Literature Review

What do physicians want at the end? An international qualitative study on physicians’ personal end-of-life preferences and what influences them Palliative Care and Social Practice; by Sarah Mroz, Frederick Daenen, Sigrid Dierickx, Freddy Mortier, Ludovica De Panfilis, Luca Ghirotto, Toby Campbell, Kenneth Chambaere, and Luc Deliens; 7/4/25 Research Results: ... Most physicians prefer to avoid aggressive and life-prolonging treatment, physical and mental suffering, and being a burden. They prioritize being in a peaceful environment and communication with loved ones. Various factors influence preferences including cultural, social, and religious beliefs, and legislative environment, but most significant are the deaths of loved ones and clinical practice. Death and dying become normalized the more they are reflected upon and discussed, and this process can also provide personal growth which helps physicians provide better care to patients and families.

Advance care planning in Hispanic populations with Parkinson’s Disease: Investigating disparities in end-of life careClinical Parkinsonism & Related Disorders; by Taylor Peabody, Monica Abou-Ezzi, Lucila Hernandez, Henry Moore, Silvia Vargas-Parra, Alberto Cruz, Danielle S. Shpiner; 8/25ACP [advance care planning] is a topic of increasingly recognized importance among the PD [Parkinson's disease] research and patient communities. Despite evidence that many people with PD across ethnic groups consider this topic important, our study showed that Hispanic people with PD may have less access and experience with this aspect of care. These findings represent an important area for future study, so that all people with PD can benefit from the opportunity to participate in ACP if in alignment with their goals of care.

Palliative care needs of older adults with and without dementia during post-acute care in skilled nursing facilitiesJournal of Applied Gerontology; by Joan G Carpenter, Elisha Oduro, Nancy Hodgson, Shijun Zhu, Merve Gurlu, Mary Ersek, Laura C Hanson; 8/25Seriously ill older adults, including those living with Alzheimer’s disease and related dementias (ADRD), often receive disease-focused rehabilitative care in skilled nursing facilities (SNF) with little consideration for their palliative care (PC) needs. Using baseline data from a pilot pragmatic clinical trial (N=52), we conducted a cross-sectional study to compare the clinical characteristics and the PC needs of older adults with and without ADRD receiving SNF care. Functional decline was the most common global indicator for palliative care among both groups. While there was no statistically significant difference in PC needs between the two groups, the most prevalent PC needs for all were pain (63.5%), feeling anxious or worried (59.6%), family and friends being anxious or worried (57.7%), and need for information (46.2%). Older adults with and without an ADRD diagnosis who are admitted to post-acute SNF care may benefit from universal screening and tailored PC services.

[Canada] Simplifying palliative symptom management: Elastomeric infusions in hospice and home careBritish Journal of Nursing; by Vincetic Bozidar, Natalie Wm Hertzman, Daphne Broadhurst; 7/25Palliative care patients often require frequent, resource-intensive, intermittent subcutaneous injections or complex infusion pumps for end-of-life symptom management. Our findings suggest that continuous subcutaneous infusions via elastomeric infusion pumps offer a promising and feasible approach to end-of-life symptom management in hospice and home care. Elastomeric infusions may enhance simplicity, acceptability, safety, efficacy, and efficiency of care, compared to traditional routine subcutaneous injections.

Ethical obligations to inform patients about use of AI toolsJAMA; by Michelle M. Mello, Danton Char, Sonnet H. Xu2; 7/25When a health care organization decides to deploy an AI tool, it should decide whether notification or consent is ethically required. To decide that disclosure is not required at the point of care is not to conclude that organizations have no transparency obligations concerning their use of AI. Two complementary steps can help discharge these obligations. First, health care organizations’ websites and written materials distributed to patients should explain how the organization uses AI to deliver better, safer, more efficient care and protect staff well-being. This kind of transparency honors patients’ desire to know how their care may be affected by AI and may help some make decisions about where to seek care. 

Improved outcomes and cost with palliative care in the Emergency Department: Case-control studyThe Western Journal of Emergency Medicine; Brandon Chalfin, Spencer M Salazar, Regina Laico, Susan Hughes, Patrick J Macmillan; 7/25This small pilot case-control study included a subset of all patients referred by emergency physicians and hospitalists for palliative care within 24 hours of registration, physically present in the ED. CONCLUSION: Embedding hybrid physicians in the ED significantly shortened hospital stays and reduced charges for seriously ill patients. A notable secondary outcome was that 26.5% of ED visits in the case group did not result in hospital admission, compared to all controls being admitted ... In addition, more cases than controls had a code status of comfort care at discharge ... These findings support the further exploration of integrating such physicians into ED settings to enhance patient care and optimize hospital resources.

