Literature Review

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.

Estimating the predictability of questionable open-access journalsScience Advances; by Han Zhuang, Lizhen Liang, Daniel E. Acuna; 8/25Questionable journals threaten global research integrity, yet manual vetting can be slow and inflexible. Here, we explore the potential of artificial intelligence (AI) to systematically identify such venues by analyzing website design, content, and publication metadata. Evaluated against extensive human-annotated datasets, our method achieves practical accuracy and uncovers previously overlooked indicators of journal legitimacy... Our study defines “questionable open-access journals” as journals violating the best practices outlined by the Directory of Open Access Journals (DOAJ) and showing indicators of low editorial standards.Publisher's note: The authors use AI to evaluate open-access journals adherence to best publishing practices - an interesting use of AI that could be applied to many other settings. The list of open-access journals can be found here.

Understanding trauma in the context of direct care work in nursing homesJournal of Applied Gerontology; by Alfred Boakye, Jennifer Craft Morgan, Candace L. Kemp, Antonius D. Skipper; 8/25Direct care workers (DCWs) experience job quality challenges such as heavy workload, low pay, and few benefits. Layered risks such as the COVID-19 pandemic and systemic racism have impacted DCWs, made them more vulnerable, and increased turnover and the precarity of the long-term care system and residents’ care. Findings suggest that DCWs are often crippled with challenges stemming from the impact of COVID-19, work-related factors, and personal factors. Understanding the intersection of trauma provides a detailed contextual description of care work, which is important for developing practical coping strategies, either at the personal or organizational levels, and developing more refined trauma-informed initiatives to build resilience and support DCWs.

A digital therapeutic intervention for inpatients with elevated suicide risk: A randomized clinical trialJAMA Network; by Craig J. Bryan, Patricia Simon, Samuel T. Wilkinson, Michael H. Allen, Jeremiah Perez, Caleb Adler, Khatiya Moon, Lauren Astorino, Kristen M. Carpenter, Luke Misquitta, Katherine Brownlowe, Lauren R. Khazem, Jarrod Hay, Austin G. Starkey, Julia Tartaglia, Helena Winston, Scott Simpson, Alecia D. Dager, Seth Feuerstein; 8/25Does a smartphone-based digital therapeutic intervention designed to deliver suicide-focused cognitive behavior therapy (CBT) reduce future suicide attempts among patients hospitalized with acutely elevated suicide risk? In this randomized clinical trial of 339 inpatients in psychiatric hospitals, no difference was found in time to first actual suicide attempt between those who used the digital therapeutic intervention and those who used the control application. The digital therapeutic intervention did not impact time to first suicide attempt after discharge among patients admitted for suicidal ideation and/or suicide attempts.Publisher's note: As AI is studied in healthcare, it's interesting to explore both what works and what doesn't.

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Top ten tips palliative care clinicians should know about intensive care unit consultationJournal of Palliative Medicine; by Ankita Mehta, Karen Bullock, Jillian L. Gustin, Rachel A. Hadler, Judith E. Nelson, William E. Rosa, Jennifer B. Seaman, Shelley E. Varner-Perez, Douglas B. White; 8/25Critical illness and ICU stays can be extremely distressing for patients and their loved ones. Providing palliative care in the ICU, although a standard component of comprehensive care delivery, involves understanding the individual culture of each specific ICU, collaboration with multiple providers, and interfacing with surrogate decision makers while patients may not be able to communicate and are undergoing interventions that are unfamiliar to them and loved ones. These top ten tips aim to support palliative care clinicians providing consultation in ICUs. Specifically, these tips address initial relationship building with ICU clinicians and teams to foster effective collaboration, establishing goals of care by assessing health-related values, explaining treatment options, individualizing prognostic discussions, and managing end-of-life symptoms for patients while in the ICU and throughout ICU discharge transition.

