Literature Review

Provision of end-of-life care in austere environmentsWilderness & Environmental Medicine; by Jason W. David, Hui Z. Feng, Danny Lammers, Russell Day; 6/25End-of-life care presents unique challenges in austere or resource-limited environments where traditional medical resources are scarce or absent. This review explores the complexities of providing end-of-life care under such constraints, including recognition of the dying patient and techniques to alleviate suffering and allow death with dignity in under-resourced or expeditionary environments. Moreover, it presents these techniques in an accessible manner for providers without formal hospice training to use. Based on a literature review of hospice and palliative medicine, insights from the body of literature in wilderness and austere medicine, and the authors’ experiences in practicing in austere environments, this paper discusses practical approaches to symptom management, ethical considerations in end-of-life decision making, and accessible interventions with limited resources.Publisher's note: An interesting article for all healthcare professionals to consider...

Granting permission: Toward embracing griefJournal of Social Work in End-of-Life and Palliative Care; by Rennie Bimman; 3/25Grief, unavoidable and often excruciating, is rarely sufficiently acknowledged or supported in Western society. It is not granted permission to exist without barriers. By considering and evaluating grief experiences through the lens of their access to permission, clinicians can collectively imagine and promote inclusivity in grief. Permission is presented as a conceptual framework and clinical tool, with broader micro- and macro-level applications for both professional and layperson engagement, offering a foundation for further implementation and research.

Timing and outcomes of palliative care integration into care of adolescents and young adults with advanced cancerOncology Practice; Jeremiah Bonnet, BA; Colin Cernik, MS; Hajime Uno, PhD; Lanfang Xu, MS; Cecile A. Laurent, MS; Lauren Fisher, MS; Nancy Cannizzaro, BA; Julie Munneke, BA; Robert M. Cooper, MD; Joshua R. Lakin, MD; Corey M. Schwartz, MD; Mallory Casperson, BA; Andrea Altschuler, PhD; Lawrence H. Kushi, ScD; Chun R. Chao, PhD; Lori Wiener, PhD; Jennifer W. Mack, MD, MPH; 5/25Adolescent and young adult (AYA) patients with cancer frequently receive intensive measures at the end of life; many also express care goals that align with a palliative approach. [In this study] nearly three quarters (73%) [of  AYA patients] were referred to palliative care before death. Thirty-six percent of palliative care referrals took place before the last 90 days of life; 30% were in the last month of life. Palliative care referrals and their timing were associated with care received at the end of life, with earlier referrals associated with fewer intensive measures near death, including chemotherapy in the last 14 days of life ... as well as intensive care unit admissions, emergency room visits, and hospitalizations in the last month of life ... Patients who were referred to palliative care were more likely to have symptoms assessed in the last 90 days of life, including pain, dyspnea, nausea, diarrhea, constipation, depression, and anxiety ... 

Palliative care program characteristics and end-of-life outcomes for patients with metastatic cancerJournal of Pain and Symptom Management; by May Hua, Ling Guo, Shuang Wang, R Sean Morrison; 6/25Although U.S. palliative care programs have substantial differences in their implementation, whether this heterogeneity impacts patient outcomes is unknown. Palliative care program characteristics largely were not associated with differences in end-of-life quality metrics for patients with metastatic cancer.

Referral criteria for specialist palliative care for patients with dementiaJAMA Network Open; Yuchieh Kathryn Chang, DO; Jennifer Philip, PhD, MMed, MBBS; Jenny T. van der Steen, PhD; Lieve Van den Block, PhD, MSc; Allyn Yin Mei Hum, MD; Pedro E. Pérez-Cruz, MD, MPH; Carlos Paiva, MD, PhD; Masanori Mori, MD; Ping-Jen Chen, MD; Meera R. Agar, PhD, MPC, MBBS; Laura Hanson, MD, MPH; Catherine J. Evans, PhD, MSc, BSc; David Hui, MD, MSc; 5/25Dementia is an ever-growing public health issue with currently more than 55 million people worldwide living with this disease. Due to an aging global population, this number is projected to triple by 2050. As the number of people with dementia continues to grow worldwide, there is a need and an opportunity to collaborate and provide seamless integration of specialist palliative care with the primary palliative care already delivered to enhance the care of patients with dementia. To help advance this goal, the 15 major criteria identified here represent a first step toward clarification of primary and specialist palliative care roles and consideration for systematic screening of symptom and supportive care needs.

IU Health gets $20M gift for clinical innovation institute  Becker's Hospital Review; by Madeline Ashley; 5/20/25 Indianapolis-based Indiana University Health has received a $20 million donation from Sarah and John Lechleiter and Deborah and Randall Tobias to create the Tobias-Lechleiter Institute for Clinical Innovation. IU Health will match the donation, bringing the investment in the institute to $40 million, according to a May 20 news release shared with Becker’s. ... The institute plans to recruit 75,000 residents yearly in advanced medical studies; enroll 300,000 patients in the Indiana Biobank initiative over five years to aid research into genomic risk factors pertaining to Indiana’s population; attract and retain top fellows, students and faculty; enhance research resources; and increase the impact and pace of statewide medical research.

