Literature Review

Researchers at University of Pittsburgh target managed care (The state of hospice: Impacts on equity, quality, and nursing-an AAN consensus paper): managed care Insurance Newsnet; by a news reporter-staff news editor at Insurance Daily News; 4/24/26 ... This consensus paper examines the current state of hospice care in the US and the impact of changing hospice business models on health equity, healthcare quality, and nursing practice. Review of current literature and government policy statements related to hospice care and payment. Recommendations include updating policies to account for private equity involvement, evaluating current quality measures, addressing the existing Medicare Hospice Benefit, ensuring transparency and oversight for hospice agencies, and ensuring patient and caregiver education about hospice services.

Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategyJournal of Pain & Symptom Management; by Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev; 3/26Depression in serious illness is common, disabling, and often requires rapid improvement. In the psychiatric literature, SGA [second-generation antipsychotics] augmentation improves response and remission rates ... , with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No RCTs have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.

Discontinuation of medications with limited benefit at end of life in community-dwelling older veteransJournal of the American Geriatrics Society; by Joshua M Thorpe, Kelvin A Tran, Sherrie L Aspinall, Shelli L Feder, Brystana G Kaufman, Ann Kutney-Lee, Maria K Mor, Loren J Schleiden, Florentina E Sileanu, Carolyn T Thorpe, Courtney H Van Houtven; 4/26Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life prescribing has focused on nursing homes or hospice settings. [This study setting was] community-residing, non-hospice older veterans. Among community-dwelling older veterans in their final year of life, 73% were receiving at least one LBM at the start of that year, and 78% of these individuals continued LBM use until death. These rates parallel those reported in long-term care populations and underscore the need for community-based healthcare providers to routinely screen for LBMs and support appropriate medication discontinuation in older patients with advanced illnesses and limited life expectancy.

Engaging bereaved parent educators in pediatric end-of-life workshops: A trauma-informed onboardingJournal of Pain & Symptom Management; by Kayla Solstad, Dannell Shu, Kelly McManimon, Stacy Remke, Susan O'Conner-Von, Anne Woll, Joseph M Miller, Miriam C Shapiro, Johannah M Scheurer; 3/26Recognizing that pediatric end-of-life (EOL) scenarios occur infrequently and are distressing for trainees and other healthcare team members, our group created pediatric end-of-life care skills (PECS) simulation-based workshops to improve trainee competence for these skills. We  ... provide interprofessional workshops, including trainees from the pediatric residency program, graduate school of nursing, and graduate school of social work. Since creation of the workshops, the group and curricula have benefited immensely from including the expertise of bereaved parent educators (BPEs), who have experienced the death of their own infant or child and have been integral team members ... from workshop creation through facilitation. Research shows that families who have experienced the death of a child appreciate an interdisciplinary approach to their care and communication at the EOL. When parents of pediatric patients were asked about priorities in EOL care, they highlighted the importance of communication, emotional expression and support by staff, and ready access to multi-disciplinary staff.

Introducing palliative care: Family caregivers’ knowledge, exposure, and preferred messagingAmerican Journal of Hospice & Palliative Medicine; by Elaine Wittenberg, Joy V. Goldsmith, Sierra Forrest, Hanna G. Lee, Eva YN Yuen; 3/26Most family caregivers have never heard of palliative care, making it challenging for clinicians to introduce the subspecialty. Semi-structured phone interviews with family caregivers of patients eligible to receive palliative care were conducted. Knowledge of palliative care was significantly associated with having heard about and being offered palliative care. Caregiver exposure to palliative care was associated with age and race, with older, White caregivers significantly more likely to have heard about palliative care compared to Hispanic caregivers. Caregivers positively endorsed all message strategies designed for introducing palliative care.

Racial disparities in non-stigmatized supportive care medication use in pancreatic cancerJournal of Pain & Symptom Management; by Olga Monika Trejos Kweyete, Chardaé Whitner, David L. Deremer, Yi Guo, Jiang Bian, Lisa Scarton, Sherise C. Rogers, Diana J. Wilkie, Xiwei Lou, John M. Allen; 3/26Pancreatic cancer (PC) is associated with a high symptom burden that contributes to reduced health-related quality of life (HRQoL) and adverse clinical outcomes. This study examined racial and ethnic differences in the use of non-stigmatized SCMs [supportive care medications] during end-of-life care among patients with PC. SCM use was defined as at least one outpatient prescription claim for antiemetics, appetite stimulants, cognitive aids, headache aids, or sleep aids. Racial and ethnic disparities persist in the use of non-stigmatized SCMs among patients with PC at the end of life. These findings extend prior evidence on inequities in cancer symptom management and underscore the need for interventions that promote equitable access to supportive care medications across diverse populations.

Repeated exposure to trauma narratives and professional quality of life in palliative and end-of-life healthcare providersPalliative & Supportive Care; by Suzanne A Brier, Amy L Nadel, Charlotte Stone, Rebecca M Schwartz; 3/26This study examined how repeated exposure to trauma narratives influences professional quality of life, including burnout, secondary traumatic stress (STS), and compassion satisfaction (CS), among end-of-life healthcare providers.  Conclusions: Repeated exposure to trauma narratives is a meaningful occupational stressor for end-of-life clinicians. Resilience and organizational support appear to protect against the negative impact of trauma exposure and promote CS, highlighting key multilevel targets for trauma-informed workforce interventions. Furthermore, by identifying specific resilience factors and support systems that buffer against psychological distress, these findings offer actionable insights for developing targeted interventions to mitigate long-term professional harm.