Literature Review

Why Black, Hispanic, and Asian patients hesitate to opt for palliative care: Deep metaphors from patients, community leaders, and clinicians with shared cultural identities to shape more effective outreachJournal of Palliative Medicine; by Anthony L Back, MaryGrace S King, Kathy C Shaw, Kelly Willis, Malcolm Brooks, Arigun Bayaraa, Leon He, Vanessa Herman, Ivan Sanchez, Lindsay Zaltman, Marian S Grant; 9/25In the United States, national data show that Black, Hispanic, and Asian patients are less likely than White patients to receive palliative care (PC) despite comparable or greater symptom burden. We enrolled 15 patients (5 Black, 5 Hispanic, 5 Asian), 8 community leaders (5 Black, 3 Hispanic, 1 Asian), and 6 palliative care clinicians (2 Black, 2 Hispanic, 2 Asian). Patients' images about their experiences of being offered PC revealed the metaphor of "inside/outside"-a sense of simultaneous inclusion and exclusion with regard to their community and also the medical system. The patients' sense of belonging and protection felt from their communities was demonstrated in images that evoked the metaphor of "home," as a physical and emotional place with a sense of belonging. The metaphor of home as a place of belonging was mirrored in community leader and PC clinician interviews.

Intense grief attacks: An investigation into the factor structure of a bereavement-related phenomenonJournal of Clinical & Basic Psychosomatics; by Sherman Aclaracion Lee, Tomás Caycho-Rodríguez, Lindsey W. Vilca, Robert A. Neimeyer; 9/25Grief attacks are a highly distressing and potentially debilitating bereavement-related experience. Although empirical research on these intense eruptions of loss-related anguish is limited, the literature suggests that this phenomenon consists of a mixture of both panic attack and grief symptoms. The present study examined the factor structure of intense grief attack symptoms using data from 303 bereaved adults. These findings not only support anecdotal and clinical accounts of grief attacks but also provide partial psychometric support for the Grief Attack Questionnaire in measuring these sudden, unanticipated, and overwhelming responses to bereavement. 

Pastime activities, social connectedness, and grief resolution: A brief report highlighting the salience of socializing for grief resolution among bereaved older adultsThe Journal of Nervous & Mental Disease; by Xin Yao Lin, Holly G Prigerson, Yifan Chou, Paul K Maciejewski; 10/25We sought to examine the relationship between pastime activities (i.e., activity engagement), social connectedness with family and friends, and severity of Prolonged Grief Disorder (PGD) symptoms across younger, middle-aged, and older adults. Cross-sectional findings showed that engagement in pastime activities (e.g., travel, sports) was associated with greater social connectedness for older adults, and social connectedness was associated with lower PGD symptom severity. Engagement in pastime activities was associated with lower PGD symptom severity for middle-aged adults. Results are consistent with the socioemotional selectivity theory and the microsociological theory of adjustment to loss and suggest that grief interventions should have age-specific strategies, encourage specific pastime activities, and promote feelings of social connectedness.

A qualitative study to characterize the experiences of patients and caregivers with dementia diagnostic disclosure communication and care planningJournal of Geriatric Psychiatry and Neurology; by Joanna Paladino, Heily Chavez Granados, Jade A Connor Eruchalu, Carine Davila, Liliana Ramirez Gomez, Alissa Bernstein Sideman, Daniel Dohan, Elizabeth Lindenberger, Lindsay Dow, Ana-Maria Vranceanu, Deborah Blacker, Christine S Ritchie; 10/15/25Clinician communication at the time of a dementia diagnosis often inadequately addresses patient and caregiver needs. We aimed to characterize the communication experiences of patients and caregivers affected by dementia using an evidence-based serious illness communication framework... Dementia diagnostic disclosure would benefit from a structured yet tailored communication approach that prioritizes respectful communication, emotional support, and comprehensive care planning to meet the needs of patients and caregivers.

