Literature Review

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. ...

[Korea] 9 in 10 Koreans support ending life-prolonging treatment: study The Korea Times; by Kim Hyun-bin; 2/24/25 More than nine out of ten Koreans think that they would opt to forgo life-prolonging treatment if they were terminally ill, a new study has found, highlighting shifting attitudes toward end-of-life care in the country. According to a report released by the Korea Institute for Health and Social Affairs on Sunday, 91.9 percent of respondents expressed they would choose to discontinue life-sustaining treatment if they were diagnosed with a terminal illness or were nearing the end of life, based on a survey conducted last April and May on 1,021 men and women. 8.1 percent stated they would prefer to continue such treatment.

How boomers are personalizing their last chapter Broadview; by Larry Krotz; 2/19/25 From death doulas to digital legacies, this generation is flipping the script on end-of-life traditions. ... I confess that I don’t generally think much about dying, though many in my generation do. Baby boomers, that great bulge in the population whose concerns for so long have dominated the culture, have moved from preoccupations with creative retirement or the adequacies of the health-care system to a fascination with death. Witness the immense popularity last year of the Royal Ontario Museum’s multisensory exhibit Death: Life’s Greatest Mystery or the growth of death cafés ... For my contemporaries, death has become the next item on the to-do list. What it will look like. How to prepare for it. How to make it your own. ...

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. ...

Mayo Clinic Hospice to present improv show on end-of-life care at Marion Ross theater Albert Lea Tribune; 2/18/25 In honor of Mayo Clinic Hospice celebrating 45 years of service to Southeast Minnesota, in collaboration with Danger Boat Productions, the Naeve Health Care Foundation, and the Mayo Clinic Dolores Jean Lavins Center for Humanities in Medicine, invites the community to attend “End-of-Life: Live and Unscripted.” The event will be held at the Marion Ross Theatre from 6 to 7 p.m. March 27, with doors opening at 5:30 p.m. This unique improv show aims to bring the community together for an evening of laughter and learning. Attendees will gain insights into advanced care planning, important end-of-life care considerations and ways to support the community during end-of-life stages.Editor's note: Though readers surely will not be able to attend, we post this to spark your collaborations for community engagement and education through the arts. 

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. ...

The talk nurses don't talk about enough: Death and dying Nurse.org - Nurse Converse podcast; by "Courtney" DNP, APRN, AGNP-C; 2/11/25 ... Nursing and medical curricula extensively cover subjects such as pathophysiology, pharmacology, and anatomy, yet they often fail to provide structured training on effective communication regarding death and dying. In the podcast, the hosts recall their own educational experiences, noting that they were not equipped with the tools or frameworks necessary to engage in these sensitive discussions. One telling example from a medical course on difficult conversations revealed that when students were asked if they had received any training on the subject, not a single hand was raised. 

It’s inoperable cancer. Should AI make call about what happens next? The Harvard Gazette - Harvard University; by Alvin Powell; 2/10/25AI is already being used in clinics to help analyze imaging data, such as X-rays and scans. But the recent arrival of sophisticated large-language AI models on the scene is forcing consideration of broadening the use of the technology into other areas of patient care. In this edited conversation with the Gazette, Rebecca Weintraub Brendel, director of Harvard Medical School’s Center for Bioethics, looks at end-of-life options and the importance of remembering that just because we can, doesn’t always mean we should. When we talk about artificial intelligence and end-of-life decision-making, what are the important questions at play? ...

Advice on navigating complex caregiving Philadelphia Corporation for Aging; by Jay Nachman; 2/3/25 The biggest challenge for someone taking care of a parent or loved one is “accepting your loved one for who they are now. Not who you knew them to be,” said Dr. Kiplee Bell, an internal medicine physician who has created a practice focused on caregiving. ... It’s not uncommon, according to Bell, for minority community members to live in multi-generational households. Additionally, in some homes, grandparents are raising grandchildren. Then there is the flipside, where young children are helping to take care of their older family members. And when English is not a native tongue, language barriers can preclude an adequate understanding of how to navigate the social service and health care systems. ...

Medical professionals’ perceptions of and experiences with terminally ill Orthodox Jewish patientsAmerican Journal of Hospice and Palliative Medicine; Moshe C. Ornstein, MD, MA; David Harris, MD; 1/25Orthodox Jewish patients with terminal illnesses have unique goals and desires, often driven by halakha (Jewish law and ethics) and cultural norms. Compared to the general population, Orthodox Jewish patients with terminal illnesses are more likely to request aggressive measures at end-of-life and are less likely to have completed advanced directives and health care power of attorney documentation. They also do not always have a rabbinic authority involved in decision-making. Health care professionals highlighted strong religious and community support as positive elements of caring for this population and recommend that medical teams establish early and direct communication with rabbinic authorities for those patients for whom a rabbi’s involvement is desired.

Disproportionate use of aid in dying among people with ALS: Why ALS aid-in-dying requests are common while ALS is rareJournal of Aid-in-Dying Medicine; Carolyn Rennels, MD; Steven Z. Pantilat, MD FAAHPM, MHM; Ambereen K. Mehta, MD, MPH, FAAHPM; Allison Kestenbaum, MA, MPA, BCC-PCHAC, ACPE; Kelsey Noble, DO; Jessica Besbris, MD; Ali Mendelson, MD; Kara Bischoff, MD; 12/24People with amyotrophic lateral sclerosis (ALS) disproportionately use aid in dying. We explore aspects of the ALS experience that may help explain the higher rates of aid-in-dying requests in this disease relative to others. In particular, the desire to maintain control is prominent in the face of a relentlessly progressive disease that results in substantial disability. We also describe how the requirement for self-administration of aid-in-dying medications impacts people with ALS.

US dementia cases projected to double within 40 years Medscape Medical News; by Pauline Anderson; 1/13/25 The number of US adults who will develop dementia each year is projected to increase from approximately 514,000 in 2020 to about 1 million in 2060, new research shows. In addition, the lifetime risk of developing dementia after age 55 is estimated at 42%. The research showed that the relative growth in dementia cases is particularly pronounced for Black adults. These new findings researchers say, “highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.”

How poor communication is killing patients and burning out doctors Medpage Today's KevinMD.com; by Pamela Buchanan; 1/14/25 This week alone, I had two particularly heart-wrenching encounters [as an Emergency Room physician]: A 65-year-old man with metastatic lung cancer, convinced his shortness of breath was just pneumonia. When I explained the progression of his disease, he was shocked. No one had told him that his cancer was likely incurable. A 97-year-old woman brought in for “failure to thrive.” She was frail, pale, and not eating—classic signs of the final stages of metastatic cancer. When I suggested hospice care, she seemed blindsided, as if this reality was completely new to her. Both cases highlight a troubling trend: Patients often come to the ER not just for care, but for clarity. They don’t understand their diagnosis, prognosis, or treatment plan. ...