Literature Review

Caregiver-reported barriers and facilitators to hospice enrollment for persons with dementia: A systematic review of qualitative evidencePalliative Medicine; by Oonjee Oh, Connie M Ulrich, Lauren Massimo, George Demiris; 7/25Despite the increasing prevalence of dementia, persons with dementia often receive suboptimal care near the end of life. Dementia caregivers experience intrapersonal, interpersonal, emotional, logistical, and physical challenges in ensuring quality end-of-life support for their loved one (e.g. limited understanding of end-stage dementia, gatekeeping providers, and family conflicts). The unique needs of caregivers caring for a seriously ill family member with dementia are not being fully addressed by the current available services and policies.

Palliative delays associated with increased length of stay in older traumatic brain injury patientsThe Journal of Trauma & Acute Care Surgery; by Sarah A Hatfield, Parima Safe, Cleo Siderides, Anjile An, Cassandra V Villegas, Nicole Goulet, Robert J Winchell, Elizabeth Gorman; 7/25Trauma Quality Improvement Program guidelines recommend early goals of care discussions (≤72 hours) for older patients with severe injuries. Patients (55 years or older) with moderate to severe TBI [traumatic brain injury] ... were retrospectively identified at a level I trauma center (2020-2022). Conclusions: Delayed PI [palliative intervention] is associated with increased LOS [length of stay] in older TBI patients, with no survival difference compared with early PI. Palliative interventions should be introduced early to reduce morbidity in patients with potential poor prognosis.

End-of-life course and subspecialty palliative care involvement for children on mechanical circulatory support: Five-center retrospective cohort study from the United States, 2015–2020Pediatric Critical Care Medicine ; by Vazquez Colon, Zasha; Robinson, Lorelei; Lopez-Colon, Dalia; Joong, Anna; Waldman, Elisha; Delgado-Corcoran, Claudia; May, Lindsay J.; Cousino, Melissa K.; Peng, David M.; Lukich, Stevan; Blume, Elizabeth D.; Machado, Desiree S.; M. Moynihan, Katie; 7/25Objectives: To characterize end-of-life (EOL) care and subspecialty palliative care (SPC) involvement in children with heart disease supported on mechanical circulatory support (MCS), including ventricular assist devices (VADs) and extracorporeal membrane oxygenation (ECMO). Most pediatric deaths after MCS occur soon after discontinuation of devices while receiving invasive therapies in ICUs. SPC teams were involved in less than half of the cases, with only 21% being consulted early. SPC was associated with more ACP [advance care planning] and less CPR at EOL.

End-of-life care planning among older Vietnamese and Filipino Americans: A qualitative analysisJournal of Gerontological Social Work; Carson M. De Fries, My Ngoc To, Peiyuan Zhang, Emerson Ea, Fei Sun, Bei Wu, Sue E. Levkoff, Kaipeng Wang; 7/25Racial and ethnic disparities in end-of-life (EOL) care planning persist, particularly due to limited knowledge of culturally sensitive practices among older Vietnamese and Filipino Americans – two of the largest Southeast Asian American subgroups. Thematic analysis ... revealed a shared belief in the importance of EOL care planning in both groups, driven by the desire to honor personal wishes, reduce burden on family, and minimize conflict. Participants also expressed distrust in healthcare systems and emphasized the influence of family dynamics on EOL decisions. Notable differences emerged: Vietnamese participants more often described cultural practices that encouraged open conversations about death, while Filipino participants cited cultural taboos that hindered such discussions.

Ethics of overtreatment and undertreatment in older adults with cancerBMC Medical Ethics; by Clark DuMontier, William Dale, Anna C. Revette, Jane Roberts, Ameya Sanyal, Neha Perumal, Eric C. Blackstone, Hajime Uno, Mary I. Whitehead, Lewis Mustian, Tammy T. Hshieh, Jane A. Driver, Gregory A. Abel; 7/25This modified Delphi study convened a panel of experts in biomedical ethics and reached consensus that the principles of beneficence, non-maleficence, and autonomy are related to our previously proposed definitions of over- and undertreatment in older adults with cancer. The panel also reached consensus that, in most cases, it is unethical to make a treatment recommendation without (1) formal assessment of patient frailty (e.g., via a geriatric assessment) and (2) the opportunity for a patient to share their values, goals, and/or preferences. The panel did not reach consensus regarding the relationship between justice and over-/undertreatment; however, the panel concluded that justice applies to undertreatment when an oncologist withholds potentially beneficial cancer treatment in an older patient based on their age alone.

Expanding the conceptualization of bereavement in the perinatal periodThe Journal of Obstetric, Gynecologic & Neonatal Nursing; by Rana Limbo, Natasha Nurse-Clarke; 7/25Contemporary definitions of perinatal loss encompass a range of involuntary and unintended pregnancy outcomes, including miscarriage (loss of pregnancy before 20 weeks gestation; Mayo Clinic, 2023), ectopic pregnancy (fertilized egg implanted outside the uterus), stillbirth (the birth of a fetus who shows no signs of life at or after 20 weeks gestation; Gregory et al., 2022), and neonatal death (the death of a live-born fetus within the first 28 days of life; National Center for Health Statistics, 2024). The loss of a pregnancy or fetus or the death of a newborn is an event, and perinatal bereavement is the emotional response to that event. The need for perinatal palliative care, which refers to care provided to families who receive a life-limiting fetal diagnosis, has also emerged as a critical component in supporting families through these losses (Limbo & Wool, 2016).

