Literature Review

[England] Ambulance team uses advanced ultrasound to help frail patients avoid hospital trips Emergency Services Times; by James Devonshire; 10/16/25 The East of England Ambulance Service (EEAST) is using cutting-edge medical technology to help elderly and end-of-life care patients receive treatment in their own homes, reducing the need for hospital admissions. The service’s advanced practice (urgent care) team has introduced point of care ultrasound (POCUS)—a portable diagnostic tool previously reserved for critically ill patients—to assess bladder and urinary conditions safely and effectively in community settings. Using the handheld Butterfly ultrasound device, paramedics can perform scans and interpret results via software on iPads, allowing for faster and more accurate diagnoses.

Where comfort and nutrition meet: A case series of children with severe neurologic impairment receiving home parenteral nutrition at the end of lifeNutrition in Clinical Practice; by Dana Steien, Erin Alexander, Molissa Hager, Andrea Armellino, Megan Thorvilson; 9/25Increasingly, home parenteral nutrition (HPN) ... is used for intractable feeding intolerance (IFI), which can occur near the end of life (EOL) in children with severe neurological impairment (SNI). [Four cases were retrospectively examined and we] found that the pediatric palliative care team (PPCT) was involved in all cases during HPN decision-making and planning. The pediatric nutrition support team (PNST) and PPCT collaborated to provide individualized, goal-directed care. All [patients] were enrolled in hospice while receiving HPN. HPN at EOL requires careful ethical consideration, particularly of autonomy because families often find comfort in providing nutrition.

Palliative care at the cutting edge: Recent updates in surgical palliative careJournal of Pain and Symptom Management; by Antoinette R Esce, T J Douglas, Elizabeth Gorman, Sophia Tam, Christopher D Woodrell, Ana Berlin; 9/25Surgical patients with serious illness often experience unique clinical trajectories, systems of care, and relationships with providers. In order to meet the needs of this patient population and their care teams, hospice and palliative medicine professionals should be familiar with evolving best practices in surgical palliative care. We present the case of a geriatric trauma patient with a new diagnosis of advanced cancer cared for in a surgical intensive care unit. This example highlights important new developments in defining and supporting the geriatric trauma population, improving and expanding surgical palliative care education, and identifying which seriously ill surgical patients benefit most from palliative care interventions.

Impact of the Affordable Care Act on palliative and hospice care utilization among patients with gastrointestinal cancers: An interrupted time series analysisJournal of Palliative Medicine; by Eshetu Worku, Selamawit Woldesenbet, Mujtaba Khalil, Timothy M Pawlik; 9/25The Affordable Care Act (ACA) aimed to expand insurance coverage, improve health outcomes, and reduce costs. We assessed the impact of the ACA on hospice or palliative care utilization among [Medicare] patients with stage IV gastrointestinal (GI) cancer. Patients from minority racial groups ... and those in moderate ... and high ... Social Vulnerability Index (SVI) counties were less likely to use palliative care in both pre- and post-ACA eras. Palliative care use was associated with $2,633 lower total expenditure. Conclusion: ACA implementation did not improve palliative care utilization for racial minorities and high SVI groups.

The pitfalls that derail home health providers’ new palliative care efforts Home Health Care News; by Joyce Famakinwa; 10/14/25 ... Though home health-operated palliative care is a rarity, companies like Visiting Nurse Health System, Contessa Health and Compassus have managed to successfully incorporate these services into their broader care delivery model. When structuring an effective palliative care services program, there are some common pitfalls home health providers should avoid. “One of the biggest ones is positioning palliative care as early hospice,” Nikki Davis, senior vice president of palliative care programs at Contessa, said at Home Health Care News’ FUTURE conference. “And just make sure that there’s also clear eligibility and referral pathways, so that when you’re partnering with your home health and hospice teams, you have those processes in place, so that it’s very clear who’s eligible for palliative care.”

Stiff person syndrome in the hospice patient: A case report and discussion  Journal of Palliative Medicine; by Molly Svendsen, B Parker Layton, Shiri Etzioni, Mark Edwin; 10/13/25 Stiff Person Syndrome (SPS) is a rare, progressive autoimmune neurological disorder characterized by painful spasms, muscle rigidity, and heightened sensitivity to external stimuli. Management often relies on therapies that fall outside standard hospice formularies, creating challenges in end-of-life care for affected individuals. ... This case highlights the need for flexible, patient-centered approaches in hospice care for rare neurological conditions like SPS. Continuation of disease-specific therapies for symptom palliation can be ethically and clinically appropriate when integrated with clear goals of care. 

