Literature Review

At the end of life, doctors’ actions and patients’ wishes may be misaligned, according to a Rutgers Health study Rutgers; by Greg Bruno; 2/28/25 For terminally ill cancer patients, the final days of life are immensely personal, having the choice to continue cancer treatments, or to stop treatments and prioritize a more comfortable passing. What a patient wants, however, isn’t always what they receive, according to a Rutgers Health study published in the journal Cancer. “A patient's end of life is often not a reflection of what they want, but rather, who their oncologist happens to be,” said Login S. George, a health services researcher at the Rutgers Institute for Health, Health Care Policy and Aging Research, and lead author of the national study. “The data doesn’t indicate patient-centered treatment decisions, but rather, more habitual or default ways of treating patients,” says George, who is also a member of the Cancer Prevention and Control Program at Rutgers Cancer Institute, the state’s only National Cancer Institute-designated Comprehensive Cancer Center. ... [Click on the title's link for more statistics, insights, and recommendations.]

Understanding a patient’s AI medical journey The Hastings Center; by Ian Stevens, Erin William, Jean-Christophe Bélisle-Pion, and Vardit Ravitsky; 3/5/25As artificial intelligence becomes increasingly integrated into U.S. health care, patients should know the ways in which AI is being used in their care, concludes a new paper, “Bring a ‘Patient’s Medical AI Journey’ to the Hill.” Transparency is crucial for interactions between health care providers and individual patients, as well as for systemic level uses of AI, including:

Film: Lives well livedSecond Wave Southwest Michigan and Lives Well Lived; film by Sky Bergman; 3/6/25A Life Well Lived, a series of community meetings and learning opportunities that concludes March 15, and the documentary "Lives Well Lived," by guest speaker Sky Bergman, ... On the film's website, filmmaker Sky Berman describes, "In our society, the elderly are often overlooked. Lives Well Lived celebrates the incredible wit, wisdom, and life experiences of older adults living full and meaningful lives in their later years. Their stories are about perseverance, the human spirit, and staying positive during the great personal and historic challenges. I hope these stories inspire people of every age to achieve the longevity of both health and spirit, and to realize that growing older can be a journey to be celebrated." ... Beginning with its premiere at the Santa Barbara International Film Festival, Lives Well Lived has screened in more than 200 cities. The film has won eight awards, and the theatrical run garnered enthusiastic reviews and a 100% Fresh rating on Rotten Tomatoes. Organizations like Aging 2.0, AARP’s Movies for Grownups, Encore.org, and Leading Age have screened Lives Well Lived. Now the film is available on PBS! Editor's note: Click here for Second Wave Southwest Michigan use of this film for community outreach. Click here for the film's website, Lives Well Lived.

[Scotland, UK] ‘There’s still hope and joy to be had’: Art adds colour to end-of-life hospice care The Sunday Post; by Paul English; 3/2/25 For Alison Couston, hope is as simple as a brush stroke. ... Alison might have been forgiven for abandoning her creative energies following a devastating diagnosis of progressive supranuclear palsy (PSP) last year. ... Alison’s speech, mobility, balance and co-ordination have been affected in the period since her diagnosis. But rather than giving up, the Glasgow theatre producer is still pushing creative boundaries. ... Now Alison is herself receiving the benefit of artistic practice at a challenging time as a weekly visitor to the art room at the Prince and Princess of Wales Hospice in Glasgow’s Bellahouston Park. ... “Because of her diagnosis, she has certain limitations now and we had to work together to overcome those. She has been painting with her non-dominant hand and has embraced a more abstract expressive approach.” ... Alison’s paintings are now being gathered together for a book ... Alison said: “The book was my idea first of all as a way to raise money for the hospice. I thought if I sold my paintings in book form it would encourage more donations. 

How much does end-of-life care generally cost? 50 Plus Finance; by David Leto; 3/3/25 [For the public] ... Knowing how much end-of-life care generally costs can help you manage and prepare your finances appropriately to ease the burden on you and loved ones when the time comes. ... The cost of end-of-life care can vary widely depending on the services required. On average, however, Americans spend between $10,000 and $70,000 on such care, with the majority of expenses often occurring in the last year or month of life. These costs can stem from hospital stays, at-home care, or nursing facility care. Hospice, which focuses on comfort and pain management, typically costs less than intensive medical treatments but still averages several thousand dollars each month, or around $150 a day with insurance. Understanding these figures helps you set realistic financial expectations and prepare for them. ...

Wishing that your patient would die: Reasons and reactions Psychiatrist.com - Rounds in the General Hospital; by Yelizaveta Sher, MD; Filza Hussain, MD; Benjamin J. Hoover, MD; Matthew Gunther, MD, MA; Daniel O. Fishman, MD; Mira Zein, MD; Jose R. Maldonado, MD; Theodore A. Stern, MD; 2/25/25 Have you ever had a patient suffer so much that you wanted them to die? Have you wondered whether such thoughts and feelings are acceptable? Have you been uncertain about how you could manage your guilt over such thoughts? Have you been unsure about how to best advocate for a patient whose medical care is futile? If you have, the following case vignette and discussion should prove useful. ...

‘Global problem’: Numerous factors, biases contribute to overtreatment at end of life Healio; by Josh Friedman; 2/26/25 Nathan I. Cherny, MD, has worked all around the world. At every stop — from Australia to Israel, and Memorial Sloan Kettering Cancer Center in between — he has seen people with cancer receive overly aggressive treatment at the end of life. ... In a review published in ESMO Open, Cherny and a cohort of multinational colleagues highlighted numerous reasons why overtreatment occurs among patients approaching the end of life, ... They listed more than 20 contributing factors, including desire for control of the cancer, denial and anger, family pressure and hope preservation. The two factors that contribute most to overtreatment are optimism bias and the “counterphobic determination to treat,” which involves clinicians having a difficult time introducing the suggestion of palliative care revert to offering further treatments, Cherny said. ... Responsibility for decisions does not need to fall solely on oncologists, Cherny added. Palliative care physicians, social workers, chaplains and others can be part of a team to assist patients with their choices. ... The number of patients who are overtreated differs at each institution. “Each institution has its own culture of care,” Cherny said. Editor's note: This article puts forth significant insights for all palliative and hospice clinicians, interdisciplinary teams, and palliative/hospice executive leaders. Apply Cherny's to your referral sources: "Each institution has its own culture of care." Apply these findings to your own palliative and hospice services. 

Interdisciplinary strategies for establishing a trusting relation as a pre-requisite for existential conversations in palliative care: a grounded theory study BMC Palliative Care - Part of Springer Nature, Open Acces; by Annica Lagerin, Christina Melin-Johansson, Bodil Holmberg, Tove Godskesen, Elin Hjorth, Lena Junehag, Carina Lundh Hagelin, Anneli Ozanne, Johan Sundelöf & Camilla Udo; 2/19/25... This study aimed to gain an in-depth understanding of healthcare professionals’ (HCPs) experiences of existential conversations with patients with PC needs and their next-of-kin by generating a theoretical model. ... To emphasize the importance of ethical competence for quality patient care, particularly in PC, a combination of care ethics, clinical proficiency, relational skills and effective communication is essential. ... The potential obstacles we identified that require attention include the need for managers ... to support HCPs by allowing time for reflection, developing new routines, and providing education focused on existential conversations in PC. However, the main contribution of this study is the description of the interdisciplinary strategies HCPs used to establish meaningful, existential conversations by maintaining presence, as this paved the way for trusting conversations with patients and next-of-kin. Editor's note: Pair this with today's article "Why being trustworthy is a leadership hack that drives success."

Pennsylvania lawmaker introduces ‘No Patient Left Behind Act’ WHTM - PA Homepage; by Brady Doran; 2/19/25 A Pennsylvania lawmaker introduced a bill that would ensure hospitals have visitation policies that balance patient needs with public health protocol. According to Sen. Doug Mastriano (R-33), elderly patients left alone in hospitals experience faster physical and cognitive decline. The No Patient Left Behind Act, introduced by Mastriano, would ensure Pennsylvanians with medical treatment or end-of-life care have support by their sides. “Hospitals should be places of healing. However, for far too many, they have become places of loneliness, despair, and unnecessary suffering,” Mastriano said.

New ACS research finds low uptake of supportive care at the end-of-life for patients with advanced cancer EurekAlert! - American Association for the Advancement of Science (AAAS); Peer-Reviewed Publication by American Cancer Society; 2/21/25  Despite considerable efforts to improve the quality of end-of-life care in the United States, a new retrospective study led by American Cancer Society (ACS) researchers revealed that close to half of patients with advanced cancer received potentially aggressive care at the end-of-life at the expense of supportive care. The findings are out today in the Journal of the American Medical Association (JAMA) Health Forum. ... Study results showed only one-quarter of patients diagnosed with advanced cancer received any palliative care in the last 6 months of life, and those who received it did so mainly in the month of death. Overall, 45% of decedents experienced any indicator of potentially aggressive care. There was an increase in the mean number of acute care visits (from 14.0 to 46.2 per 100 person-months), hospice use (from 6.6 to 73.9 per 100 person-months), palliative care (from 2.6 to 26.1 per 100 person-months), and advanced care planning (from 1.7 to 12.8 per 100 person-months) over the last 6 months of life. ...

Heritage Hospice’s “Scatter Hearts” project honors veterans and patients The Advocate-Messenger, Danville, KY; by Josely Labarrere; 2/19/25 Heritage Hospice volunteers are spreading love and appreciation this Valentine’s season with the “Scatter Hearts” project, a heartfelt initiative designed to bring joy to hospice patients, particularly veterans. ... “The volunteers thought it would be a good time to honor our veterans, acknowledge the sacrifices they have made for us, and bring a smile to our hospice patients,” said Wendy Hellard, Director of Volunteer Services at Heritage Hospice. ... The wooden hearts, designed to be displayed on doors, were individually painted by Heritage Hospice volunteers and community members in bright and cheerful colors. Special hearts featuring patriotic red, white, and blue designs were created for veteran patients."

Addressing overtreatment in end-of-life cancer care Medscape; by David J. Kerr, CBE, MD, DSc; 2/19/25 ... What do we mean by overtreatment? This means that many patients who are approaching the end of life receive treatments, like directed anticancer therapies, that are unlikely to provide clinically meaningful benefits and may do more harm than good. This is an expression that I use often in the clinic when I'm explaining to patients that we have reached the end of the road in active interventions, such as chemotherapeutic drugs, that will do more harm than good. It doesn't stop us from doing our very best to look after patients. We focus on improving the quality of life and maintaining that for as long as we can, while continuing to care and look after the patients. ... Overtreatment may even, one would argue, accelerate death when you consider those 1% or 2% mortality rates that can be associated with some treatments that we offer. ...

Center for Hospice Care's BreatheEazy Program supports patients with respiratory issues LaporteCounty.Life; by Garrett Spoor; 2/13/25 One of the toughest health challenges a person can face is the trouble of breathing. Center for Hospice Care comes across a lot of patients who experience this issue and encourages many of them to become a part of their BreatheEazy program. Dr. Karissa Misner, medical director at Center for Hospice Care, considers the BreatheEazy program to be a monumental boost for patients who might have respiratory issues. “This is a specialized pulmonary program for our patients with chronic obstructive pulmonary disease,” Misner said. “It can also be used for many other terminal diagnoses that affect the lungs. Whenever there is any type of illness that causes difficulty in breathing, we can utilize this program.”