Literature Review

Palliative care’s most disruptive forces in 2025 Hospice News; by Holly Vossel; 2/25/25 Palliative care providers are taking varied routes to address the most disruptive forces they are encountering this year, rising to challenges that have been persistent across the sector. Mounting workforce pressures mark the most significant of concerns for palliative care providers, according to Dr. Martha Twaddle, The Waud Family Medical Directorship’s palliative medicine and supportive care clinical professor of medicine at Northwestern Medicine. The nation lacks a sufficient supply of palliative care professionals amid a swelling population of seriously ill patients, driving up demand. Current reimbursement streams are challenging the staffing issues even further, Twaddle stated. ... Workforce shortages and lack of sustainable reimbursement are indeed the largest obstacles to palliative care growth, according to Center to Advance Palliative Care (CAPC) CEO Brynn Bowman.

‘Global problem’: Numerous factors, biases contribute to overtreatment at end of life Healio; by Josh Friedman; 2/26/25 Nathan I. Cherny, MD, has worked all around the world. At every stop — from Australia to Israel, and Memorial Sloan Kettering Cancer Center in between — he has seen people with cancer receive overly aggressive treatment at the end of life. ... In a review published in ESMO Open, Cherny and a cohort of multinational colleagues highlighted numerous reasons why overtreatment occurs among patients approaching the end of life, ... They listed more than 20 contributing factors, including desire for control of the cancer, denial and anger, family pressure and hope preservation. The two factors that contribute most to overtreatment are optimism bias and the “counterphobic determination to treat,” which involves clinicians having a difficult time introducing the suggestion of palliative care revert to offering further treatments, Cherny said. ... Responsibility for decisions does not need to fall solely on oncologists, Cherny added. Palliative care physicians, social workers, chaplains and others can be part of a team to assist patients with their choices. ... The number of patients who are overtreated differs at each institution. “Each institution has its own culture of care,” Cherny said. Editor's note: This article puts forth significant insights for all palliative and hospice clinicians, interdisciplinary teams, and palliative/hospice executive leaders. Apply Cherny's to your referral sources: "Each institution has its own culture of care." Apply these findings to your own palliative and hospice services. 

[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.

Study shows end-of-life cancer care lacking for Medicare patients Vanderbilt University Medical Center (VUMC) News; by Tom Wilemon; 2/21/25 The study involved patients of diverse ethnic backgrounds age 66 or older who died from breast, prostate, pancreatic or lung cancers. Many Medicare patients with advanced cancer receive potentially aggressive treatment at the expense of supportive care, according to a study that analyzed Medicare records. The study, published Feb. 21 in JAMA Health Forum, examined the quality of end-of-life care among 33,744 Medicare decedents. ... Overall, claims records showed that 45% of the patients experienced potentially aggressive care (such as multiple acute care visits within days of death), while there was a low receipt of supportive care, such as palliative, hospice and advanced care planning in the last six months of life. While hospice care spiked to more than 70% during the month that death occurred, over 16% of patients spent less than 3 days in hospices. Moreover, receipt of advanced care planning and palliative care remained below 25%. Editor's note: Click here for the research article, "Contemporary Patterns of End-of-Life Care Among Medicare Beneficiaries With Advanced Cancer." Though this research was published just this past Friday February 21, 2025, multiple newsletters are posting it, highlighting different elements. 

Patients without family or health care proxies face overtreatment or limbo in hospitals WHYY - PBS; by Maiken Scott; 2/24/25 A program matches unrepresented patients with volunteers who can make care decisions for them during health care crises. ... [Intensive care physician David] Oxman says unrepresented patients are a small, but growing group. Some have outlived their family members, or are estranged from them. Maybe they’ve moved a lot, sometimes substance use or homelessness plays a role. The situation is especially complicated with patients who have dementia, or who can’t communicate their wishes for other reasons. ... Most states have provisions where medical guardians and medical decision makers can be appointed by a court, but that takes a long time. In the meantime, a search for relatives begins. David Sontag, director of ethics for Beth Israel Lahey Health in Massachusetts, ... created a matching program where health care professionals volunteer to represent patients, not within their own hospital systems because that could cross ethical boundaries, but at other hospitals. “This is an opportunity for us to help some of the most vulnerable members of our communities, those who have nobody to speak for them when they can no longer speak for themselves. And that allows us to respect their autonomy throughout their lives,” he said.

Impact of patient and caregiver beliefs on utilization of hospice and palliative care in diverse patients with advanced lung cancerAmerican Journal of Hospice and Palliative Care; Melanie Besculides, Melissa B Mazor, Carolina Moreno Alvarado, Mayuri Jain, Lihua Li, Jose Morillo, Juan P Wisnivesky, Cardinale B Smith; 2/25A prospective cohort study of newly diagnosed patients ≥18 years old with advanced lung cancer and their caregivers was conducted. Participants completed validated surveys at multiple points and electronic health records were reviewed to evaluate utilization. Minoritized lung cancer patients held more negative beliefs about HC/PC [hospice care/palliative care] yet were more likely to receive HC/PC. Further work is needed to understand factors that impact utilization among diverse patients with advanced cancer.

