Literature Review

Reconsidering neuraxial analgesia at end of life: Clinical, ethical, and socioeconomic perspectivesInterventional Pain Medicine; Sanjeet Narang , Jason Yong , David Hao, 9/25Pain is one of the most prevalent and distressing symptoms experienced by patients nearing end of life, particularly among those with cancer. While systemic opioids are the mainstay of treatment, their limitations necessitate consideration of alternative strategies. Neuraxial analgesia, including epidural and intrathecal drug delivery systems, offers targeted pain relief with reduced systemic burden. Yet despite supportive data, these interventions remain underutilized due to clinical, ethical, logistical, and socioeconomic barriers. This article examines the complex decision-making involved in offering neuraxial analgesia at the end of life, weighing risks and benefits, shifting patient goals, and the challenges of care coordination.

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. 

What do physicians want at the end? An international qualitative study on physicians’ personal end-of-life preferences and what influences them Palliative Care and Social Practice; by Sarah Mroz, Frederick Daenen, Sigrid Dierickx, Freddy Mortier, Ludovica De Panfilis, Luca Ghirotto, Toby Campbell, Kenneth Chambaere, and Luc Deliens; 7/4/25 Research Results: ... Most physicians prefer to avoid aggressive and life-prolonging treatment, physical and mental suffering, and being a burden. They prioritize being in a peaceful environment and communication with loved ones. Various factors influence preferences including cultural, social, and religious beliefs, and legislative environment, but most significant are the deaths of loved ones and clinical practice. Death and dying become normalized the more they are reflected upon and discussed, and this process can also provide personal growth which helps physicians provide better care to patients and families.

Advance care planning in Hispanic populations with Parkinson’s Disease: Investigating disparities in end-of life careClinical Parkinsonism & Related Disorders; by Taylor Peabody, Monica Abou-Ezzi, Lucila Hernandez, Henry Moore, Silvia Vargas-Parra, Alberto Cruz, Danielle S. Shpiner; 8/25ACP [advance care planning] is a topic of increasingly recognized importance among the PD [Parkinson's disease] research and patient communities. Despite evidence that many people with PD across ethnic groups consider this topic important, our study showed that Hispanic people with PD may have less access and experience with this aspect of care. These findings represent an important area for future study, so that all people with PD can benefit from the opportunity to participate in ACP if in alignment with their goals of care.

Palliative care needs of older adults with and without dementia during post-acute care in skilled nursing facilitiesJournal of Applied Gerontology; by Joan G Carpenter, Elisha Oduro, Nancy Hodgson, Shijun Zhu, Merve Gurlu, Mary Ersek, Laura C Hanson; 8/25Seriously ill older adults, including those living with Alzheimer’s disease and related dementias (ADRD), often receive disease-focused rehabilitative care in skilled nursing facilities (SNF) with little consideration for their palliative care (PC) needs. Using baseline data from a pilot pragmatic clinical trial (N=52), we conducted a cross-sectional study to compare the clinical characteristics and the PC needs of older adults with and without ADRD receiving SNF care. Functional decline was the most common global indicator for palliative care among both groups. While there was no statistically significant difference in PC needs between the two groups, the most prevalent PC needs for all were pain (63.5%), feeling anxious or worried (59.6%), family and friends being anxious or worried (57.7%), and need for information (46.2%). Older adults with and without an ADRD diagnosis who are admitted to post-acute SNF care may benefit from universal screening and tailored PC services.

Top ten tips palliative care clinicians should know about the future of generative intelligenceJournal of Palliative Medicine; by Pragat Patel, Raj Patel, Gilad Kuperman, Monica Consolandi, David Collett, Shunichi Nakagawa, Nicolas Burry, Karl B Bezak, Jake Strand, Mihir Kamdar, Judith E Nelson, William E Rosa, Craig D Blinderman; 8/25Artificial intelligence (AI) is transforming health care and has implications for palliative care (PC) and serious illness communication (SIC). This article integrates interdisciplinary and interprofessional expertise, providing key tips for PC clinicians to best leverage AI-driven tools to enhance PC practices, care efficiency, and patient- and family-centered outcomes. AI-driven tools range from predictive analytics to improve intervention delivery to AI-assisted communication and documentation of goals of care. Beyond these potential benefits are important ethical, logistical, and equity considerations that must be carefully addressed.

