Literature Review

How health systems are saving money with centralized pharmaciesModern Healthcare; by Caroline Hudson; 8/27/25Health systems are centralizing pharmacy operations to cut costs. Many systems are bringing drug inventory, fulfillment and distribution under one roof. Centralization can help systems navigate a rapidly changing pharmaceutical industry.

Transformative impacts of clinical pharmacists in hospice careMcKnight's Home Care; by Deanna Douglass; 8/20/25Hospice represents a unique niche in the healthcare system, with goals and best practices that differ significantly from those of curative care. One defining characteristic of hospice is the use of medications to manage symptoms rather than improve or restore health. Pharmacists with specialized hospice and palliative care expertise have long played a vital role in enhancing quality of life for patients in their final days. From managing complex symptoms to ensuring cost-effective prescribing, these dedicated professionals are indispensable partners within interdisciplinary care teams and for hospice leadership. [This article discusses:]

Proportional sedation for persistent agitated delirium in palliative care-A randomized clinical trialJAMA Oncology; David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing Chen, Patricia Bramati, Sanjay Shete, Eduardo Bruera; 7/25Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. 

[Belgium] Christian perspectives on palliative sedation: A literature studyBMC Palliative Care; Jonathan Lambaerts, Bert Broeckaert; 7/25Overall, there is a positive but cautious attitude towards palliative sedation in the four major Christian traditions. All recognise that palliative sedation can help alleviate patient suffering. They remain cautious in their support, however, as they consider the line between palliative sedation and life-ending treatments (e.g. euthanasia) to be too blurred. Moreover, the Christian traditions are aware that lowering the level of consciousness is not without its problems.

Creating user personas to represent the needs of dementia caregivers who support medication management at home: Persona development and qualitative studyJMIR Aging; by Anna Jolliff, Priya Loganathar, Richard J Holden, Anna Linden, Himalaya Patel, Jessica R Lee, Aaron Ganci, Noll Campbell, Malaz Boustani, Nicole E Werner; 7/25Caregiver-assisted medication management plays a critical role in promoting medication adherence and quality of life for people living with Alzheimer disease or related dementias (ADRD). Caregivers in this study demonstrated a range of characteristics and values that informed their approach to medication management. They used a combination of technology-based strategies and strategies situated in their physical environments to manage medications. The personas created can be used to inform interventions, such as digital tools, that address caregivers' unmet needs.

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. Guest Editor's Note, Drew Mihaylo, PharmD: Practicing clinical vigilance regarding medication utilization is essential at any stage of illness. Prescribing cascades are common, under-recognized and often harmful. Approaching the emotional topic of medication change must be done with compassion and sensitivity tied to patient specific goals of care. Creativity to this end has been a focus of mine for sometime now as a clinical pharmacist serving serious illness patients nationally.

Telemedicine special registrations for controlled substancesJAMA Health Forum; by Jacob T. Kannarkat, John Torous, Joseph T. Kannarkat; 7/25Since the COVID-19 pandemic, the requirement for in-person evaluation of patients prior to the prescribing of controlled substances via telehealth, as established by the Ryan Haight Online Pharmacy Consumer Protection Act (Ryan Haight Act), has remained provisionally held. The Drug Enforcement Agency (DEA) previously proposed rulemaking to reintroduce the in-person patient evaluation requirement, as some unscrupulous clinicians and companies took advantage of this deregulated environment to overprescribe controlled substances. However, these flexibilities were extended through December 31, 2025, after the public voiced concerns over possible care disruptions in a landscape increasingly dependent on telehealth. Now, the DEA aims to compromise on prescribing flexibility with more practical enforcement measures.

Facing new CMS pressure, providers should audit mental health diagnoses, prescriptions: expert McKnights Long-Term Care News; by Kimberly Marselas; 7/22/25 As reported in McKnight’s Long-Term Care News on July 23, “Nursing homes should be auditing documentation for all residents with mental health disorders to ensure their diagnoses are compliant with new federal guidance, a well-known clinical reimbursement recommended Tuesday. Leigh Ann Frick, president of Care Navigation Consulting, made that suggestion while reviewing updated Long-Term Care Surveyor Guidance that went into effect in late April. At over 900 pages, the new manual and appendixes have left many providers still navigating the changes and how best to respond to them. When it comes to giving antipsychotic medications, diagnosing patients with disorders that require them, or identifying and responding to any other patient needs, the guidance puts new emphasis on the use of professional standards, Frisk explained. Guest Editor’s Note, Judi Lund Person:  For nursing home residents who have elected the Medicare hospice benefit, this information may apply. Diagnosing mental health issues, prescribing, and documenting based on professional standards is an important component in the updated Long-Term Care Surveyor guidance issued in April.

