Literature Review

The Stanford Letter Project helps you discuss your end-of-life wishesKALW 91.7 FM - Your Call, Bay Area, CA; by Rose Aguilar and Nina Kissinger; 3/18/25 On this edition of Your Call, we discuss the importance of conversations, letters, and advance directives in communicating your end-of-life care wishes to loved ones and doctors. Although 92 percent of US adults say it's important to discuss their end-of-life care wishes, only 32 percent have had this conversation, and less than one-third have advanced-care directives in place. ... The Stanford Letter Project was designed to give you the tools you need to start the process. Dr. VJ Periyakoil, the founder and director of the project, shares her insights into making end-of-life care plans and resources to help guide you through the process. ... Resources [with links to the content]:

[International] Healthcare on the brink: Palliative Care Unit and Late Shift The 75th Berlin International Film Festival - Part 7, wsws.org; by Martin Nowak and Bernd Reinhardt; 3/16/25 Two films, the drama Late Shift (Heldin) and the documentary Palliative Care Unit (Palliativstation), featured at this year's Berlin International Film Festival, addressed the current situation in German and Swiss hospitals. The sold-out festival screenings reflected the burning public interest in this topic. This is particularly remarkable bearing in mind that Palliative Care Unit has a running time of more than four hours. ... [In the] documentary Palliative Care Unit by Philipp Döring, shot at the Franziskus Hospital in Berlin, ... [the] camera quietly observes the daily routine, staff consultations and the constant empathy of the head of the ward towards employees and seriously ill patients, who usually spend their last weeks here. The very calm, always discreet images emphasise the necessity of sufficient time for care and reflection when making life-critical decisions. ... How can the highest possible quality of life be achieved? The high ethical standard of treating incurable patients as active human beings ... is admirable and makes a lasting impression throughout the film.

The preference for acute rehospitalization scale: Evaluating preference for acute rehospitalization in pediatric hospice patientsJournal of Palliative Medicine; Kelley Newcomer, Katherine Maddox; 3/25Since the passage of the Affordable Care Act, children are able to access pediatric hospice while still pursuing life-prolonging care. This can create confusion between hospice and palliative care staff and families about current goals of care (GOC), which evolve over time. Hospice and palliative care teams created, implemented, and evaluated a five-point scale to summarize the Preference for Acute Rehospitalization (PAR) Scale for children on concurrent care hospice. Most users reported they agreed or strongly agreed the PAR Scale helped them to understand families' GOC and feel more confident giving advice with urgent questions.

How to start the hospice conversation: Judy Bartel Cleveland.com, Cleveland, OH; by Guest columnist Judy Bartel, chief clinical officer for Hospice of the Western Reserve; 3/9/25 Discussing hospice care with a loved one is one of life’s most delicate and emotional conversations. For many, the word “hospice” evokes fear -- fear of finality, of giving up, of losing hope. But the truth is, hospice isn’t about giving up; it’s about focusing on what matters most -- comfort, dignity and quality of life. ...

Report finds those with Parkinson’s have unmet hospice needsMcKnights Long-Term Care News; by Kristen Fischer; 3/6/25 Hospice use varies depending on whether a person has Parkinson’s disease, Lewy body dementia or Alzheimer’s disease and those with Parkinson’s may have more unmet needs, a new study finds. Researchers evaluated data on 11,327,324 Medicare beneficiaries enrolled in hospice between 2010 and 2020 as part of their study, which was published Tuesday in JAMA Network Open. ... Hospice enrollees who had Parkinson’s disease and dementia with Lewy bodies were less likely to be disenrolled from hospice due to extended prognosis compared to those with Alzheimer’s disease. People who had Parkinson’s disease but not dementia with Lewy bodies were more apt to have longer stays over 180 days and turn hospice away compared to those with Alzheimer’s disease. (Short stays were defined as those less than seven days.)

[Canada] 'Getting everyone on the same page': Long-term-care nurses' experiences with advance care planningInternational Journal of Older People Nursing; Preetha Krishnan, Susan McClement, Genevieve Thompson, Marie Edwards, Philip St John; 3/25Ensuring comfort for LTC [long-term care] residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP [advance care planning] level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place. Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.

Palliative care clinicians goals-of-care notes more extensive than other providers’ documentation Hospice News; by Jim Parker; 3/5/25 A team of researchers has developed a standardized goals-of-care note to document patient wishes in the electronic medical record. Many patients do not experience goals-of-care conversations in a timely manner. But even among those who have, their wishes can get lost if they are not documented. The standardized note created by a research team from the Regenstrief Institute, the Indiana University School of Medicine and Indiana University Health can help health care providers be aware of and access patients’ goals of care, according to lead investigator Dr. Alexia Torke. ... The research on the note was published in the American Journal of Medicine.

