Literature Review

“It’s an homage”: Noah Wyle quietly sneaked in a tribute in one of the best episodes of ‘The Pitt’ FandomWire; by Arian Cruz; 4/18/25 In the fourth episode of The Pitt titled 10:00 A.M., Noah Wyle’s Dr. Michael ‘Robby’ Robinavitch monitored Mr. Spencer during his final hours while dealing with his own thoughts about the death of his beloved mentor, Dr. Adamson. He remembers the advice he received from him and shared it with the children of the dying patient as they waited for their father to pass. The phrases ‘I love you,’ ‘Thank you,’ ‘I forgive you,’ and ‘Please forgive me’ are words that need to be heard when someone is at the end of their life. Wyle revealed that he took these lessons from palliative care physician and author Ira Byock when he was writing the screenplay. Wyle said these short phrases are profound and hold deep meanings beyond their simplicity. He made sure to weave them in on the show while taking inspiration from his own mother for the emotional scenes. He shared via USA Today: "A very similar event had played out with my mother and her brother when saying goodbye to my grandfather. After she shared this with me, I just said ‘Thank you,’ went right back to my typewriter and wrote the scene. It’s an homage to my mother, my uncle and my grandfather.Editor's and Publisher's note: And we thank you, Dr. Ira Byock, for your profound, immeasurable influence for so many of us--professionally with those we serve, and personally with our own families and friends.

TIEC, trauma capacity, and the moral priority of surrogate decision makers in futility disputesThe Journal of Clinical Ethics; Autumn Fiester; Spring 2025In the past 15 years, trauma-informed care (TIC) has evolved as a new paradigm in healthcare that recognizes the impact of past traumas on patients' and families' healthcare experience while seeking to avoid inducing new trauma during clinical care. A recent paper by Lanphier and Anani extends TIC principles to healthcare ethics consultation (HEC) in what they label "trauma-informed ethics consultation" (TIEC), which calls for the "addition of trauma informed awareness, training, and skill in clinical ethics consultation." While Lanphier and Anani claim that TIEC is "novel, but not radical" because it builds on the approach to HEC endorsed by the American Society for Bioethics and Humanities, I believe that TIEC has radical implications, particularly regarding ethical obligations to surrogate decision makers (SDMs). Given what I call the SDM's "trauma capacity," I argue that TIEC accords moral priority to SDMs over patients in certain types of end-of-life cases, particularly futility disputes, which is a radical departure from the conventional HEC approach to SDMs.

Palliative care and advanced cardiovascular disease in adults: Not just end-of-life care: A scientific statement from the American Heart Association AHAIASA Journals - American Heart Association; by Lucinda J. Graven, PhD, APRN, FAHA, Lisa Kitko, PhD, RN, FAHA, Martha Abshire Saylor, PhD, MSN, BA, RN, Larry Allen, MD, MHS, FAHA, Angela Durante, PhD, RN, Lorraine S. Evangelista, PhD, RN, CNS, WAN, FAHA, Amy Fiedler, MD, James Kirkpatrick, MD, Lakeisha Mixon, MSW, and Rachel Wells, PhD, MSN, BA on behalf of the American Heart Association Complex Cardiovascular Nursing Care Science Committee of the Council on Cardiovascular and Stroke Nursing; and Council on Cardiovascular Surgery and Anesthesia; 4/17/25  ... This scientific statement (1) discusses the application of effective communication, shared decision-making, age-friendly care, and advance care planning in advanced cardiovascular disease palliative care; (2) provides a summary of recent evidence related to palliative care and symptom management, quality of life, spiritual and psychological support, and bereavement support in individuals with advanced cardiovascular disease and their care partners; (3) discusses issues involving diversity, equity, and inclusion in cardiovascular disease palliative care; (4) highlights the ethical and legal concerns surrounding palliative care and implanted cardiac devices; and (5) provides strategies for palliative care engagement in adults with advanced cardiovascular disease for the care team.

Why good palliative care clinicians get fired JAMA Network - Viewpoint; by Abby R. Rosenberg, MD, MS, MA; Elliot Rabinowitz, MD; and Robert M. Arnold; 4/14/25 Even the most seasoned palliative care clinician gets fired. In the past year, one of us was fired after asking whether a patient endorsing suicidal ideation had access to a gun; the patient requested not to see the palliative care team because we asked intrusive questions and documented the encounter. One of us was fired after supporting a family’s decision to discontinue life-sustaining therapies for their loved one with multisystem organ failure; the primary intensivist suggested palliative care overstepped in discussing options for which the family (and clinical teams) was not ready. And one of us was fired after sharing the impression that a patient with cancer was dying; the family suggested they preferred the oncologist’s version of a more hopeful future.

I have an advance directive, not because I have a serious illness, but because I have a family. ~ Ira Byock, MD

One of Deserae Turner’s last wishes comes true as family, friends hold small horse show in her honor ABC-4 KTVX, Cache Valley, UT; by Trevor Myers; 4/12/25 For six years, Deserae Turner rode horses and competed in shows alongside her siblings. In 2017, things changed after Deserae was shot in the head and began her journey of recovery. ... Deserae and her family had not been to another horse show since she was shot — that is, until Saturday, April 12. After a recent health complication, Deserae decided to enter hospice care, and one of her last wishes was to ride a horse and see a horse show again.

