Literature Review

Improving timeliness of palliative care referrals within the ICU: A quality improvement project Dimensions of Critical Care Nursing (DCCN); by Stephanie Fiore, Simone O'Donovan, Kerry A Milner; 1/23/26 ... Using the Model for Improvement, this quality improvement project was conducted over 7 months, including a 4-month baseline phase and a 3-month implementation phase. ICU nurses used a PC screening tool to evaluate patients within 48 hours of admission. The project aimed to increase PC screenings to 75% and ensure PC referrals within 48 hours. ...  The implementation phase saw a significant increase in PC screenings, with compliance reaching 90.9% after process adjustments. 

Husband with Parkinson's was admitted into at-home hospice program and has dramatically improved. Have others experienced this? Aging Care; by Klwolf; 1/21/26 My DH has Parkinson’s that has been getting progressively worse for months. In early December we had him assessed for hospice and he was admitted. Since then, he’s improved dramatically. Has anyone else experienced dramatic improvement AFTER hospice enrollment? The hospice staff simply shrugs and says this sometimes happens and that we need to be prepared for him to revert back to his previous state. Editor's Note: Many clinicians have seen individuals improve after hospice enrollment, often due to better symptom control, reduced stress, or consistent interdisciplinary care. The concern here is not the improvement itself, but the hospice team’s reported response. A shrug can feel dismissive to families already living with uncertainty. How do we teach teams to communicate about improvement—honoring hope while preparing families with clarity, compassion, and trust?

Palliative care staff attitudes toward music therapy for hospitalized adult patientsAmerican Journal of Hospice & Palliative Medicine; by Katherine A. Carney, Rachel M. Wiste, Susanne M. Cutshall, Christina Wood, Rachel C. Gentes, Brianna E. Larsen, Nana A. Tiwaa, Amelia E. Tetlie, Regina M. Mackey; 12/25There is emerging evidence that music therapy (MT) is an effective tool within palliative care to manage patients’ complex needs. This performance improvement project aimed to assess palliative care staff members’ attitudes toward the current utilization of MT within the institution’s hospital-based interdisciplinary practices. Top reasons for MT referral were psychosocial support, pain and symptom management, and coping. The most common symptom-focused indications were anxiety, mood, and existential distress. In this single-institution performance improvement project, staff attitudes were highly favorable toward MT for palliative care patients. MT is utilized for a variety of reasons, can be highly effective for improving patients’ quality of life, and may also be of direct benefit to staff.

Why asking about “critical abilities” is misguided: Lessons learned from the updated Serious Illness Conversation Guide Journal of General Internal Medicine; by Joel Michael Reynolds, PhD and Michael Pottash, MD, MPH; 1/20/26 The Ariadne Labs’ Serious Illness Care Program is a care delivery model that aims to improve conversations between patients and their clinicians about serious illness. This is accomplished through its foundational tool: the serious illness conversation guide. ... As of 2022, the Serious Illness Care Program has a footprint in over 44 countries and in all 50 states. The conversation guide had been translated into over 13 languages and nearly 18,000 clinicians had been trained on its use. In 2023, the Serious Illness Care Program released an updated conversation guide. ... Gone was the future-oriented question about critical abilities: “What abilities are so critical to your life that you can’t imagine living without them?” A more present-focused question about activities replaced it: “What activities bring joy and meaning to your life?” ... The revision of the Serious Illness Conversation Guide signals more than a semantic change. Its revision of the critical abilities question instead reflects a deeper reckoning with the ethical limitations of traditional advance care planning and with the import of disability bioethics. 

Patients' perceptions of autonomy in palliative care: Two patient interview exemplars Palliative Care and Social Practice; by Kristen Tulloch, Julia Acordi Steffen, John P Rosenberg; 1/19/26 Results: Four themes were identified: (a) my involvement in healthcare decisions, (b) change to my autonomy during illness progression, (c) self-assessing my abilities to exercise autonomy and (d) my coping mechanisms for loss of autonomy. Palliative care patients perceived and managed their autonomy amidst their illnesses, revealing a sense of loss of autonomy extending beyond healthcare into many daily activities. Participants wished to exercise autonomy in nuanced ways, varying in intensity across many aspects of their lives, underscoring the importance of recognising and respecting individuals' wishes for autonomy.Editor's Note: The authors’ focus on coping with loss of autonomy is essential. As illness progresses, autonomy can erode not only in medical decisions but across daily life, identity, and meaning—losses that are too often overlooked in clinical care. The frequently misapplied “Five Stages of Grief” can further blur this reality, reducing complex, personal experiences to linear expectations not supported by contemporary grief research. Understanding how patients adapt to loss of autonomy is foundational to truly person-centered palliative care.

