Literature Review

“I’m as mad as hell and I’m not going to take this anymore!”JAMA Neurology; David N. Korones, MD; 4/25So shouted news broadcaster Howard Beale in the iconic 1976 film “Network” as he decried pollution, unemployment, inflation, crime, and all that was wrong in the world back then. And so shouted I, as I slammed down the phone after yet another denial from an insurance company—this time denial of treatment for an 8-year-old little girl with a brain tumor.Every day the phone, email, and text messages mount: an antinausea medication is not approved, oral chemotherapy is denied to a child because it is in liquid form, and only tablets are approved, brain surgery is denied because the patient has the misfortune of not living in the same state as the neurosurgeon who has the unique skill set to remove it, an insurance company that had previously approved an essential therapy for one of my patients now, for inexplicable reasons, denies refills half way through her prescribed course of treatment. Perhaps the more we push back, send them bills for our time, follow that up with bill collectors, call our congressional representatives, and summon our hospital leadership, we can gather a chorus of physicians, patients, hospital leaders, and politicians who all open their windows and, following Howard Beale’s lead, scream in unison that they, too, are mad as hell, and it is long past time to change this unjust system of care. To paraphrase Howard Beale, “our children, our patients are human beings, goddammit, their lives have value!”

The pharmacology of aid in dying: From database analyses to evidence-based best practicesJournal of Palliative Medicine; by Patrick Macmillan, Susan Hughes, Angelique Loscar, Lonny Shavelson; 4/25We investigated the efficacy of four commonly used aid-in-dying medication protocols-using the time to sleep and time to death as proxies for efficacy. This first-time analysis of aid-in-dying medication protocols showed that while a sedative alone had the best median time to death, the most recent sedative/cardiotoxin protocol had an acceptable median time to death of 0.8 hours, but with fewer prolonged-death outliers.

Drivers of palliative care and hospice use among patients with advanced lung cancerCancer Medicine; by Megan C Edmonds, Melissa Mazor, Mayuri Jain, Lihua Li, Marsha Augustin, José Morillo, Olivia S Allen, Amina Avril, Juan P Wisnivesky, Cardinale B Smith; 1/25Despite rigorous evidence of improved quality of life and longer survival, disparities in the utilization of palliative and hospice care persist for racial and ethnic minority patients with cancer. This study evaluated the impact of psychosocial factors on utilization of these services. Minority patients with advanced lung cancer were more likely to receive a palliative care referral and specialty level consultation when compared to non-minority patients. Our work highlights the importance of proactive referral processes in facilitating access to palliative and hospice services, particularly among younger patients.

Top ten tips palliative care clinicians should know about diagnosing, categorizing, and addressing fatigueJournal of Palliative Medicine; by Gregg A Robbins-Welty, Danielle Chammas, Ethan J Silverman, Maria Felton Lowry, Elizabeth Hale, Corina Martinez, Morgan M Nakatani, Daniel Shalev, Paul Noufi, Paul A Riordan, Keri O Brenner, William E Rosa, Christopher A Jones; 3/25Fatigue is a multifactorial symptom that is commonly faced by patients with cancer, chronic disease, and other serious illnesses. Fatigue causes suffering across biopsychosocial domains and affects patients and their loved ones. In this article, a consortium of professionals across cancer care, physical therapy, exercise, pharmacy, psychiatry, and palliative medicine offers tips and insights on evaluating, categorizing, and addressing fatigue in the setting of serious illness. The comprehensive approach to managing fatigue underscores the importance of collaborative efforts characteristic of interdisciplinary palliative care. Prioritizing screening, diagnosing, and treating fatigue is crucial for enhancing patients' and families' overall quality of life.

Advancing the primary palliative workforce: Pilot results of the Educating Social Workers in Palliative and End-of-Life Care (ESPEC) self-study programJournal of Palliative Medicine; Myra Glajchen, Cathy Berkman, Shirley Otis-Green, Russell K Portenoy; 4/25Health social workers caring for the seriously ill may lack preparation in the primary palliative skills needed for this complex task. An evidence-based, nationally scalable, multimodality training program-Educating Social Workers in Palliative and End-of-Life Care (ESPEC)-was developed to address the training needs of health social workers. Prior to completing the online training, 21.6%-50.0% of participants rated themselves as "very confident" in the clinical practice skills central to the role of the social worker in serious illness care. After completing the modules, 58.8%-81.4% rated themselves as "very confident" in both clinical and professional skills, with significant changes in nine clinical practices and four professional practices. This pilot supports the feasibility, acceptability, and educational potential of the ESPEC self-study training in increasing confidence in key practices of primary palliative care for health social workers.

Research study participation: High-quality hospice care for all patientsShannon Walsh, a doctoral researcher at the RAND Corporation and the Pardee RAND Graduate School, is conducting a study on how hospice ownership structures impact the delivery of care for patients with Alzheimer’s Disease and Related Dementias (ADRD). The study uses Medicare data and interviews with informal caregivers to explore care quality, caregiver experience, and access to services – particularly within for-profit hospices, including those affiliated with private equity firms. Ms. Walsh is currently recruiting family caregivers of ADRD patients who received hospice care in the past two years to participate in a confidential, one-hour phone interview. [Please click the link above for additional information.]

Preferences for communication about prognosis among children with cancer, parents, and oncologistsJAMA Network Open; Caroline Christianson, MD; Calliope Reeves; Harmony Farner, MA; Shoshana Mehler, BA; Tara M. Brinkman, PhD; Justin N. Baker, MD; Pamela Hinds, PhD, RN; Jennifer W. Mack, MD, MPH; Erica C. Kaye, MD, MPH; 4/25Should oncologists elicit communication preferences from patients with pediatric cancer and their parents before disclosing prognosis? In this study, patients, parents, and oncologists recommended preemptive elicitation of communication preferences with the goal of improving alignment of prognostic disclosure with patient and caregiver communication needs, thereby enhancing quality of care. These findings demonstrate that patients and caregivers are open to discussing prognostic communication preferences, and that oncologists also recognize the potential value in this communication approach, even as they rarely engage in it. 

Quality measure considerations for pediatric palliative and end-of-life careAmerican Journal of Hospice and Palliative Medicine; Hannah Hommes, MSN, RN; Diane Forsyth, PhD, RN; April Rowe Neal, PhD, RN; 3/25 There is an emerging need to provide high-quality pediatric palliative care and end-of-life care to children, adolescents, and young adults with life-limiting illnesses. The aim of this literature review was to explore current quality measures utilized in pediatric palliative care and end-of-life care among pediatric patients with life-limiting illnesses within the conceptual framework of Comfort Theory. Emergent themes among quality measures were categorized into 7 domains: (a) Alleviation of distressing symptoms, (b) Structures and processes of care, (c) Health care utilization, (d) Location of death and bereavement care, (e) Patient and family experiences, (f) Psychological and spiritual care, and (g) Cultural, ethical, and legal considerations. These domains support the physical, psychospiritual, sociocultural, and environmental contexts of Comfort Theory. Quality measure research, development, and standardization should focus within the 7 domains identified for the promotion of comfort, equity, and accessible care.

Designing and developing interprofessional learning experiences in palliative care: A collaborative workshop approachPalliative Medicine Reports; Carolyn Kezar, Justine McGiboney, Michael D. Barnett, Richard Taylor, Rebecca Edwards, Ella H. Bowman, Elizabeth McAlister, Moneka A. Thompson, Tara Schapmire, Chao-Hui Sylvia Huang; 4/25Team-based care is vital in palliative care, but there is limited interprofessional education (IPE) among health care providers, leading to siloed learning. We aimed to design, implement, and evaluate an Interprofessional Education Exchange (IPEX) Death and Dying workshop to foster interdisciplinary collaboration and improve participants’ comfort with palliative care competencies. The primary findings of our study support our initial goal of creating an effective and engaging learning experience, as demonstrated by the significant increase in comfort levels across all interprofessional competency domains. The use of a case-based, interdisciplinary approach to PC [palliative care] education was particularly impactful, with improvements of up to 50% in some areas. Notably, 96% of learners agreed that working with peers from other disciplines enhanced their education, suggesting that early collaboration can improve communication and team-based care in clinical practice.

Private equity’s impact on medical traineesHealth Affairs; by Alexander P. Philips, Viknesh Kasthuri, Russell Hawes, Hunter Kramer, Barbara Chiu, Pragi Patel, Hannah Harrelson; 4/14/25Over the past decade, private equity (PE) ownership of physician practices and health care delivery systems in the United States has increased substantially. It is widely acknowledged that the trend toward short-term, profit-driven ownership challenges physician autonomy and raises ethical questions for physicians and patients. However, current discussions must more adequately recognize the effect of these trends on medical trainees. As medical students, we provide a perspective as future stakeholders amid a rapidly evolving landscape. In this Forefront article, we review PE’s involvement in health care, its impact on physicians and patients, the persistent professional and ethical challenges that directly affect medical trainees of all levels, and advocate for policy changes to protect trainees and address the underlying incentives that cause physicians to sell to PE.

Identifying palliative care needs in heart failure patients with nurse-led screening Journal of Hospice & Palliative Nursing; by Cantey, Christina DNP, FNP-C, AACC, CCK; Douglas-Mattis, Yhaneek DNP, AGACNP-BC; Lisiakowski, Jillian DNP, FNP-C; Fowler, Caley MSN, RN; Ejem, Deborah PhD, MA; 4/18/25 ... This quality improvement project aimed to improve the identification of unmet palliative care needs in patients with heart failure admitted to a progressive care unit by implementing a standardized nurse-administered palliative care screening tool. ... Implementing a nurse-administered screening tool effectively identified unmet palliative care needs among patients with heart failure with reduced ejection fraction and NYHA III. Despite low rates of palliative consults, standardization using IPOS could increase screening, contribute to institutional triggering palliative consultations, and improve awareness of unmet needs.

Patient, provider, and health system determinants of hospice Length of Stay Palliative Medicine Reports; by Eliza Thompson, Daniel Sanchez Pellecer, Gregory J Hanson, Shealeigh A Inselman, Jenn M Manggaard, Kevin J Whitford, Jacob J Strand, Rozalina G McCoy; 4/3/25Background: Benefits of hospice care, such as improvement in quality of life and reduced costs, depend on duration of enrollment in hospice services, making timely hospice referral essential. ... Conclusion: Based on a review of hospice referral patterns, the integration of hospice care into subspecialty practices, long-term care facilities, and advanced practice education could be an effective strategy to improve hospice LOS.