Literature Review

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.

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. ..."

Guest Voice: What ‘It’s a Wonderful Life’ teaches us about living with MS Multiple Sclerosis News Today; by Donald Kushner, MD; 8/15/25 Donald Kushner, MD, is a retired physician, board certified in internal medicine and hospice and palliative care. He has been living with multiple sclerosis (MS) for more than 20 years and draws on his dual perspective as both doctor and patient to explore illness, identity, and adaptation. He’s writing a book about how people with chronic illness and their support systems can better understand — and talk to — each other.

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.

‘You made my life’: VITAS caregiver scores NHL tickets for hospice patient through Wish Maker program McKnights Home Care; by Foster Stubbs; 8/8/25 When hospice nurse Natalie Villabrera-Williams came to visit her client and hockey lover, Alan Reddish, last year she noticed that he was growing a beard that would make Rip Van Winkle blush. When she asked him if he wanted to shave it off, he explained that his beard would remain unkempt as long as his beloved Florida Panthers remained in the 2025 NHL Playoffs. ... After that interaction, Villabrera-Williams, a nurse for VITAS Healthcare in Broward County, FL, saw an opportunity to bring Reddish, of Lauderhill, FL, closer to the action on the ice.  ...

Caring for every breath: Carolina Caring Advanced Lung Care Program launched August 1st Carolina Caring, Newton, NC; Press Release; 8/8/25 A specialized lung care program providing care for complex respiratory conditions will bring needed comfort and support to many individuals. Launched on August 1st, 2025, Carolina Caring’s Advanced Lung Care Program helps patients receive the personalized care they need for their advanced respiratory illness at end of life, while remaining comfortably at home—leading to a reduction of hospitalizations and improved quality of life for patients and their families. 

Sovereign Hospice highlights nutrition's role in hospice home care services News Channel Nebraska (NCN), reprinted from Aubrey, TX; Press Release; 8/8/25 Eating becomes more than a necessity during serious illness—it becomes a part of daily care that supports comfort, strength, and emotional connection. At Sovereign Hospice in Aubrey, Texas, nutrition is integrated into the services hospice offers, especially for patients receiving hospice at home services. The goal is to use food as a gentle tool to improve quality of life. Serious illnesses can change how patients eat. Appetite loss, difficulty swallowing, and taste changes are common, but they can be managed through small adjustments. 

Ethics of overtreatment and undertreatment in older adults with cancerBMC Medical Ethics; by Clark DuMontier, William Dale, Anna C. Revette, Jane Roberts, Ameya Sanyal, Neha Perumal, Eric C. Blackstone, Hajime Uno, Mary I. Whitehead, Lewis Mustian, Tammy T. Hshieh, Jane A. Driver, Gregory A. Abel; 7/25This modified Delphi study convened a panel of experts in biomedical ethics and reached consensus that the principles of beneficence, non-maleficence, and autonomy are related to our previously proposed definitions of over- and undertreatment in older adults with cancer. The panel also reached consensus that, in most cases, it is unethical to make a treatment recommendation without (1) formal assessment of patient frailty (e.g., via a geriatric assessment) and (2) the opportunity for a patient to share their values, goals, and/or preferences. The panel did not reach consensus regarding the relationship between justice and over-/undertreatment; however, the panel concluded that justice applies to undertreatment when an oncologist withholds potentially beneficial cancer treatment in an older patient based on their age alone.

Demystifying dying in end-of-life-care: A phenomenological perspective Death Studies; by Elisabet Sernbo, Magnus Weber, Charlotta Öhrling, Stina Nyblom; 8/26/25 This article focuses on experiences of the process of dying. The empirical material consists of interviews with patients in palliative care and their significant others. The analysis draws attention to the lived experiences of the participants - embedded in time, identities, social relations, and everyday lives - and to how the possibility of sense-making is conditioned by the lifeworld. ... [This] needs to be understood as reorienting work: supporting people when their lines become disrupted or need to be altered. This requires a display of radical empathy ...

Tennessee plans to execute inmate amid concerns his heart implant will shock him repeatedly CNN; by Dakin Andone; 8/4/25 Tennessee plans to execute Byron Black on Tuesday for the 1988 murders of a woman and her two young daughters, despite concerns from his attorneys that a device implanted to restore his heartbeat could repeatedly shock him as he’s put to death. The device – an implantable cardioverter-defibrillator, or ICD – is at the center of a court battle that has been unfolding for several weeks. Black’s attorneys want the device deactivated at or immediately before his lethal injection Tuesday morning. If it isn’t, they say the effects of the lethal injection drugs will cause the ICD to shock Black’s heart, perhaps repeatedly, in an attempt to restore it to a normal rhythm. This will cause Black a prolonged and torturous execution, the attorneys argue, violating Eighth Amendment protections against cruel and unusual punishment.Editor's Note: Though this is not a hospice case, this traumatic scenario for persons with implantable cardioverter-defibrillator being repeatedly shocked--even after death--is crucial for the hospice interdisciplinary to know. Clinical, ethical, and legal issues abound. Click here for Shocked at End-of-Life: An Educational Video for Hospice Workers about Implantable Cardioverter-Defibrillators, research published by the Journal of Pain and Symptom Management, May 2024.

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. A prescribing cascade example cited in the research involves older patients taking calcium channel blockers for blood pressure control, which can cause ankle swelling side effects. Instead of first adjusting the blood pressure drug, some doctors immediately prescribe a diuretic to reduce the swelling — which for some, can create an unnecessary drug pair.

Telemedicine special registrations for controlled substancesJAMA Health Forum; by Jacob T. Kannarkat, John Torous, Joseph T. Kannarkat; 7/25Since the COVID-19 pandemic, the requirement for in-person evaluation of patients prior to the prescribing of controlled substances via telehealth, as established by the Ryan Haight Online Pharmacy Consumer Protection Act (Ryan Haight Act), has remained provisionally held. The Drug Enforcement Agency (DEA) previously proposed rulemaking to reintroduce the in-person patient evaluation requirement, as some unscrupulous clinicians and companies took advantage of this deregulated environment to overprescribe controlled substances. However, these flexibilities were extended through December 31, 2025, after the public voiced concerns over possible care disruptions in a landscape increasingly dependent on telehealth. Now, the DEA aims to compromise on prescribing flexibility with more practical enforcement measures.