Literature Review

Hospice enrollment in young adult LGBTQ + decedents with cancer: A multi-site single healthcare system studyBMC Palliative Care; by Sanjna Rajput, Riham Suleiman, Brittany Kimball, Aminah Jatoi, Elizabeth Cathcart-Rake; 11/25Methods [of the study]: A single healthcare system, 4000 + self-reported LGBTQ + database of patients with cancer identified young adult decedents (18-39 years old at death) to report the percentage who died with hospice, the conversations that preceded hospice enrollment, time-on-hospice, and circumstances that surrounded the deaths of those not enrolled. From the database, ... 67% ... were enrolled in hospice ... Conversations that preceded enrollment discussed (1) limited cancer therapeutic options with worsening end-of-life symptoms and how hospice could help ("discussed… decline and how patient would not want to die hooked up to machines"); (2) medical staff's acknowledgement of same sex spouse/life partners ("[She] is here with her wife"); (3) the inclusion of the birth family in end-of-life discussions, especially if the decedent had been single ("Her father met us… this was difficult news for him to hear.").  Conclusions: Most young adult LGBTQ + decedents with cancer receive hospice services with thoughtful and inclusive conversations that precede enrollment.

Hospice and palliative medicine fellows' perspectives on physician-assisted dying education: Hospice and palliative medicine fellows' perspectives on physician-assisted dyingJournal of Pain and Symptom Management; by James Cescon, Antoinette Esce, Melanie Koren, Edith Meyerson, Mollie A Biewald, Robert M Arnold, Anup Bharani, Laura Belland; 11/25Physician-Assisted Dying (PAD) is legal in a growing number of U.S. states, with access expanding nationally due to recent legislative changes. An anonymous nine-item survey was sent to all HPM fellows (N=21) at the Icahn School of Medicine at Mount Sinai. All respondents agreed that learning about PAD in fellowship is important. Topics of interest included ethical considerations (95%), legal criteria (86%), responding to requests in serious illness conversations (86%), navigating requests (76%), and pharmacology/modes of ingestion (71%). While only 10% intended to provide PAD in future practice, 57% were unsure or had not thought about it, and 33% were not considering it. These findings underscore a clear educational need and may guide curriculum development.

Software as a medical practitioner—Is it time to license artificial intelligence?JAMA Internal Medicine; by Eric Bressman, Carmel Shachar, Ariel D. Stern, Ateev Mehrotra; 11/25The Healthy Technology Act of 2025, a bill being considered by Congress, would permit artificial intelligence (AI) systems to prescribe medications without human sign-off. While allowing AI to practice independently may still be a stretch, large language models are already being used to support diagnosis and treatment. These applications challenge the current regulatory framework for clinical AI, which has focused on software as a medical device (SaMD). The US Food and Drug Administration (FDA) has cleared more than 1000 AI tools using this framework, mostly for narrow, well-defined tasks. However, generative models can be applied across domains, straining the SaMD framework. In this Viewpoint, we explore the application of a licensure paradigm to clinical AI systems, arguing that this offers a more reliable regulatory framework.

Navigating loss: An in-depth exploration of grief and spiritual resilience in Hispanic and Latino culturesUrban Social Work; by Angelica Olivo; 11/25This was a phenomenological study that highlighted how culture, spirituality, and coping mechanisms influenced Hispanic and Latino community grief.  ... [The study] identified themes on death beliefs, traditional grieving practices, cultural taboos, family roles, and religious faith, providing rich data on cultural and spiritual factors in grief. The themes that emerged from the analysis were related to death beliefs, traditional grieving practices, cultural taboos, family roles, and religious faith. Findings supported a second line of evidence that diverse subgroups and the longitudinal grief experience may better inform understandings of, and improve cultural competency in, bereavement support.

Home Health Aides caring for adults with heart failure-A pilot randomized clinical trialJAMA Network Open; by Madeline R. Sterling, Cisco G. Espinosa, Sasha Vergez, Margaret V. McDonald, Joanna Ringel, Jonathan N. Tobin, Samprit Banerjee, Nicola Dell, Lisa M. Kern, Monika M. Safford; 11/25Objective: To examine the effectiveness of an education- and communication-based intervention among HHAs caring for patients with HF.  In this pilot randomized clinical trial including 102 agency-employed HHAs randomized to training alone or in addition to an application that allowed HHAs to exchange text messages with nurse supervisors, training improved HHAs’ HF knowledge and HF caregiving self-efficacy. The addition of the application did not improve these primary outcomes, but it significantly reduced HHAs’ self-reported preventable 911 calls, a secondary outcome.

