Research study participation: NIH MAiD study recruitment
Personal communication; by Stacy Fischer, Dan Matlock; 4/22/25
We are Dr. Stacy Fischer and Dr. Dan Matlock, physicians at the University of Colorado Anschutz Medical Campus and co-principal investigators on a National Institutes of Health-funded study to understand the experiences of patients seriously considering medical aid in dying and their caregivers. Our multidisciplinary team includes geriatricians, bioethicists, and both quantitative and qualitative experts... Our goal is to recruit 300 patients and caregivers nationwide, and we would deeply appreciate your continued support in helping us connect with individuals who are seriously considering MAiD and their caregivers (e.g., those who have scheduled or completed their first MAiD consultation).

Identifying palliative care needs in heart failure patients with nurse-led screening 
Journal of Hospice & Palliative Nursing; by Christina Cantey, Yhaneek Douglas-Mattis, Jillian Lisiakowski, Caley Fowler, Deborah Ejem; 4/18/25 
... This quality improvement project aimed to improve the identification of unmet palliative care needs in patients with heart failure admitted to a progressive care unit by implementing a standardized nurse-administered palliative care screening tool. ... Implementing a nurse-administered screening tool effectively identified unmet palliative care needs among patients with heart failure with reduced ejection fraction and NYHA III. Despite low rates of palliative consults, standardization using IPOS could increase screening, contribute to institutional triggering palliative consultations, and improve awareness of unmet needs.

Location of terminal care in pulmonary hypertension
CJC Open; by Ramzi Ibrahim, Adam Habib, April Olson, Farah Shrourou, Hoang Nhat Pham, Mahmoud Abdelnabi, Maryam Emami Neyestanak, Sabrina Soin, See-Wei Low, Bhupinder Natt, Mamas A. Mamas, Timothy Barry, Chadi Ayoub, Reza Arsanjani, Franz P. Rischard, Kwan Lee; 4/25
Palliative care services have seen an increase in utilization in recent years, yet this uptrend has not been observed uniformly across all groups. The recent decline in mortality within inpatient facilities, despite the persistently high mortality rates of PH [pulmonary hypertension], depicts better coordinated patient-centered care, including hospice and at-home services. Nonetheless, place-of-death disparities remain, linked to demographic variables. Specifically, minority ethnic groups in the US have not experienced this increase. These populations often harbor misconceptions and unconscious biases about the nature of palliative care. The Pulmonary Hypertension Association, recognizing this gap, has advocated for the integration of palliative care into the treatment regimen for patients with PH.

Private equity’s impact on medical trainees
Health Affairs; by Alexander P. Philips, Viknesh Kasthuri, Russell Hawes, Hunter Kramer, Barbara Chiu, Pragi Patel, Hannah Harrelson; 4/14/25
Over the past decade, private equity (PE) ownership of physician practices and health care delivery systems in the United States has increased substantially. It is widely acknowledged that the trend toward short-term, profit-driven ownership challenges physician autonomy and raises ethical questions for physicians and patients. However, current discussions must more adequately recognize the effect of these trends on medical trainees. As medical students, we provide a perspective as future stakeholders amid a rapidly evolving landscape. In this Forefront article, we review PE’s involvement in health care, its impact on physicians and patients, the persistent professional and ethical challenges that directly affect medical trainees of all levels, and advocate for policy changes to protect trainees and address the underlying incentives that cause physicians to sell to PE.

Breaking with the status quo in end-of-life care through de-implementation 
Journal of Internal Medicine; by Chetna Malhotra, Ellie Bostwick Andres; 4/17/25
This paper addresses the challenge of de-implementing low-value care practices in the end-of-life (EOL) context, where burdensome interventions often offer marginal life-extending benefits, incur substantial costs and diminish quality of life. We examine the complexities involved in discontinuing such practices, including clinician biases, institutional cultures favouring aggressive interventions and communication barriers among healthcare providers, patients and families. ... De-implementation at the EOL requires sensitivity to the complex, emotional nature of EOL care and provides a unique opportunity to integrate palliative care approaches and improve overall EOL care quality.

Designing and developing interprofessional learning experiences in palliative care: A collaborative workshop approach
Palliative Medicine Reports; Carolyn Kezar, Justine McGiboney, Michael D. Barnett, Richard Taylor, Rebecca Edwards, Ella H. Bowman, Elizabeth McAlister, Moneka A. Thompson, Tara Schapmire, Chao-Hui Sylvia Huang; 4/25
Team-based care is vital in palliative care, but there is limited interprofessional education (IPE) among health care providers, leading to siloed learning. We aimed to design, implement, and evaluate an Interprofessional Education Exchange (IPEX) Death and Dying workshop to foster interdisciplinary collaboration and improve participants’ comfort with palliative care competencies. The primary findings of our study support our initial goal of creating an effective and engaging learning experience, as demonstrated by the significant increase in comfort levels across all interprofessional competency domains. The use of a case-based, interdisciplinary approach to PC [palliative care] education was particularly impactful, with improvements of up to 50% in some areas. Notably, 96% of learners agreed that working with peers from other disciplines enhanced their education, suggesting that early collaboration can improve communication and team-based care in clinical practice.

Family caregiving for older persons with dementia at end-of-life: A comprehensive overview
International Perspectives on Family Caregiving; by Cynthia A. Hovland; 4/25
Family caregiving for older persons with dementia at the end of life is a perplexing, challenging, and growing concern across the United States and other developing countries. This overview looks at these epidemiological forecasts, scope, and impact of dementia on the family and caregiver. Using a bio-psycho-social theoretical framework helps to understand identified problems and issues for the caregiver and implications for the older adult with dementia. Caregiver issues include the burdens as well as positive aspects of this role, but the unknown trajectory of dementia poses significant challenges. Caregivers' responses are impacted by their individual resilience and supports, and recommendations for approaches, strategies, and interventions for caregivers and health professionals are provided.

Quality measure considerations for pediatric palliative and end-of-life care
American Journal of Hospice and Palliative Medicine; by Hannah Hommes, Diane Forsyth, April Rowe Neal; 3/25
There is an emerging need to provide high-quality pediatric palliative care and end-of-life care to children, adolescents, and young adults with life-limiting illnesses. The aim of this literature review was to explore current quality measures utilized in pediatric palliative care and end-of-life care among pediatric patients with life-limiting illnesses within the conceptual framework of Comfort Theory. Emergent themes among quality measures were categorized into 7 domains: (a) Alleviation of distressing symptoms, (b) Structures and processes of care, (c) Health care utilization, (d) Location of death and bereavement care, (e) Patient and family experiences, (f) Psychological and spiritual care, and (g) Cultural, ethical, and legal considerations. These domains support the physical, psychospiritual, sociocultural, and environmental contexts of Comfort Theory. Quality measure research, development, and standardization should focus within the 7 domains identified for the promotion of comfort, equity, and accessible care.

Increasing timely code status discussions in hospitalized children with medical complexity
Journal of Hospital Medicine; by James Bowen, Laura Brower, Daniel Kadden, Jasmine Parker, Alexandra Delvalle, Andrew Krueger, Kristin Todd, Rachel Peterson; 4/25
Children with medical complexity (CMC) have an increased risk of hospitalization and clinical deterioration. Documentation of code statuses concordant with family goals is rare, increasing the risk of serious unintended consequences. We aimed to increase the percentage of patients with documentation of timely code status orders (CSOs) from 5% to 80% over 6 months. Multiple plan-do-study-act cycles were performed focusing on interventions aimed at key drivers, including increasing knowledge in performing code status discussions (CSDs) and improving understanding of institutional policies. The average percentage of patients who received a CSO placed in their chart within 72 h of admission to the CCT [complex care team] increased from 5% to 61% over 6 months.

Preferences for communication about prognosis among children with cancer, parents, and oncologists
JAMA Network Open; by Caroline Christianson, Calliope Reeves, Harmony Farner, Shoshana Mehler, Tara M. Brinkman, Justin N. Baker, Pamela Hinds, Jennifer W. Mack, Erica C. Kaye; 4/25
Should oncologists elicit communication preferences from patients with pediatric cancer and their parents before disclosing prognosis? In this study, patients, parents, and oncologists recommended preemptive elicitation of communication preferences with the goal of improving alignment of prognostic disclosure with patient and caregiver communication needs, thereby enhancing quality of care. These findings demonstrate that patients and caregivers are open to discussing prognostic communication preferences, and that oncologists also recognize the potential value in this communication approach, even as they rarely engage in it. 

[Taiwan] Palliative care with negative pressure wound therapy application in malignant wounds: a systematic review
Journal of Wound Care; by Xiao-Feng Yao, Yen-Jen Wang, Yang-Sheng Lin; 4/25
Of 765 articles screened, 14 eligible studies were included in the review. The location of the hard-to-heal wounds was widely distributed: five wounds on the scalp; three wounds over the anogenital area; and the remaining wounds on the trunk and extremities. The reported outcomes included: improvement of wound healing; decreased exudation and malodour of the wound; decreased pain sensation; eligibility for further treatment; and a shift to the homecare system. The findings of this study suggested NPWT [negative pressure wound therapy] could be a choice in palliative care for patients with malignant wounds. However, more studies are needed to evaluate the efficacy of NPWT in these wounds.

[Sweden] A human right to assisted dying? Autonomy, dignity, and exceptions to the right to life
Nursing Ethics; by Jon Wittrock; 4/25
Debates on assisted dying remain controversial and call out for conceptual clarification. What is the moral basis for assessing competing arguments, and what is the best way to frame these arguments in terms of actual and potential human rights? This article aims to investigate whether autonomy alone suffices as a moral source for human rights and whether, on this basis, there should be a positive human right to assisted dying, and a negative human right to assist others in dying. Drawing upon discussions in political theory, medical ethics, and human rights scholarship, the article develops an account of autonomy as multidimensional and subject to trade-offs.

Riders Up! ... Simone Biles will be calling the "Riders Up!" command at today's Kentucky Derby 2025. "Riders Up" serves as the signal for jockeys to mount their horses in preparation for the race. 

Editor's note (from Louisville, KY): What if we were to start each workday with a personalized "Riders Up!" command? It means we're ready. Prepared. Skilled and equipped to adjust to whatever unexpected twists and turns and challenges we encounter. Yet for us as hospice professionals, beating out competition should be less important. "Riders Up?" Yes! Our job is to help patients and families reach their own Finish Lines, in their own space and time.

Bonus: Want your own bugler's "Call to Post"? Click here to play.