Research study participation, 8/23/25

Ethical obligations to inform patients about use of AI toolsJAMA; by Michelle M. Mello, Danton Char, Sonnet H. Xu2; 7/25When a health care organization decides to deploy an AI tool, it should decide whether notification or consent is ethically required. To decide that disclosure is not required at the point of care is not to conclude that organizations have no transparency obligations concerning their use of AI. Two complementary steps can help discharge these obligations. First, health care organizations’ websites and written materials distributed to patients should explain how the organization uses AI to deliver better, safer, more efficient care and protect staff well-being. This kind of transparency honors patients’ desire to know how their care may be affected by AI and may help some make decisions about where to seek care. 

Improved outcomes and cost with palliative care in the Emergency Department: Case-control studyThe Western Journal of Emergency Medicine; Brandon Chalfin, Spencer M Salazar, Regina Laico, Susan Hughes, Patrick J Macmillan; 7/25This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted ... In addition, more cases than controls had a code status of comfort care at discharge ... These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.

Behavioral symptoms in patients with dementia are associated with care partner abusive behaviorsJournal of Elder Abuse & Neglect; by Emily LeRolland, Francesca Falzarano, Karen L. Siedlecki; 8/25Abuse of older adults with dementia is an increasingly prevalent public health concern in the United States. The current study examined whether care recipient behavioral symptoms (e.g. aggressive or agitated behaviors) predicted abusive behaviors by care partners. Results indicate that most participants reported engaging in at least one abusive behavior toward their care recipient. Behavioral symptoms in care recipients were a significant predictor of abusive behavior perpetrated by the care partner, even after controlling for a large number of covariates. Care partner depressive symptoms significantly mediated the relationship between care recipient behavioral symptoms and care partner abusive behavior. Our results suggest that physician screening for depression in care partners and referral to appropriate resources may be one avenue for decreasing the risk of abuse toward care recipients. 

Clinician and caregiver perspectives on managing dementia behaviors in hospiceMedpage Today; by Elethia W. Tillman; 7/25New research reveals a gap in training and resources for managing behavioral and psychological symptoms of dementia (BPSD) in hospice settings, impacting both patient well-being and caregiver burden. Key points include:

"It may cost you your money, it costs you your life": A framework for financial hardship in dementiaGerontologist; by Krista L Harrison, Emily R Adrion, Juliana Friend, Sarah B Garrett, Madina Halim, Michael Terranova, Alissa B Sideman, Nicole D Boyd, Georges Naasan, Joni Gilissen, Pei Chen, Melissa D Aldridge, Daniel Dohan, Michael D Geschwind, Alexander K Smith, Christine S Ritchie; 7/25Care for persons with dementia costs ∼ $500 billion annually in the United States. Few qualitative studies or conceptual frameworks of the financial experiences of people impacted by dementia exist. This study examined how patients and caregivers impacted by different types of dementia and at different points in the disease journey described financial issues within a palliative care context... Even in a well-resourced population, the financial toll of dementia can be substantial. The Direct-Emotional-Logistical framework of dementia financial hardship can be used to assess financial impacts in palliative care settings.

Research Institute for Home Care and National Alliance for Care at Home ink affiliation agreement National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 8/20/25 The Research Institute for Home Care (the Institute) and the National Alliance for Care at Home (the Alliance) have entered into an affiliation agreement to strengthen and expand research efforts while further unifying the care at home movement. The agreement is effective immediately. ... With this affiliation, the Institute will remain an independent research organization, ... The Institute’s Board of Directors will continue to independently oversee its research agenda and initiatives. The Alliance will provide comprehensive management support for the Institute’s operations. At the launch of the affiliation, Dr. Steve Landers, CEO of the Alliance, will also serve as the President of the Institute. Jennifer Schiller, the former Executive Director of the Institute, has joined the Alliance leadership team and will continue to support Institute initiatives along with other Alliance leaders. Jennifer Sheets, Founder and CEO of Carezzi, will remain the Board Chairman of the Institute.