Literature Review

Kirk Greene: Why every family needs an estate planning ‘lifeboat drill’ Noozhawk, Santa Barbara County, CA; by Kirk Greene; 11/21/25 Over many years, my financial services firm conducted “lifeboat drills” with our clients. Some of the drills were focused on trying to help clients understand how much market volatility they could really handle. But we also ran “lifeboat drills” about estate planning. We would typically meet with a married couple and pretend that one of the spouses (often the husband) had just died or become incapacitated. The unfortunate spouse was encouraged to just listen as we worked through what his or her spouse would have to deal with. 

The potential of music as a nonpharmacologic intervention for the ICU—Sound medicineJAMA Internal Medicine; by Farah Acher Kaiksow, Eduard Eric Vasilevskis; 10/25The intensive care unit (ICU) offers lifesaving interventions, but it is also associated with considerable patient pain, anxiety, and high rates of delirium. Delirium in patients in the ICU is a highly prevalent condition associated with increased inpatient mortality and long-term cognitive impairment. Unfortunately, the medications used to treat pain and anxiety in the ICU may simultaneously trigger delirium. This conundrum has motivated researchers to investigate alternative, nonpharmacologic therapies for pain and anxiety that have the potential to be less delirium inducing.Assistant Editor's note: Perhaps this is an area where palliative care practitioners could lend expertise. Maybe a Music Therapist could be involved in designing a "sound medicine" program for ICU patients, as described in the article. And this could be a great research project-evaluating outcomes using music therapy as an intervention for suffering patients in the ICU, or in any setting, for that matter.

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.

Grateful patient finds strength and support through UConn Health’s ALS Program UConn Today; by Jennifer Walker; 11/17/25 ... ALS, also known as Lou Gehrig’s disease, is a progressive neurodegenerative disorder that affects the nerve cells in the brain and spinal cord responsible for muscle movement. ... Originally conceptualized by Dr. Amanda Hernandez, division chief of Neuromuscular Medicine, the UConn Health ALS and MD Program provides a “one-stop shop” for patients with progressive neuromuscular diseases that often require coordination across multiple specialties. ... “Our social worker meets every patient,” said Viguera Altolaguirre. “We address caregiver stress, financial barriers, and emotional coping. Palliative care helps patients navigate difficult decisions about feeding tubes, ventilation, and future planning—always at their own pace and comfort level.” 

AI-assisted decision-making for end-stage organ failure: Opportunities and ethical concerns Artificial Organs; by John W Haller, Olga D Brazhnik, Kathleen N Fenton; 11/17/25 ... This paper discusses current applications of AI in healthcare, emphasizing the complex decision-making necessary for patients with organ failure. It outlines how AI can support risk stratification, patient selection, and outcome prediction, particularly in transplantation practices that increasingly rely on robust data to inform care pathways. ... There is a need for standardized, high-quality data, rigorous validation, and transparent algorithms to mitigate biases that could exacerbate disparities in care. Ethical considerations demand attention to equitable access, patient privacy, and the preservation of the human element in patient-clinician relationships. 

Q&A: Prognostic preferences ‘a swinging pendulum’ for older adults with end-stage kidney disease (ESKD)Healio; by Lucas Laboy and Annie Liu, DO, MPH, MS; 11/17/25 Older adults with end-stage kidney disease and their care partners expressed dynamic prognostic preferences over time, according to study findings published in Clinical Journal of the American Society of Nephrology. Serious conversations with patients with ESKD can be difficult for nephrologists, according to Annie Liu, DO, MPH, MS, associate physician at Mass General Brigham, and colleagues. ... Key themes included:

Navigating choice: Eating, drinking and decision-making at end of life for individuals with cognitive impairmentJournal of Clinical Practice in Speech-Language Pathology; by Laura Chahdaa, Druvni Pererab, Darcy Longc, Laura Knauerb, Sanora Yonand; 10/25Current clinical guidelines offer limited direction for speech-language pathologists (SLPs) supporting eating and drinking decisions in palliative care (PC), particularly for individuals with dysphagia and co-occurring cognitive impairment. This population presents unique clinical, ethical and interpersonal challenges that often fall outside existing frameworks such as ‘Eating and Drinking with Acknowledged Risk’. This scoping review explores the key considerations for SLPs involved in end-of-life decisionmaking in these complex cases. A qualitative scoping review was conducted and analysed thematically [and] ... six overarching themes were identified: person-centred care; emotional and relational dynamics; ethical decision-making complexity; medical risk; barriers to effective clinical practice; and legal considerations. Findings reveal inconsistencies in practice and limited guidance for SLPs navigating care for individuals with cognitive impairment at the end of life.

Understanding challenges and barriers to quality end-of-life care for patients with hematologic malignancies: A GIMEMA surveyAnnals of Hematology; by Leonardo Potenza, Fabio Efficace, Eleonora Borelli, Paola Fazi, Thomas Baldi, Francesca Tartaglia, Francesco Sparano, Claudio Cartoni, Pasquale Niscola, Claudia Mucciarini, Oreofe Odejide, Eduardo Bruera, Camilla Zimmermann, Marco Vignetti, Mario Luppi, Elena Bandieri; 10/25Patients with hematologic malignancies often receive aggressive end-of-life (EOL) care, which may be partly related to hematologists' discomfort with discontinuing aggressive treatments at EOL. We assessed a cohort of Italian hematological oncologists through a GIMEMA online survey to explore their attitudes toward standard measures of quality EOL care, their opinions on barriers to providing this care, and potential interventions. In conclusion, Italian hematologists find most standard EOL quality measures acceptable, they identify barriers to quality care, and are open to interventions, including early integration of palliative care, to improve patients' EOL care. However, they lack familiarity with GOC [goals of care] and ACP [advance care planning] discussions, highlighting the need for communication skills training.

[Australia] Defining the symptoms of personality and behaviour changes in brain tumour patients and their impact on caregiversSupportive Care in Cancer; by Emma McDougall, Haryana M Dhillon, Karin Piil, Lauren J Breen, Anna K Nowak, Sara Nordentoft, Sine Kjærgaard, Georgia K B Halkett; 10/25This study highlights the nuances and complexity in conceptualising personality changes in patients with a brain tumour and the grief, isolation, and safety concerns experienced by carers. Brain tumour-related aggression was identified as a significant concern by both healthcare professionals and carers, lacking clinical guidelines internationally for managing violence and aggression in this population. Future research is required to test interventions and support for safeguarding and risk management for patients and their family members.

[France] End-of-life sedation and spousal grief: Exploring bereavement narratives with and without continuous deep sedationPalliative Care & Social Practice; by Livia Sani, Yasmine Chemrouk, Marthe Ducos, Pascal Gauthier, Marie-Frédérique Bacqué; 10/25This study explored how bereavement experiences differ based on the use of CDSUD [Continuous Deep Sedation Until Death]. Spouses whose partners received CDSUD often reported emotional disruption and unresolved grief, while those without CDSUD described greater relational continuity and a more gradual farewell. Across both groups, the quality of communication, emotional preparedness, and involvement in end-of-life decisions shaped the grieving process. These findings emphasize the emotional complexity of CDSUD, particularly when implemented suddenly or without sufficient explanation. Palliative care teams should prioritize transparent, timely discussions about sedation options and provide tailored emotional support throughout the dying process.

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.

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.

ID# 1904730 Peripheral nerve stimulation, a minimally invasive option for end of life pain managementNeuromodulation: Technology at the Neural Interface; by Jeffrey Cao; 10/25Peripheral nerve stimulation (PNS) works by delivering targeted electrical pulses to peripheral nerves, which transmit sensory and motor signals between the central nervous system and the body. Integrating peripheral nerve stimulation (PNS) into hospice care for cancer patients marks a significant advancement in pain management, focusing on personalized and comprehensive approaches to enhance the quality of life. The reported cases highlight the effectiveness of PNS in targeting specific nerves for pain relief, complementing pharmacological therapies and improving overall patient outcomes. As research continues, PNS holds promise as a key intervention in palliative care ...