Literature Review

Unique ethical dilemmas occur in long-term care settings: Staff need ethics resources  Medical Ethics Advisor; by Stacey Kusterbeck; online ahead of print 12/1/25 issue ... “The position paper was developed in response to concerns from our members about the ethical challenges of the changing environment in long-term services,” says Jason M. Goldman, MD, MACP, president of the American College of Physicians. ... Discharge disposition, communication issues (either among the clinical team or between clinicians and parents), behavior problems, and goals of care were the top ethical issues reported. Lack of caregiver support was another frequent unique ethical concern. Editor's Note: Your hospice is in a unique role to provide ethics trainings for end-of-life care, and thus building trust, clinical best practices, and referrals. The CMS Hospice Conditions of Participation require: Hospices That Provide Hospice Care to Residents of a SNF/NF or ICF/MR (§ 418.112) (f) Standard: Orientation and training of staff. Finally, this rule requires a hospice to assure the orientation of SNF/NF and ICF/MR staff caring for hospice patients. Staff orientation must address the following topics: hospice philosophy; hospice policies regarding patient comfort methods, pain control, and symptom management; principles about death and dying; individual responses to death; patient rights; appropriate forms; and record keeping requirements.

“I was horrified”: 34 surgeons and doctors recall their worst mistakes BoredPanda; by Justin Sandberg; 11/19/25 Someone asked “Medical professionals, what mistake have you made in your medical career that, because of the outcome, you've never forgotten?” and people shared their stories from fortunately comical to downright grim. ...#4.  I work in palliative care, ... I knew he wanted to be a DNR (do not resuscitate). I wrote it on my note. But I didn't re-fill out the hospital paperwork. The next day, I got to work to discover he'd been coded and was on a ventilator in the ICU. Instead of passing peacefully, his wife had to make the decision to turn off life support.  ...Editor's Note: Entry #20 comes from a hospice nurse describing a patient with severe bone pain started on morphine—then an out-of-town daughter arrived, shocked to see “Daddy on morphine.” What unfolded was realistic and tragic. This story highlights two timely essentials:

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.” 

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:

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.

10 common sibling clashes while caring for parents—and how to resolve them AOL.com; 11/10/25 Sibling conflicts over the care of elderly parents are quite common, along with disputes over estates and inheritance. ... 

The sliver of light after losing a child: Personal perspective - a child's loss can provide elusive and rare gifts. Psychology Today; by David R Patterson PhD, ABPP; by 11/10/25 I have often said that working with patients who are dying has brought an ironic, but transient, feeling of exhilaration to my life. Most care providers who work in hospice will explain to us that people who are aware of their impending mortality have a sense of being in the present that those of us who are not so close to that inevitability can only admire from a distance. ... I don’t know whether this resonates with other parents that have lost a child, but I can say that a very clear impact of my son’s loss has been to become acutely aware of my own mortality. ... After living with my son’s death for three years, I am only just beginning to grasp the lessons that his death is teaching me.

"The Wounded Generation": Bearing the invisible scars of war CBS News; by Lesley Stahl; 11/9/25 In 1984, President Reagan commemorated the 40th anniversary of the invasion of Normandy, and paid tribute to the World War II soldiers known as "The Greatest Generation." ... But in his new book, historian David Nasaw calls them "The Wounded Generation." "They are the Greatest Generation, but they returned from war, bringing wounds home with them that are invisible; they're psychic wounds," he said. "Now we know that a lot of those wounds were PTSD. But PTSD was not diagnosed for 40 years after the return of the World War II veterans. ... Nasaw said [of his own father,] "He came home smoking three or four packs of Luckys a day. He came home with a heart condition from the war. He dies at age 61. And I had never had the chance to find out what happened in Eritrea, what he went through. So, what do I do as a historian? I can't find out his story, so I jumped in to find out the story of his generation."Editor's Note: While most World War II veterans are now gone, many of today’s hospice patients—particularly those who served in combat—carry similar invisible scars. Their psychic wounds, once unnamed, often resurface in life’s final chapter. This story also echoes in their adult children, who now seek to understand the unspoken pain that shaped their families. For more insight and support—especially regarding post-9/11 veterans—see the Wounded Warriors Project. 