“I Don’t Know What to Say”-A multimodal educational and environmental intervention to improve bedside nursing communication at end of lifeJournal of Hospice & Palliative Nursing; Wolownik, Gregory DNP, AGPCNP-BC, ACHPN; Wholihan, Dorothy DNP, AGPCNP-BC, ACHPN, FPCN, FAAN; 4/25... research shows inpatient medical-surgical nurses are not adequately trained to deliver end-of-life (EOL) care. This lack of foundational learning leads to gaps when communicating with patients and families and negatively impacts quality of care. A literature review and staff interviews identified barriers to communication, such as lack of formal education and experience; personal, cultural, and emotional challenges; and high workload. A multimodal intervention focusing on improving staff nurse communication skills was designed ...[including] environmental cues, engaging pocket cards, and an education module on communication techniques. Nurses demonstrated increased confidence and competence immediately following the education session, enduring at 4 weeks. Innovative, clinically relevant interventions can positively impact communication skills without requiring increased time commitments or high cost.

Stroke deaths and their racial disparities increased over last 20 years EurekAlert! - American Association for the Advancement of Science (AAAS); by Peer Review Publication; 4/9/25 Over the last two decades, ischemic stroke mortality rates in the U.S. have grown, with almost 3 in 10 deaths occurring at home, and increases particularly among racial minorities and rural residents. These growing disparities were among the findings of a new study publishing April 9, 2025, in the open-access journal PLOS One by Jason Lim of Georgetown University School of Medicine, U.S., and colleagues. ...  The analysis included 237,617 recorded ischemic stroke deaths. The study found that age-adjusted ischemic stroke mortality rates, after years of decline, have increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. Additionally, there has been a noticeable shift in the place of death, with more people dying at home instead of in hospitals or other medical facilities. From 1999 to 2020, the percentage of at-home deaths increased from 8.44% to 29.31%.Editor's note: Pair this research with ongoing shut-downs of rural hospitals, rural emergency room access, and more. This ongoing increase is one of many, ongoing alarms. Ethics. Integrity. Mission. It's past time to improve patient care.

A hospice nurse made a promise—and found homes for 1,300 pets  Miami Herald, Miami, FL; by Jen Reeder; 4/7/25Working as a hospice nurse, Joanne Bonicelli spent years offering comfort to dying people. Then, in 1998, a request from one patient changed her life. A young woman in her 40s had a fluffy white dog named Jasper, who never left her side while she was at Pikes Peak Hospice & Palliative Care in Colorado Springs, Colorado.  One day, the woman called Joanne to her bedside. “I don’t know where Jasper will end up or who will care for him when I am gone…it’s just too painful to bear,” she told Joanne as tears streamed down her face. “I can’t die in peace worrying what will happen to him…can you euthanize him in my arms as I pass?” The heart-wrenching request stunned Joanne. She asked a veterinarian about what they could do, and after meeting Jasper, the vet’s eyes welled with tears at the prospect of putting down a healthy dog. There has to be a better way, they both agreed. [Continue reading ...]

2 nursing staff practices tied to safety risks: Study Becker's Clinical Leadership, Washington, DC; by Mariah Taylor; 4/3/25 Washington, D.C.-based George Washington University and Premier researchers found overreliance on agency nurses and nurse overtime was associated with lower patient safety. The study, published April 2 in JAMA Network Open, analyzed data on quality measures for pressure ulcers and nurse staff overtime and agency use from 70 U.S. hospitals from January 2019 through December 2022. Researchers found that nearly half of the hospitals in the study utilized more nurse overtime and agency hours than was safe. The average hours exceeding safe thresholds for agency staff reached 140% and 63.6% for nurse overtime. Overuse of agency nurses and overtime hours was associated with increased rates of pressure ulcers. [Continue reading ...]

A dying wish: Man with terminal cancer travels to volunteer in all 50 states ABC-7 News, Bay Area, CA; by 4/6/25 When Doug Ruch was told he had just 12 to 18 months to live, he didn't choose to stay home. Instead, he hit the road - on a mission to help as many people as possible while he still can. "I thought to myself, I have two choices. I can sit at home and wait to die, or I can go out and live," he told ABC7 News. [Continue reading ...] Editor's note: For more, visit Doug's website, www.dyingtoserve.com.

‘The most someone wants is to be heard’: Students foster connection, create memoirs for hospice patients The Daily Texan - University of Texas, Austin, TX; 4/3/25 ... Brought to UT in 2023, Last Writers is a service organization where student volunteers interview hospice patients over the course of several months to write a memoir that is then printed and given to the patients and their families. The process is intended to bring comfort to hospice patients and create a physical memento for the families, representing their lives once they pass. ... “It’s not often that you’re a college student and you get to meet someone who is going to pass away in the next few months,” Nguyen said. “To be with them in that very vulnerable point, it gives you a lot of perspectives. A lot of our members come out of it realizing how much they have to live for. … It makes us more grateful in life and puts our mortality into perspective.” [Continue reading ...]

A rapid review of psychedelic-assisted therapy in the context of palliative careJournal of Hospice & Palliative Nursing; Miller, Megan PhD, RN; Meyers, Molly BSN, RN; Martin, Annona MSc; Napolitano, Stephanie MA, LMHC; Dorsen, Caroline PhD, FNP-BC; Penn, Andrew MS, PMHNP; Rosa, William E. PhD, MBE, APRN, FPCN; 4/25Psychedelic-assisted therapy (PAT) involves supported experiences with psychedelic medicines in carefully curated environments. Results support safety and initial efficacy of PAT for psycho-spiritual-existential outcomes among carefully screened and highly homogonous samples of patients with serious illness (predominantly cancer). Additional work is needed to (1) explore PAT's safety and efficacy within more diverse samples and contexts, (2) train palliative care providers on PAT, (3) determine systems of care delivery best suited for translation of PAT into practice, and (4) begin developing policy solutions to support safe and equitable access to PAT. Because many patients lack access to basic psychosocial-spiritual-existential care, careful consideration is needed around integration of PAT. The psychedelic substances which are the topic of this article are not currently FDA approved for use in the United States.