Literature Review

P4s are either unhelpful or unnecessary. Proposing a better AI-powered solution to predict patients' preferencesBioethics; by Beatrice Marchegiani; 5/26The Personalized Patient Preference Predictor (P4) has been proposed as an AI tool to aid surrogate decision-making when incapacitated patients lack advance directives. This paper argues that P4s face a fundamental dilemma: they are either unnecessary or unhelpful. To address  ... [its] limitations, I propose a better AI-powered alternative: the Patient Preference Retriever (PPR). Rather than generating new text, the PPR uses vector search techniques to retrieve relevant statements from a patient's digital footprint, presenting them verbatim alongside metadata such as date, context, and source. This approach offers greater transparency, respects autonomy more reliably, and supports surrogate decision-makers in weighing authentic evidence. I conclude that while advance directives remain the gold standard, retrieval-based approaches like the PPR provide a more reliable and ethically defensible use of AI in surrogate decision-making than generative approaches like P4s.

Stakeholder perspectives on integrating ADEPT into end-of-life care for nursing home residents with dementia: A qualitative descriptive studyInternational Journal of Older People Nursing; by Susanny J Beltran, Latarsha Chisholm, Emily Jaijairam; 5/26Nursing homes care for a significant proportion of individuals with advanced dementia, yet timely hospice referrals remain a challenge. The Advanced Dementia Prognostic Tool (ADEPT) is a mortality risk score instrument that holds promise for improving care planning by providing a standardised, accessible method for identifying residents at risk of death within 6 months. Current processes for identifying hospice-eligible residents rely on regular assessments and interdisciplinary collaboration but reveal significant gaps, including delays in referrals and inconsistent practices. Participants viewed ADEPT as a promising tool to complement goals-of-care conversations and enhance care planning, rather than exclusively triggering hospice initiation. Implementation barriers included the need for electronic system integration, regulatory compliance and staff education, while facilitators encompassed strong leadership support, interdisciplinary coordination and alignment with existing workflows.

The clinical relevance of sleep disturbance ("insomnia") in patients with advanced cancer receiving palliative care: A scoping reviewSupportive Care in Cancer; by Shauna Munir, Eva Jones, Faith Precious Omeokwe, Andrew Neil Davies; 5/26Sleep disturbance ("insomnia") is common in patients with advanced cancer receiving specialist palliative care. The studies highlight that sleep disturbance is associated with a range of physical symptoms (e.g. fatigue, drowsiness), a variety of psychological problems (e.g. anxiety, depression), impaired quality of life, and reduced overall survival. Sleep disturbance is an "orphan" symptom, and the results of this scoping review suggest that it deserves much greater attention. Indeed, healthcare professionals should screen all palliative care patients for the problem and, when identified, perform a thorough assessment and initiate an appropriate treatment.

Hospice care provider and compassion fatigue research projectPersonal communication; by Michelle Jackson; 6/10/26Researchers at Missouri State University are conducting a research survey regarding compassion fatigue, resilience, and participation in meaningful activities for hospice care providers. Participation deadline 7/12/26. For additional information and to participate, click here.

Black grief, Black healing: Exploring African American parents grief with cultural implications for treatmentFamily Process; by Nyla Rogers, Shareefah Al'Uqdah, Denzell Brown, Briayanna Johnson; 6/26African American parents experience child loss at disproportionately high rates, yet family systems and grief literature have largely overlooked this population's grief experience. This paper examines how therapists can provide culturally responsive care to African American parents navigating the death of a child. Drawing on existing literature, this paper expounds on the historical trends within the African American family system while delineating unique African American grief practices. Practical and culturally relevant clinical practices such as facilitating robust social support networks, creating structured opportunities for public and communal mourning, and therapeutically addressing the intensity of grief-related emotional responses are provided. Family therapists are called to expand their grief frameworks and family interventions beyond individualized, Western-centric models to encompass the collective, justice-oriented dimensions of loss that shape the lived experiences of African American families.

Voluntarily stopping eating and drinking (VSED) with hospice support in America: A case seriesJournal of Pain and Symptom Management; by Hope A Wechkin, Elizabeth T Loggers; 5/26Despite increasing public awareness of voluntary stopping of eating and drinking (VSED), there are no descriptions of the clinical course of US patients who pursue VSED, with or without hospice support... We employed retrospective chart review methodology to review a consecutive case series of 20 patients who requested and received hospice support for VSED... While this study has significant limitations, VSED was completed by all who initiated the process and death generally occurred within 10 days. Therefore, those initiating VSED should be considered eligible for hospice care, with care initiated quickly. Symptoms during VSED were typical of hospice patients and can be managed using common hospice techniques and medications.

Ketamine for depression in serious illness: Evidence, safety, and practical approachesJournal of Pain & Symptom Management; by Paul Noufi, Joshua B. Borris, Danielle Chammas, Cara L. McDermott, Nneka N. Ufere, Jason A. Webb, Daniel Shalev; 4/26Patients with serious illness and short prognoses often experience depression and suicidal ideation. Traditional antidepressants are limited by delayed onset, creating a need for rapidly acting therapies. Ketamine and esketamine [nasal spray] offer the strongest evidence among rapid-acting antidepressants and may be preferred when urgent symptom relief is needed. However, rigorous psychiatric trials in serious illness are lacking. Clinicians should consider prognosis, access to Risk Evaluation and Mitigation Strategies-certified esketamine programs or equivalent regulatory frameworks outside the US, and the need for an appropriate maintenance regimen when integrating ketamine into palliative care depression management.