Literature Review

For AYAs with advanced cancer, study finds serious communication gaps about their care National Cancer Institute; by Daryl McGrath; 4/15/25 Many adolescents and young adults (AYAs) with advanced cancer don’t have discussions with their clinicians about how they want to approach palliative care until the final weeks of life, a study of medical records of nearly 2,000 young patients showed. ... Talking about care and treatment near the end of life is one of the most challenging aspects of caring for AYAs with advanced cancer, said Ashley Wilder Smith, Ph.D., M.P.H., of NCI’s Healthcare Delivery Research Program and co-leader of NCI’s Adolescent and Young Adult Oncology Working Group. ... “When a young person is faced with a disease that may lead to an early death, it’s vitally important to give them the opportunity to think about what’s most important to them and what happens to them in terms of care in the time they have left,” she said.

[China] Asian family members' participation in advance care planning: An integrative reviewPalliative Medicine; Jing-Da Pan, Ka Yan Ho, Gui-Fen Guan, Min-Min Chang, Cui-Rong Tan, Xin-Yan Qiu, Hong-Li Liu, Ke-Lan Lin, Wen-Ting Xu, Shan Pan, Qi Liu, Ting Mao, Katherine Ka Wai Lam, Dong-Lan Ling; 3/25The willingness of Asian family members to participate in advance care planning is high, while their actual engagement remains low. Based on the barriers, facilitators, and Asian family members' roles influencing participation identified in our study, a six-dimensional conceptual model was developed: Asian family members' roles, problem-solving skills, communication, affective responsiveness, affective participation, and controlling behavior in advance care planning. Barriers to effective participation were identified: inadequate advance care planning legislation, insufficient public education, and influences from Confucianism or traditional beliefs. Additionally, filial piety was shown to have a paradoxical effect on Asian family members' participation in advance care planning in Asian countries. 

Conversations today to empower tomorrow: VITAS Healthcare elevates National Healthcare Decisions Day VITAS Healthcare; Press Release; 4/7/25 Only one in three adults in the United States have a written advance directive, a document critical in providing guidance to medical teams regarding one’s end-of-life wishes. As a pioneer and national leader in hospice and palliative care, VITAS Healthcare advocates for National Healthcare Decisions Day (April 16) and advance care planning––regardless of a person’s age or health status....  On April 16, VITAS will host a free webinar, Advance Directives and Advanced Care Planning, exploring the history, application and types of advance directives. VITAS Regional Medical Director Heather Veeder, MD, will provide practical advice to help healthcare professionals engage in difficult but necessary conversations with patients and families/caregivers. [Continue reading ...]

National Healthcare Decisions Week highlights the importance of Advance Care Planning JAX Chamber - Jacksonville News, Jacksonville, FL; 4/1/25 National Healthcare Decisions Week kicks off on April 14, 2025, with a nationwide effort to raise awareness about the importance of advance healthcare decision-making. This initiative encourages individuals to take proactive steps in planning for their future healthcare needs. Through various events and resources, the week aims to promote thoughtful conversations about healthcare decisions and the completion of advance directives to ensure patients' wishes are known and respected. ... For more information about National Healthcare Decision Day, please visit http://nhdd.org.

The intent of the Physician's Order for Life-Sustaining Treatment: Reflecting patient wishes and institutional obligationsJournal of Hospice and Palliative Nursing; Jeannette Jeannie Meyer; 4/25Portable Medical Orders (PMO) such as the Physician's Order for Life-Sustaining Treatment and the Medical Order for Life-Sustaining Treatment have proven to be valuable documents that allow patients who are medically frail or have life-limiting illnesses to communicate their health care wishes. The PMO depends on a conversation between the trained health care provider and the patient or their designee. A PMO with incomplete signatures is not a valid legal document. In the scenario presented here, the author discusses a scenario in which the discussions did not take place and the signatures are questionable, leading the patient to receive aggressive medical treatment that might not be in their best interests. The reasons behind the above ethical issues are related to a misconception and misuse of the PMO within a long-term care facility. Unfortunately, as noted in the literature cited and in the author's own experience, these ethical issues are not uncommon.

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

Hospice of the Chesapeake leader aims to think outside the box on hospice, palliative care McKnights Home Care; podcast by Liza Berger with Rachel Jordan; 3/27/25 As the director of legislative affairs and advocacy at Hospice of the Chesapeake, the largest independent not-for-profit hospice provider in the state of Maryland, Rachel Jordan strives to treat the patient and not the disease. This helps explain why she worries less about the line between “curative” and “noncurative” care and more about whether a particular treatment helps to make a patient feel more comfortable. Jordan spoke to McKnight’s Home Care about her views of hospice and palliative care for a Newsmakers podcast. [Continue to the podcast ...]

