating for earlier advance care planning (ACP) and identifying patients who would benefit from timely palliative integration to ensure goal-concordant care.

Moral distress is the wound behind bedside careKevinMD.com; by Amanda Dean, RN; 8/9/2026A physician I follow on social media is an incredibly talented artist. He turns medical scenarios into cartoon sketches, as if they belong in a Sunday newspaper instead of on a telephone screen. One of his recent renderings depicted the typical ICU patient: intubated, sedated, and surrounded by machines. Standing beside the hospital bed were two individuals with captions over their heads saying, “Look at all of this! This is torture! He is suffering!” An identical image was placed by its side, the only difference being the captions overhead. This time they read, “Look at all of this! What amazing care! He’s getting everything!” The images invited almost 200 comments, ranging far and wide along the opinionated spectrum. ...

Mandatory mortality surprise question screening in the ED: Identification and associations with end-of-life care outcomesJournal of Palliative Medicine; by Nancy Kim, Karen Jubanyik, Peiyuan Liu, Giselle O'Connor, Ling Han, Rohit B Sangal, R Lynn Fiellin, Jennifer Kapo, Elizabeth Prsic, Shelli Feder; 7/26Early identification of patients with serious illness remains challenging in the emergency department (ED), where clinical decisions are made under time constraints. The mortality surprise question (MSQ) is a brief prognostic screen that may help identify patients needing end-of-life services. Results: Among 113,397 admissions (74,816 patients), MSQ completion was 100%; 7.8% received a "No" response. A "No" response was strongly associated with increased palliative care consultation ... , ACP documentation ... , hospice referral ... , comfort-measures-only orders ... , hospice disposition ... , higher inpatient mortality ... , and increased 30-day readmission ... Palliative care consultation occurred earlier among MSQ "No" than MSQ "Yes" encounters.

LATE vs Alzheimer’s: Biomarkers, Mixed Dementia, and Clinical Realities with Nate Chin and Sterling Johnson GeriPal; podcast by GeriPal with Sterling Johnson and Nate Chin; 8/6/26 Up until just a couple years ago, an 85-year-old patient presenting with gradual, amnestic memory loss was almost automatically presumed to have Alzheimer’s disease. However, new biomarkers and the recognition of conditions like Limbic-predominant age-related TDP-43 encephalopathy (LATE) are reshaping our understanding of cognitive decline in older adults. It’s looking more clear that pure Alzheimer's dementia is rare in older adults, and co-occurring pathologies that may include Alzheimer’s, LATE, Lewy Body, and vascular neuropatholigies, are the rule rather than the exception. ... Sterling Johnson is a clinical neuropsychologist and researcher who leads the CLARiTI study, which is attempting to uncover the intersecting causes of dementia.  Nate Chin is the medical director and Clinical Core Co-Leader for the Wisconsin Alzheimer’s Disease Research Center (ADRC), the host of the Dementia Matters podcast, and author of a new book When Memory Fades.  

Hospice care in the era of AI: hospices' views on data-driven tools to support live discharge decisionsJournal of the American Geriatrics Society; by Elizabeth A. Luth, Caitlin Brennan, Susan Hurley, Kira G. Sheldon, Yongkang Zhang; 8/3/26 Live discharge occurs for 20% of hospice enrollees, resulting in loss of support and disruptive care transitions, with higher risk for patients with Alzheimer's disease and related dementias (ADRD). Little is understood about how data-driven clinical decision support tools (e.g., predictive algorithms) might support decision making regarding live discharge. ... This paper advances our understanding of multilevel factors hospices face in supporting patients discharged alive. It establishes hospices' interest in adopting data-driven tools to support live discharge and outlines criteria for successful development and implementation of these tools.

MUSC College of Nursing expands global role in palliative care education through ELNEC partnership Medical University of South Carolina, Charleston, SC; Press Release; 7/30/26 The Medical University of South Carolina (MUSC) College of Nursing (CON) has joined the End-of-Life Nursing Education Consortium (ELNEC) as an official partner. This partnership strengthens national and global efforts to prepare the healthcare workforce for the growing demand for palliative care. Alongside City of Hope and the American Association of Colleges of Nursing, the MUSC College of Nursing reinforces a shared commitment to improving the quality of palliative care in the United States and around the world. “We are proud to join ELNEC in advancing palliative care education at a time when the need has never been greater. ...” said Catherine Durham, DNP, APRN, dean of the College of Nursing. 

