Literature Review

New ACP paper provides ethical guidance amid controversies and changing practices in organ transplantation American College of Physicians (ACP), Philadelphia, PA; Press Release; 10/28/25 The American College of Physicians today issued a position paper on ethical considerations surrounding organ transplantation, saying the needs of the donor patient and family must be prioritized and the process should be trustworthy and transparent. “Ethical Issues in Organ Transplantation: A position paper from the American College of Physicians” was published in Annals of Internal Medicine.  It clarifies the duties and roles of care teams of prospective donor-patients, recipient-patients, and organ procurement teams, reaffirming that end-of-life decision making for prospective donor-patients must center on their best interests independent of organ donation potential. ... “This guidance is relevant to all involved in organ transplantation and particularly to internal medicine physicians who advise their patients about advance care planning and organ donation, caring for them prior to organ transplantation,” said Jason M. Goldman, MD, MACP, President, ACP. 

Peaceful acceptance of illness among older adults with advanced cancer Journal of Pain and Symptom Management; by Sule Yilmaz, Elizabeth Gilbride, Sofiia Hryniv, William Consagra, Supriya G Mohile, Eva Culakova, Beverly Canin, Arul Malhotra, Rachael Tylock, Judith O Hopkins, Jane Jijun Liu, Jamil Khatri, Marissa LoCastro, Maya Anand, Allison Magnuson, Kah Poh Loh; 10/23/25 Context: Peaceful acceptance of illness is associated with lower psychological distress and increased engagement in advance care planning among adults with advanced cancer. Limited data exist on factors influencing illness acceptance in older adults. ... Conclusion: Patient psychological health, perceived prognosis, and caregiver education were linked to PEACE. Triadic interventions addressing these factors may enhance end-of-life care for older adults with advanced cancer.

An age-old fear grows more common: ‘I’m going to die alone’ Miami Herald; by Judith Graham, Kaiser Health News; 10/17/25 This summer, at dinner with her best friend, Jacki Barden raised an uncomfortable topic: the possibility that she might die alone. “I have no children, no husband, no siblings,” Barden remembered saying. “Who’s going to hold my hand while I die?” ... It’s something that many older adults who live alone — a growing population, more than 16 million strong in 2023 — wonder about. ... More than 15 million people 55 or older don’t have a spouse or biological children; nearly 2 million have no family members at all.

Patients with advanced cancer often receive treatments that conflict with their goals Healio; by Josh Friedman; 10/20/25 Many patients with advanced cancer who prefer treatment that prioritizes quality of life receive therapies focused on preserving it. A retrospective analysis showed nearly 40% of individuals with advanced cancer who preferred treatment that improved their comfort felt clinicians gave them therapies meant to increase longevity.

Health Data Analytics Institute (HDAI) deploys innovative use of LLMs for summarizing and supporting patient preferences at a leading cancer center Bluegrass Live; by PR Newswire, Boston, MA; 10/20/25 An innovative new protocol called Better Real-time Information on Documentation of Goals of care for Engagement in Serious Illness Communication (BRIDGE-SIC) is being launched today at Dana-Farber Cancer Institute. BRIDGE-SIC uses Health Data Analytics Institute (HDAI) large language models (LLMs) to extract and summarize patients' goals of care conversations and their risk stratification tools for patient selection. The AI summaries identify and summarize prior goals of care conversations documented in patients' medical records and share them with inpatient and outpatient clinicians when patients with cancer are admitted to the hospital.

The pitfalls that derail home health providers’ new palliative care efforts Home Health Care News; by Joyce Famakinwa; 10/14/25 ... Though home health-operated palliative care is a rarity, companies like Visiting Nurse Health System, Contessa Health and Compassus have managed to successfully incorporate these services into their broader care delivery model. When structuring an effective palliative care services program, there are some common pitfalls home health providers should avoid. “One of the biggest ones is positioning palliative care as early hospice,” Nikki Davis, senior vice president of palliative care programs at Contessa, said at Home Health Care News’ FUTURE conference. “And just make sure that there’s also clear eligibility and referral pathways, so that when you’re partnering with your home health and hospice teams, you have those processes in place, so that it’s very clear who’s eligible for palliative care.”

The Center to Advance Palliative Care and the National Kidney Foundation make the case for the integration of palliative care into kidney disease management PR Newswire, New York; by The Center to Advance Palliative Care; 10/8/25 Despite facing high rates of distressing symptoms—including fatigue, pruritus, and pain—people living with advanced kidney disease are far less likely than those with cancer to receive appropriate pain and symptom management. And fewer than 10% of older adults receiving dialysis report having had conversations about their goals of care. These are two of the many important statistics highlighted in The Case for Palliative Care in Kidney Care, a new publication from the Center to Advance Palliative Care (CAPC) and the National Kidney Foundation (NKF), which emphasizes the critical need to integrate palliative care services into the treatment of patients with advanced kidney disease. 

What we get wrong about death, according to end-of-life workers Yahoo Lifestyle, originally appeared on HuffPost; by Monica Torres; 10/10/25 The one big thing that people have in common is that we all will die, and we likely will experience the death of someone we love, too. ... That’s why it can help to hear the insights of people who see death all the time, because understanding it now can help us better process grief about others and feel more at ease when thinking about our own mortality. ...

Beyond bars: Evaluating end-of-life care and surrogate decision-making for hospitalized incarcerated personsJournal of Palliative Medicine; by Zack Watson, Julie Brown, Abhinav Vyas, Stacey Tillman, Sumi Misra, Rajiv Agarwal, Cheryl Gatto, Allison McCarthy, Mohana Karlekar; 9/25Incarcerated persons (IPs) retain the constitutional right to health care, yet they face unique challenges in accessing palliative care (PC) and designating surrogates, especially when incapacitated. We present two cases of hospitalized IPs with life-limiting illnesses who experienced significant barriers in identifying and engaging surrogates. Both cases underscore the effect of delays in communication with surrogates and restricted end-of-life (EOL) visitation due to correctional policies. These delays limited the delivery of optimal interdisciplinary PC and bereavement support. Despite clear legal guidance under the Tennessee Health Care Decisions Act, misinformation and procedural ambiguity among medical and correctional staff impeded timely and appropriate care.

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 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.

State decision-making approaches in seriously ill people with intellectual/developmental disabilityJournal of Pain and Symptom Management; by Matthew Castillo, Arlen G. Gaines, Caitlyn M. Moore, Cynthia X. Pan; 8/25Hospice and palliative care (HAPC) clinicians supporting individuals with intellectual and developmental disabilities (IDD) navigate complex decision-making pathways while promoting autonomy and dignity. Approximately 1–3% of the global population lives with IDD, and many healthcare professionals feel ill-prepared to meet their unique needs, particularly in serious illness planning. This manuscript presents the case of Mr. A, an adult with Down syndrome, to illustrate practical ACP [advance care planning] and supported decision-making considerations across Maryland, New York, and Pennsylvania. Each state’s legal requirements for appointing a healthcare agent (HCA), determining capacity, and avoiding guardianship are discussed. Through thoughtful ACP and supported decision-making, HAPC clinicians can promote appropriate autonomy for individuals with IDD, fostering inclusive serious illness discussions and ethical practices across diverse legal landscapes.