Advance care planning in patients nearing the end of life: A pre-intervention study of racial disparities and provider factors Journal of General Internal Medicine | Springer; by Vedha Penmetcha BA, Mia Marcotte BA, Yashaswani Chauhan MD, Malathi Srinivasan MD, Adrian M. Bacong PhD, Amelia Sattler MD; 1/19/26 The pre-intervention study of Advance Care Planning (ACP) in patients nearing the end of life highlighted significant racial disparities and the impact of provider factors on ACP documentation. The study found that Asian patients were least likely to have ACP documentation in their charts, and minorities who had ACP conversations were less likely to have documentation. This suggests that ACP conversations are often not documented in the electronic health records of these patients, indicating a need for targeted interventions to improve ACP documentation rates. The study also revealed that providers may struggle to identify who and when to engage in ACP conversations, which can be a barrier to effective ACP.

A different kind of care: The compelling case for palliative care in advanced kidney disease docwirenews; by Keightley Amen; 1/20/26 Advanced kidney disease requires some of the most complex care in medicine due to medical management, comorbid conditions, symptom burden, patient and family psychosocial needs, difficult conversations, and advance care planning. Despite the significant coordination needed, care for this patient population is often more fragmented, with less access to supportive services, than for people with other chronic, life-limiting illnesses.

Ethics roundtable: Prescribing controlled substances in a terminally ill patient with suspected substance abuse disorder and opioid agreement violations American Journal of Hospice and Palliative Medicine; by Steven J Baumrucker, MD, FAAFP, FAAHPM, HMDC, Melissa Broome, MSN, APRN, FNP-C, ACHPN, Gregory T Carter, MD, Matt Stolick, Ph.D,  Scott P Boyles, MDiv, Gregg VandeKieft, MD, MA, Andrew Wampler, JD, Lindsay Wilson, DO, FAAFP, Carolyn George, PsyD, Matthew A Murphy, MD, and Saima Rashid, MD; January 2026 This ethics roundtable examines how clinicians should navigate prescribing controlled substances for a terminally ill patient with suspected substance use disorder and opioid agreement violations. Contributors explore the ethical tension between alleviating suffering and minimizing harm, questioning how opioid agreements apply in end-of-life care and emphasizing individualized, compassionate decision-making grounded in dignity, trust, and proportional risk.

Increased criminal and civil enforcement by DOJ for skin substitutes in wound care JD Supra; by Tanisha Palvia, Jenn Sugar, Moore & Van Allen PLLC; 1/15/26 The Department of Justice recently announced, “[i]n the first [criminal] prosecution of its kind,” that husband and wife owners of wound graft companies were sentenced to 14.5 and 15 years imprisonment respectively for causing over $1.2 billion in false claims to be submitted to Medicare Part B and other federal health care programs for medically unnecessary wound grafts. ... The massive scheme had medically untrained sales representatives find elderly Medicare beneficiaries, often in hospice care, with any kind of wound.

What is palliative medicine and why is it so misunderstood? MedPage Today's KevinMD.com; by Patricia M. Fogelman, DNP; 1/16/26 After years of leading palliative medicine departments, as a Fellow of the American Academy of Hospice and Palliative Medicine, I’ve had countless conversations that start the same way. A colleague in the hallway says, “Oh, palliative care—that’s so important. You all are so nice.” Or a hospital administrator tells me, “We wish we could give you more, but resources are tight right now.” Or my personal favorite: “Palliative care is great, but this patient isn’t ready for that yet.” Each time, I smile and nod, but inside I’m thinking: I used to say the same things before I came into palliative medicine, because once upon a time, I also had no idea what we actually do. 

Neuropalliative care in movement disordersContinuum: Lifelong Learning in Neurology; by Benzi M Kluger; 12/25Over the past decade, significant progress has been made to advance palliative care approaches for patients with Parkinson disease and other movement disorders. This population has significant palliative care needs that are poorly met under traditional models of care, including nonmotor symptom management, advance care planning, psychosocial support, spiritual and existential support, care partner support, and timely referrals for specialist and end-of-life palliative care (hospice). Clinical trials demonstrate that specialist palliative care can improve many patient and family outcomes. Neurologists can use the five-pillars framework (nonmotor symptoms, advance care planning, psychosocial and spiritual support, care partner support, and timely involvement of specialist palliative care) to systematically address common sources of suffering that are poorly recognized in traditional models of care. This framework can be integrated into previsit screening forms and note templates to improve the detection of palliative issues.