Literature Review

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.

The dying man who gave me flowers changed how I see care MedPageToday's KevinMD.com; by Augusta Uwah, MD; 9/2/25 Today for the first time, I got flowers from a grateful patient. And I reflect on how rough the week has been, all the things that seemed impossible and insurmountable, and everything that has brought me to this point. The patient is going on hospice, he’s going to die, yet he felt that I made a significant impact that he wanted to show his gratitude. And that almost brought me to tears. ... 

Update on malpractice claimsLinkedIn; by Elizabeth Hogue; 9/3/25New analysis by Claggett, Sykes and Garza Trial Lawyers shows that registered nurses (RNs) and physicians continue to top the list of health professions most likely to be sued for malpractice... While the total number of malpractice suits has decreased by almost 20% in ten years, the severity of claims has risen... Home care nurses, including those providing hospice and palliative care, were the most vulnerable to professional liability claims of all nursing specialties... [The article includes factors that may contribute to increases in claims against home health nurses and strategies that nurses can use to protect themselves from malpractice claims.]

Why palliative care is more than just end-of-life support MedPageToday's KevinMD.com; by Dr. Vishal Parackal; 9/1/25 ... Palliative care as a system requires strong interpersonal and cross-specialty communication for smooth functioning, as patients may require expert opinions from different fields to optimize their treatment plan. Patient education for systemic follow-ups and establishing a baseline of knowledge regarding their diagnosis and potential danger signs helps create a better environment for holistic care. While we focus on the physical aspects of care and diagnosis, we often fail to realize the psychological and mental impact that such conditions can have on the patient and their family. ... The opportunity to make a meaningful difference in patients’ lives by easing their suffering and enhancing their quality of life is profoundly fulfilling. ... Editor's Note: Excellent descriptions of palliative care.

What do physicians want at the end? An international qualitative study on physicians’ personal end-of-life preferences and what influences them Palliative Care and Social Practice; by Sarah Mroz, Frederick Daenen, Sigrid Dierickx, Freddy Mortier, Ludovica De Panfilis, Luca Ghirotto, Toby Campbell, Kenneth Chambaere, and Luc Deliens; 7/4/25 Research Results: ... Most physicians prefer to avoid aggressive and life-prolonging treatment, physical and mental suffering, and being a burden. They prioritize being in a peaceful environment and communication with loved ones. Various factors influence preferences including cultural, social, and religious beliefs, and legislative environment, but most significant are the deaths of loved ones and clinical practice. Death and dying become normalized the more they are reflected upon and discussed, and this process can also provide personal growth which helps physicians provide better care to patients and families.

More time, less paperwork: The quiet revolution in primary careModern Healthcare; by Alex Kacik; 8/26/25Concierge and direct primary care practices are gaining traction among physicians, employers and patients increasingly frustrated with traditional care pathways. The growth of these practices, where patients pay membership fees in exchange for increased access to physicians, is a symptom of Medicare and Medicaid reimbursement that has not kept pace with inflation, advisers, doctors and policy experts said. Growing care backlogs, coding and documentation tasks that take doctors away from patients and seemingly ever-rising health insurance premiums are also contributing, they said. “A year ago, I would’ve told you these care models were a slowly evolving, quiet phenomenon,” said Dr. Zirui Song, an associate professor of healthcare policy at Harvard Medical School and a primary care provider at Massachusetts General Hospital. “It is now evolving quite rapidly — it is not so quiet anymore.”Publisher's note: Is concierge medicine coming to a hospice or palliative care provider near you...?

