Literature Review

Improving quality of life and end-of-life care: Standardizing goals of care notes in EHRs EurekAlert! - American Association for the Advancement of Science (AAAS), Indianapolis, IN; Regenstrief  Institute, peer-reviewed publication; 2/19/25 ... A new study by researchers from Regenstrief Institute, the Indiana University School of Medicine and Indiana University Health presents the standardized goals of care note they developed, deployed and evaluated as a quality improvement initiative at IU Health, a large, statewide healthcare system. ... The study authors report:

Addressing overtreatment in end-of-life cancer care Medscape; by David J. Kerr, CBE, MD, DSc; 2/19/25 ... What do we mean by overtreatment? This means that many patients who are approaching the end of life receive treatments, like directed anticancer therapies, that are unlikely to provide clinically meaningful benefits and may do more harm than good. This is an expression that I use often in the clinic when I'm explaining to patients that we have reached the end of the road in active interventions, such as chemotherapeutic drugs, that will do more harm than good. It doesn't stop us from doing our very best to look after patients. We focus on improving the quality of life and maintaining that for as long as we can, while continuing to care and look after the patients. ... Overtreatment may even, one would argue, accelerate death when you consider those 1% or 2% mortality rates that can be associated with some treatments that we offer. ...

New insights into older hearts  The New York Times; by Paula Span; 2/15/25 It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart. Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention. ... [In] recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths. ... That can complicate decision-making for heart patients in their 70s and beyond, however. Certain procedures or regimens may not markedly extend the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and are contending with other illnesses as well. “We don’t need to open an artery just because there’s an artery to be opened,” said Dr. Alexander, referring to inserting a stent. “We need to think of the whole person.” ...

Cancer, aging, and meaning: Navigating psychosocial challenges The ASCO Post (Association for Clinical Oncology); by Ramy Sedhom, MD; 2/18/25 I’ve learned a lot about medicine over the years, but one thing I wasn’t taught was how to guide someone through the existential weight of dying. My education centered on diagnosing, curing, or at least managing disease—not on the delicate art of helping people and their loved ones cope with what cannot be cured. Now, several years into my career as an oncologist, primarily caring for older adults, I recognize that providing cancer care for the whole patient requires deep attention to their psychosocial health needs. ...

Death Matters: The gift of presence: Tips for visiting someone who is dying Squim Gazette, Squim, WA; by Jeanette Stehr-Green, Volunteer Hospice of Clallam County; 2/12/25 We sometimes avoid visiting friends or family members who are terminally ill. We make lots of excuses. We don’t know what to say. We don’t know how to act. We don’t want to be a bother. The hard truth is that dying, the final stage of life, can be a lonely experience without the presence of family and friends. A visit during this time can bring comfort to the dying person and their family. It can also provide an opportunity to share feelings, reminisce, and say goodbye. Visiting a dying person seems difficult because most of us lack experience. It only takes a little courage and a few ideas to create a meaningful moment. ... Editor's note: These excellent guidelines empower hospice patients' families and friends--and protect patients' vulnerable energies and emotions--in multiple settings across the trajectory of dying. How might you adapt these for your own patient/caregiver support and community outreach?

Class action over UHG's alleged AI-driven care denials advances Modern Healthcare; by Lauren Berryman; 2/13/25 A class action regarding UnitedHealthcare’s alleged use of artificial intelligence to deny care for Medicare Advantage members will continue playing out in court, but with fewer claims. In a court filing Thursday, a federal judge said two of seven claims brought against UnitedHealth Group by health plan members and their families — who alleged the company used AI to deny coverage for medically necessary post-acute care — can move forward. UnitedHealth Group has been battling the lawsuit, filed in the U.S. District Court for the District of Minnesota, since November 2023. Plaintiffs have alleged the company's health insurance unit UnitedHealthcare used an AI tool called nH Predict to make coverage decisions, sometimes overriding physician judgment. 

