Literature Review

Integrating psychotherapeutic concepts to enhance serious illness communication: Assessment of a model curriculumJournal of Palliative Medicine; Danielle Chammas, Keri Brenner, Amanda Moment, Sarah E. Byrne-Martelli, Leah B. Rosenberg, Daniel Shalev; 5/25 Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. Using Kern’s six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. Results: Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. Conclusions: A multisite, half-day workshop significantly enhanced palliative care clinicians’ knowledge and perceived application of core psychotherapeutic concepts.

Providing support to children during the loss of an important adult in the ICUIntensive Care Medicine; Ruth Kleinpell, Bénédicte Gaillard-Le Roux, Jozef Kesecioglu; 5/25Research on bereavement care in the ICU has demonstrated associated benefits, including facilitating emotional adjustments, meaning-making, and resilience. As Rowland and colleagues highlight, helping children process information effectively without feeling overwhelmed is important, as they need supportive adults to provide honest, developmentally appropriate explanations. The strategies highlighted in their narrative review can help ICU clinicians to tailor bereavement care for children to support them through the loss of an important adult in the ICU.

Sex and racial/ethnic differences in end-of-life care preferences in persons with Parkinson's Disease and related disordersMovement Disorders; Whitley W Aamodt, Lynn Eickholt, David G Coughlin, Lisa Solomon, Katharine A Rendle, Carly Marshall, Joaquin A Vizcarra, Nabila Dahodwala; 5/25In persons with Parkinson's disease (PD) and related disorders (PDRD), rates of end-of-life (EoL) hospitalization are greatest, and rates of hospice utilization lowest, among men and persons of color. In adjusted models, women with PDRD were more likely than men to prefer religious/spiritual support at the end of life. Compared with White participants with PDRD, non-White participants were more likely to consider EoL hospitalization, less likely to consider medical aid in dying, and less familiar with palliative care. In four focus groups involving 14 questionnaire respondents, contributors to EoL decision-making included medical knowledge/information, personal experiences, family dynamics, religion/spirituality, and resources/cost. Conclusions: EoL care preferences differ by sex and race/ethnicity in persons with PDRD. These preferences are influenced by multiple factors and may contribute to differential EoL outcomes, emphasizing the need for individualized, culturally competent EoL care. 

Trends in home health care among traditional Medicare beneficiaries with or without dementiaJAMA Network Open; Rachel M. Werner, MD, PhD; Seiyoun Kim, PhD; R. Tamara Konetzka, PhD; 5/25In the US, nearly 7 million people live with Alzheimer disease and other dementias, a number that is expected to increase as the population ages. Although many people with dementia live in nursing homes or other institutional settings, institutional use is decreasing, and a growing majority of people with dementia are opting to live at home and receive care in the community. Home-based care is typically consistent with most people’s preferences and may be particularly important for those with dementia, as institutional settings and transfers can be stressful and disorienting.

[Canada] The discourse of medical assistance in dying and its relationship with hospice palliative care in Canada: An integrative literature reviewJournal of Advanced Nursing; Jennifer D Dorman, D Shelley Raffin Bouchal, Eric Wasylenko, Shane Sinclair; 5/25Three themes identified from the data were the relationship between MAiD [medical assistance in dying] and HPC [hospice pallaitive care], suffering in the context of MAiD, and moral distress and moral uncertainty in providing or not providing MAiD. The discourse around the relationship between MAiD and HPC is complex and contextual. Personal and professional understandings of end-of-life care differ and influence perspectives on how and whether MAiD and hospice palliative care can be reconciled. Findings consider how the concepts of end of life, MAiD, HPC, suffering, and moral distress influence and are influenced by the discourse of dying. 

[Canada] Health leaders’ perspectives and attitudes on medical assistance in dying and its legalization: A qualitative studyBMC Medical Ethics; Amanda Yee, Eryn Tong, Rinat Nissim, Camilla Zimmermann, Sara Allin, Jennifer L Gibson, Madeline Li, Gary Rodin, Gilla K Shapiro; 5/25This study highlights the wide-ranging and complex attitudes health leaders may hold towards MAiD [Medical Assistance in Dying] and identifies the convergence of multiple factors that may have contributed to the legalization of MAiD in Canada. Participants identified six factors that they believed to have led to the introduction of MAiD in Canada: public advocacy and influence; judicial system and notable MAiD legal cases; political ideology and landscape; policy diffusion; healthcare system emphasis on a patient-centred care approach; and changes in societal and cultural values. Participants expressed wide-ranging attitudes on the legalization of MAiD. Some described overall agreement with the introduction of MAiD, while still raising concerns regarding vulnerability. Others held neutral attitudes and indicated that their attitudes changed on a case-by-case basis. Participants described four factors that they considered to have had influence on their attitudes: personal illness experiences; professional experiences and identity; moral and religious beliefs; and, the valence of patient autonomy and quality of life.

