Literature Review

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.

Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysisThe American Journal of Emergency Medicine; by Satheesh Gunaga, Abe Al-Hage, Alyssa Buchheister, Harish Neelam, Jessica Corcoran, Michael Welchans, Kirby Swan, Mahmoud Awada, Joseph Miller, Fabrice Mowbray; 8/25Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. A total of 8,055 HPC consults were ordered for 6,370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1,355 in 2023 (367 % increase ... ). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023.

The Faith Care Family Project: A pilot intervention for African American dementia family caregiversAmerican Journal of Alzheimer's Disease and Other Dementias; Noelle L Fields, Ling Xu, Ishan C Williams, Fayron Epps, Samantha Tinker; 8/25The Faith Care Family (FCF) Project was a telephone based, volunteer-led intervention for African American Alzheimer’s disease and related dementias (AD/ADRD) family caregivers that was piloted in one predominantly African American church. Church volunteers indicated overall significant improvements knowledge of AD/ADRD after the training as well as after the intervention. Quantitative results indicated that caregivers increased their knowledge of dementia, reported improved coping skills, and reported increased positive aspects of caregiving. Feeling a connection, normalizing the challenges of caregiving, gaining or reinforcing knowledge, and sharing community resources were themes from qualitative interviews with the family caregivers.

Proportional sedation for persistent agitated delirium in palliative care-A randomized clinical trialJAMA Oncology; David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing Chen, Patricia Bramati, Sanjay Shete, Eduardo Bruera; 7/25Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. 

Research study participation, 8/23/25

Standardized assessment of patient experience in pediatric palliative care: A national collaborationJournal of Pain & Symptom Management; by Ashley K Autrey, Stacey Rifkin-Zenenberg, Tracy Hills, Jennifer Salant, Rachna May, Elliot Rabinowitz, Chelsea Heneghan, Laura Drach, Emma Jones, Rachel Thienprayoon; 7/25Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC [pediatric palliative care] services. Results: Patients/ families felt heard and understood and would recommend PPC. Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.

Social relationships and end-of-life quality among older adults in the United States: The impacts of marital, kinship, and network ties The Journals of Gerontology; by Kafayat Mahmoud, Deborah Carr; 7/25We examine marital status differences in recent decedents’ end-of-life care and gender differences therein, and the role of other social ties (children, siblings, network members) in influencing the quality of end-of-life care. Divorced decedents fared poorly on multiple outcomes, being less likely than married or widowed persons to receive excellent care and to have personal care needs met. Divorced and widowed decedents were less likely to receive respectful treatment relative to married decedents. We found no significant gender differences in these patterns. Persons with more siblings and network members had superior pain management. Hospital patient advocates could also aid those who lack close kin at the end of life.

Do not resuscitate (DNR) emergency medical services (EMS) protocol variation in the United StatesThe American Journal of Emergency Medicine; by Amelia M Breyre, E Jane Merkle-Scotland, David H Yang, Kenneth Hanson, Sameer Jagani, Abe Tolkoff, Satheesh Gunaga; 7/25Do Not Resuscitate (DNR) orders are essential for ensuring that critically ill patients receive care from Emergency Medical Service (EMS) aligned with their preferences. However, significant variations exist in EMS protocols regarding acceptable DNR documentation leading to discordant care, moral distress, and ethical dilemmas. Although most EMS protocols have dedicated DNR protocols, this is not universal and there is significant variability in types of documentation recognized as valid. Documentation that is concise, portable, and designed for EMS use, such as the POLST is preferred. Assistant Editor's note: It is this variability in protocols that personally scares many of us who work in the EOL field. It is not uncommon to hear a hospice/palliative worker joke that they want a "DNR tatoo on their chest"! Perhaps it would be easier (and less painful) to continue to promote POLST, or something similar, in each of our respective workplaces.

Issues in developing multilingual graphics-based digital caregiver guides for dementia careDiscourse, Context & Media; by Boyd H. Davis, Margaret Maclagan, Meredith Troutman-Jordan; 8/25To increase the opportunity to educate caregivers for persons with dementia, particularly the nearly 40% of migrant healthcare workers emigrating to the US, we have chosen an adaptation of graphic medicine as a means of presenting these workers with conversations about dementia care in two formats of ‘mini-comics’: photo-based and cartoon. Our graphic Caregiver Guides are a form of mediated digital discourse that incorporate both words and pictures, and thereby support caregivers as they draw immediately useful guidance from online materials when offering daily off-line care. Each guide covers a situation that occurs commonly as caregivers care for people living with dementia.