Literature Review

[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. 

You’ve got a friendtor in me: Innovations in peer mentoring for mid-career palliative care cliniciansAmerican Journal of Hospice and Palliative Medicine; April Zehm, MD; Andrew J. Lawton, MD; Leah B. Rosenberg, MD; Sudha Natarajan, PhD, MSN; Bethany-Rose Daubman, MD; 3/25 Mentoring is crucial to professional success, but little is known about the professional development needs of mid-career hospice and palliative medicine (HPM) clinicians. An interprofessional “friendtor” group of five HPM clinicians from three academic medical centers met monthly and for a year-end focus group. Several themes emerged that highlight the importance of peer support when navigating major life decisions, boundary-setting, and non-clinical practice challenges, celebrating friendtors’ personal and professional milestones, and having a productive space for shared academic pursuits. Given the challenges and vulnerabilities the field of HPM is experiencing with workforce sustainability and burnout, the importance of developing supports outside of traditional mentorship paradigms is a valuable area of focus. Our work suggests that a friendtorship model may be an effective tool for sustaining mid-career HPM clinicians.

Stroke deaths and their racial disparities increased over last 20 years EurekAlert! - American Association for the Advancement of Science (AAAS); by Peer Review Publication; 4/9/25 Over the last two decades, ischemic stroke mortality rates in the U.S. have grown, with almost 3 in 10 deaths occurring at home, and increases particularly among racial minorities and rural residents. These growing disparities were among the findings of a new study publishing April 9, 2025, in the open-access journal PLOS One by Jason Lim of Georgetown University School of Medicine, U.S., and colleagues. ...  The analysis included 237,617 recorded ischemic stroke deaths. The study found that age-adjusted ischemic stroke mortality rates, after years of decline, have increased across all urbanization levels since 2009, with the most pronounced rises in non-metropolitan areas. Additionally, there has been a noticeable shift in the place of death, with more people dying at home instead of in hospitals or other medical facilities. From 1999 to 2020, the percentage of at-home deaths increased from 8.44% to 29.31%.Editor's note: Pair this research with ongoing shut-downs of rural hospitals, rural emergency room access, and more. This ongoing increase is one of many, ongoing alarms. Ethics. Integrity. Mission. It's past time to improve patient care.

Interprofessional advance care planning to enhance end-of-life care: A community assessmentCreighton Journal of Collaborative Practice and Education; Meghan Potthoff, Amanda Kirkpatrick, Jenny Jessen, Cathy Fox, Victoria Haneman, Megan Piotrowski, Beatriz Rodriguez, Sydney Langlois; 3/25Lawyers and financial planners are more often sought for estate directives than primary care providers for end-of life planning. Lack of role clarity and divergent views about advance care planning (ACP) responsibility among healthcare providers lead to further delay of these important discussions. A qualitative, exploratory design was employed to investigate ACP understanding, barriers, and needs among aging Nebraskans and Omaha-metro community agencies that serve these consumers. Conclusions: Improved ACP discussions are needed for supporting value-aligned end-of-life care by educating aging adults about, and documenting their wishes for, life-sustaining treatments and other decisions surrounding death. Enhanced role clarity, increased competence, and a collaborative approach are needed among interprofessional team members involved to improve these end-of-life discussions. 

Perioperative integration of palliative care and urology for patients with serious urologic illness: A qualitative need finding inquiryJournal of Pain and Symptom Management; Bhagvat J Maheta, Nainwant K Singh, Jonathan Bergman, Cati G Brown-Johnson, Alekhya Gunturi, Nickolas Interrante, John T Leppert, Karl A Lorenz, Isabella G Raspi, Karleen F Giannitrapani; 3/25Many urologic serious illnesses are treated with surgical procedures, which may put patients at a further risk of diminished quality of life. [We] purposefully sampled urologists, palliative care physicians, and clinical team members at fourteen geographically distributed Veteran Health Administration sites. We identified one general overall theme, to "change culture" so that PC [palliative care] is not a "last resort" ... Utilizing telehealth and team member role expansion when discussing the initial diagnosis, with surgery as a potential treatment option, allows for multiple conversations ... Creating a process to ensure goal of care conversations occur, since "urologic procedures can have complications that significantly impact quality of life" ... [and] during the pre-operative visits, interdisciplinary input and evaluation of the patient prior to surgery allows the patient to "have a sort of joint meeting with us and the urologist."

Impact of outpatient palliative care services on resource utilization and cost management in a capitated Medicare populationJournal of Palliative Medicine; Parag Bharadwaj, Gagandeep Gill, Nathan Dyjack, Lindsay Fahnestock, Lorie D'Amore, Shuinn Chang, Nancy Hanna, Tanya Dansky, Gwyn Merz, Annamarie Jones, David Kim, Manjit Randhawa; 3/25The integration of palliative care into the U.S. health care system has grown significantly, with outpatient palliative care services (OPCSs) playing an increasingly vital role in managing patients with serious illnesses. Results [of this study] demonstrate substantial growth in OPCS enrollment, with a 129% increase from 2019 to 2023. Per-member-per-month costs showed a sustained reduction, with a 23% decrease by 2023. In addition, there were consistent reductions in ED [emergency department] visits and IP [in-patient] admissions, indicating effective outpatient care management. Patients transitioning from OPCS to hospice exhibited longer hospice stays, further emphasizing the benefits of early palliative care interventions.

[Germany] Do we have a knowledge gap with our patients?-On the problems of knowledge transfer and the implications at the end of lifeInternational Journal of Environmental Research and Public Health; Nils Heuser, Hendrik Heers, Martin Gschnell, Fabian Urhahn, Severin Schrade, Christian Volberg; 2/25Cancer patients are often unaware of their exact diagnosis, stage of disease, and prognosis. In the patients observed, it was found that many of them were unaware of their stage of disease, which can have a huge impact on their end-of-life decisions, such as the type of treatment they want. Many patients were also unaware of their own treatment. There is a risk that false hopes of cure may be attached to therapies and that, as a result, patients may be less likely to opt for palliative care with a focus on maintaining quality of life.

Primary palliative care in assisted living and residential care-A metasynthesisJournal of Hospice & Palliative Nursing; David, Daniel PhD, MS, BSN; Jimenez, Vanessa MPH, BS; Brody, Abraham A. PhD, RN, FAAN; 3/25Assisted living (AL) and residential care (RC) settings are experiencing substantial growth as older adults with lower care needs seek alternatives to nursing homes. Despite this trend, there is a lack of skilled nursing care to support palliative care (PC) in these environments. Studies highlighted challenges and opportunities for delivering primary PC in these environments, emphasizing the importance of addressing physical symptoms, psychological distress, social isolation, and spiritual needs among residents with serious illnesses. The metasynthesis underscores the critical role of primary PC in enhancing quality of life and care continuity for older adults residing in AL/RC settings. It also identifies gaps in current practices and emphasizes the need for tailored interventions and training to support care providers in delivering comprehensive PC to this population. By integrating qualitative research findings with the National Consensus Project guidelines, this metasynthesis provides a comprehensive overview of primary PC in AL/RC settings.

Palliative care in the intensive care unit: An integrative review of intensive care unit health care professionals' views and experiences Dimensions of Critical Care Nursing (DCCN); by Berit Lindahl and Susan Kirk; May-Jun 2025 ... Our findings suggest there is variation in how palliative care in the ICU is conceptualized and interpreted. Intensive care unit professionals need enhanced competencies and training to develop their confidence in providing palliative care and improve role clarity. Such training should focus on serious illness conversations with patients/families and interdisciplinary teamwork. Integration of palliative consultants into the ICU could be further developed.

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. 

Children as living solid organ donors: Ethical discussion and model hospital policy statementThe Journal of Clinical Ethics; Gyan C. Moorthy, Aidan P. Crowley, and Sandra Amaral' Spring 2025In recent years, more attention has been paid to living donation as a means to reduce the suffering of individuals with end-stage kidney or liver disease. Implicated ethical issues include medical risk and risk of coercion, counterbalanced by improved medical outcomes and the benefits of saving a life. Living donation becomes particularly ethically complicated with the prospect of child donation, given the child’s developing autonomy and uniquely dependent status. We outline four broad ethical considerations pertinent to living child organ donation: (1) beneficence, (2) respect for the family as a moral unit, (3) respect for the child as a person, and (4) justice. We conclude that it can be ethical for a healthy child to donate a kidney or liver lobe to a close relative who has exhausted other options provided that certain protections are put into place.

Population-based payments to deliver health care to unhoused individualsJAMA Health Forum; Sudhakar V. Nuti, MD, MSc; Amanda K. Johnson, MD, MBA; Theodore Long, MD, MHS; 3/25The 770,000 people experiencing homelessness in the US have a high prevalence of disease and high health care utilization. Compared to the general population, unhoused individuals in the US have a 3.5 times higher mortality rate and 27-year reduced life expectancy. To this end, we propose population-based payment models (PBPs) as a novel mechanism to provide increased, stable, and predictable funding for health care for unhoused individuals. PBPs are the most advanced category of value-based alternative payment models, where health care organizations are given a prospective payment to care for a population of patients, with the flexibility to tailor care without incentivizes to optimize billable encounters, while being held accountable for improved outcomes and costs. The flexibility in how to invest and earn funding is essential for focused investment in these models, as increased reimbursement alone is insufficient.

Quality of life in heart failure. The heart of the matter. A scientific statement of the Heart Failure Association and the European Association of Preventive Cardiology of the European Society of CardiologyEuropean Journal of Heart Failure; Maurizio Volterrani, Geza Halasz, Stamatis Adamopoulos, Pier Giuseppe Agostoni, Javed Butler, Andrew J.S. Coats, Alan Cohen-Solal, Wolfram Doehner, Gerasimos Filippatos, Ewa Jankowska, Carolyn S.P. Lam, Ekaterini Lambrinou, Lars H. Lund, Giuseppe Rosano, Marco Metra, Stefania Paolillo, Pasquale Perrone Filardi, Amina Rakisheva, Gianluigi Savarese, Petar Seferovic, Carlo Gabriele Tocchetti, Massimo Piepoli; 3/25 Patients with heart failure (HF) experience much worse QoL [quality of life] and effort intolerance than both the general population and people with other chronic conditions, since they present a range of physical and psychological symptoms, including shortness of breath, chest discomfort, fatigue, fluid congestion, trouble with sleeping, and depression. The importance of QoL for patients with HF is highlighted in a survey showing that 61% attached more weight to QoL over longevity, with 9% and 14% willing to trade 6 and 12 months, respectively, for perfect health and better QoL.It is for these reasons that the Heart Failure Association is developing a new score for QoL in HF, sensitive to mechanism-specific interventions and tailored to be sensitive to changes within individual patients.