Online dialectical behavioral therapy for emotion dysregulation in people with chronic pain-A randomized clinical trialJAMA Network Open; Nell Norman-Nott, BPsychSc; Nancy E. Briggs, PhD; Negin Hesam-Shariati, PhD; Chelsey R. Wilks, PhD; Jessica Schroeder, PhD; Ashish D. Diwan, MD, PhD; Jina Suh, PhD; Jill M. Newby, PhD; Toby Newton-John, PhD; Yann Quidé, PhD; James H. McAuley, PhD; Sylvia M. Gustin, PhD; 5/25Chronic pain, defined as pain persisting beyond 3 months,1 affects 20% to 30% of the population. Beyond its sensory experience, chronic pain is an intrinsically emotional experience associated with heightened negative emotions, including anger, worry, and low mood, alongside a diminished capacity to regulate emotions. Dysregulated emotions contribute to comorbid psychological disorders; symptoms of anxiety and depression, which are present in 50% to 80% of people with chronic pain; and worsening pain intensity. One emotion regulation–focused intervention being adapted for chronic pain is dialectical behavioral therapy (DBT). In DBT skills training, emotion regulation is improved by encouraging emotion recognition, emotion expression, and reaction evaluation. Results of small in-person trials of DBT for people with chronic pain show promise to improve emotion dysregulation, depression, anxiety, and pain intensity.

Naming the pain: Grief-ism, grief-ist, and the linguistics of lossIllness, Crisis & Loss; Laurel E. Hilliker, Bob Baugher; 5/25This article introduces two new terms, Grief-ism and Grief-ist, to expose some of the behaviors, actions, inactions, and unrealistic expectations of others (from individual support persons to societal institutions) towards bereaved individuals. In this article, we provide examples of subtle prejudice, discrimination, and marginalization involving those adjusting to significant loss. As well, this work draws attention to the medicalization and policing of the process of grief by well-meaning others. We believe these actions accumulate over time, weigh down those who are grieving loss, and tend to make the grief feel unsupported. As a result, people coping with the loss of a loved one may experience feelings of isolation and, in some cases, a lengthening of the grief process.

Where adults with heart failure die: Insights from the CDC-WONDER databaseCirculation: Heart Failure; Farman Ali, Shaaf Ahmad, Aman Ullah, Ali Salman, Adarsh Raja, Faizan Ahmed, Prinka Perswani, Ahsan Alam, Jishanth Mattumpuram, Muhammad Talha Maniya, Hamza Janjua, Tyler J Bonkowski, Aravinda Nanjundappa; 5/25This study underscores the shifting trends in the locations of death among patients with HF [heart failure], with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. Hospice/nursing home deaths increased from 30.95% ... in 1999 to 34.71% ... in 2017, but declined to 29.54% ... by 2023. Young adults (20-34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities. 

Avoidant and approach-oriented coping strategies, meaning making, and mental health among adults bereaved by suicide and fatal overdose: A prospective path analysisBehavioral Sciences; Jamison S. Bottomley, Robert A. Neimeyer; 5/25The current study shed light on the role of avoidance- and approach-oriented coping strategies in aggravating or ameliorating the longer-term distress of the survivors of such losses, roughly half of whom showed continued clinical-level elevations of prolonged grief, posttraumatic stress, and depressive symptomatology two years following the death. The results provided cautionary evidence that avoidant coping through denial, distraction, and behavioral disengagement prospectively predicted higher levels of prolonged grief and posttraumatic stress, with the impairment of meaning making about the loss accounting for much of the variance in the former outcome. In contrast, actively approaching others for support and attempting to confront and surmount the problems posed by bereavement consistently predicted a reduction in prolonged grief, posttraumatic stress, and depression symptoms in the months that followed. The latter impacts were found to be fully mediated by the enhancement of meaning making about the loss, carrying practical implications for bereavement support and grief therapy for this vulnerable population of mourners.

Gaps in the coordination of care for older adults with or at risk for cardiovascular disease The American Journal of Managed Care; by Lisa M. Kern, MD, MPH,Joselyne E. Aucapina,Samprit Banerjee, PhD, Joanna B. Ringel, MPH, Jonathan N. Tobin, PhD, Semhar Fisseha, MPH, Helena Meiri, MA, RN, Madeline R. Sterling, MD, MPH, Kurt C. Stange, MD, PhD, Monika M. Safford, MD, Paul N. Casale, MD, MPH; 6/3/25 ... To determine whether older adults with cardiovascular disease (CVD) or CVD risk factors perceive gaps in communication among their providers and whether they consider those gaps to be consequential, we conducted a cross-sectional survey of Medicare beneficiaries 65 years and older with CVD or CVD risk factors and highly fragmented ambulatory care (reversed Bice-Boxerman Index score ≥ 0.85).

Provision of end-of-life care in austere environmentsWilderness & Environmental Medicine; by Jason W. David, Hui Z. Feng, Danny Lammers, Russell Day; 6/25End-of-life care presents unique challenges in austere or resource-limited environments where traditional medical resources are scarce or absent. This review explores the complexities of providing end-of-life care under such constraints, including recognition of the dying patient and techniques to alleviate suffering and allow death with dignity in under-resourced or expeditionary environments. Moreover, it presents these techniques in an accessible manner for providers without formal hospice training to use. Based on a literature review of hospice and palliative medicine, insights from the body of literature in wilderness and austere medicine, and the authors’ experiences in practicing in austere environments, this paper discusses practical approaches to symptom management, ethical considerations in end-of-life decision making, and accessible interventions with limited resources.Publisher's note: An interesting article for all healthcare professionals to consider...

Granting permission: Toward embracing griefJournal of Social Work in End-of-Life and Palliative Care; by Rennie Bimman; 3/25Grief, unavoidable and often excruciating, is rarely sufficiently acknowledged or supported in Western society. It is not granted permission to exist without barriers. By considering and evaluating grief experiences through the lens of their access to permission, clinicians can collectively imagine and promote inclusivity in grief. Permission is presented as a conceptual framework and clinical tool, with broader micro- and macro-level applications for both professional and layperson engagement, offering a foundation for further implementation and research.