Literature Review

Quality of death and end-of-life care among stroke patients: A comparative study of Mexican American and non-Hispanic White surrogate decision makersEquity Neuroscience; by Imadeddin Hijazi, Lewis B Morgenstern, Robert Michael Miller, Erin Case, Madeline Kwicklis, Darin B Zahuranec; 10/25 Racial and ethnic differences in patterns of end-of-life care have been previously reported, though there has been little work on the quality of end-of-life care in Mexican American (MA) stroke patients. Contrary to our original hypothesis, we did not identify an ethnic difference in surrogate reports of the quality of death and end-of-life care after stroke between MA patients and NHW [non-Hispanic White] patients after adjusting for demographic and clinical factors. This result is encouraging, as it implies that in this community, ethnic disparities in end-of-life care may not be as pronounced as reported in other populations. Furthermore, the high scores on both surveys indicate overall satisfaction with care regardless of ethnicity. 

Trends in hospice use among older adults with dementia and cancer by race and ethnicity 2011–2021Journal of the American Geriatrics Society; by Inbal Mayan, Siqi Gan, John Boscardin, Krista L. Harrison, Jennifer E. James, Alexander Smith, Lauren J. Hunt; 11/25Hospice use among older adults has expanded substantially, with more than 1.7 million Medicare beneficiaries enrolled annually. Yet, disparities by race and ethnicity in hospice remain. It is unknown whether these disparities have narrowed over time or whether trends differ by clinical condition. We examined changes in hospice use by race and ethnicity among decedents with dementia and cancer, two common terminal diagnoses with different trajectories and implications for hospice eligibility.

Hospice, palliative care, and care experiences among Medicare beneficiaries with cancerJournal of Geriatric Oncology; by Lisa M Lines, Miku Fujita, Kim N Danforth, Daniel H Barch, Michael T Halpern, Michelle A Mollica, David T Eton, Ashley Wilder Smith; 11/25Among 37,025 Medicare beneficiaries with cancer, 11.1 % received hospice (with or without PC) and 7.4 % received PC only. Nearly 30 % of the sample died within five years of diagnosis; fewer than one-third of decedents received hospice. Factors associated with receiving hospice included increasing age, non-Hispanic ethnicity, American Indian/Alaska Native and multiracial identities, living in higher-income neighborhoods, survey-completion proxy assistance, fair/poor general health, advanced stage at diagnosis, and more illness burden. Independent predictors of PC encounters included age 75-79, female identification, no dual enrollment, no proxy assistance, and more illness burden. Differences in care experience associated with hospice or PC use were shown for two care experience measures: doctor communication scores and doctor rating scores were higher among beneficiaries who received neither hospice nor PC relative to beneficiaries who received hospice.

S41 Delayed palliative care consultation among veterans with pancreatic cancer: An analysis of patterns and outcomesThe American Journal of Gastroenterology; by Adla, Akhil; Walker, Hayes; Whitwell, Samantha; Yn, Louis; Tombazzi, Claudio; 10/25Pancreatic cancer is characterized by a rapid disease progression, and poor overall prognosis, necessitating a comprehensive approach to care. The American Society of Clinical Oncology strongly recommends early palliative care consultation for all advanced pancreatic cancer patients, at the time of diagnosis or within the 8-12 weeks of diagnosis. Timely palliative care involvement has been shown to improve symptom management, mood, and improved survival. Despite these benefits, palliative care referrals are often delayed, limiting the potential impact on patient outcomes. This study reveals a dramatic percentage of patients who did not have palliative care consultations in a timely fashion as recommended by American Society of Clinical Oncology. 

5.2 consultation-Liaison perspectivesJournal of the American Academy of Child & Adolescent Psychiatry; by Julia A. Kearney;10/25Parents suffer loss and anticipatory grief, struggle with complex medical decision-making, and bear the primary burden of talking to their children about illness, death, and loss. Clinical intervention can: 1) improve communication around child prognosis and medical decision-making; 2) support parents in having open conversations with their children; and 3) directly assess and address parent mental health. Parents and caregivers appreciate resources to address their mental health in pediatric settings, need expertise from clinicians experienced in pediatric illness and palliative care, and need programs to overcome barriers such as parents’ unwillingness or inability to leave their child and the unpredictability of the child’s illness. While nothing can eliminate the suffering and grief of families facing a child’s terminal illness, clinicians can increase hope by helping enhance meaning, connection, trust, and love while reducing guilt and regret.  

AI, health, and health care today and tomorrow-The JAMA Summit Report on artificial intelligenceJAMA; Derek C. Angus, Rohan Khera, Tracy Lieu, Vincent Liu, Faraz S. Ahmad, Brian Anderson, Sivasubramanium V. Bhavani, Andrew Bindman, Troyen Brennan, Leo Anthony Celi, Frederick Chen, I. Glenn Cohen, Alastair Denniston, Sanjay Desai, Peter Embí, Aldo Faisal, Kadija Ferryman, Jackie Gerhart, Marielle Gross, Tina Hernandez-Boussard, Michael Howell, Kevin Johnson, Kristine Lee, Xiaoxuan Liu, Kimberly Lomis, Alex John London, Christopher A. Longhurst, Ken Mandl, Elizabeth McGlynn, Michelle M. Mello, Fatima Munoz, Lucila Ohno-Machado, David Ouyang, Roy Perlis, Adam Phillips, David Rhew, Joseph S. Ross, Suchi Saria, Lee Schwamm, Christopher W. Seymour, Nigam H. Shah, Rashmee Shah, Karandeep Singh, Matthew Solomon, Kathryn Spates, Kayte Spector-Bagdady, Tommy Wang, Judy Wawira Gichoya, James Weinstein, Jenna Wiens, Kirsten Bibbins-Domingo, for the JAMA Summit on AI; 10/25AI will disrupt every part of health and health care delivery in the coming years. Given the many long-standing problems in health care, this disruption represents an incredible opportunity. However, the odds that this disruption will improve health for all will depend heavily on the creation of an ecosystem capable of rapid, efficient, robust, and generalizable knowledge about the consequences of these tools on health. AI is changing how and when individuals seek care and how clinicians interact with patients, establish diagnoses, and implement and monitor treatments. In contrast to drugs or more traditional medical devices, there is little consensus or structure to ensure robust, safe, transparent, and standardized evaluation, regulation, implementation, and monitoring of new AI tools and technologies.

Human-AI collaborative content analysis: Investigating the efficacy and challenges of LLM-assisted content analysis for TikTok videos on palliative careProceedings of the Association for Information Science & Technology; by Souvick Ghosh, Ketan Malempati, Camille Charette; 10/25Palliative care is frequently misunderstood, yet short videos on social media can help disseminate useful information and build supportive communities. In this study, we propose an iterative LLM-LLM agentic conversational approach to identify palliative care themes from 56 TikTok videos. Our approach identified themes such as Policy, Advocacy, and Access, as well as Emotional Support and Coping while highlighting omissions like Humor and Saying Goodbye, underlining the need for human oversight. The contributions of this work include a new annotated dataset of 242 TikTok videos, a validated LLM-based thematic analysis pipeline, and evidence that combining automated and human-in-the-loop methods enhances reliability and accuracy in short-form video analysis.

Enhancing palliative care integration in the Cardiac Surgical Intensive Care Unit: A multidisciplinary quality improvement projectAmerican Journal of Hospice and Palliative Medicine; by Crystal Hope Bennett Schiano; 10/25The rate of unmet palliative care (PC) needs is high in critical care areas, especially in the surgical patient population, where PC involvement is notoriously late in the patient’s clinical progression. This quality improvement project aimed to evaluate the ability of education, workflow delineation, and an evidence-based assessment tool to improve the integration of PC in a cardiac surgical intensive care unit (TICU). The intervention included education, workflow delineation, and an evidence-based frailty assessment (FA) implementation. The outcomes of this project were similar to those of the existing literature, further revealing that ICUs are challenging care settings in which to connect patients with PC for the first time. Future studies on the effects of FA in the cardiac surgical patient population are warranted to find the most appropriate settings for assessment and associated interventions based on identifying a patient’s frailty.

Allowing natural death in end-of-life decision-makingGeriatric Nursing; by Jodi Erickson, Mary Ann Cantrell, Meredith MacKenzie Greenle; Nov-Dec 2025To act in concordance with the wishes of people who are dying, the healthcare system must empower patients and healthcare professionals to communicate effectively and in a way that minimizes distress for all involved. More specifically, the use of negation in the term “Do Not Resuscitate” (DNR) in EOL decision-making conversations may contribute to the confusion regarding the meaning of the terms in actual clinical practice. The terminology of DNR and sometimes “Do Not Attempt Resuscitation” (DNAR) is utilized in most healthcare settings and is also incorporated into most portable medical orders, such as POLST forms. “Allow Natural Death” (AND) is a term that has been suggested as an alternate to DNR in EOL situations and does appear in some portable medical orders. This quantitative study indicates that healthy adults may prefer the use of AND instead of DNR when having EOL decision making discussions.

An explicit live discharge protocol for hospice-initiated live dischargesJournal of the American Medical Directors Association; by Stephanie P. Wladkowski, Susan Enguidanos, Tracy A. Schroepfer;1/26Hospice-initiated discharges, or those not requested by patients or caregivers, are distinct from voluntary disenrollment from hospice because they often occur without adequate preparation. Hospice patients who have stabilized and been deemed no longer terminal can disrupt continuity of care, leaving patients and their caregivers unprepared for the complex medical, emotional, and logistical needs posthospice. Currently, no standardized guidelines exist to support hospice clinicians in planning for and conducting these live discharges. To address this gap, an explicit live discharge protocol (LDP) was developed to guide hospice clinicians in supporting patients who are no longer eligible to receive hospice and are discharged alive and their caregivers.