Care transformation in palliative care: Leveraging a payor-provider partnership to fast-track growth of a palliative programJournal of Palliative Medicine; Emily Jaffe, Emily Hobart, Alexandra Aiello, Amber Shergill, Amanda Harpster-Hagen, Tyson S. Barrett; 5/25This study describes a unique partnership between an insurer and a provider to enhance the quality, availability, and access to palliative services. A retrospective cohort analysis of insurance claims data for patients receiving palliative care compared to a matched cohort not receiving palliative care services from 2019 through 2022. Outcomes demonstrated a total savings of $4,526,408 through reductions in costs for the treatment group compared to the control group for total cost of care ...., inpatient stays ($5,672 ... ) , outpatient visits ($229 ... ), professional claims ($1,243 ... ), and pharmacy fills ($17 ... ). The treatment group had lower skilled nursing facility ($1,049 ... ) and inpatient rehabilitation facility ($216 ... ) costs. The treatment group had higher rates of hospice care (83.7% in the treatment compared to 50.2% ... ) but had lower lengths of stay (four days compared to five ... ).Conclusions: Collaborative investment in a palliative program by a payor and provider system shows significant financial savings for an insurer when patients receive evidence-based palliative care near the end of life.

Palliative care in acute care surgery: research challenges and opportunitiesTrauma Surgery Acute Care Open; by Amelia W Maiga, Vanessa Ho, Rachel S Morris, Lisa M Kodadek, Thaddeus J Puzio, Gail T Tominaga, Masami Tabata-Kelly, Zara Cooper; 3/25Acute care surgeons routinely care for individuals who may benefit from palliative care. Patients exposed to traumatic injury, emergency surgical conditions, major burns and/or critical surgical illness are more likely to be experiencing a serious illness than other hospitalized patients. This narrative review summarizes the current state of research challenges and opportunities to address palliative care in acute care surgery.

Trends in the use of advance care planning and cognitive assessment and care planning service visits: Moving toward a palliative-informed approach for ambulatory care of community-dwelling persons with dementia and their caregiversAlzheimer's & Dementia; by Jennifer B Seaman, Yurun Cai, Dianxu Ren; 4/25Both the advance care planning (ACP) visit and cognitive assessment and care planning service (CAACPS) visit offer palliative-oriented care for persons with Alzheimer's disease and related dementias (ADRD); however, the rate of ACP visits remains low, and little has been reported regarding CAACPS visits. Furthermore, few reports describe use of either visit among Medicare Advantage (MA) beneficiaries. Discussion: Few MA beneficiaries with ADRD received ACP or CAACPS visits, and the delivery of CAACPs visits is similar to that reported for non-MA beneficiaries.

The 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancerJAMA Network Open; Rebecca Rodin, MD, MSc; Lihua Li, PhD; Karen McKendrick, MPH; Krista Harrison, PhD; Lauren J. Hunt, PhD, RN; Ulrike Muench, PhD, RN; Cardinale B. Smith, MD, PhD; Melissa D. Aldridge, PhD, MPH, MBA; R. Sean Morrison, MD; 5/25In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in first-line opioids while less-safe tramadol and less-effective gabapentinoid prescribing continued to rise. Further revision of the recent 2022 CDC guideline and oncology pain management guidelines may be needed to help address these potentially inappropriate analgesic shifts.

Successful strategies for operationalizing goals-of-care documentationNEJM Catalyst: Innovations in Care Delivery; by Matthew J. Gonzales, Nusha Safabakhsh, Suzanne Engelder, Deborah Unger, Ira Byock; 5/25Goals-of-care (GOC) conversations are critically important to ensure that clinical teams and health systems know what matters to their patients, enabling treatment plans to be aligned with patients’ goals. However, because many conversations are ad hoc and clinician dependent, patients with serious medical conditions often do not have GOC conversations documented in their health record... [In 2024], 2024, 8,533 out of 10,063 (84.8%) of patients who were in an ICU for 5 or more days had a documented GOC conversation in the electronic health record at some point between hospital admission and prior to the fifth ICU day. This compares with a preintervention rate of just 555 out of 8,143 (6.8%) of patients who were in an ICU for 5 or more days having a documented GOC conversation [in 2016]. Essential strategies included centering efforts within the organization’s mission and vision, partnering with clinical leaders to set strong quality standards and corresponding metrics, easing documentation within the electronic health record, and designing and implementing effective communication skills–building workshops.

A narrative review—Characterizing palliative care curriculum aimed at high school adolescents and young adultsIllness, Crisis and Loss; Austin B. Elder; 4/25The aim of this narrative review is to explore the characteristics of palliative care curriculum developed for high school adolescent and young adults (AYAs). Characteristics including a variety of designs, methods, and strategies were all identified to have positive participation, feedback, and experiences from high school AYA being provided palliative care curriculum. Conclusions: The literature indicates that the use of subject matter experts within palliative care curriculum for high school students is a core characteristic in meeting the World Health Organizations recommendation to embed palliative care curriculum into public awareness strategies.

Palliative and end-of-life care in stroke: A scientific statement from the American Heart AssociationStroke; by Claire J Creutzfeldt, Julia Bu, Amber Comer, Susan Enguidanos, Barbara Lutz, Maisha T Robinson, Darin B Zahuranec, Robert G Holloway, American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology; 2/25Stroke has multidimensional effects on patients and their families because of threats to personhood, prognostic uncertainty, and the need to adapt to functional changes after stroke. Palliative care has evolved as both a specialty and a skillset with a goal to improve communication about goals of care and quality of life for patients and their families that emphasizes a holistic, all-person approach. After stroke, palliative care needs (eg, to address pain and physical, emotional, psychosocial, and spiritual distress) are insufficiently addressed by current models of care. Integrating palliative care principles is fundamental in all stages of stroke and should include strategies to improve communication about prognosis and goals of care, address psychosocial needs such as coping with loss, navigating complex health care systems, and preparing for death when necessary.