Palliative care remains underused among young adults with advanced cancer in U.S. American Cancer Society, Chicago, IL; 10/10/25 Although palliative care use has increased over time among young adults with advanced cancers in the United States, new research led by the American Cancer Society (ACS) found that utilization still remains very low. Palliative care focuses on improving the quality of life for individuals with serious or life-limiting illnesses. ... Researchers, led by Kewei (Sylvia) Shi, MPH, at the American Cancer Society, used the National Cancer Database to identify patients aged 18-39 who were newly diagnosed with stage-IV cancers. ... The study included a total of 76,666 patients. The percentage receiving any palliative care increased from 2.0% in 2010 to 4.8% in 2023.

An age-old fear grows more common: 'I'm going to die alone' The Washington Post; by Judith Graham; 10/11/25 As families fracture, people are living long and are more likely to find themselves without close relatives or friends at the end of their lives. [Full access may be limited by a paywall.]

[Italy] The implantable cardioverter-defibrillators at the end of life: A double-edged sword of a life-saving technologyTrends in Cardiovascular Medicine; by Giacomo Mugnai, Davide Genovese, Luca Tomasi, Alessia Gambaro, Flavio Ribichini; 9/25Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.

The expanding role of family medicine in Alzheimer's Disease and other dementias Patient Care; by Grace Halsey; 10/7/25 [From the 2025 Family Medicine Experience conference] Family medicine's unique position in dementia management spans initial diagnosis through end-of-life care. ... Dementia Staging: Clinical Assessment and Hospice EligibilityFor practical bedside assessment and hospice determination, the Functional Assessment Staging Tool (FAST) proves particularly valuable.1 The FAST scale includes 7 main stages, progressing from no impairment (stage 1) through severe dementia requiring total care (stage 7). Stage 7 breaks down further into substages (7a-7f) that capture specific functional losses including ambulation, independent sitting, smiling, and head control. Eligibility for hospice care generally requires FAST stage 7c or beyond, indicating ... [continue reading this important criteria] Editor's Note: Leaders must understand hospice eligibility criteria when setting census goals, guiding teams, and communicating with families. Getting it wrong risks fraudulent billing, angry caregivers when live discharges occur, or too little care that comes too late. Getting it right ensures dignity, humanity, and meaningful final moments amid dementia's long goodbyes—true measures of compassionate hospice dementia care.

Life lessons from a palliative care psychologist - and how to support a dying loved one HELLO! onMSN; by Pilar Hernán; 10/5/25 ... Psychological support becomes a fundamental pillar for providing comprehensive and humane care, from managing emotional pain to adapting to the new reality. MD Anderson Cancer Centre psycho-oncologist Fátima Castaño helps us understand the process, explaining how we can support a loved one in palliative or end of life care, and shares the powerful life lessons she has learned through her work.

Adult Protective Services work with clients at the end of life: Challenges and support needsJournal of Elder Abuse and Neglect; by Wei-Lin Xue, Joy Swanson Ernst, Pi Ju Liu; 9/25Adult Protective Services (APS) professionals frequently interact with clients who are seriously ill or dying as they investigate cases of elder abuse and self-neglect. This study explored the unique challenges and support needs of APS workers in these end-of-life contexts. Thematic analysis identified two overarching domains: (1) challenges – including family conflict, limited caregiver preparedness, client self-determination, challenges to service access, and emotional strain on professionals; and (2) support needed – such as improved interagency collaboration, peer and organizational support. Participants emphasized the emotional toll of witnessing client decline and death, and highlighted gaps in training, coordination, and workplace support. Findings highlight the need for targeted policy and practice reforms to better equip APS professionals addressing elder abuse and self-neglect at the end of life.

Rise in late-stage lung cancer in nonsmokers highlights need for awareness and screening Medscape Medical News; by Evra Taylor; 9/5/25 ... The common thinking is that lung cancer is a smoker’s disease, but that isn’t the full picture, Jessica Moffatt, PhD, vice president of programs and health system partnerships at Lung Health Foundation in Toronto, told Medscape Medical News. ... Moffatt and her colleagues are working to dispel the stigma that smokers “get what they deserve.” Rosalyn Juergens, MD, professor of oncology at McMaster University in Guelph, Ontario, and president of Lung Cancer Canada, said, “If you find out someone has lung cancer, your first question shouldn’t be ‘Did you smoke?’ It should be ‘What can I do to help you along this journey?’ ”