Hospice of the Valley launches support group for people with mild cognitive impairment Lovin' Life; by Lin Sue Flood; 11/2/25 Living with mild cognitive impairment (MCI) can be an isolating experience, but a new program from Hospice of the Valley offers a welcoming space for connection and support. GATHER is a peer-led group where individuals diagnosed with MCI can share their experiences, navigate emotions, and discover new coping strategies together. ... GATHER provides a safe environment for members to lead their own discussions. Unlike traditional support groups, members are empowered to guide conversations toward topics that are most relevant to them. This novel format models successful programs in Europe. 

Clinician and parent perspectives on essential psychosocial care in pediatric cancerJAMA Pediatrics; by Kimberly S. Canter, Anne E. Kazak, Natalie Koskela-Staples, Michele A. Scialla, Kimberly Buff, Emily Pariseau, Victoria A. Sardi-Brown, Julia B. Tager, Lori Wiener; 10/25The Standards for Psychosocial Care for Children With Cancer and Their Families provide guidelines for evidence-based psychosocial care for children with cancer and their families. The Implementing the Standards Together: Engaging Parents and Providers in Psychosocial Care (iSTEPPP) study extends the standards through innovative collaborative research between clinicians and patient and family advocates, with the goal of widespread clinical implementation of standards that clinicians and parents or caregivers agree to be priorities. The 3 standards prioritized by parents and clinicians in this study offer insight into shared priorities for psychosocial care in pediatric cancer. However, misalignment on other priority standards (parental mental health, palliative care, and neurocognitive monitoring) highlights the differences in perception between parents and clinicians. Areas lacking agreement are a stark reminder of potential challenges when working to meet the holistic needs of children with chronic diseases and their families, as clinicians and parents may not agree on which needs are most important.

Four nurses in two weeks assaulted at Essentia Hospitals: Nurses say violence is a consequence of unsafe staffing and inaction Minnesota Nurses Association, Brainer, MN; Press Release; 10/28/25Nurses with the Minnesota Nurses Association (MNA) are once again outraged and deeply concerned after two more violent assaults on nurses at Essentia Health. A nurse at Essentia Health St. Joseph’s Medical Center in Brainerd was attacked by a patient last Thursday, followed by another assault at the same facility over the weekend. The latest incidents come less than two weeks after two nurses were injured at Essentia Health St. Mary’s Medical Center in Duluth. Four nurses assaulted in under two weeks reflects a dangerous pattern in Essentia facilities—one that nurses have been warning about for years.Editor's Note: Continue reading for preventable actions and red flags, "True safety comes from care-based prevention." These were hospital settings; the home care settings your staff and volunteers enter provide much higher risks with less control. Ask your direct care staff for examples of professional situations that were unsafe. Office-based leaders, you might be surprised. Examine your workplace violence policies, procedures, trainings, incident reporting, and follow-up.

Peaceful acceptance of illness among older adults with advanced cancer Journal of Pain and Symptom Management; by Sule Yilmaz, Elizabeth Gilbride, Sofiia Hryniv, William Consagra, Supriya G Mohile, Eva Culakova, Beverly Canin, Arul Malhotra, Rachael Tylock, Judith O Hopkins, Jane Jijun Liu, Jamil Khatri, Marissa LoCastro, Maya Anand, Allison Magnuson, Kah Poh Loh; 10/23/25 Context: Peaceful acceptance of illness is associated with lower psychological distress and increased engagement in advance care planning among adults with advanced cancer. Limited data exist on factors influencing illness acceptance in older adults. ... Conclusion: Patient psychological health, perceived prognosis, and caregiver education were linked to PEACE. Triadic interventions addressing these factors may enhance end-of-life care for older adults with advanced cancer.