Bioethics Artificial Intelligence Advisory (BAIA): An Agentic Artificial Intelligence (AI) framework for bioethical clinical decision support Cureus; by Taposh P. Dutta Roy; 3/12/25 Healthcare professionals face complex ethical dilemmas in clinical settings in cases involving end-of-life care, informed consent, and surrogate decision-making. These nuanced situations often lead to moral distress among care providers. This paper introduces the Bioethics Artificial Intelligence Advisory (BAIA) framework, a novel and innovative approach that leverages artificial intelligence (AI) to support clinical ethical decision-making. The BAIA framework integrates multiple bioethical approaches, including principlism, casuistry, and narrative ethics, with advanced AI capabilities to provide comprehensive decision support. 

Hidden battles: Keeping cancer secret Harvard Health Publishing - Harvard Medical School; by Maureen Salamon; post is dated 4/1/25, retrieved from the internet 3/25/25 Some people choose to conceal their diagnosis and treatment. Here's why — and reasons that approach can sometimes backfire. ... [In addition to privacy motives, Cristina Pozo-Kaderman, a senior psychologist at Harvard-affiliated Dana-Farber Cancer Institute] says cancer patients may also wish to:

Utah funeral home is first in state to offer "human composting" as a green alternative to traditional burials Salt Lake City Weekly, Salt Lake City, UT; by Aimee L. Cook; 3/19/25 ... Jason and Shayneh Starks, who opened [Starks Funeral Parlor in Millcreek] in 2005, offer their clients an innovative and environmentally conscious option—natural organic reduction (NOR), often called human composting. This process transforms the deceased into nutrient-rich soil over a period of 8 to 12 weeks. While the concept may sound unconventional to some, it's gaining traction with families in Utah and beyond, ... "We're seeing a lot of interest from environmentally conscious individuals who want a natural, meaningful way to return to the earth," observed Shayneh Starks, who has worked in funeral services since 1995. Natural organic reduction has already been legalized in states like Washington, Oregon and California, but Utah has yet to officially approve this process.  Currently, Starks Funeral Parlor assists families who wish to choose this option by transferring remains out of state to Seattle, ensuring that those who value NOR have access to it.

Nursing home residents, family members, and staff members views about a good death and preferred place of death for a nursing home residentOmega-Journal of Death and Dying; Janet Sopcheck, Ruth M. Tappen; 2/25Our study ... revealed that residents, like family members and staff members, had mixed opinions of the place of death for the NH resident, highlighting the importance of having advance care planning sessions with residents and their families to gain an understanding regarding their choices. Our study found the predominant and common qualities across the three participant groups of a good death include painless or pain-free, without suffering, peaceful, quiet, and dying in my sleep. Interestingly, almost one-fifth of the participants disagreed with the term good death, offering that death is not good as the person is no longer alive. Based on this study’s finding, using the term a good death in research and in advance care planning sessions may not be relevant or appropriate and instead focus on what care is necessary to promote a natural death, as mentioned by a few participants.

‘Early discussions on what to expect can lessen the strain’ Nursing Times; by Kylie Chaffin; 3/19/25 The article explains the pros and cons of nutrition and hydration at end of life and the several types of artificial nutrition and hydration that can be used, written in a way patients and families can understand. Resources and educational articles, like this one, can also be a great way to introduce new or even more effective ways nurses and care team members can support patients and families when pursuing a palliative approach to their health and wellbeing. My question for readers is, “Should the conversation of end-of-life, hospice and palliative care, and nutritional changes, be initiated sooner rather than later in patients with a terminal diagnosis?”

Delaware House passes end-of-life option bill for terminally ill adults ABC Action News 6, Dover, DE; by 6abc Digital Staff; 3/20/25 Currently, medical aid for euthanasia is legal in 10 U.S. states and the District of Columbia. Delaware's House of Representatives has passed a bill giving some terminally ill residents the right to take their life. The bill allows mentally capable adult residents, who have been given a prognosis of six months or less to live, the option to request and obtain life-ending medication. The bill now heads to the Senate. ... Now, for the 10th time, Delaware lawmakers are trying once again to get the bill passed. ... Governor Matt Meyer has signaled his support if the bill passes the Senate,  ...