When less is more: Addressing polypharmacy in high-risk populations Pharmacy Times; by Andrew E. Esch, MD, MBA and Alain Hipensteele; 7/7/25 As digital health tools and artificial intelligence (AI)–powered clinical decision support systems become increasingly embedded in pharmacy workflows, pharmacists are gaining new opportunities to identify and address the risks of polypharmacy—particularly in high-risk populations such as older adults and those receiving palliative care. At the same time, evolving deprescribing guidelines and ongoing drug shortages have underscored the need for coordinated, patient-centered medication management strategies. In this interview with Pharmacy Times®, Andrew E. Esch, MD, MBA, director of the Palliative Care Program Development at the Center to Advance Palliative Care, discusses how pharmacists are using emerging technologies to streamline medication reviews, reduce therapeutic duplication, and engage caregivers in deprescribing conversations. 

Zuranolone in palliative care: Promise and practicality for the rapid treatment of depressionThe American Journal of Hospice & Palliative Care; Eric Prommer; 6/25Zuranolone is an orally available antidepressant classified as a neuroactive steroid. Neuroactive steroids act as positive allosteric modulators for both synaptic and extrasynaptic GABA, making them distinct from currently available drugs targeting major depression and insomnia. By modulating GABA binding sites, neuroactive steroids enhance the function of GABA, which is depressed in major depression. The drug has a rapid onset of action, which differs from currently available antidepressants that are used in palliative care. [This] ... paper will review the pharmacology, pharmacodynamics, safety profile, and clinical studies showing its effectiveness in major depression and how it can potentially be helpful in the palliative care population.

[UK] Palliative sedation at the end of life: Practical and ethical considerationsClinical Medicine; Dr Caroline Barry MBBS FRCP LLM FHEA PG Cert; Dr Robert Brodrick MB ChB (Hons) MA MRCP FHEA; Dr Gurpreet Gupta MBBS BSc PG Cert; Dr Imranali Panjwani LLB, PGDip, PG Cert, PhD; 6/25Highlights: The aim of palliative sedation is to relieve refractory suffering with the use of medications to reduce consciousness. Where palliative sedation is being used to treat agitation at the end of life, it is important to exclude and/or address reversible causes prior to starting medication. The drug, dose and route of administration of palliative sedation may vary according to the indication for treatment. Appropriate and proportionate use of palliative sedation does not hasten death. Suffering may have different meanings for people depending on their backgrounds and life experiences.

A single academic site study of five years evaluating pharmacy students’ palliative care clinical reasoning using Script Concordance TestingAmerican Journal of Hospice ad Palliative Medicine; Florence Labrador, PharmD-c; Kyle P. Edmonds, MD, FAAHPM; Toluwalase A. Ajayi, MD, FAAP, FAAHPM; Rabia S. Atayee, PharmD, BCPS, APh, FAAHPM; 5/25This study aimed to evaluate the impact of a Pain and Palliative Care elective didactic course on enhancing clinical reasoning skills among Doctor of Pharmacy (PharmD) students using the Script Concordance Test (SCT). The elective course was offered six times, covering various palliative care topics such as opioid management, procedural pain, and end-of-life care. The study found a statistically significant improvement in SCT scores from pre- to post-course assessments ... This study demonstrates the effectiveness of a targeted palliative care elective in improving clinical reasoning skills among pharmacy students.

WHO unveils new guideline to improve global access to controlled medicines World Health Organization; by Departmental update; 5/26/25 The World Health Organization (WHO) has released a rapid communication outlining its comprehensive new guideline on balanced national policies for controlled medicines. The guideline’s recommendations were officially presented during a high-level side event at the Seventy-eighth World Health Assembly on Friday 23 May 2025. It is designed to support countries in ensuring safe, equitable and affordable access to essential controlled medicines which are critical for treating acute and chronic pain, mental health conditions, substance use disorders and other serious health issues.