Behavioral symptoms in patients with dementia are associated with care partner abusive behaviorsJournal of Elder Abuse & Neglect; by Emily LeRolland, Francesca Falzarano, Karen L. Siedlecki; 8/25Abuse of older adults with dementia is an increasingly prevalent public health concern in the United States. The current study examined whether care recipient behavioral symptoms (e.g. aggressive or agitated behaviors) predicted abusive behaviors by care partners. Results indicate that most participants reported engaging in at least one abusive behavior toward their care recipient. Behavioral symptoms in care recipients were a significant predictor of abusive behavior perpetrated by the care partner, even after controlling for a large number of covariates. Care partner depressive symptoms significantly mediated the relationship between care recipient behavioral symptoms and care partner abusive behavior. Our results suggest that physician screening for depression in care partners and referral to appropriate resources may be one avenue for decreasing the risk of abuse toward care recipients. 

Clinician and caregiver perspectives on managing dementia behaviors in hospiceMedpage Today; by Elethia W. Tillman; 7/25New research reveals a gap in training and resources for managing behavioral and psychological symptoms of dementia (BPSD) in hospice settings, impacting both patient well-being and caregiver burden. Key points include:

Proportional sedation for persistent agitated delirium in palliative care-A randomized clinical trialJAMA Oncology; David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing Chen, Patricia Bramati, Sanjay Shete, Eduardo Bruera; 7/25Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. 

[Canada] Palliative care access and use among homeless individuals: A scoping reviewBMC Palliative Care; by Ashley Rodericks-Schulwach, Ravi Gokani, Lynn Martin; 7/25Homeless individuals experience unique needs and challenges when PC. Many of the challenges experienced are related to the stigma of homelessness– it negatively impacts the relationship people have with PC professionals as well as creates barriers to access. Implementation of integrated and intersectoral PC programs that employ harm reduction approaches is needed to ensure that people experiencing homelessness receive PC that promotes dignity and comfort. Specialized staff training to work with this population is also needed to improve quality of PC care provided. Future research that employs an intersectional lens to better understand the needs of sub-groups within the homeless population is needed, as is use of consistent terminology related to PC services to ensure both understanding and generalizability of findings. 

Asking older adults with impaired cognition and care partners about serious illness experiences can elicit goals of care during advance care planning Americn Journal of Hospice and Palliative Medicine; by Glory H. Thai, BS, Valecia Hanna, MS, Peiyuan Zhang, MSW, Chase Mulholland Green, MPH, John Cagle, PhD, MSW, Jennifer L. Wolff, PhD, and Martha Abshire Saylor, PhD, RN; 8/13/25 Older adults with cognitive impairment and their care partners were able to respond to serious illness experience questions, with responses eliciting a spectrum of goals of care. Integrating such questions into advanced care planning (ACP) for older adults with cognitive impairment may clarify goals of care and improve decision-making for patients and families. 

[UK] 'Dementia has got two faces': grief as an experience of holding on and letting go for people living with primary progressive aphasia and posterior cortical atrophyAging and Mental Health; Claire Waddington, Henry Clements, Sebastian Crutch, Martina Davis, Jonathan Glenister, Emma Harding, Erin Hope Thompson, Jill Walton, Joshua Stott; 8/25Research on grief in people with primary progressive aphasia (PPA) and posterior cortical atrophy (PCA), is limited, despite the unique challenges these individuals face due to lack of understanding of their condition, younger age at onset and atypical symptom profile. The current study explores the losses people living with PPA or PCA experience and what helps to navigate these losses. The impact and navigation of loss is reflected across five interconnecting themes: what I have lost, am losing and will lose, shared and unique sense of loss, balance between what is lost and what remains, changes in relationships and what helps in navigating loss. These findings will be used alongside existing grief theory and interventional frameworks to develop a psychosocial intervention for people living with dementia.

Standardized assessment of patient experience in pediatric palliative care: A national collaborationJournal of Pain & Symptom Management; by Ashley K Autrey, Stacey Rifkin-Zenenberg, Tracy Hills, Jennifer Salant, Rachna May, Elliot Rabinowitz, Chelsea Heneghan, Laura Drach, Emma Jones, Rachel Thienprayoon; 7/25Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC [pediatric palliative care] services. Results: Patients/ families felt heard and understood and would recommend PPC. Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.