Literature Review

Bridging the gap: A scoping review of clinical decision support systems in end-of-life care for older adults Journal of Palliative Medicine; by Susanny J Beltran, Lainey Dorris, Marie Hamel, Shanelle Harvey, Mustafa Ozkaynak, Kenan Sualp; 11/17/25 online ahead of print Background: ...  This scoping review maps the current landscape of clinical decision support (CDS) systems in EOL care, identifies key system types, and examines their effectiveness in guiding clinical decisions. ... Results: A total of 31 studies were included, categorizing CDS systems into prognostic tools, referral tools, and care informing tools. ...

Ethics: Electronic Health Record (EHR) evolution AMA Journal of Ethics; Nov 2025 issue ... This theme issue investigates which kinds of work EHRs should do—and for whom—and whose interests EHRs should serve when information is entered, organized, reviewed, responded to, extracted, or amended. This issue also investigates which values should inform EHR stewardship and innovation decisions and from whose perspectives the stakes of those decisions should be framed. [Articles include:

In-flight emergencies: Practical medicine and ethical considerations Medscape; by Stephen Powell, MD, Bret A. Nicks, MD, MHA, Michael W. Supples, MD, MPH; 11/3/25As a medical professional, are you prepared to respond to an in-flight medical emergency as a passenger on a commercial aircraft? Key questions are addressed about the scope of care, available equipment, decision-making regarding diversions, and liability concerns. Editor's Note: The Federal Aviation Administration (FAA) "expects the 2025 Thanksgiving travel period to be the busiest in 15 years." Please read and share.

Coordinating at-home care, enhancing quality of life as a hospice nurse case manager Grand Haven Tribune; by Emmanuel Hospice; 11/19/25 Throughout her career, Brittany Rickert has explored nursing jobs in various settings but keeps getting drawn back to hospice. For her, there's little out there that offers such a unique and rewarding experience. "There are landmarks throughout our lives and death is one of them," says Rickert, a nurse of 15 years. "It is very special to be allowed into that sacred space with patients and their loved ones, to support them through such a pivotal portion of their life." ... She defines her position as the "coordinator of the patient experience altogether," working alongside an interdisciplinary team to bring supportive services directly to patients, wherever they call home.

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.

“I was horrified”: 34 surgeons and doctors recall their worst mistakes BoredPanda; by Justin Sandberg; 11/19/25 Someone asked “Medical professionals, what mistake have you made in your medical career that, because of the outcome, you've never forgotten?” and people shared their stories from fortunately comical to downright grim. ...#4.  I work in palliative care, ... I knew he wanted to be a DNR (do not resuscitate). I wrote it on my note. But I didn't re-fill out the hospital paperwork. The next day, I got to work to discover he'd been coded and was on a ventilator in the ICU. Instead of passing peacefully, his wife had to make the decision to turn off life support.  ...Editor's Note: Entry #20 comes from a hospice nurse describing a patient with severe bone pain started on morphine—then an out-of-town daughter arrived, shocked to see “Daddy on morphine.” What unfolded was realistic and tragic. This story highlights two timely essentials:

End-of-life palliative care: Role of the family physician American Family Physician (AFP); by Tamara L. McGregor, MD, MA, Jared Morphew, MD, and Heather Ann Dalton, MD; 11/25 issue To care for patients at the end of life, family physicians should be able to evaluate the causes of symptoms, differentiate between distressing symptoms and common end-of-life changes, and balance treatment effectiveness with potential adverse effects, while ensuring alignment with the patient's values and wishes. Editor's Note: What networking, relationship-building, and education do you nurture with family physicians in your service areas?

Sage advice on aging and dying from a Colorado geriatrician CPR News; by Andrea Dukakis; 11/17/25 Geriatricians – doctors trained to treat older adults – are a scarce commodity across the country and in Colorado. The state has about a million residents aged 65 and older and, according to the most recent data available, only 110 geriatricians. ... Here are five things we learned about aging from Dr. Erika Altneu, a geriatrician in Salida:

When health care teams run short, physician burnout rises American Medical Association (AMA); by Sara Berg, MS; 11/4/25 ... Drawing on data from the AMA Organizational Biopsy®, the study reveals that inadequate team staffing was also linked to physicians’ intentions to cut clinical hours or leave their organizations. The findings underscore how sustained workforce shortages and daily understaffing continue to affect morale and retention in medicine long after the acute phase of the COVID-19 public health emergency. Participants included 970 physicians from 15 organizations.

Achieving goal-concordant care with goals of care consultations in the Emergency Department American Journal of Hospice and Palliative Medicine; by Stacy Nilsen, PhD, RN, Diane Wintz, MD, Kelly Wright, MSN, MBA, RN, Debra Poeltler, PhD, MPH, RN, Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA; 10/24/25 Introduction: Time constraints may be prohibitive to adequate goals of care (GOC) discussions and could delay critical decision making in urgent or emergent situations. ... Method: A retrospective record review was conducted for patients 65 and older at a single community hospital between January and December 2023. Included patients had at least one GOC documented discussion with a nursing team called Advanced Illness Management (AIM) and were admitted or placed in observation. ... 3377 patients met the inclusion criteria. ... Conclusions: There were positive findings in LOS, ICU, and cost with AIM consultation within 24 hours of presenting to the ED, when compared to waiting for a later consultation, supporting consideration of forward-placement of GOC discussion.

31 shocking confessions people made to their doctors and nurses on their deathbed BussFeed; by Hannah Marder; 11/12/25 Being on your deathbed puts everything into perspective, and sometimes, the dying have something big to get off their chests. No one knows this better than those who work with the dying, who bear witness to these disturbing confessions. ...Editor's Note: This BuzzFeed feature compiles unverified, anonymous accounts of “deathbed confessions” shared by clinicians online. While written for popular appeal, it touches a truth familiar to hospice and palliative professionals: dying patients often reveal deeply held truths when facing the end. We share it as a reminder that such moments call for clinical steadiness, ethical awareness, and the presence of board-certified chaplains—those uniquely trained to meet these revelations with compassion and care.

The sliver of light after losing a child: Personal perspective - a child's loss can provide elusive and rare gifts. Psychology Today; by David R Patterson PhD, ABPP; by 11/10/25 I have often said that working with patients who are dying has brought an ironic, but transient, feeling of exhilaration to my life. Most care providers who work in hospice will explain to us that people who are aware of their impending mortality have a sense of being in the present that those of us who are not so close to that inevitability can only admire from a distance. ... I don’t know whether this resonates with other parents that have lost a child, but I can say that a very clear impact of my son’s loss has been to become acutely aware of my own mortality. ... After living with my son’s death for three years, I am only just beginning to grasp the lessons that his death is teaching me.