Literature Review

Rethinking slow codes: Gina Piscitello, Parker Crutchfield, Jason WassermanGeriPal podcast; by Eric Widera, Alex Smith, Gina Piscitello, Parker Crutchfield, Jason Wasserman; 10/23/25I’m going to begin with a wonderful quote from a recent editorial in Bioethics by our guests Parker Crutchfield & Jason Wasserman. This quote illustrates the tension between the widely held view in bioethics that slow codes are unethical, and the complexity of real world hospital practice: “Decisive moral positions are easy to come by when sitting in the cheap seats of academic journals, but a troubling ambivalence is naturally characteristic of live dilemmas.” ... Today we talk about what constitutes a slow code, short code, show code, and “Hollywood code.” We talk about walk don’t run, shallow compressions, and…injecting the epi into the mattress! We explore the arguments for and against slow codes: harm to families, harm to patients, moral distress for doctors and nurses; deceit, trust, and communication; do outcomes (e.g. family feels code was attempted) matter more than values (e.g. never lie or withhold information from family)? ... One thing we can all agree about: the ethics of slow codes need a rethink.

Pastime activities, social connectedness, and grief resolution: A brief report highlighting the salience of socializing for grief resolution among bereaved older adultsThe Journal of Nervous & Mental Disease; by Xin Yao Lin, Holly G Prigerson, Yifan Chou, Paul K Maciejewski; 10/25We sought to examine the relationship between pastime activities (i.e., activity engagement), social connectedness with family and friends, and severity of Prolonged Grief Disorder (PGD) symptoms across younger, middle-aged, and older adults. Cross-sectional findings showed that engagement in pastime activities (e.g., travel, sports) was associated with greater social connectedness for older adults, and social connectedness was associated with lower PGD symptom severity. Engagement in pastime activities was associated with lower PGD symptom severity for middle-aged adults. Results are consistent with the socioemotional selectivity theory and the microsociological theory of adjustment to loss and suggest that grief interventions should have age-specific strategies, encourage specific pastime activities, and promote feelings of social connectedness.

Hospice of the Chesapeake and Partners In Care join to support aging communityHospice of the Chesapeake press release; by Elyzabeth Marcussen; 10/24/25Hospice of the Chesapeake is proud to announce that Partners In Care of Maryland, Inc., has officially joined its family of services under a newly formed umbrella organization, Chesapeake Health Partners... As Maryland’s largest independent nonprofit hospice organization, Hospice of the Chesapeake has been a trusted resource for individuals and families facing serious illness, helping them live each day with intention and peace. Partners In Care, a Maryland-based nonprofit, has built its legacy on helping older adults remain independent and engaged through its signature Service Exchange model where members help one another with transportation, handyman services, social connection and more.Note: This is in addition to Chesapeake Supportive Care and Southern Maryland House Calls partner to expand access to in-home palliative care in Calvert County, which we posted on 10/17/25.

Executive Personnel Changes - 10/24/25

Incarceration and quality of cancer careJAMA Network Open; by Oluwadamilola T. Oladeru, Ilana B. Richman, Jenerius A. Aminawung, Jason Weinstein, Lisa B. Puglisi, Rajni Mehta, Hsiu-Ju Lin, Emily A. Wang, Cary P. Gross; 10/25The incarcerated population in the US is aging, and an estimated 15% of incarcerated adults, or approximately 175,000 individuals, are now 55 years or older. With this demographic shift, diseases of aging have become more prevalent, and cancer now ranks as the most common cause of death among people who are incarcerated in the US. Despite the growing prevalence, cancer outcomes among those incarcerated lag behind those with no history of incarceration. Individuals diagnosed with cancer while incarcerated or immediately following release have an approximate 2-fold increase in cancer-related mortality compared with the general population, even after adjusting for stage at diagnosis. Along with other published literature, this work suggests that gaps in quality of care may contribute to observed disparities in outcomes.Assistant Editor's note: Most of us cannot imagine what it would be like to be in prison. With cancer. And perhaps even dying there. Steven Garner knows. He spent many decades as an inmate at a state penitentiary. While there, he became a hospice volunteer supporting dying inmates, training other volunteers, and he served to pioneer Hospice in Corrections programs throughout the US. Steven is out of prison now, living his best life in Colorado and consulting around the nation about ways to improve end of life care for incarcerated persons. Oprah Winfrey was involved in sharing Steven's story in a documentary called Serving Life. NPR published an article about Steven in February 2024. Additionally, Hospice Analytics has posted a link to a 20-minute video about Steven's life and work in prison: Angola Prison Hospice: Opening the Door. Steven is featured in The Historic New Orleans Collection's recently released book Captive State: Louisiana and the making of mass incarceration and he shared God Behind Bars' YouTube video Life changing day inside Angola Prison. If you'd like more information, Steven Garner has a website.

One Day or Day One?

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!

Clinician and parent perspectives on essential psychosocial care in pediatric cancerJAMA Pediatrics; by Kimberly S. Canter, Anne E. Kazak, Natalie Koskela-Staples, Michele A. Scialla, Kimberly Buff, Emily Pariseau, Victoria A. Sardi-Brown, Julia B. Tager, Lori Wiener; 10/25The Standards for Psychosocial Care for Children With Cancer and Their Families provide guidelines for evidence-based psychosocial care for children with cancer and their families. The Implementing the Standards Together: Engaging Parents and Providers in Psychosocial Care (iSTEPPP) study extends the standards through innovative collaborative research between clinicians and patient and family advocates, with the goal of widespread clinical implementation of standards that clinicians and parents or caregivers agree to be priorities. The 3 standards prioritized by parents and clinicians in this study offer insight into shared priorities for psychosocial care in pediatric cancer. However, misalignment on other priority standards (parental mental health, palliative care, and neurocognitive monitoring) highlights the differences in perception between parents and clinicians. Areas lacking agreement are a stark reminder of potential challenges when working to meet the holistic needs of children with chronic diseases and their families, as clinicians and parents may not agree on which needs are most important.

Compassionate care, measurable impact: Evaluation of embedded physician-led palliative care in a community oncology practiceJCO Oncology Practice; by Haibei Liu, Jillian Hellmann, Jessica Heintz, Geoffrey Daniel Moorer, Karen Miller; 10/25This analysis indicates that embedding palliative care physicians within a community oncology practice significantly increases hospice enrollment and LOS [length of stay] greater than 3 days. These findings support a cooperative care model as a practical strategy for integrating palliative care physicians into community-based oncology practices to improve patients’ EOL outcomes. 

Affirming healthcare experiences among older Black-and White-identifying gay men living with serious illness: A qualitative study in the Deep SouthAmerican Journal of Hospice & Palliative Care; by Korijna Valenti, Michael Barnett, Stacy Smallwood, Ronit Elk; 10/25Older gay men living with serious illness often face challenges related to identity, disclosure, and relational recognition in healthcare settings [and] these challenges are particularly acute in the Deep South, where affirming care remains inconsistent, and disparities persist. Three main themes were identified [in this study]: (1) Experiences of Inclusion and Visibility, (2) Positive Communication, and (3) Sharing Sexuality and Effect on Care. Clear communication, honesty, and opportunities to ask questions were critical in navigating medical decisions. Discussions of sexual orientation were context-dependent and often shaped by perceptions of safety. Recognition of chosen family members, particularly partners, was central to participants' sense of dignity and affirmation in care.

Live discharges of patients in hospice home settings-Relief or grief: A narrative studyThe American Journal of Hospice & Palliative Care; by Jacek T Soroka, Amanda L Paulson-Blom, Alla Blotsky, Jennifer L Derrick, Margaret T Mudroch; 10/25Approximately 20% of hospice patients in the US are discharged alive, often due to Medicare regulations. One of the caregivers described discharge as distressing and poorly coordinated; the other reported a positive experience shaped by prior knowledge and financial resources. Both emphasized the importance of clear communication, care planning (eg, to avoid loss of durable medical equipment), and interdisciplinary support. Live hospice discharge can cause emotional and practical disruption, especially when not accompanied by a care transition plan or access to durable medical equipment. This study highlights the need for team-based communication, sensitivity in language, and continued support. Assistant Editor's note: There can be immense ambivalence among patients and loved ones when one is discharged alive from hospice. Usually, these patients have been with hospice for many months or even years. Perhaps the discharge is viewed as good news-even GREAT news(!) that the patient has "graduated" from hospice. Maybe loved ones will throw a graduation party(!) as it means that the patient is no longer terminally ill (as defined by hospice regulations). On the other hand, some patients/loved ones can become very distraught, wondering how they will get along without having a nurse to call in the middle of the night, without their beloved aide who brightens their day with the TLC of the bath-hair-nail care, and without the support and guidance of their social worker and/or chaplain. Some patients/loved ones will feel angry and abandoned. Best practices dictate that hospices be proactive in discharge planning when the health of their long length-of-stay patients hits a plateau; discharge should never come as a surprise. There should be frequent and ongoing discussions with the patient/loved ones about the potential for live discharge. Discharge planning needs to include: how the patient will get their DME/medical supplies/medications?, who does the loved one call in the middle of the night if there is a medical crisis?, who can provide tangible support and spiritual guidance (if desired)?, and can palliative care ease the transition once hospice has discharged?

Bridging care and support: Social services in hospicePalliative Care and Social Practice; by M. Courtney Hughes, Erin Vernon, Magdalena McKeon, Michelle L. Foster; 10/25 We recently surveyed informal caregivers of hospice patients nationwide who were currently caring for a hospice patient or had cared for one within the prior 2 years about the types of social services they found valuable... [Most frequently mentioned social service categories included: counseling and support groups, personal care assistance, and meals.] The above survey findings and our experience in conducting studies with informal caregivers of hospice patients over the last decade highlight the vital role a variety of social services play as hospice patients and their families navigate the emotional, practical, and logistical challenges that accompany end-of-life care. Services such as counseling, care coordination, resource navigation, and support groups help families cope with the stress, grief, and uncertainty that often arise during this time. Social workers and related professionals provide a bridge between the clinical team and the family, ensuring that the patient’s needs are met while also addressing the well-being of informal caregivers. This holistic approach helps families feel supported as they make decisions that honor their loved one’s wishes.Publisher's note: This article is a result of a survey promoted earlier this year in Hospice & Palliative Care Today, and other sources. Thank you to all who participated!