Utilization of antibiotics for the treatment of urinary tract infections in end-of-life patients
American Journal of Hospice and Palliative Medicine; by Abigail Thomas, Lacey Davis, Allie Dolan, Rebecca Prewett; 8/25
The use of antibiotics for end-of-life patients is controversial; currently there is limited guidance on the use of antibiotics in hospice patients... The purpose of this project is to examine the utilization of antibiotics for urinary tract infections (UTIs) in hospice patients... The prescribing of antibiotics in end-of-life patients is not always appropriate regardless of the PPS. This may indicate that antibiotics are initiated in asymptomatic hospice patients, and the utilization of unnecessary medications presents the risk of adverse effects.

End-of-life symptoms in persons dying with advanced dementia in the community setting: Findings from IN-PEACE
Journal of Pain and Symptom Management; by Kurt Kroenke, Sujuan Gao, Susan E. Hickman, Alexia M. Torke, Nina M. Johnson, Amy Pemberton, Andrea Vrobel, Minmin Pan, Laura R. Holtz, Greg A. Sachs; 8/25
This article characterizes symptom burden in persons with advanced dementia dying in the community who were enrolled in a 2-year trial of home-based palliative care. Symptoms did not generally worsen from enrollment to time of death and symptom severity was similar to persons with dementia dying in a nursing home.

Collective leadership in home-based palliative care: Advancing APRN roles to enhance success
Home Health Care Management & Practice; by Nicole DePace, Rebecca Souza, Therese Rochon, Paula Rego, Constance Dahlin; 6/25
Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.

Quality indicators and patient outcome measures for palliative care in cancer patients: A systematic review
Ecancermedicalscience; by Chase Peng Yun Ng, Moira Hegyi, Grant Lewison, Tania Pastrana, Eve Namisango, James Cleary, Barbara Hasties, Eric Kabisa, Helena Musau, Kathryn Spangenberg, Paola Ruiz, Zipporah Ali, Mertixell Mallafre-Larrosa, Alfredo Polo, Julie Torode, Ajay Aggarwal, Richard Sullivan, Mevhibe Hocaoglu; 6/25
With the exponential rise in global cancer incidence, the surge in demand for palliative care has outstripped capacity, limiting patients' access to quality and holistic palliative care, especially in low- and middle-income countries. There is an overall lack of standardisation of QIs [quality indicators] and POMs [patient outcome measure], as well as variability in evidence of palliative care research. We recommend that stakeholders collaborate to develop a standardised repository of metrics for monitoring and evaluating palliative care services at both individual and system levels, with a particular focus on structural and process indicators. Incorporating validated, patient-centred measures and selecting key items as quality indicators will enable meaningful tracking of changes, guiding resource allocation and driving improvements in patient-centred care.

Palliative video consultation and symptom distress among rural inpatients-A randomized clinical trial
Critical Care Medicine; by Marie A. Bakitas, Shena Gazaway, Felicia Underwood, Christiana Ekelem, Vantrice T. Heard,  Richard Kennedy, Andres Azuero, Rodney Tucker, Susan McCammon, Joshua M. Hauser, Lucas McElwain, Ronit Elk; 7/25
The triple threat of rural geography, racial inequities, and older age has hindered access to high-quality palliative care for many people in the US. Only 70% of the deep South vs 85% to 94% of the rest of the US has palliative care despite the deep South having the greatest needs due to suboptimal health care access and elevated morbidity and mortality. In this RCT [randomized clinical trial] among Black or African American and White chronically ill hospitalized adults, culturally based specialist palliative care video consultation was not associated with statistically significant reduced symptom distress compared with usual care, but there was a clinically meaningful difference ... between groups. Contrary to our hypotheses, intervention participants’ QOL [quality of life] and resource use (secondary outcomes) also were not improved.
Assistant Editor's note: This study reminds us that palliative care delivered virtually, as opposed to in-person, may not be of benefit to some individuals. It also reminds us that palliative care, in its finest form, usually works best when delivered on an ongoing basis by a known, trusted professional(s). 

Parental authority and the weight of assent: Navigating moral dilemmas in adolescent end of life care
Journal of Bioethical Inquiry; by A. L. Heifner, M. M. Ortiz, T. L. Major-Kincade, C. O’Connor; 6/25
In the current era of moral pluralism, medical decisions must account for much more than clinical considerations: they must abide by legal standards of decision-making which usually prioritize parental preferences. Conflict abounds between the parent or other legal decision-maker and healthcare team in situations where the parent prefers not to disclose the severity of the adolescent’s illness or the healthcare team believes continuing lifesaving therapies are not in the adolescent’s best interest. These dilemmas challenge how we solicit adolescents’ preferences (assent) and their options for refusal (dissent). We explore the moral distress healthcare workers face navigating conflict amongst various stakeholders involved in the adolescent’s end-of-life care. Strategies to minimize moral distress are also provided.

Effectiveness of an educational intervention in enhancing end-of-life care understanding and decision-making in African Americans
Palliative & Supportive Care; by Delicia Pruitt, Megan Reilly, Stephen Zyzanski, Neli Ragina; 7/25
AA [African American] patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL [end of life] care options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Physician Orders for Life-Sustaining Treatment in rural Virginia
Sage Open Aging; by Pamela B Teaster, E Carlisle Shealy; 6/25
Physician Orders for Life-Sustaining Treatment (POLST) arose in 1991 to improve end-of life-care for patients with advanced, chronic, and progressive illnesses whose death is imminent within a year. POLST attempted to address problems inherent in advance directives (e.g., poor completion rates, confusing form language, dismal communication with a surrogate). POLST exists in all U.S. states, although each is unique and uptake is inconsistent, particularly in rural areas. The purpose of this study was to investigate current practices and barriers around POLST in a rural area using an online survey and interviews with practitioners. Findings included the need for consistent funding, clarification of goals, and greater and varied opportunities for staff training.

Exploring a collective grief experience in the U.S.: Qualitative findings from older parents whose only child has died
Omega; by Yongqiang Zheng, Leslie G Wuest, Jeongah Kim, Rebecca A Rodriguez; 6/25
Despite its profound physical and mental health impacts, research on the loss of an only child in later life among older U.S. adults remains scarce. This phenomenological qualitative study explores the lived experiences and meanings older bereaved parents attribute to their loss. Inductive thematic analysis revealed 6 themes: the enduring intensity of grief, significant secondary losses, feelings of isolation and alienation, the role of social support in coping, and spirituality and religion's influence on their journey. By amplifying these parents' voices, the study lays a foundation for understanding their unique grief and underscores the gaps in U.S. policy and mental health services. These findings deepen insight into an understudied population, highlighting the need for enhanced resources for older bereaved parents.

Complications of gastrostomy tube placement in patients with dementia: A national inpatient analysis
Surgical Endoscopy; by Spencer R. Goble, Thomas M. Leventhal; 6/25
Gastrostomy tubes have not been shown to improve long-term outcomes in patients with dementia, yet the risk of short-term complications have not been well characterized in this population. Conclusions: Gastrostomy tube placement complications do not appear to be increased in patients with dementia. However, those who undergo gastrostomy tube placement are less likely to discharge to home which has important quality of life implications.

[Norway] iLIVE volunteer study: Volunteer and healthcare professional perceptions of newly developed hospital end-of-life-care volunteer services, in five countries
Palliative Medicine; by Tamsin McGlinchey, Stephen Mason, Grethe Skorpen Iversen, Dagny Faksvåg Haugen, Inmaculada Ruiz Torreras, Pilar Barnestein Fonseca, Miša Bakan, Berivan Yildiz, Ruthmarijke Smeding, Anne Goossensen, Agnes van der Heide, John Ellershaw; 5/25
Volunteer services that provide direct support to patients receiving palliative and end-of-life care in hospitals are new and developing, but little is known about the use and experience of such services from key stakeholders. 20 Volunteers and 20 healthcare professionals were recruited. Three overall themes were generated: (1) Volunteers provided 'unique, distinct, 'community' support' bringing familiarity to an unfamiliar, medically focussed environment. (2) Volunteers were able to 'establish a connection centred on 'being there' within the acute hospital environment' despite the fast paced and highly changeable environment. (3) Through 'relational interactions adapted to the individual person' volunteers attended to patients' existential and emotional needs. These services confer benefits that are transferrable across cultures and countries, 'fusing' formal care with the informal visiting of family or friends, attending to patients' existential needs.

[Canada] Electronic decision support for deprescribing in older adults living in long-term care-A stepped-wedge cluster randomized trial
JAMA Network Open; by Emily G. McDonald, Justine L. Estey, Cody Davenport, Émilie Bortolussi-Courval, Jeffrey Gaudet, Pierre Philippe Wilson Registe, Todd C. Lee, Carole Goodine; 5/25
Potentially inappropriate prescribing (PIP) occurs when medications that carry a higher risk of harm than benefit are prescribed. It occurs more often among older adults in the setting of polypharmacy (taking multiple medications) and is costly and harmful. PIP and potentially inappropriate medications (PIMs) contribute to excess adverse drug events, such as falls, fractures, cognitive decline, hospitalization, and death [and] the problem is more pronounced for older adults living in nursing homes (long-term care [LTC] homes). Depending on the screening criteria used, in some studies, the prevalence ranges from 67.8% to 87.7% of nursing home residents. Electronically generated, individualized reports that contained prioritized opportunities for deprescribing in older adults were paired with preexisting quarterly medication reviews [and] this study found that electronic decision support paired with the usual workflow could render the deprescribing process scalable and effective.

Be yourself; everyone else is already taken. ~Oscar Wilde