Over a quarter of adolescents, young adults with cancer who want to die at home do not Healio; by Jennifer Byrne; 2/20/25 More than one-fourth of adolescents and young adults with cancer who wished to die at home did not attain this goal, according to research published in JAMA Network Open. Researchers conducted a retrospective cohort study that included adolescents and young adults (AYA; age range, 12 to 19 years) with cancer who died between 2003 and 2019. The cohort included patients treated at Dana-Farber Cancer Institute, Kaiser Permanente Northern California or Kaiser Permanente Southern California. ... Healio spoke with Odejide about the rationale for the study, the importance of the findings, and strategies oncologists can employ to ensure more goal-concordant end-of-life care for AYA patients with advanced cancers. [Click here for Helio's discussion with the lead researcher, Oreofe O. Odejide, MD, MPH, associate professor of medicine at Dana-Farber Cancer Institute.]  Editor's note: Examine this JAMA article, which we posted in our Saturday Research issue, 1/18/25: "Preferred and actual location of death in adolescents and young adults with cancer."

Innovations in serious illness care with Bree Owens Teleios Collaborative Network (TCN); podcast by Chris Comeaux; 2/19/25 In this episode of TCNtalks, host Chris Comeaux interviews Bree Owens, a licensed clinical social worker and co-founder of The Holding Group.  They discuss Bree’s journey in the healthcare field, particularly in Palliative Care. Bree shares insights on learning the importance of meaningful conversations with patients and their families about care options, which led her to the unique model of The Holding Group.  Her organization has created space, hence the name The Holding Group, for a patient-centered approach, helping patients and their families find the right care at the right place and at the right time.  Bree emphasizes the significance of informed consent and the role of social workers in facilitating these discussions to enhance patient outcomes and satisfaction.

An interview with Clinical Psychologist (retired) Johanne de Montigny, M.A.Ps. ehospice; interview between Dr. Stefanie Gingras and Johnne de Montigny; 2/14/25 Ahead of her February 19, 2025 lecture entitled “What I’ve learned about accompaniment, death and bereavement: 29 years of psychological services at the heart of an MUHC care team (1986-2015)”, part of the McGill National Grand Rounds programme, Johanne de Montigny shared her thoughts with Program Director and palliative care physician Dr. Stéfanie Gingras.Dr. Stéfanie Gingras (SG): How did you first become interested in the field of palliative care?Johanne de Montigny (JdM): It was a very profound and sudden experience where I almost died that guided me in this choice. I survived a plane crash, in which 17 people (out of 24) died. After this event, I asked myself what I was going to do with my life. For me, that meant choosing a profession that would be meaningful. After returning to school to study psychology, I chose to become a palliative care psychologist. After being confronted with sudden death, I wanted to understand how people reacted when they learned that they were going to die, that they still had time, and how to live with it. ... In those moments, I remembered that before I died – because I thought I was going to die – the young flight attendant who, in the space of a minute before the crash, had managed to help us contain the shock and give us some hope. She told us, “Whatever happens, we’re together and we’re going to get through this together.” That one relational minute made all the difference. It enabled us, I believe, to survive psychically before dying physically. She was my first carer just before she died. ... As for the family, what was most striking for me was the realization that the end of life is a time of unparalleled intimacy. Editor's note: This rich life-reflection provides powerful insights in light of many recent plane tragedies.

New insights into older hearts  The New York Times; by Paula Span; 2/15/25 It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart. Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention. ... [In] recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths. ... That can complicate decision-making for heart patients in their 70s and beyond, however. Certain procedures or regimens may not markedly extend the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and are contending with other illnesses as well. “We don’t need to open an artery just because there’s an artery to be opened,” said Dr. Alexander, referring to inserting a stent. “We need to think of the whole person.” ...

Americans who’ve become caregivers rose by a third in 10 years The Daily Sentinel, Grand Junction, CO; 2/14/25 A growing numbers of family members now provide care for older adults who live at home or in residential care settings, a new study shows. Their ranks increased 32%, from 18.2 million to 24.1 million, between 2011 and 2022, according to new research in the journal Health Affairs. The number of hours that these folks spent caring for older adults with dementia jumped by nearly 50%, from an average 21.4 hours per week in 2011 to 31 hours in 2022. Exactly what is driving the increase in family or unpaid caregiving is not fully understood, but researchers speculate that it may be due to a rise in the number of people who live with the folks who they assist. For the study, researchers culled data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) in 2011 and 2022.  

Advanced cardiac care boosts symptom management, quality of life Carolina Caring, Newton, NC; by Cassidy Collins; 2/12/25 For those living with advanced heart disease or heart failure diagnoses, access to the right medical care can greatly improve their quality of life. This Heart Month, Carolina Caring is spotlighting the Advanced Cardiac Care Program, which provides treatment and clinical support to help patients with heart failure manage their symptoms from wherever they call home. It is the first program of its kind in North Carolina and one of the first established in the nation. It also recognized as a Certified Care program in Palliative/Hospice Heart Failure from the American Heart Association (AHA). Since this certification, Carolina Caring saw a drop to zero readmissions for primary congestive heart failure Hospice patients by the end of 2024. The benefits of this comprehensive, home-based cardiac care program are best illustrated through individuals such as Shirley, a hospice patient who began her journey with Carolina Caring last spring.