Literature Review

Temporal trends in opioid-related care and pain among Veterans at the end of lifeJournal of Pain and Symptom Management; by Melissa W. Wachterman, Stuart R. Lipsitz, Erin Beilstein-Wedel, Walid F. Gellad, Karl A. Lorenz, Nancy L. Keating; 7/25In response to the opioid crisis, federal guidelines were implemented, including the Veterans Health Administration's (VA) Opioid Safety Initiative in 2013. The impact of policies on patients near the end of life is unknown. Over a time period during which opioid safety initiatives were implemented, opioid prescribing near the end of life decreased, accompanied by decreases in opioid-related hospitalizations but increases in pain. These findings suggest that important tradeoffs may exist between reducing opioid-related serious adverse events and undertreating patient pain in the last month of life. Opioid prescribing guidelines could consider incorporating prognosis into recommendations.

When GIP is not enough: Revocation of hospice to meet patient goalsJournal of Pain and Symptom Management; by Margaret Krasne, Alden Rinaldi, Richard Leiter; 5/25In 2021, 6.3% of hospice discharges were due to beneficiary revocation. The Hospice Care Index, a quality metric impacting hospice reimbursement, penalizes hospices for revocations, regardless of the reason for revocation. We will review the literature on reasons for hospice revocation, factors affecting revocation rates, the impact of revocation on quality metrics, and strategies for optimizing revocation rates.Publisher's note: This was a poster session at the 2/25 AAHPM conference.

A narrative review of clinicians’ perspectives on palliative care for advanced liver diseaseCurrent Hepatology Reports; Nicholas Hoppmann, Susan Feldman, Aidan Warner; 6/25 Integration of PC [palliative care] services for patients with ALD [advanced liver disease] is complicated by an unpredictable disease course and lack of comprehensive understanding of PC services across healthcare systems. In our current early stage of integration, clinicians’ perspectives highlight two major steps forward on the path to robust PC integration including increasing medical education on PC broadly and within hepatology to dispel misconceptions and provide skills to deliver primary PC as well as increasing collaboration between hepatology and specialty PC tailored to fit individual practice settings.Assitant editor's note: Perhaps the unpredictability of advanced liver disease is exactly why palliative care could be helpful. This may serve as a fruitful opportunity for PC programs to educate hepatologists. 

Re-examining early in early palliative care: Precedent, reality, and future research prioritiesJCO Oncology Practice; by Laura A. Petrillo, Julia L. Agne; 6/25Nearly 700,000 people in the United States are living with metastatic solid tumor malignancies in 2025, a number that continues to grow because of advances in survival-extending therapy. Even with therapeutic advances, however, metastatic cancer continues to negatively affect patients' quality of life because of bothersome symptoms and psychological, social, and spiritual distress. Palliative care is specialized medical care focused on alleviating suffering for individuals with serious illness, including those with advanced cancer. On the basis of on substantial evidence demonstrating its efficacy in improving quality of life, ASCO and other organizations now recommend the early integration of palliative care with oncology care for all individuals living with advanced cancer. [Also see accompanying article: Early Integration of Outpatient Palliative Care Among Adults With Advanced Cancer in a Safety-Net Health System: A Patterns of Care Analysis; by Lisa DiMartino, Vincent Merrill, Celette Sugg Skinner, Timothy P. Hogan, Navid Sadeghi, Alva Roche-Green, Winnie Wang, Arthur S. Hong]

My one wild and precious life—The purpose of medical careJournal of Pain and Symptom Management; by Abinav K. Jyotis; 7/25“My One Wild and Precious Life - The Purpose of Medical Care”, contains reflections of a medical student as a naive little boy, inspired by his late grandfather, pinning to becoming a physician, who later struggles to find purpose in the unidealistic world of the current healthcare system. But, through his exposure to “Pallium India”, a non-profit palliative care organization in Kerala, India, healthcare once more gains meaning and signifies the importance of love and care amidst a patient's journey through pain and suffering.

NIH grant funding losses, by stateBecker's Hospital Review; by Mackenzie Bean; 6/19/25National Institutes of Health grant terminations have hit some states dramatically harder than others, with just three accounting for more than two-thirds of all rescinded funding this year, according to a June 17 report from Grant Watch... Massachusetts, New York and North Carolina absorbed more than 68% of these cuts, driven by significant funding losses at prominent research institutions such as Boston-based Harvard Medical School and Columbia University Health Sciences in New York City... Below is a state-by-state breakdown of NIH grant funding losses, offering a snapshot of where grant terminations are being felt the most.

Palliative care in liver transplantationCurrent Transplantation Reports; Michelle Ng, Elliot Tapper; 5/25 Palliative care is an underutilized resource due to the misconception that being a liver transplant candidate precludes patients from accessing these services. However, early integration of palliative care has become increasingly important for both pre- and post-liver transplant patients as it not only improves patient outcomes, but also promotes quality of life that extends beyond graft or patient survival. We discuss strategies to manage pain, ascites, hepatic encephalopathy, pruritis, muscle cramps, sexual dysfunction, depression, anxiety, insomnia, and malnutrition. These symptoms are best addressed with a multi-modal approach with non-pharmacologic therapies as an adjunct. 

Caring beyond cure-Perspectives of pediatric oncology nurses on end-of-life careJournal of Hospice & Palliative Nursing ; Scarperi, Peter BSN, RN; MacKenzie Greenle, Meredith PhD, RN, ANP-BC, CNE; June, 2025In a sample of nursing students and nurses working in pediatric oncology, this mixed-methods study aimed to describe attitudes toward and experiences of providing end-of-life care and examine the relationship between education, work experience, and attitudes. Overall, participants held positive attitudes toward end-of-life care, with staff nurses more positive than student nurses. All participants had provided end-of-life care, yet only 2 (5.41%) thought their education thus far prepared them. Age, education, experience, and burnout were associated with attitudes toward providing end-of-life care. Qualitative themes included challenges of preparedness and training, the nurse’s role, and parent team barriers. Training in pediatric end-of-life care is crucial to improve nurses’ comfort with providing this care.

Examining education models for clinical staff working with people with intellectual and developmental disabilities in hospice and palliative care: A narrative literature reviewAmerican Journal of Hospice and Palliative Care; Caitlyn M Moore; 5/25Despite individuals with intellectual and developmental disabilities (IDD) living longer with serious illness, healthcare professionals report inadequate training in this area. Additionally, IDD specialists consistently express discomfort and limited knowledge regarding HAPC [hospice and palliative care]. Findings indicate that while several studies demonstrate positive outcomes regarding knowledge, self-efficacy, and satisfaction among participants, there is a lack of standardized training and patient-centered metrics. Existing interventions largely focused on improving the knowledge of IDD staff regarding HAPC, with limited attention given to educating HAPC professionals on the nuances and complexities needs of people with IDD. This review underscores the importance of developing and implementing evidence-based and standardized training programs that encompass the needs of both HAPC and IDD specialists.

Cocota's story: Life lessons in aging, resilience, and end-of-life agency from a Brazilian matriarchJournal of the American Geriatrics Society; Thiago J Avelino-Silva, Niousha Moini; 6/25In Cocota's case, a hip fracture in her 80s did not lead to permanent disability; rather, she reclaimed her daily routines, demonstrating the interplay between physical robustness and unwavering determination. Equally telling was her decision to "stop eating and drinking" near life's end, exemplifying resilience as a final expression of agency. We further explore how her experiences align with deeper forms of well-being, marked by purpose and prosocial behavior, and practical wisdom, including emotional regulation and sound moral judgment. By examining her life journey, clinicians and community partners can better appreciate how resilience spans physical, cognitive, psychosocial, and spiritual domains, ultimately guiding more integrated strategies to support older adults. The lessons learned have direct relevance for clinical interventions, community programs, and public health initiatives aimed at fostering autonomy and meaningful engagement in later life.

Evaluation of reporting of race and ethnicity in hospice and palliative care researchJournal of Palliative Medicine; Kimberly S Johnson, Karen Bullock, Cardinale B Smith, Deborah B Ejem, Nadine J Barrett, A'mie Preston, Kenisha Bethea, Marisette Hasan, Ramona L Rhodes; 5/25The disproportionate impact of the COVID-19 pandemic on marginalized communities due to structural racism has led to an increased focus on diversity, equity, and inclusion in medical literature. Among the eligible articles reviewed, there were 48 unique racial and ethnic categories [and] the most common groups specified were White (N = 77), Black (N = 52), and Hispanic/Latino (N = 36). Over half of articles (n = 53, 60.2%) combined minoritized groups into a nonspecific category (e.g., "other"), and 30 (34.1%) articles specified White populations alone or White populations with a nonspecific category for other groups. Seventeen (19.3%) articles included over 90% White participants, and only 3 (3.4%) articles had a minority health or health disparity focus. In this review of high impact, practice changing articles, the lack of appropriate representation of minoritized racial and ethnic groups, frequent use of non-standard categories to describe race and ethnicity, and the small number of articles focused on health disparities raise concerns about the generalizability of research findings, equity in research processes, and attention to populations that experience disparities in palliative care outcomes.

Integrating psychotherapeutic concepts to enhance serious illness communication: Assessment of a model curriculumJournal of Palliative Medicine; Danielle Chammas, Keri Brenner, Amanda Moment, Sarah E. Byrne-Martelli, Leah B. Rosenberg, Daniel Shalev; 5/25 Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. Using Kern’s six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. Results: Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. Conclusions: A multisite, half-day workshop significantly enhanced palliative care clinicians’ knowledge and perceived application of core psychotherapeutic concepts.