Incarceration and quality of cancer careJAMA Network Open; by Oluwadamilola T. Oladeru, Ilana B. Richman, Jenerius A. Aminawung, Jason Weinstein, Lisa B. Puglisi, Rajni Mehta, Hsiu-Ju Lin, Emily A. Wang, Cary P. Gross; 10/25The incarcerated population in the US is aging, and an estimated 15% of incarcerated adults, or approximately 175,000 individuals, are now 55 years or older. With this demographic shift, diseases of aging have become more prevalent, and cancer now ranks as the most common cause of death among people who are incarcerated in the US. Despite the growing prevalence, cancer outcomes among those incarcerated lag behind those with no history of incarceration. Individuals diagnosed with cancer while incarcerated or immediately following release have an approximate 2-fold increase in cancer-related mortality compared with the general population, even after adjusting for stage at diagnosis. Along with other published literature, this work suggests that gaps in quality of care may contribute to observed disparities in outcomes.Assistant Editor's note: Most of us cannot imagine what it would be like to be in prison. With cancer. And perhaps even dying there. Steven Garner knows. He spent many decades as an inmate at a state penitentiary. While there, he became a hospice volunteer supporting dying inmates, training other volunteers, and he served to pioneer Hospice in Corrections programs throughout the US. Steven is out of prison now, living his best life in Colorado and consulting around the nation about ways to improve end of life care for incarcerated persons. Oprah Winfrey was involved in sharing Steven's story in a Netflix documentary called Serving Life. NPR published an article about Steven in February 2024. Additionally, Hospice Analytics has posted a link to a 20-minute video about Steven's life and work in prison: Angola Prison Hospice: Opening the Door. And finally, if you'd like more information, Steven Garner has a website. 

Health care in the USA: money has become the missionThe Lancet; by Adam Gaffney, Steffie Woolhandler, David U Himmelstein, Danny McCormick; 10/21/25Despite extraordinary scientific and medical resources, the US health-care system underperforms. In this Review we consider the damage wrought by decades of market-based policies that have stimulated profit-seeking by insurers and health-care providers.

Study examines biological causes of cancer deaths: Tumors invading large blood vessels may be to blame, UTSW researchers say UT Southwestern Medical Center, Dallas, TX; by Newsroom; 10/16/25 The ultimate cause of death from cancer may not be metastatic disease, as researchers have long surmised, but an infiltration of tumors into major blood vessels that cause blood clots and multiorgan failure, a one-of-a-kind clinical study led by UT Southwestern Medical Center suggests. These findings, published in Nature Medicine, could spur interventions that extend the lives of patients with advanced cancers. 

Perinatal bereavement rooms: A narrative review of physical space in perinatal griefArchives of Gynecology and Obstetrics; by Ruby Castilla-Puentes, Azul F. Isidoro, Alfonsina Orosito, Samantha Eaton, Manuela Goyeneche, Liliana González Cabrales, Gabriela Santaella; 9/25 Perinatal loss is a profoundly complex form of grief, often linked to heightened risk of prolonged bereavement and adverse mental health outcomes. Perinatal grief rooms—private, supportive spaces within healthcare settings—aim to help families process their loss, spend time with their baby, and create meaningful memories in a respectful environment. Despite increasing recognition of the importance of bereavement care, dedicated grief rooms remain under-researched and inconsistently implemented. Advancing this field will require rigorously designed studies, development of design standards, and collaborative partnerships among healthcare providers, researchers, policymakers, and design experts to ensure equitable access to therapeutic spaces for grieving families.Assistant Editor's note: It strikes me that those experiencing grief of any kind, not just perinatal grief, could benefit from a grief room--a private, comfortable, inviting space--where loved ones can be together and grieve. Many hospice in-patient facilities have such a room. Wouldn't it be wonderful if every hospital, nursing home, assisted living facility, etc., had a grief room?! Perhaps hospice organizations could explore a multi-facility collaboration to make that happen. 

Pulse check: Status update on pediatric palliative and hospice community-based coverageJournal of Palliative Medicine; by Meaghann S Weaver, Alix Ware, Deborah Fisher, Betsy Hawley, Holly Davis, Lisa C Lindley, Steven M Smith, Conrad S P Williams, Tej Chana, Christy Torkildson; 9/25Half (49%) of [the country's surveyed hospice and palliative] organizations reported increasing the number of pediatric patients accepted into their care over the past five years. Programs are less likely to include perinatal (61%) patients compared to infants through young adults (94%). Trauma increased as a reason for pediatric enrollment. Nonmetro geographies are less likely to provide services for children. The pediatric palliative average annual census was 271, and the pediatric hospice average annual census was 74. The pediatric patient's average length of stay for palliative care was 154 days and for hospice was 96 days, [with] Medicaid (47%) [being] ... the most common form of reimbursement. Lack of trained personnel, low referrals, and funding were depicted as the most common barriers.