Challenges in effective communication for end-of-life decision making in clinical practiceHospital Practice; by Anish Bhardwaj; 7/25Decisions on end-of-life (EOL) care are a complex process that involves multiple stakeholders including patients, their families, and healthcare providers. Myriad factors play a role in making these decisions, such as desires of the patient and surrogates, advance directives, the patient's health condition, expectations about the disease course and prognosis, metaphysical beliefs about life and death, spiritual and socio-cultural backgrounds and views, quality of life considerations, legal connotations, costs of care, and nuances surrounding organ donation and procurement. This treatise utilizes three real-life examples to highlight the complexity and debate surrounding these decisions, especially in terms of interface of medicine and legal process, especially when a patient is in coma or a vegetative state and decisions transfer to surrogates. 

Evaluating the role of palliative care in emergency department opioid use among advanced cancer patientsSupportive Care in Cancer; by Joel Nortey, Shiyun Zhu, Andrew Lynch, Hannah Whitehead, Nirmala Ramalingam, Raymond Liu; 7/25 Patients with advanced cancer often experience severe symptoms that significantly impact their quality of life, leading to frequent emergency department [ED] visits for pain management. These visits not only diminish patient quality of life, but also impose substantial costs on the healthcare system. Our study highlights the significant role that PC can play in reducing ED utilization for pain management needs among advanced cancer patients, improving quality of life and alleviating healthcare burdens.

Telemedicine special registrations for controlled substancesJAMA Health Forum; by Jacob T. Kannarkat, John Torous, Joseph T. Kannarkat; 7/25Since the COVID-19 pandemic, the requirement for in-person evaluation of patients prior to the prescribing of controlled substances via telehealth, as established by the Ryan Haight Online Pharmacy Consumer Protection Act (Ryan Haight Act), has remained provisionally held. The Drug Enforcement Agency (DEA) previously proposed rulemaking to reintroduce the in-person patient evaluation requirement, as some unscrupulous clinicians and companies took advantage of this deregulated environment to overprescribe controlled substances. However, these flexibilities were extended through December 31, 2025, after the public voiced concerns over possible care disruptions in a landscape increasingly dependent on telehealth. Now, the DEA aims to compromise on prescribing flexibility with more practical enforcement measures.

Regional anesthesia for hip fracture surgery in older adults: A retrospective comparison of outcomes using ACS NSQIP dataGeriatric Orthopaedic Surgery & Rehabilitation; Arissa M. Torrie, MD, MHS; Gerard P. Slobogean, MD, MPH; Rachel Johnson, MD; Ron E. Samet, MD; Samuel M. Galvagno, DO, PhD; Robert V. O’Toole, MD; Nathan N. O’Hara, PhD, MHA; 6/25Surgical fixation of hip fractures in older adults is associated with significant morbidity and mortality. This study found that regional anesthesia, presumably using peripheral nerve block techniques, may offer advantages beyond pain control, with potential protective benefits in high-risk hip fracture patients. Future clinical trials should examine peripheral nerve block benefits beyond pain management, identify mechanisms of action, determine optimal techniques for different risk profiles, and assess long-term outcomes. By combining the insights from this study with carefully designed future research, researchers can work towards developing more effective, patient-centered approaches to anesthesia for older adults undergoing surgical fixation of hip fractures.

Hospital decision-making and adoption of health-related social needs programs in US hospitalsJAMA Network Open; by Dina Zein, Cory E. Cronin, Neeraj Puro, Berkeley Franz, Elizabeth McNeill, Ji E. Chang; 6/25In response to health disparities in the US, the Centers for Medicare & Medicaid Services (CMS) released a Framework for Health Equity recommending increased hospital commitment and leadership engagement around screening for health-related social needs (HRSNs). This cross-sectional study found that hospitals with multiple layers of management engagement tended to adopt multifaceted strategies that address patients’ social needs, which are critical components of health equity frameworks. Interestingly, hospitals where only senior management was involved were more likely to offer specific programs like food insecurity and transportation services, although these associations were generally smaller compared with when both senior and other management were engaged.

Simulating the overall hospital quality Star ratings with random measure weightsJAMA Network Open; Benjamin D. Pollock, PhD, MSPH; Daniel S. Ubl, MPH; Subashnie Devkaran, PhD; Sean C. Dowdy, MD; 7/25We found that only 244 US hospitals achieved reliable excellence in hospital quality in 2024 when defined as 90th percentile performance or better in at least 50.0% of 100,000 simulations using random weights for each measure in the CMS Overall Star Ratings. Our analysis highlights that there is meaningful variation in hospital quality performance across the spectrum of quality measures, even among 5-star hospitals. Future efforts to assess this variation may allow for better identification of reliably excellent hospitals, which could in turn lead to solicitation of evidence regarding the processes or cultures that separate reliable excellence from inconsistent greatness in hospital quality. 

Certified Child Life Specialists in hospice and palliative care organizations: A state of the professionAmerican Journal of Hospice and Palliative Medicine; by Jennifer Mangers-Deans, Alyssa Friedberg, Kimberly Downing, Lisa C. Lindley; 8/25Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.