Literature Review

Facebook and perinatal loss: Facebook groups use among parents from the U.S., France and ItalyOmega-Journal of Death and Dying; by Livia Sani, Meryem Labouihi, Joanne Cacciatore, Marie-Frédérique Bacqué; 9/25This study explores how ... [Facebook] groups are used after perinatal loss and evaluates their psychological role for bereaved parents. We conducted a thematic analysis of posts from FB groups in the U.S. and France over one month; a third group from Italy was excluded due to insufficient activity. Four main categories emerged: emotional responses to loss, subsequently born children, mutual sharing of memories of their deceased children and practical information. Findings reveal similarities between the French and U.S. groups, particularly in how mothers express emotions, seek validation, and commemorate their children. The lack of active Italian groups may reflect cultural attitudes toward grief. 

Critical care physicians’ perspectives on nudging in communicationJAMA Network Open; by Derek R. Soled, Christy L. Cummings, Laura M. Berbert, David N. Williams, William B. Feldman, Robert D. Truog, Emily B. Rubin; 9/25Our qualitative study on the experiences and perspectives of nudges by critical care physicians identified multiple themes relating to the appropriate use and ethics of nudging patients in clinical decision-making. In the decision-making context, a nudge is defined as “any aspect of the choice architecture [the intentional arrangement and presentation of options to subtly guide people towards certain choices] that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” While nudges preserve a person’s choice set without restricting options, they make it more likely that a person will choose some particular option by triggering decision-making heuristics and biases. Many physicians described nudging as an inevitable and natural part of communication—but one that must be used thoughtfully for it to be ethically justifiable. Assistant Editor's note: As a clinician, I can see where nudging may be appropriate at certain times, and when the clinician knows the values, concerns and goals of the patient/family. However, often the critical care clinician does not have that intimate knowledge of their preferences. In these situations, a better choice than nudging might be to request a palliative care consult, so that goal concordant decision making can be explored. 

The Family Caregiver Act—Safeguarding the human care chainJAMA Pediatrics; by Eli Y. Adashi, I. Glenn Cohen; 9/25On August 9, 2024, Jay Robert Pritzker, governor of Illinois, signed into law House Bill (HB) 2161 (Public Act 103-0797), likely the nation’s leading caregiving antidiscrimination legislation. The new law, which took effect January 1, 2025, prohibits employment discrimination against individuals saddled with family caregiving responsibilities. It is by dint of the enactment of HB 2161 that Illinois became the sixth state or district to legally require some form of this employee protection. Alaska, Delaware, Maine, Minnesota, New York, and Washington, DC, precede it, though some of these limit their protection to parents. Moreover, HB 2161 defines personal care as activities wherein a family member assumes responsibility for one or all of the basic needs of an ailing relative, replete with the provision of emotional support and/or transportation to medical appointments. A covered family member may include a child, stepchild, spouse, domestic partner, sibling, parent, mother-in-law, father-in-law, grandchild, grandparent, or a stepparent.Assistant Editor's note: "The Human Care Chain"--what a wonderfully descriptive title this is to describe the Illinois law. Those words evoke strong images of connectedness, humanness, caring, compassion, dedication, goodness, and love. As end-of-life and serious illness care providers, we understand the tremendous value, comfort and necessity of The Human Care Chain.

[Italy] The implantable cardioverter-defibrillators at the end of life: A double-edged sword of a life-saving technologyTrends in Cardiovascular Medicine; by Giacomo Mugnai, Davide Genovese, Luca Tomasi, Alessia Gambaro, Flavio Ribichini; 9/25Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death, but their function poses a significant challenge in palliative care, where goals shift from life prolongation to comfort. A substantial percentage of patients receive painful, futile shocks in their final days, causing significant distress. This review synthesizes evidence on the impact of these shocks and underscores the gap between clinical practice and patient-centered care. Key barriers to timely ICD deactivation include clinician discomfort, patient misconceptions, and systemic flaws like fragmented care and absent institutional protocols. This review argues for a paradigm shift towards proactive, interdisciplinary care, calling for structured communication, routine advance care planning, and the integration of palliative cardiology models to ensure this life-saving technology does not compromise a dignified death.