Advanced cardiac care boosts symptom management, quality of life Carolina Caring, Newton, NC; by Cassidy Collins; 2/12/25 For those living with advanced heart disease or heart failure diagnoses, access to the right medical care can greatly improve their quality of life. This Heart Month, Carolina Caring is spotlighting the Advanced Cardiac Care Program, which provides treatment and clinical support to help patients with heart failure manage their symptoms from wherever they call home. It is the first program of its kind in North Carolina and one of the first established in the nation. It also recognized as a Certified Care program in Palliative/Hospice Heart Failure from the American Heart Association (AHA). Since this certification, Carolina Caring saw a drop to zero readmissions for primary congestive heart failure Hospice patients by the end of 2024. The benefits of this comprehensive, home-based cardiac care program are best illustrated through individuals such as Shirley, a hospice patient who began her journey with Carolina Caring last spring.

Impact of inpatient palliative care on end-of-life care among patients with early-onset colorectal cancerJournal of Clinical Oncology; Suriya Baskar, Bohae R Lee, Rajiv Midha, Udhayvir Singh Grewal; 1/25Palliative care has proven benefits in elderly patients with advanced cancer; however, the objective benefits of palliative care in younger patients with cancer remain under-studied. We sought to examine the impact of inpatient palliative care consultation on end-of-life (EOL) care among hospitalized patients with early-onset colorectal cancer (EO-CRC). Inpatient palliative care consultation at EOL among patients with EOCRC was associated with lesser use of aggressive interventions and higher rates of DNR code status. We also noted significantly lower costs of hospitalization among patients receiving inpatient palliative care consultation at EOL. These results underscore the importance of integration of inpatient palliative care consultation among patients with EOCRC at EOL. 

How to live when you know you are dying Equity Atlas; 2/11/25 Living with the knowledge of impending death is an incredibly challenging and emotional experience. Whether facing a terminal illness or a life-threatening situation, the idea of living when you know you are dying can be overwhelming. However, it is possible to find peace, acceptance, and even joy in the midst of such difficult circumstances. In this article, we will explore how to navigate this journey with grace and courage. ... How does one navigate this difficult journey? We turned to professionals in the field for their insights on how to live when you know you are dying.

Bringing children home: Kentucky Children’s Hospital’s approach to pediatric end-of-life care American Hospital Association; 2/8/25 When parents have a child with a serious illness, all they want is for their child to get well. If that no longer becomes a possibility, often all they want is to bring their child home. Most — around 70% — of pediatric deaths related to illness occur in the hospital, but the Kentucky Children’s Health Pediatric Advanced Care Team offers some families the chance to transport their child home using life-sustaining technology. That’s not an easy feat; these patients are medically fragile, and the outcome can be unpredictable. A team made up of hospital administrators, hospice providers, coroner and the transportation team comes up with a plan. The child’s parents complete an informed consent procedure, recognizing that their child may not survive the journey home. The transportation team tries to ensure that the journey is as comfortable as possible, as well as planning what to do if the child’s condition deteriorates on the journey. If that happens, he or she will be supported as they pass without resuscitation efforts.

What we talk about, or not, when talking about death Enumclaw Courier-Herald; by Wire Service; 2/9/25 Death is a guarantee for everyone, so why do people shy away from talking about it and using words like death and dying? ... As a death doula and grief coach, Kathleen Putnam hopes that providing care to those who are grieving can help change the language surrounding death. ... Putnam explains that in present society, people want to avoid grief and pain. With medical advancements and industries and marketing systems focusing on keeping people alive, the rhetoric surrounding dying has become negative. Putnam also pointed out that instead of using phrases like “they died” or “they’re dying,” other phrases like “pass away” and “they went to sleep” have become popular when talking about a loss.

A broader end-of-life-view: The need for hospice and palliative care extends beyond the elderly, as the patient population at Transitions LifeCare suggestsTriangle Business Journal, Raleigh, NC; by Connie Gentry; 2/7/25 Although the likelihood of developing cancer is highest for anyone over age 65, the American Cancer Society’s annual report on cancer statistics, released last month, noted increasing incidents of many cancer types among younger adults and women. ... But positive outcomes were also reported: The cancer mortality rate in the U.S. declined by 34 percent from 1991 to 2022 and, since 1970, cancer mortality in children 14 years and younger has declined by 70 percent and among adolescents ages 15 to 19 years it has dropped by 63 percent. ... Although the majority of their hospice patients are over the age of 75, Transitions LifeCare is seeing an increase in younger patients. Last year, roughly 9 percent of their hospice patients were under age 65, almost evenly divided between women and men.