Literature Review

PHarmacist avoidance or reductions in medical costs in PALLiative care inpatient services: PHARM-PALLJournal of Palliative Medicine; by Celena Wilson, Jennifer Ku; 8/26Inpatient palliative care (PC) pharmacists have been shown to improve clinical and team outcomes. To quantify the cost avoidance (CA) associated with a full-time inpatient PC pharmacist based on clinical interventions. Conclusions: A PC pharmacist may help avoid significant health care costs, particularly in the areas of deprescribing, identifying untreated indications, and using PC expertise to make therapeutic recommendations.

Advance care planning in an urban hospital: Sustainability and growth in documenting care plans over four-yearsAmerican Journal of Hospice & Palliative Care; by Khadeja Kausar, Edward Coffield, Sampath Gopalan, Regina Tarkovsky, Sarah Egan, Robert A Press, John Marshall; 8/26Many acute care patients are admitted without advance care plans (AC-Plans) which may result in patients receiving care misaligned with their preferences. Accordingly, ACP [advance care planning] is needed within hospitals, however, implementation barriers exist. [In this study] the hospital's ACP program components included: primary palliative care, simulation-based training, and ACP and AC-Plan training and education. The percentage of patients with ACPs at discharge increased from 4.4% to 19.1% from the first to fourth program year. The odds of having an AC-Plan at discharge in years 2, three, and four were 3.44, ... 5.87, ... and 8.97 ... times higher than the odds of having one during the first program year. The growth and sustainability of the hospital's ACP program demonstrates that barriers to ACP within hospitals can be overcome and successful programs implemented.

Digital Deception: Survey Bots and the Ethics of Data IntegrityEthics & Human Research; by W Frank-Ito, LA Eldridge, J Matthews; 9/26The rapid growth of artificial intelligence and automated systems has significantly impacted digital survey-based research, particularly when recruitment is conducted via social media platforms. This case study details the erosion of data integrity in a 2025 follow-up survey, originally designed to replicate a successful 2021 study. Despite implementing increasingly sophisticated antifraud mechanisms such as CAPTCHA, IP geo-restrictions, and behavioral validation, survey bots repeatedly infiltrated the study, rendering the dataset unusable. This highlights a critical tension between broad digital accessibility and the vulnerability of online research to fraud. Moreover, the use of financial incentives to participate in research, while effective in increasing response rates, was found to amplify bot activity and raise ethical dilemmas surrounding compensation and data quality... The authors call for the urgent development of fieldwide standards, institutional support, and robust fraud prevention strategies to preserve the methodological and ethical integrity of digital research.

Inspiring a culture of ownership through mutual accountability-A health care system's approach to connecting bedside expertise with boardroom strategyNursing Management; by Torry Robinson, Stuart Downs; 8/26A health care system's approach to integrating the American Association of Critical-Care Nurses Healthy Work Environment (HWE) standards across organizational levels demonstrates a replicable pathway for aligning bedside expertise with boardroom strategy, an essential linkage in organizational strategic planning. This article describes one health care system's 3-year journey in embedding the HWE framework throughout the deployment of the nursing strategy. Following operationalization of HWE as a component of the nursing strategic framework, the health care system achieved sustained improvement across all domains of the Healthy Work Environment Assessment Tool (HWEAT), bolstering an organizational commitment to continuously improve and measure practice-environment health. This transparent, high-visibility approach emphasizes accountability from the Chief Nurse Executive to frontline nurses, underpinning a shared commitment that aligns clinical practice with organizational strategy. Organizations that embed HWE into their nursing strategic plan empower nurses at every level to shape and share ownership of the practice environment.

Time is of the essence: evaluating short-term prognosis tools in cancer and non-cancer patients Journal of Pain and Symptom Management; by Kayla Sheehan, Navasuja Kumar, Julia Pudar, Susan Duong, Megan Bricely, Mohamman Alhameed, Mohammed Kabeto, Donglin Zeng, Adam Marks; 8/27/26 Accurate end-of-life prognostication supports patient, family, clinician, and health system decision-making. The Palliative Prognostic Index (PPI), Palliative Performance Scale (PPS), and Short-Term Prognosis Signs (SPS) have been used in palliative care populations, particularly advanced cancer (1-3), but their utility for short-term prognostication in non-cancer patients is less established.

Health and health care access among Afghan refugee women in the United StatesJAMA Network Open; by Nazineen Kandahari, Nilufar N. Kayhani, Fareha Moulana Zada, Zahra Kayhani, Zarin Noor, Nicholas Nelson, Susan L. Ivey; 8/26Afghans are one of the world’s largest refugee populations. Afghan women face compounded health risks due to sociocultural restrictions, low literacy, forced displacement, and limited health care access, yet little is known about their experiences with health care after resettlement in the US. In this qualitative study of 23 Afghan women residing in the US who shared their experiences accessing health care, key barriers included sociocultural constraints on women’s autonomy, inadequate interpretation services, culturally insensitive health care, intergenerational stigma surrounding sexual and reproductive health knowledge and care, and mental health challenges. Structural barriers produced mistrust in and miscommunication with clinicians and led to use of home remedies. These findings suggest a need for health care interventions that are sensitive to sociocultural contexts and immigration histories to address the needs of Afghan refugee women in the US.

The prevalence of Medical Power of Attorney documentation in a large healthcare system: A retrospective cohort studyJournal of Palliative Care; by Angeli Sirilan, Alexandria Ellershaw, Tony Gaidici, Jacob Lahti, Michael Ruta, Richard Elias, Sandeep Pagali, Kristina Balangue, Sumit Agarwal, Nimit Agarwal; 8/26Designation of a Medical Power of Attorney (MPOA) is a key component of advance care planning (ACP) that ensures patient preferences are honored when decision-making capacity is not present. This study aimed to quantify MPOA documentation rates [in adult hospitalized patients] and identify demographic and clinical factors associated with documentation presence. Male sex, White race, older age (67.0 vs 54.3 years), and unmarried status were associated with a higher MPOA documentation rate ...  Dementia ...  and malignancy ...  were associated with higher odds, while discharge against medical advice was associated with lower odds ...  of MPOA documentation. Conclusions: MPOA documentation rates were low, highlighting missed opportunities to identify alternate decision makers when a patient lacks capacity.