Size of the financial incentives in Medicare’s Skilled Nursing Facility Value-Based Purchasing ProgramJAMA Network Open; Robert E. Burke, Franya Hutchins, Jonathan Heintz, Syama R. Patel, Scott Appel, Julie Norman, Atul Gupta, Liam Rose, Rachel M. Werner; 9/25The Skilled Nursing Facility Value-Based Purchasing (SNF VBP) program seeks to reduce all-cause 30-day readmissions from SNF for traditional Medicare beneficiaries recently discharged from the hospital. Under SNF VBP, most SNFs receive a financial bonus or penalty up to 2% of their total traditional Medicare revenues each year, on the basis of their performance on 30-day readmission rates compared with other SNFs, or their own improvement in readmission rates over time. In this cohort study, we found that the size of the financial incentives at the SNF level are relatively small in terms of dollars and as a proportion of net operating income, and that most SNFs experienced substantial variability from year to year in their incentive payments. These 2 factors may have contributed to the relative lack of effectiveness of the SNF VBP program. First, if the level of the penalty is not sufficient to hire additional staff, purchase equipment (such as an x-ray machine or laboratory testing), or invest in new care processes, then SNFs will not be able to improve their ability to manage changes in patient condition. 

Palliative care at the cutting edge: Recent updates in surgical palliative careJournal of Pain and Symptom Management; by Antoinette R Esce, T J Douglas, Elizabeth Gorman, Sophia Tam, Christopher D Woodrell, Ana Berlin; 9/25Surgical patients with serious illness often experience unique clinical trajectories, systems of care, and relationships with providers. In order to meet the needs of this patient population and their care teams, hospice and palliative medicine professionals should be familiar with evolving best practices in surgical palliative care. We present the case of a geriatric trauma patient with a new diagnosis of advanced cancer cared for in a surgical intensive care unit. This example highlights important new developments in defining and supporting the geriatric trauma population, improving and expanding surgical palliative care education, and identifying which seriously ill surgical patients benefit most from palliative care interventions.

Examining public-facing hospice medical aid in dying participation policies in legalizing U.S. jurisdictionsJournal of Palliative Medicine; by Todd D. Becker, Paul Duberstein, Elizabeth A. Luth, Sanjana Kumar, Samuel Nemeth, Kira Phillips, Veda Kota, Elissa Kozlov; 9/25 Nearly 9 in 10 patients in the United States who use medical aid in dying (MAID) are enrolled in hospice. Only 39 of 724 hospices (5.4%) published a public-facing MAID participation policy. Policy availability was low even within the two jurisdictions mandating hospice online publication (0 of 52 from New Mexico [0.0%]; 14 of 389 from California [3.6%]). Moreover, even when published, policy content was highly variable and often too vague to discern which MAID-related activities were permitted. For instance, 18 of 39 policies (46.2%) did not report whether or not physicians were permitted to prescribe MAID medication. The lack of availability and specificity in hospices’ public-facing MAID participation policies may jeopardize patient access to legal end-of-life care options. 

The National Dementia Workforce Study: The plan for organization sample frames and data collectionJournal of the American Geriatrics Society; by James Wagner, Laura M Wagner, Sheryl Zimmerman, Johanna van Tyen Silbersack Hickey, Kate Stewart, Sandi Nelson, Ji Qi, Raphael Nishimura, Piotr Dworak, Margaret Hudson, Jennifer Kelley, Heidi Guyer, Amy R Pettit, Donovan T Maust, Joanne Spetz; 9/25The National Dementia Workforce Study was designed to improve our understanding of the individuals and systems who care for people with dementia, but designing and implementing such a study is challenging due to the large number of patient care organizations, clinical and direct care roles, and locations in which care is provided. While there are national sampling frames available for federally certified nursing homes (i.e., via data from the Center for Medicare and Medicaid Services), there are no national sampling frames for assisted living communities or home care agencies. We describe the plan for sampling and recruitment procedures to be used in each stage and discuss limitations, including implications for coverage of the target population. Data collected through these surveys will be available to the research community.