Literature Review

Assisted ventilation withdrawal in motor neuron disease: updated results BMJ Supportive & Palliative Care; by Lucy Bleazard, Jonathan Palmer, David Wenzel, Thomas Jeffery, and Christina Faull; 3/24/25 Introduction: Patients with ventilator-dependent motor neuron disease (MND) may request withdrawal of their assisted ventilation. Facilitating this process as a healthcare professional (HCP) can be emotionally and practically challenging. The Association for Palliative Medicine (APM) issued guidance to support HCPs and invited anonymised accounts of the withdrawal process to provide an update on the guidance. ... Results: Younger patients tended to need higher doses to achieve adequate symptom management prior to withdrawal. Practices of weaning the ventilator varied significantly between respondents. The median time to death following withdrawal of ventilation was 30 min, with three-quarters of patients dying within 2 hours. Conclusion: This is the largest data set to date regarding the withdrawal of assisted ventilation in MND. This updated analysis reaffirms that a personalised, titrated approach remains appropriate and effective. The revised APM Guidance 2025 incorporates new sections on recommendations for managing the ventilator. [Continue reading ...]

Bringing palliative care to every patient with cancer: A conversation with Janet L. Abrahm, MD, FACP, FAAHPM, FASCO The ASCO Post, in partnership with the American Society of Clinical Oncology; by Jo Cavallo; 3/25/25 Janet L. Abrahm, MD, FACP, FAAHPM, FASCO, ... has become a widely recognized leader in the field of supportive care and palliative medicine, serving for nearly a decade on the leadership team of the American Academy of Hospice and Palliative Medicine and helping to craft the first Hospice and Palliative Medicine certifying examination offered by the American Board of Internal Medicine. ... In a wide-ranging interview with The ASCO Post, Dr. Abrahm discussed the importance of providing every patient with cancer access to palliative medicine throughout survivorship, how oncologists can become more effective communicators, and strategies to alleviate patients’ suffering at the end of life.

RFK Jr. continues pioid Crisis PHE into its eighth year Inside Health Policy; by Dorothy Mills-Gregg; 3/19/25 HHS Secretary Robert F. Kennedy Jr. recently renewed the department’s longest ongoing public health emergency (PHE) first declared under the first Trump administration: the opioid abuse crisis. While the Centers for Disease Control and Prevention found a 25.5% decrease in overdose deaths in 2024 compared to the previous year, HHS says the opioid PHE needs to be renewed for another 90 days so federal coordination efforts can continue and key flexibilities for HHS will be preserved.Editor's note: How recently have you reviewed your Policies & Procedures for destroying drugs in the patient's home, upon death--in accordance with state laws? For staff education and accountability? For communicating this with family? For assessing possible drug diversion of opioids, with appropriate follow-up actions? Additionally, numerous hospice bereavement programs have been flooded with grief needs of bereaved family members from opioid deaths. Click here for the U.S. Department of Justice's Drug Enforcement Administration - Diversion Control Divsion; more focused, scroll down to their "Home Disposal Methods."

Revamped tool can reliably assess pain symptoms in dementia patients: researchers McKnights Long-Term Care News; by Zee Johnson; 3/17/25 ... A team of researchers reconstructed the End-of-Life Dementia-Comfort Assessment in Dying, or EOLD-CAD, after a multifacility study showed that caregivers could adequately and reliably address a host of pain symptoms seen in end-of-life dementia patients. ... When clinicians working in the SNFs that were part of the trials used the EOLD-CAD, they were able to detect patterns in more than 600 residents that fell into four categories: physical distress, symptoms of dying, emotional distress, and well-being. Common symptoms observed across these categories were restlessness, shortness of breath, choking, gurgling, difficulty in swallowing, fear and anxiety. ...

Hospice Insights Podcast - Psychedelics and end of life care: Understanding the legal landscape Hospice Insight - The Law and Beyond; by Husch Blackwell LLP; 3/12/25 There has been a lot of buzz around psychedelics, and particularly their potential usefulness in treating existential suffering at the end of life. Husch Blackwell was the first law firm in the country to establish a Psychedelics & Emerging Therapies practice group devoted to helping clinicians, researchers, and investors navigate the complex and difficult legal and regulatory issues involved in developing new therapies in this space. In this episode, host Meg Pekarske is joined by the leaders of Husch Blackwell’s Psychedelics & Emerging Therapies practice group, Kimberly Chew, Karen Luong, and Natasha Sumner, who provide an overview of what psychedelics are, their legal status under federal and state laws, and liability considerations for clinicians.

Walgreens sells to private equity firm Sycamore Partners Healthcare Brew - Pharma; by Nicole Ortiz; 3/11/25 Since December, rumors have floated around that Walgreens was going to be acquired by private equity (PE) firm Sycamore Partners. And while analysts told Healthcare Brew at the time that it was unlikely to happen, the tides appear to have turned in the PE company’s favor. On March 6, Walgreens Boots Alliance announced in a press release that it had signed a definitive purchase agreement with Sycamore for up to $23.7 billion. However, when Walgreens’s debts and assets to be potentially divested are taken out, the total sale price is actually closer to around $10 billion, per the ll Street Journal, turning the retailer into a private entity after nearly a century as a public company.

Hallucinogens may elevate death risk by more than twofold Medscape; by Liz Scherer; 3/5/25 Hallucinogens are associated with a 2.6-fold increased risk for premature death in some individuals seeking emergency care, according to a recent study. The risks are especially substantial in vulnerable patients who are suicidal, who are susceptible to severe mental illness, or have comorbid conditions such as respiratory disease or cancer. The findings come at a time of renewed interest in the therapeutic potential of substances like psilocybin, lysergic acid diethylamide, methylenedioxymethamphetamine (MDMA), and ketamine for mood and substance use disorders. In 2023, the Canadian Institutes of Health Research allocated roughly $3 million to three clinical trials examining psilocybin-assisted psychotherapy in the treatment of alcohol use disorder, treatment-resistant depression, and end-of-life psychological distress in patients with advanced cancer.

Charges dismissed against chef accused of trying to kill his Monterey county mother KSBW Action News-8, Monterey, CA; by Felix Cortez; 2/28/25 A popular San Francisco area chef who was arrested along with his sister and charged with trying to kill their mother more than two years ago has had attempted murder charges dismissed against him. “In over 30 years of practice, this was one of the saddest cases I have ever seen and one of the most incompetent investigations by the Monterey County Sheriff’s Department that I have ever seen,” said Juliet Peck, the attorney for James Stolich. ... The mother was terminally ill and lived on a ranch off Highway 68 outside Salinas. “James’ mother’s only wish was to die at home without pain, surrounded by her daughter, son, and pets,” Peck said. But that never happened; Tinker died about a week later in a hospice facility, never to see her children again, because an emergency protective order obtained by the sheriff’s office prevented the children from visiting their dying mother. ... According to court documents, the daughter, Whitney, was the “agent designated to make all health care decisions for her mother,” which included administering medication to help alleviate her mother’s pain. ...The original criminal complaint alleging attempted murder charges said Whitney or a co-conspirator “crushed up pills with a mallet.” A close friend of Tinker was willing to testify that Whitney had no intent to kill her mother but was simply following her mother’s “directive to provide effective and sufficient palliative care even if it hastened her death.”Editor's note: This case raises numerous issues, including but not limited to community education (including law enforcement), Advance Directives, patient and caregiver education and support, MAiD (Medical Aid in Dying) or the End Of Life Option Act (EOLOA) in California, ethics, and the dying process (note that "the mother died about a week later in a hospice facility). 

Center for Hospice Care's BreatheEazy Program supports patients with respiratory issues LaporteCounty.Life; by Garrett Spoor; 2/13/25 One of the toughest health challenges a person can face is the trouble of breathing. Center for Hospice Care comes across a lot of patients who experience this issue and encourages many of them to become a part of their BreatheEazy program. Dr. Karissa Misner, medical director at Center for Hospice Care, considers the BreatheEazy program to be a monumental boost for patients who might have respiratory issues. “This is a specialized pulmonary program for our patients with chronic obstructive pulmonary disease,” Misner said. “It can also be used for many other terminal diagnoses that affect the lungs. Whenever there is any type of illness that causes difficulty in breathing, we can utilize this program.”

Kroger partners with Express Scripts to expand pharmacy services Becker's Hospital Review; by Alexandra Murphy; 2/6/25 Cincinnati-based Kroger Health has reached a new agreement with Express Scripts, the pharmacy benefit services arm of Evernorth, to provide access to prescription medications and health services at the Kroger Family of Pharmacies for Express Scripts Customers. Under the new agreement, the Kroger Family of Pharmacies will resume serving customers in Express Scripts' Medicare Part D and Tricare/Department of Defense plans, according to a Feb. 5 Kroger news release. This comes after Kroger ended its contract with Express Scripts in September of 2022, after months of unsuccessful negotiations over a new agreement. 

Opioid painkillers less available to people of color HealthDay News / Coastal Breeze News, Marco Island, FL; 1/30/25 People of color now have less access to prescription opioid painkillers than white patients, an unintended consequence of efforts to stem America’s opioid epidemic. Communities of color have a 40% to 45% lower distribution of commonly prescribed opioids, compared to majority white communities, researchers reported in a study published Jan. 23 in the journal Pain. This could prevent opioid painkillers from reaching those in true need of them, like cancer patients, researchers said. 

DEA proposed telemedicine prescribing rule could burden hospice physicians and hospice operations Morgan Lewis, Washington, DC; by Howard J. Young, Jacob J. Harper, and Roshni Edalur; 1/27/25 Signaling a possible future approach to regulating Schedule II-V prescribing via telemedicine in lieu of in-person examinations, on January 17 the DEA issued a notice of proposed rulemaking regarding its next iteration of controlled substance prescribing controls. With comments due March 18, 2025, the Proposed Rule is not subject to the Trump administration’s executive order freeze on new proposed regulations. [Click on the title's link to continue reading.]