Literature Review

Perioperative integration of palliative care and urology for patients with serious urologic illness: A qualitative need finding inquiryJournal of Pain and Symptom Management; Bhagvat J Maheta, Nainwant K Singh, Jonathan Bergman, Cati G Brown-Johnson, Alekhya Gunturi, Nickolas Interrante, John T Leppert, Karl A Lorenz, Isabella G Raspi, Karleen F Giannitrapani; 3/25Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. [We] purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites. We identified one general overall theme, to "change culture" so that PC [palliative care] is not a "last resort" ... Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations ... Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life" ... [and] during the pre-operative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist."

Top ten tips palliative care clinicians should know about dysphagia and adult swallowing interventions in serious illnessJournal of Palliative Medicine; Sanora Yonan, Taylor Wilde, Alexa Rogers, Kelly J Trumpatori, Kristie Calix, Christina Barnes, Terri Durkin, Eric Mecusker, Christopher A Jones, Caitlyn M Moore, Laura Chahda, Amanda Stead, Lisa A LaGorio, Paula Leslie; 3/25This article highlights the important role of speech-language pathologists (SLPs) in palliative care (PC), emphasizing their contribution to supporting people with eating, drinking, and swallowing difficulties during serious illnesses and at the end of life. The recommendations underscore the necessity of interdisciplinary collaboration among SLPs and other PC team members, the importance of patient and caregiver education, and the application of patient-centered, comfort-focused approaches to dysphagia intervention. Drawing on current research and expert insights, this article explores the use of SLP services in PC, as well as the challenges in supporting people with eating and drinking difficulties in advanced stages of illness, embedded with practical tips for clinicians.

Navigating the intersection of heart failure and palliative care: A holistic approach to improving quality of life Cureus; by Awanwosa V. Agho, Fatimot Disu, Efeturi M. Okorigba, Okelue E. Okobi, Safiyya Muhammad, Toheeb Bakare, Chioma Ezuma-Ebong, Nneka Muoghalu; 3/30/25 ... Historically, palliative care has often been perceived as a last-resort option, introduced only when curative treatments have failed, creating a false dichotomy between life-prolonging therapies and symptom management. However, modern palliative care frameworks emphasize its integration throughout the disease trajectory, particularly for chronic, progressive illnesses like heart failure. ... Palliative care should ideally be initiated at diagnosis of advanced heart failure or with early signs of significant symptom burden to ensure timely, patient-centered support, as recommended by ACC, AHA, and HFSA guidelines

The most personal column I’ve ever written The Times, United Kingdom; by Professor Tanya Byron; 3/31/25 ... This column will be more personal than any other I have written in my now 20 years writing for The Times. I write it four days after my sister Katrina and I lost our beloved mum, Elfie, who ... had advanced end-stage dementia. Where do we start when trying to describe the many moments of heartbreak and the challenges that come with the long goodbye we have faced with our parents? Dementia is unpredictable. We say goodbye more than once and so the pain of bereavement does not begin at the time of death. Instead it is a prolonged pain marked by gradual losses. Watching a loved one slowly fade away over months or years brings grief, exhaustion and deep emotional turmoil. Amid all this is the experience of being on a rollercoaster of loss and hope, an experience that creates huge lurches between perceptions and emotions. There are moments of clarity and regression, ... [Continue reading ...]

Children as living solid organ donors: Ethical discussion and model hospital policy statementThe Journal of Clinical Ethics; Gyan C. Moorthy, Aidan P. Crowley, and Sandra Amaral' Spring 2025In recent years, more attention has been paid to living donation as a means to reduce the suffering of individuals with end-stage kidney or liver disease. Implicated ethical issues include medical risk and risk of coercion, counterbalanced by improved medical outcomes and the benefits of saving a life. Living donation becomes particularly ethically complicated with the prospect of child donation, given the child’s developing autonomy and uniquely dependent status. We outline four broad ethical considerations pertinent to living child organ donation: (1) beneficence, (2) respect for the family as a moral unit, (3) respect for the child as a person, and (4) justice. We conclude that it can be ethical for a healthy child to donate a kidney or liver lobe to a close relative who has exhausted other options provided that certain protections are put into place.

Quality of life in heart failure. The heart of the matter. A scientific statement of the Heart Failure Association and the European Association of Preventive Cardiology of the European Society of CardiologyEuropean Journal of Heart Failure; Maurizio Volterrani, Geza Halasz, Stamatis Adamopoulos, Pier Giuseppe Agostoni, Javed Butler, Andrew J.S. Coats, Alan Cohen-Solal, Wolfram Doehner, Gerasimos Filippatos, Ewa Jankowska, Carolyn S.P. Lam, Ekaterini Lambrinou, Lars H. Lund, Giuseppe Rosano, Marco Metra, Stefania Paolillo, Pasquale Perrone Filardi, Amina Rakisheva, Gianluigi Savarese, Petar Seferovic, Carlo Gabriele Tocchetti, Massimo Piepoli; 3/25 Patients with heart failure (HF) experience much worse QoL [quality of life] and effort intolerance than both the general population and people with other chronic conditions, since they present a range of physical and psychological symptoms, including shortness of breath, chest discomfort, fatigue, fluid congestion, trouble with sleeping, and depression. The importance of QoL for patients with HF is highlighted in a survey showing that 61% attached more weight to QoL over longevity, with 9% and 14% willing to trade 6 and 12 months, respectively, for perfect health and better QoL.It is for these reasons that the Heart Failure Association is developing a new score for QoL in HF, sensitive to mechanism-specific interventions and tailored to be sensitive to changes within individual patients. 

Palliative care clinic offers supportive care for patients with end-stage heart failure Yale School of Medicine; by Rachel Martin; 3/25/25 ... Michael Beasley, MD, [Yale] assistant professor of medicine (cardiovascular medicine), and Nora Segar, MD, [Yale] assistant clinical professor (general internal medicine) and director of palliative medicine at the Saint Raphael Campus of Yale New Haven Hospital, recently established a new outpatient clinic to provide dedicated palliative care for people with end-stage heart failure. ... “For many patients with advanced heart failure, hospice care does not meet their needs until very late in their course,” said Segar, an early champion of the clinic. “Instead, by providing early palliative care outside of the hospital, when it’s not a time of crisis, we can help patients accept and cope with their prognosis, manage their symptoms, and continue making plans for the future.” New patients receive longer appointments, which allows the team to hear their stories and start building relationships with them. [Continue reading ...]Editor's note: For all palliative and hospice leaders, we highlight this last statement: "New patients receive longer appointments, which allows the team to hear their stories and start building relationships with them."

Assisted ventilation withdrawal in motor neuron disease: updated results BMJ Supportive & Palliative Care; by Lucy Bleazard, Jonathan Palmer, David Wenzel, Thomas Jeffery, and Christina Faull; 3/24/25 Introduction: Patients with ventilator-dependent motor neuron disease (MND) may request withdrawal of their assisted ventilation. Facilitating this process as a healthcare professional (HCP) can be emotionally and practically challenging. The Association for Palliative Medicine (APM) issued guidance to support HCPs and invited anonymised accounts of the withdrawal process to provide an update on the guidance. ... Results: Younger patients tended to need higher doses to achieve adequate symptom management prior to withdrawal. Practices of weaning the ventilator varied significantly between respondents. The median time to death following withdrawal of ventilation was 30 min, with three-quarters of patients dying within 2 hours. Conclusion: This is the largest data set to date regarding the withdrawal of assisted ventilation in MND. This updated analysis reaffirms that a personalised, titrated approach remains appropriate and effective. The revised APM Guidance 2025 incorporates new sections on recommendations for managing the ventilator. [Continue reading ...]

Feasibility study of using electronic patient-reported outcomes to screen patients with advanced solid cancers for palliative care needsJournal of Palliative Medicine; Tara L Kaufmann, Matthew Kearney, Dagoberto Cortez, John W Saxton, Katie Goodfellow, Carolyn Smith, Patrick Chang, Katherine Sebastian, Aaron Galaznik, Julie Scott, Elizabeth Ann Kvale, Arif H Kamal, Antonia V Bennett, Angela M Stover, Ashley M Henneghan, Michael Pignone, Gabrielle Betty Rocque; 3/25Standardized, needs-based screening and triage systems are essential to more effectively address patients' palliative care needs. We developed a 13-item ePRO [electronic patient-reported outcomes] palliative care survey to assess multidimensional palliative care needs and conducted a pilot study (n = 25) of a palliative care screening intervention using ePRO monitoring and presentation of ePRO reports to a multidisciplinary care team. Patients found the ePRO palliative survey acceptable and appropriate. Screening patients for unmet palliative needs using ePRO monitoring is feasible, acceptable, and appropriate among patients, but more work is needed to understand the perspectives of diverse patients and how to integrate ePRO palliative care screening into clinical workflows.

Inpatient use of valproic acid in agitated delirium by palliative medicineAmerican Journal of Hospice and Palliative Medicine; Sarah Jacobs, DO; Leah Herbst, DO; Carlos Fernandez, MD; Zankhana Y. Mehta, MD; Amanda Young, MS; Mellar P. Davis, MD; 2/25Valproic acid (VPA), an anti-epileptic medication available in intravenous and parenteral forms, has recently been used to treat agitation associated with delirium. VPA as an adjunct in treating delirium has been reported to be opioid, antipsychotic and benzodiazepine sparing. ... this study did show that 50% of patients did not require benzodiazepines or antipsychotics at all, and that VPA might have a role in sparing the use of medications such as antipsychotics and benzodiazepines which have poor evidence in the management of agitation in delirium.

Revamped tool can reliably assess pain symptoms in dementia patients: researchers McKnights Long-Term Care News; by Zee Johnson; 3/17/25 ... A team of researchers reconstructed the End-of-Life Dementia-Comfort Assessment in Dying, or EOLD-CAD, after a multifacility study showed that caregivers could adequately and reliably address a host of pain symptoms seen in end-of-life dementia patients. ... When clinicians working in the SNFs that were part of the trials used the EOLD-CAD, they were able to detect patterns in more than 600 residents that fell into four categories: physical distress, symptoms of dying, emotional distress, and well-being. Common symptoms observed across these categories were restlessness, shortness of breath, choking, gurgling, difficulty in swallowing, fear and anxiety. ...

Sarcopenia in terminally ill patients with cancer: Clinical implications, diagnostic challenges, and management strategies Journal of Hospice & Palliative Care; by Se-Il Go, Myoung Hee Kang, and Hoon-Gu Kim; 3/1/25 Sarcopenia, characterized by progressive loss of skeletal muscle mass and strength, is a prevalent but often overlooked condition in patients with cancer who are terminally ill. It contributes to functional decline, increased symptom burden, and reduced quality of life, yet remains underrecognized in palliative care. Diagnosing sarcopenia in this population is challenging because conventional imaging techniques are often impractical. Instead, alternative assessments, such as the Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls questionnaire (SARC-F), anthropometric measurements, and bioelectrical impedance analysis offer feasible options. Management should focus on symptom relief, functional preservation, and patient comfort, rather than on muscle mass restoration.