Executive Personnel Changes - 10/10/25

Today is World Mental Health Day: October 10, 2025 - Part 2Adapted from World Mental Health Day; by Joy Berger, Hospice & Palliative Care Today; 10/8/24Heads up our newsletter's readers: Tomorrow is World Mental Health Day. Its 2025 theme is "Access to Services - Mental Health in Catastrophies and Emergencies." Numerous stories are suddenly populating talk shows and printed/digital stories. We've compiled several resources as a springboard for ways you can support this significant initiative, not only on "its day" but also all year round.

Microsoft tries to catch up in AI with healthcare push, Harvard dealThe Wall Street Journal; by Sebastian Herrera; 10/8/25  Microsoft has a lofty goal: to become an artificial-intelligence chatbot powerhouse in its own right rather than leaning on its partnership with the ChatGPT maker, OpenAI. ... A major update of Copilot scheduled for release as soon as this month will be the first to reflect a new collaboration between Microsoft and Harvard Medical School, people familiar with the matter said. The new version of Copilot will draw on information from the Harvard Health Publishing arm to respond to queries about healthcare topics. [access may be limited by a paywall]

For World Mental Health Day: Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. ~ Fred RogersEditor's Note: Bonus from Fred Rogers when accepting his Lifetime Achievement Emmy Award: " ... All of us have special ones who have loved us into being. Would you just take along with me--10 seconds--to think of the people who have helped you become who you are. Those who have cared about you, and have wanted what was best for you in life. Ten seconds of silence. I'll watch the time. Whomever you've been thinking about, how pleased they must be to know the difference you feel they've made. ..."

Home health & hospice's top advocacy priorities TIMSHME.com; by Steve Landers; 10/5/25 The National Alliance for Care at Home (the Alliance) is the largest organization representing, advocating for and convening providers of home-based care, representing over 1,500 organizations and more than 10,000 agencies serving millions of people nationwide. ... Last month, the Alliance convened more than 230 frontline providers and leaders in Washington to advocate for these priorities.  ... Advocates shared the key issues impacting care, why it matters and what Congress should do about it.

The expanding role of family medicine in Alzheimer's Disease and other dementias Patient Care; by Grace Halsey; 10/7/25 [From the 2025 Family Medicine Experience conference] Family medicine's unique position in dementia management spans initial diagnosis through end-of-life care. ... Dementia Staging: Clinical Assessment and Hospice EligibilityFor practical bedside assessment and hospice determination, the Functional Assessment Staging Tool (FAST) proves particularly valuable.1 The FAST scale includes 7 main stages, progressing from no impairment (stage 1) through severe dementia requiring total care (stage 7). Stage 7 breaks down further into substages (7a-7f) that capture specific functional losses including ambulation, independent sitting, smiling, and head control. Eligibility for hospice care generally requires FAST stage 7c or beyond, indicating ... [continue reading this important criteria] Editor's Note: Leaders must understand hospice eligibility criteria when setting census goals, guiding teams, and communicating with families. Getting it wrong risks fraudulent billing, angry caregivers when live discharges occur, or too little care that comes too late. Getting it right ensures dignity, humanity, and meaningful final moments amid dementia's long goodbyes—true measures of compassionate hospice dementia care.

Telepalliation creates a sense of security: A qualitative study of patients with cancer receiving palliative carePalliative Medicine; by Jarl Voss Andersen Sigaard, Elisabet Dortea Ragnvaldsdóttir Joensen, Una Rósa Birgisdóttir, Helle Spindler, Birthe Dinesen; 10/7/25 ... The aim of this study was to explore patients' experiences with the functionality of the Telepalliation program while receiving specialized palliative care. ... Results: Four key themes emerged: "Sense of coherence," "Telepal platform," "Roles of spouse/partner and relatives," and "Cross-sector collaboration." The program improved patients' sense of security and coherence by enhancing communication with healthcare professionals. ... The platform also successfully integrated relatives into the care process. Editor's Note: While this research was conducted in Denmark, it surely resonates with patient care in the US. Reference articles in the uncertainties of government shutdowns, legislative needs to extend telehealth, and more: