Literature Review

Survival variation and predictors of length of stay in US hospice patientsInternational Perspectives and Future Directions for Practice, Research, and Policy; by Ian Duncan, Xiyue Liao, Terri Maxwell; 6/26End-of-life (EOL) patients in the US Medicare program represent a large and growing population, as well as a disproportionate share of Medicare’s costs. Survival of patients in hospice is, however, highly variable, implying an opportunity for improved management by enhancing the prediction of survival. Actuaries, health economists, policy analysts, and health services researchers have studied expenditures at the EOL for Medicare decedents for many years, finding that survival at EOL is highly variable. We discuss the utilization of hospice benefits for patients at the EOL in the United States.

Clinical Artificial Intelligence as a novice nurse: Leadership responsibilities for safe implementationNurse Leader; by Asiah Ruffin; 5/26Clinical artificial intelligence (AI) technologies are increasingly integrated into health care environments, influencing clinical workflows, documentation, decision-making, and patient communication. While AI is often introduced as a technical innovation, its implementation presents significant leadership responsibilities related to safety, workforce readiness, and organizational oversight. This commentary proposes an analogy that conceptualizes clinical AI systems as novice nurses—entities that require structured orientation, supervision, feedback, and ongoing development rather than autonomous trust. Using this analogy, the article examines risks associated with premature reliance on AI, including workflow disruption, performance variability over time, and limited user understanding of system capabilities and limitations. The commentary also outlines practical leadership considerations, including investing in workforce education, collaborating with human factors experts, establishing governance processes, and engaging in policy advocacy.

Palliative care or hospice? Flipping the classroom for 1st year pre-clinical medical students with interactive online contentAmerican Journal of Hospice & Palliative Care; by Maxwell Vergo, Charles Wang, Lawrence Myers; 5/26Although palliative care competencies appear on USMLE [United States Medical Licensing Examination] examinations, pre-clinical curricula devote minimal time to end-of-life education. We created a 30-minute interactive online module in Articulate 360™ for first year students covering palliative care definitions, eligibility criteria, and care settings. In-class time was restructured to small group case discussions distinguishing primary palliative care, specialty palliative care, and hospice. Correct responses on a palliative care examination question improved from 57% (2020-2021, virtual lecture) to 66%, 67%, and 80% in subsequent years with the flipped intervention. The pre-work engaged students in learning (79-89% agreement), enabled focus on advanced topics during class (73-77% agreement), and was described as interactive and helpful in teacher evaluations.

Pediatric home-based hospice and palliative care: A scoping reviewBMC Palliative Care; by Ellen Davis, Daniel H Grossoehme, Toluwalase Ajayi, Justin N Baker, Pamela S Hinds, Lisa Humphrey, Jill Ann Jarrell, Rachel Thienprayoon, Sarah Friebert; 5/26Pediatric palliative and/or hospice care is provided across a broad spectrum of settings, ranging from inpatient to outpatient to a child's home. Pediatric home-based hospice and/or palliative care teams offer a specialized, interdisciplinary approach to care, allowing children to stay in the home while offering comprehensive support. Common themes emerged [in this review] including studies analyzing models of care, characterizing the population, end-of-life decision making, clinical outcomes of home-based hospice and/or palliative care, costs and economic impact, family experiences, quality domains, specific treatment modalities, and the use of telehealth. Overall, the available literature supported home-based hospice and/or palliative care as an effective model of care, reducing the burden on families, improving quality of life, and allowing families to stay in their preferred setting for care without sacrificing clinical outcomes.

Nurse perceptions of end-of-life care quality across long-term care, home, and social model hospice home settings: A qualitative descriptive studyAmerican Journal of Hospice & Palliative Care; by Helen Mavis Farrar, Kelley Easterling Scott; 5/26This qualitative descriptive study explored nursing perspectives on end-of-life care quality across 3 distinct community settings: long-term care facilities, patients' homes, and social model hospice homes. Nurses provide most of the direct end-of-life care in these settings, yet their perspectives remain understudied. Semi-structured interviews were conducted with 11 licensed nurses who had provided end-of-life care across all 3 settings. Analysis revealed 4 major themes: (1) setting-based care disparities, (2) nurses as educators and translators, (3) mediation of caregiver burden across settings, and (4) relationship-based care as foundational for peaceful deaths. Care setting profoundly influenced these nurses' ability to deliver quality end-of-life care. 

Flourishing within vulnerability: on human fragility and the conditions for a habitable environment Theoretical Medicine and Bioethics; by Irene Quiliconi; 6/24/26 In recent philosophical discourse, "flourishing" has emerged as a concept of growing importance—often linked to the field of well-being studies and explored by various and different disciplines. The article approaches flourishing not as an abstract ideal, but rather as a condition that must be understood as rooted in the lived reality of human vulnerability. More specifically, I argue that any genuine account of human flourishing must regard vulnerability— human inherent fragility and reciprocal dependence—not as an impediment, but as the very foundation from which meaningful flourishing can arise. 

Caregiving stressors and sleep outcomes: Examining group differences among caregivers of persons living with dementia The Journals of Gerontology; by Fei Wang, Seungjong Cho, Anne Conway, Yejin Heo, Christine Lau, Karyne Machry; 5/26Caring for persons living with dementia often involves high levels of physical demands and emotional burden, which may undermine caregivers’ sleep quality. Few studies have examined sleep health among Black caregivers of persons living with dementia, despite the fact that they are underrepresented in dementia research and experience poorer sleep outcomes compared to non-Hispanic White caregivers. Subjective caregiving stressor (i.e., role overload) was positively associated with sleep disturbance. A significant interaction showed that the association between role overload and sleep disturbance was stronger among Black caregivers than in non-Hispanic White caregivers. Findings also suggest that Black caregivers of persons living with dementia may experience greater vulnerability to the adverse role of role overload in relation to sleep.

Knowledge of advance care planning and advance directives among US adults: Implications for health policy and practicePalliative Care & Social Practice; by Anisah Bagasra, Gretchen Agans; 5/26Advance care planning (ACP) is the process of identifying and communicating values and goals in preparation for future shared decision-making in medical settings. Decisions are legally supported by an advance directive (AD) document designating healthcare agent(s) and future medical treatment preferences. Although important, ACP engagement in the United States remains low. Findings indicate persistent gaps in ACP and AD literacy among US adults, along with misconceptions about access, time, and costs that may be contributing to low engagement. Increasing public education and expanding access to knowledgeable professionals may help reduce barriers and promote more equitable engagement in ACP.