Validation of a claims-based algorithm for specialist palliative care delivery in metastatic cancerJournal of Pain and Symptom Management; by May Hua, Zhixin Yang, Ling Guo, J Brian Cassel, R Sean Morrison, Guohua Li; 11/25The lack of valid methods to identify specialist palliative care (PC) delivery in population-level data impedes comprehensive understanding of its use... We developed a claims-based algorithm to identify specialist PC, using a physician billing claim from a known PC clinician as the gold standard, retaining candidate variables with a positive predictive value (PPV) >60%... A simple algorithm can identify receipt of specialist PC care in Medicare claims for patients with metastatic cancer with reasonable accuracy.Publisher's Note: While this is a statistically sophisticated article, findings support use of the palliative care provider specialty code (Provider Specialty Code 17) and encounter for palliative care code (ICD-10 Z51.5) to identify specialist palliative care delivery in a specific population (Medicare beneficiaries with metastatic cancer claims).

Managing competing interests between appointed surrogates and extended family in end-of-life care available to purchaseAmerican Academy of Pediatrics; by Derek R. Soled, Elizabeth Lanphier, Ianthe R.M. Schepel, Maya Scott; 11/25This Ethics Rounds article brings together perspectives from a clinical ethicist, 2 resident physicians in pediatrics, and a social worker on a case involving a terminally ill, intubated, and sedated young adult patient whose health care proxy, extended family, and health care team disagree on the course of her care. Although the proxy, the patient’s adult sister, seems to agree in principle with the health care team’s recommendation to withdraw life-sustaining treatment, she is unwilling to consent to withdrawal due to perceived pressure from her extended family. From an ethics perspective, we discuss the concept of the “marginalized decision-maker” and how to blend the “best interests” approach from pediatric medicine with the “substituted judgment” standard applied in adult medicine when making decisions for incapacitated young adult patients. From a clinical perspective, we explore features of this case that may contribute to feelings of moral distress within the medical team, identify best practices for leading team and family meetings to avoid values imposition and promote shared decision-making, and argue for the importance of training physicians in clinical ethics and reflective skills to improve the quality of patient care and reduce experiences of moral distress in the workplace. Finally, we explore the role that family dynamics, families’ culture and values, and past experiences in the health care system can play in shared decision-making conversations.

Perceived value of transfusion access and hospice services among patients with blood cancersJAMA Network Open; by Hari S. Raman, Angel M. Cronin, Scott F. Huntington, Hajime Uno, Caitlin Brennan, Susan Lysaght Hurley, Anna Tidswell, Richard M. Kaufman, Sarah M. Lanahan,  Kimberly S. Johnson, James A. Tulsky, Gregory A. Abel, Oreofe O. Odejide; 11/25In this survey study, our analysis suggests that for many patients with advanced hematologic cancers, the ability to maintain access to blood transfusions is the primary factor in deciding whether to enroll in hospice. Given that the majority of hospices in the US do not provide transfusion access, patients with blood cancers are faced with the impossible choice of preserving access to palliative transfusions vs accessing quality home-based hospice care. This dichotomy between transfusion access and hospice care may contribute to the low rate of hospice use in this population. Our findings underscore the need to develop and test novel hospice delivery models that combine palliative transfusions with routine hospice services to effectively alleviate discomfort and optimize the QOL [quality of life] of patients with blood cancers near the EOL [end of life].Assistant Editor's note: In the calendar year 2024 data from Medicare Hospice claims indicate that only 3.0% of beneficiaries had a blood cancer diagnosis, per Hospice Analytics. This article suggests some great ideas about how hospice can address the expense of blood transfusions with CMS. But until that happens, hospices could consider approaching their local transfusion center about a contract for a reduced price for blood transfusions for patients in need. Ultimately, this will benefit the hospice, the transfusion center (potentially more patients), and most importantly, the patient.