Literature Review

Antibiotics at end of life: Where are we now and where are we going? A narrative reviewAmerican Journal of Hospice and Palliative Medicine; by Patrick D Crowley, Francis X Whalen, Leslie R Siegel, Douglas W Challener; 8/25Antibiotics are frequently prescribed at the end of life, though the benefits and harms are not well understood. Prescribing practices vary based on individual situation and geographic location. Patients with cancer and those hospitalized receive more antibiotics than those enrolled in outpatient hospice. Urinary tract infections and pulmonary infections are the most common conditions treated with antibiotics at the end of life -most often with penicillin derivatives and vancomycin in the hospital, fluoroquinolones in outpatient, and cephalosporins in both settings. When asked, patients most often prefer limiting antibiotics to symptom management at the end of life. Physicians’ over-estimation of patient preference for antibiotics and the increased probability of misdiagnosis increases antibiotic prescription rates. Antibiotics can improve symptoms when used for specific diseases at the cost of drug reactions, resistant organisms, and delayed discharge. Antibiotic use has variable results on survival duration.

Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settingsJournal of Palliative Care; Mona Ibrahim Hebeshy, PhD, RN; Darcy Copeland, PhD, RN; 6/25With the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. [Conclusions:] Nurses generally feel competent; however, they often lack confidence in addressing patients’ social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.

Fireproofing the soul: Navigating fear of the afterlife among palliative care patientsJournal of Palliative Medicine; Ptr Shannon Blower, Jonathan Walker, Lucius Walker, Steven Radwany; 6/25Among palliative care patients, spiritual uncertainty about what may await them after death is a fairly common but often overlooked source of anxiety. Specifically, patients (especially those from orthodox Christian backgrounds that propound the concept of hell as a literal place) may harbor unexpressed fears about being consigned to hell due to the perceived sins they have committed in life. Such fears can be genuinely debilitating and may result in non-responsiveness to traditional palliative therapy. Here, we discuss our experiences with this phenomenon and propose some possible solutions. We offer readers suggestions for how to best identify potential sufferers, broach the subject with such patients, and reassure them.

Medicare Advantage plan disenrollment: Beneficiaries cite access, cost, and quality among reasons for leavingHealth Affairs; by Geoffrey J. Hoffman, Lianlian Lei, Ishrat Alam, Myra Kim, Lillian Min, Zhaohui Fan, Deborah Levine; 6/25Medicare Advantage (MA) is growing in popularity, but it is seeing substantial plan disenrollments among high-risk Medicare beneficiaries. Understanding and addressing factors associated with disenrollment are crucial for improving MA access and quality but are complicated by data issues, including the inability to adequately assess beneficiaries’ perceptions of access and quality in MA... Difficulty accessing needed medical care was more strongly associated with MA-to–traditional Medicare exits than MA-to-MA plan switching. Dissatisfaction with access, cost, and quality was much more common for enrollees in poor health. These findings renew concerns about access to high-quality care for high-risk and other MA enrollees.

Strengths and opportunities: Clinicians' perspectives on palliative care for Amyotrophic Lateral Sclerosis (ALS) in the United StatesMuscle & Nerve; Kara E Bischoff, Gayle Kojimoto, David L O'Riordan, Yaowaree L Leavell, Samuel Maiser, Astrid Grouls, Alexander K Smith, Steven Z Pantilat, Benzi M Kluger, Ambereen K Mehta; 6/25Half of ALS clinicians [surveyed] reported they are able to manage patients' pain (55%) and mood symptoms (52%) "very well." Fewer reported managing care partner needs (43%) and spiritual/existential distress (29%) "very well." Fifty-eight percent of pALS [people with ALS] are referred to outpatient PC and 69% to hospice at some point in the illness. ALS clinicians generally felt satisfied with PC teams' care, but PC clinicians were less confident managing motor symptoms (51% confident) and helping care partners understand how to provide care (51%) and use equipment (25%). Most clinicians felt the quality of PC provided by ALS (77%) and PC (90%) teams is good/excellent. However, qualitative comments highlighted that both ALS and PC clinicians have knowledge gaps, and collaboration between ALS and PC clinicians should increase.

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.