RN median hourly pay, by stateBecker's Hospital Review; by Kelly Gooch; 8/19/25Median hourly base pay for registered nurses varies across states, with RNs in California earning the most, according to SullivanCotter’s “2025 Health Care Staff Compensation Survey Report.” The survey, released in July, covers nearly 2.5 million healthcare employees across over 2,660 participating organizations, including more than 800,000 individual RNs, licensed practical nurses and nursing managers. Here is the median per-hour base pay for RNs, by state, according to survey data shared with Becker’s [see article for all states]:

Why more doctors can't make ends meetAxios; by Tina Reed; 8/12/25America's doctors are working harder and getting paid less. And that could soon translate into less access for some patients. The big picture: A new report from consultancy Kaufman Hall shows primary care physicians and specialists are delivering more services since the pandemic. But they're not making more money because of stagnant reimbursements from public and private insurers and inflation. The data helps explain why medical practice bankruptcies hit a six-year high last year — and why some providers are shifting to pricey procedures for cash-paying customers to boost their bottom lines.

Flu, COVID-19 vaccination rates falling among health care workers WWLP, Springfield, IL, originally Boston, MA; by Alison Kuznitz; 8/14/25 The rate of Massachusetts health care workers vaccinated against the flu and COVID-19 is declining, despite state officials pushing for the vast majority of providers to get their shots in order to stunt the spread of illnesses. The Department of Public Health’s goal is to achieve an annual flu and COVID immunization rate of 90% or higher among eligible health care personnel at all licensed facilities and emergency medical services. ... During the 2024-25 respiratory virus season, an average of 83.5% of providers in acute care hospitals were vaccinated against the flu, ... That compares to ... 52.3% in nursing homes, 68.7% in rest homes, 52.2% in adult day health programs, 21.2% in EMS and 65.4% in hospice. Editor's Note: Is 65.4% high enough for health care workers who consistently tending many of the most vulnerable persons receiving health care? What are the vaccination rates for your organization? 

Hands Journal of the American Medical Association (JAMA); by R. Jordan Williams, MD, MPH; 8/13/25Lend me your hand Callused or calaminedWrinkled or plump,Nails bittenNails extendedSplintered and pittedNails neatly or never cropped.Lend me your hand Strong or weak Cold or warmingSwollen and swanned; Gnarled in knots ...Editor's Note: Continue reading this powerful poem. Additionally, JAMA published this description of the poem, "Poetry and the Medicine of Touch" by Rafael Campo, MD, MA: "In this deeply felt poem, the hand becomes a potent metaphor for our shared humanity ... Aspiring clinicians are still taught to assess, to palpate, to diagnose through touch. Yet, as “Hands” reminds us, patients’ hands hold far more than clinical signs—they reflect stories, histories, fears, and hopes. ..."

Integrating advance care planning into end-of-life education: Nursing students’ reflections on advance health care directive and Five Wishes assignmentsNursing Reports; by Therese Doan, Sumiyo Brennan; 7/25Advance care planning tools, such as the Advance Health Care Directive (AHCD) and Five Wishes, provide experiential learning opportunities [for prelicensure nursing students] that bridge theoretical knowledge with real-world patient advocacy. In this study, students were asked to complete either the AHCD or Five Wishes document as though planning for their own end-of-life care, encouraging personal reflection and professional insight. Students developed critical insights into their personal values, envisioned themselves in EOL scenarios, and reflected on their responsibility as future nurses. The assignment fostered both professional development and personal growth, making it a meaningful experience within the nursing curriculum. By encouraging students to engage personally with end-of-life decisions, the assignment cultivates empathy, ethical reflection, and a readiness to initiate sensitive conversations.

Implementation of the Pressure Injury Prevention Care Bundle at a home based hospice program: A quality improvement project The Texas Medical Center (TMC) Library Health Sciences Resource Center; by Adaeze U. Amechi-fannin; 8/11/25 Pressure injuries remain a common and serious problem in hospice care, especially among patients who are immobile or confined to bed. Although effective prevention methods are known, inconsistent use of these methods, limited caregiver training, and poor documentation have continued to prevent success in many hospice settings. These wounds cause pain, increase infection risk, and reduce quality of life, making prevention especially important in end-of-life care. ... This project demonstrates that combining structured training, evidence-based care steps, and attention to individual patient needs can successfully reduce pressure injuries in home hospice environments.