Scans tell us about the cancer. Functional status tells us about the patient. South Florida Hospital News and Healthcare Report; by Dr. Ileana Leyva; 8/1/26 In an era of precision oncology, we closely track biomarkers, imaging findings and treatment response. Yet one of the strongest predictors of how a patient is truly doing often receives less attention: functional status. When patients experience progressive fatigue, need more assistance with daily activities or spend more time in bed, clinicians and families may normalize these changes as expected consequences of cancer or treatment. Yet progressive functional decline is frequently the clearest indication that an illness trajectory is changing. It is often a signal that warrants a broader conversation about prognosis, goals of care and whether the current treatment plan still aligns with what matters most to the patient. As physicians, we routinely rely on objective measures to assess disease progression. While scans tell us how a tumor is behaving, functional status tells us how the patient is living. Both are essential to understanding prognosis and making care decisions that align with patient goals.Editor's Note: Read this phrase again, "While scans tell us how a tumor is behaving, functional status tells us how the patient is living." Whule this article is for oncologist, your hospice interdisciplinary teams' interactions with patients and caregivers provide rich, relevant, time-sensitive conversations, observations, and supportive interventions. What kinds of team coordination exist between your physicians and team members who visit regularly in the patient's home setting (aka, home/ALF/LTC)?

Why traditional primary care fails frail elders and the future need for specialized models | part one Teleios Collaborative Network (TCN); podcast hosted by Chris Comeaux with Dr. Bethany Snider; 7/29/26 Traditional primary care wasn't designed for today's frail elders—and that gap may be one of healthcare's greatest challenges. As America's population ages, healthcare leaders face an urgent question: Is the traditional primary care model enough to care for frail older adults with complex medical, functional, and social needs?  In Part One of this thought-provoking conversation, Chris Comeaux welcomes Dr. Bethany Snider, Chief Medical Officer of Everent Health, to explore why the future of serious illness care requires a fundamentally different approach. Together, they unpack the emerging concept of the frail elder practice—a longitudinal, interdisciplinary model that extends beyond office visits to meet patients where they are, both physically and emotionally.

One clinician, every conversation: Palliative care delivery by solo APRN hospitalists in Critical Access HospitalsJournal of Hospice & Palliative Nursing; by Melissa Skoff; 7/26Advanced practice registered nurses (APRN) who practice as solo hospitalists in critical access hospitals are often underrecognized in their role in providing palliative and end-of-life care. This article describes the full scope of the solo APRN hospitalist in a critical access hospital setting with close attention to how complex patient demands contribute to the challenges in providing high-quality end-of-life communications. This article examines clinical, educational, and ethical dimensions of this work, and presents a case example that illustrates how these pressures present during a shift. Strategies to strengthen rural palliative care capacity are discussed, including tele-palliative care, remote ethics support, and APRN-centered education. As rural workforce shortages persist and continue to rise, alongside rising patient acuity, naming and addressing these structural gaps is essential in improving quality of care and protecting the well-being of a solo APRN hospitalist.

Adopting the fourth pillar of acute care surgery: the current state of palliative medicine in trauma care Current Trauma Reports; by Alison Haruta and Kathleen O'Connell; 7/30/26Although most older trauma patients survive hospitalization, many deaths occur within six months after discharge, making early goals-of-care (GOC) discussions essential. However, palliative care consultation remains significantly underused, occurring in only 2–4% of severely injured trauma cases. ... Primary palliative care skills are essential for trauma surgeons, though effective integration into the trauma system has been variable. As the need grows, the specialty palliative care work force cannot keep up with demand, highlighting the need for surgeons to learn and perfect their primary palliative care skills, including communication skills and holistic symptom management. Palliative care should function as a core pillar of trauma care, ensuring dignity, reducing non-beneficial treatments, and improving end-of-life experiences for patients and families.