Palliative care researchers use qualitative data to understand the full picture of patients' lives St. Jude Research; by Heather Johnson; 8/26/25 The central goal of palliative care is to provide comfort, relieve suffering and improve the quality of life for those dealing with serious illnesses. That care is interdisciplinary. It must be. Quality of life relates to physical, social, emotional, spiritual and psychological needs. Addressing those needs requires teamwork from physicians and clinicians in a range of disciplines. ... Palliative care studies often use mixed methods approaches to capture the full picture of what can be subjective outcomes. For example, scales and surveys may provide a foundation for assessing symptom relief, while qualitative research, such as patient interviews and focus groups, helps researchers understand the meaning behind the numbers.  Editor's Note: Yes. Measures for hospice and palliative success and growth are more than dollar amounts and the number of locations. Pairing qualitative research with quantitative data, researchers and leaders must seek to "understand the meaning behind the numbers." Ongoing, be sure to explore our newsletter's Saturday issues for relevant, timely evidence-based research articles--quantitive and qualitive data--to improve the care of persons who needing hospice and palliative care.

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.

Physician billing for advance care planning among Medicare fee-for-service beneficiaries, 2016-2021The Permanente Journal; by Nan Wang, Changchuan Jiang, Elizabeth Paulk, Tianci Wang, Xin Hu; 8/25In 2016, the Centers for Medicare & Medicaid Services started reimbursing practitioners for their time spent providing advance care planning (ACP) with patients. Results: The percentage of practitioners billing ACP visits tripled from 1.76% in 2016 to 4.56% in 2021, with the highest percentage among hospice and palliative medicine practitioners (36.94%) in 2021. ACP service volume was similar by metropolitan status for hospice and palliative medicine, but it was higher in nonmetropolitan regions for cancer-related specialties, non-cancer terminal disease specialties, and primary and geriatrics care. This nationwide analysis showed low adoption of ACP billing by 2021, and it varied widely across specialties. This may reflect practical challenges of ACP related to comfort level with ACP discussion and documentation burden among the professional communities.

AI in palliative care: A scoping review of foundational gaps and future directions for responsible innovationJournal of Pain and Symptom Management; by Selen Bozkurt, Soraya Fereydooni, Irem Kar, Catherine Diop Chalmers, Sharon L Leslie, Ravi Pathak, Anne M Walling, Charlotta Lindvall, Karl Lorenz, Ravi Parikh, Tammie Quest, Karleen Giannitrapani, Dio Kavalieratos; 8/25AI holds increasing promise for enhancing palliative care through applications in prognostication, symptom management, and decision support. However, the utilization of real-world data, the rigor of validation, and the transparency and reproducibility of these AI tools remain largely unexamined, posing critical considerations for their safe and ethical integration in sensitive end-of-life settings... AI in palliative care remains in early development, showing promise in areas such as prognosis and documentation support. However, limited validation, insufficient cross-site testing, and lack of transparency currently limit clinical applicability. Future research should emphasize external validation, inclusion of broader patient data, and adoption of open science practices to ensure these tools are reliable, safe, and trustworthy.

NIH publishes plan to drive Gold Standard ScienceNIH press release; Jay Bhattacharya, MD PhD, Director, NIH; 8/22/25I am pleased to announce the release of NIH’s new plan to promote gold standard science across all agency activities. Building on NIH’s longstanding commitment to scientific integrity, this forward-looking plan incorporates the nine, interlocking tenets of gold standard science adopted by the U.S. Government and aligns with the Department of Health and Human Services’ framework for achieving these principles... Gold Standard of Science is:

Supreme Court narrowly OKs NIH cutsBecker's Hospital Review; by Madeline Ashley; 8/22/25On Aug. 22, the U.S. Supreme Court allowed the Trump administration to move forward with broad cuts to National Institutes of Health grants connected to diversity, equity and inclusion policies, while leaving unresolved whether the policy itself was lawfully enacted, NBC News reported Aug. 21.Publisher's note: Some of our providers and researchers may be connected to some of these NIH grants...

Exploring virtual reality as an intervention to improve symptom severity in hospice-eligible patientsAmerican Journal of Hospice and Palliative Care; by Hannah Maciejewski, Kathryn Levy, Catherine M Mann, Suzanne S Sullivan, Gina Schuster, Christopher W Kerr; 7/25Virtual reality (VR) as an intervention has appeared in the literature and in clinical settings across many different populations. To expand the use of this care option, it is worth considering the ways in which a VR application may benefit individuals with life-limiting illness in hospice and palliative care settings. The incorporation of VR as a therapy option may aid in symptom management and support people nearing the end of life in focusing on aspects of their overall well-being.