Patient put in hospice at 52 celebrates life years after admission, thanks to heart surgery KCTV-5, Kansas City, MO; by Morgan Riddell; 2/27/25 A local man with heart failure who was told numerous times he only had months to live now has a new outlook on life two years later. ... It started in 2023. Sam Edwards, who was diagnosed with ALS after serving in the military, started experiencing new pains. He went to doctors who all determined Sam was just experiencing issues related to ALS. Then, a doctor at the VA Hospital noticed some tests were off and found Sam was experiencing heart failure. What he needed was open heart surgery, but doctors determined the risk of putting Sam on the operation table was too high. Not only was he at risk of having a stroke and dying on the operating table, but his recovery would also be months long and painful. They declined to do the surgery at the VA and suggested Sam go get a second opinion. This is when he was connected with Dr. Michael Gibson.Editor's note: While we in the palliative and hospice field promote earlier admissions to care and elimination of overtreatment, another side of the coin exists. Click on the title's link to read more about this hospice patient who sought out a second opinion. Imagine: the hospice patient is you (at age 52); or a family member; or a best friend. Especially as AI becomes more prevalent in assessing palliative and hospice referrals, we must see the bigger picture and retain human element. 

Can default palliative care referrals increase consults? Medscape; edited by Gargi Mukherjee; 3/4/25 A default palliative care referral intervention increased palliative care consultations by more than fivefold and decreased end-of-life systemic therapy by more than half among patients with advanced cancer being treated in the community oncology setting. ...

Charges dismissed against chef accused of trying to kill his Monterey county mother KSBW Action News-8, Monterey, CA; by Felix Cortez; 2/28/25 A popular San Francisco area chef who was arrested along with his sister and charged with trying to kill their mother more than two years ago has had attempted murder charges dismissed against him. “In over 30 years of practice, this was one of the saddest cases I have ever seen and one of the most incompetent investigations by the Monterey County Sheriff’s Department that I have ever seen,” said Juliet Peck, the attorney for James Stolich. ... The mother was terminally ill and lived on a ranch off Highway 68 outside Salinas. “James’ mother’s only wish was to die at home without pain, surrounded by her daughter, son, and pets,” Peck said. But that never happened; Tinker died about a week later in a hospice facility, never to see her children again, because an emergency protective order obtained by the sheriff’s office prevented the children from visiting their dying mother. ... According to court documents, the daughter, Whitney, was the “agent designated to make all health care decisions for her mother,” which included administering medication to help alleviate her mother’s pain. ...The original criminal complaint alleging attempted murder charges said Whitney or a co-conspirator “crushed up pills with a mallet.” A close friend of Tinker was willing to testify that Whitney had no intent to kill her mother but was simply following her mother’s “directive to provide effective and sufficient palliative care even if it hastened her death.”Editor's note: This case raises numerous issues, including but not limited to community education (including law enforcement), Advance Directives, patient and caregiver education and support, MAiD (Medical Aid in Dying) or the End Of Life Option Act (EOLOA) in California, ethics, and the dying process (note that "the mother died about a week later in a hospice facility). 

Hospice of the Piedmont offers discount book, conversation starters for family and friends Augusta Free Press, Waynesboro, VA; by Crystal Graham; 2/26/25 Hospice of the Piedmont has your ticket to discounts at restaurants, theaters, wineries and breweries as well as advice for starting a meaningful conversation with loved ones. ... The printed coupon book offers buy-one-get-one-free entrees, free theater tickets and half price wine tastings. It also includes thoughtful conversation starters designed to spark meaningful discussions with family and friends about life and its final journey. “So much of life happens around the dinner table, at a winery with friends or on a night out at the theater,” said Jenn Downs, chief marketing and development officer at HOP. “We wanted to give people a way to enjoy those experiences while encouraging people to have the kinds of conversations that truly matter.” Editor's note: Applause to Hospice of the Piedmont for this creative, engaging integration of community partnerships (with restaurants, theaters, etc.), hospice fund-raising, and catalyst for meaningful, potentially life-changing dialogues.

[Australia] Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi studyIntensive and Critical Care Nursing; Laura A Brooks, Elizabeth Manias, Bodil Rasmussen, Melissa J Bloomer; 2/25Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus. These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds.