Literature Review

Improving outcomes for ICU family members: The role of spiritual careJournal of Palliative Medicine; by Alexia M Torke, Shelley Varner-Perez, Emily S Burke, Amber R Comer, Susan Conrad, LaVera Crawley, Deborah Ejem, Jennifer Gabbard, Patricia E Kelly, Buddy Marterre, Ariel Modrykamien, Patrick O Monahan, Sarah Nouri, Csaba Szilagyi, Douglas White, George Fitchett; 4/25Having a family member hospitalized in the intensive care unit (ICU) can be a stressful experience for family members, encompassing both psychological and spiritual distress. While research has delved into the impact of spiritual care for ICU family members, further investigation is still needed to determine the most effective approaches for delivering such care. This narrative review will describe a conceptual model aimed at guiding future research in this endeavor. The model proposes that chaplains provide emotional, spiritual, and information support to ICU family members. This affects both their ICU experience, decision making, and outcomes for the patient and family.

Does sedation affect patients’ spiritual experience at the end of life? An intersection between medicine and spiritualityJournal of Pain and Symptom Management; by Anne L. Dalle Ave, Daniel P. Sulmasy; 1/25Spirituality, consciousness, sedation, end-of-life, end-of-life care, spiritual experiences Key Message This article explores the role of sedation with respect to the patient’s spiritual experiences at the end of life. As healers, healthcare professionals offer compassionate care to body and soul. While drugs with sedative effects may be an answer to some bodily and psychological suffering, other forms of care, such as spiritual care or counseling, may better address other forms of suffering, particularly the fear of death.

[Australia] Overtreatment of older people near end of life: A qualitative scoping review of modalities, drivers, and solutionsOmega-Journal of Death and Dying; Samantha Fien, Emily Plunkett, Daniel Wadsworth, Magnolia Cardona; 4/24This study aimed to understand the drivers better to help minimise further risks of overtreatment for older people near the end of life (dysthanasia). Determinants included healthcare system factors, patient-centered care, family and caregiver, and clinician perspectives. This review confirms that despite almost two decades of recognition of the potential harms of overtreatment near the end of life, society, patients, and health systems have a role to play in reducing and addressing the determinants. We offer a range of solutions for clinicians, health service managers, and members of the public to consider.

The pharmacology of aid in dying: From database analyses to evidence-based best practicesJournal of Palliative Medicine; by Patrick Macmillan, Susan Hughes, Angelique Loscar, Lonny Shavelson; 4/25We investigated the efficacy of four commonly used aid-in-dying medication protocols-using the time to sleep and time to death as proxies for efficacy. This first-time analysis of aid-in-dying medication protocols showed that while a sedative alone had the best median time to death, the most recent sedative/cardiotoxin protocol had an acceptable median time to death of 0.8 hours, but with fewer prolonged-death outliers.

Barriers to perioperative palliative care across Veterans Health Administration hospitals: A qualitative evaluationAmerican Journal of Surgery; by Emily E Evans, Sarah E Bradley, C Ann Vitous, Cara Ferguson, R Evey Aslanian, Shukri H A Dualeh, Christina L Shabet, M Andrew Millis, Pasithorn A Suwanabol; 3/25While providers recognize the importance of palliative care and end-of-life care, obstacles to its use exist at various levels. Identification of these barriers highlights areas to focus future efforts to improve the quality of palliative and end-of-life care for Veterans.

The real-world effect of early screening for palliative care criteria in a medical intensive care unit: An instrumental variable analysisAnnals of the American Thoracic Society; by Chad H Hochberg, Rebecca A Gersten, Khyzer B Aziz, Margaret D Krasne, Li Yan, Alison E Turnbull, Daniel Brodie, Michelle Churchill, Danielle J Doberman, Theodore J Iwashyna, David N Hager; 2/25Early identification of intensive care unit (ICU) patients likely to benefit from specialist palliative care could reduce the time such patients spend in the ICU receiving care inconsistent with their goals. Conclusions: Despite significantly increased specialty palliative care consultation, there was no evidence that early screening for palliative care criteria affected time to DNR/ICU discharge or other secondary outcomes.

Systemic functioning of Puerto Rican families with a cancer patient: A qualitative-oriented mixed-methods studyJournal of Health Psychology; Nicole M. Vélez Agosto; 4/25Puerto Ricans are part of marginalized communities that are impacted by health disparities, such as lifestyles, health behaviors and access to care (Simmons et al., 2011). The purpose of study was to assess systemic functioning in Puerto Rican families with a cancer patient using the Spanish translated version of the Family Genogram Interview (FGI) that measures Bowen’s four emotional processes in nuclear family and family of origin. Results suggested an acceptable reliability for the FGI-Spanish and higher presence of symptoms in a spouse or partner, symptoms in family of origin, focus on a child and emotional cutoff in family of origin. Qualitative findings suggested that main concerns for participants were related to family changes surrounding illness and familial roles, consistent with Bowen’s theory and clinical implications for designing systemic interventions for Puerto Rican families.

Private equity’s impact on medical traineesHealth Affairs; by Alexander P. Philips, Viknesh Kasthuri, Russell Hawes, Hunter Kramer, Barbara Chiu, Pragi Patel, Hannah Harrelson; 4/14/25Over the past decade, private equity (PE) ownership of physician practices and health care delivery systems in the United States has increased substantially. It is widely acknowledged that the trend toward short-term, profit-driven ownership challenges physician autonomy and raises ethical questions for physicians and patients. However, current discussions must more adequately recognize the effect of these trends on medical trainees. As medical students, we provide a perspective as future stakeholders amid a rapidly evolving landscape. In this Forefront article, we review PE’s involvement in health care, its impact on physicians and patients, the persistent professional and ethical challenges that directly affect medical trainees of all levels, and advocate for policy changes to protect trainees and address the underlying incentives that cause physicians to sell to PE.

Patient, provider, and health system determinants of hospice Length of Stay Palliative Medicine Reports; by Eliza Thompson, Daniel Sanchez Pellecer, Gregory J Hanson, Shealeigh A Inselman, Jenn M Manggaard, Kevin J Whitford, Jacob J Strand, Rozalina G McCoy; 4/3/25Background: Benefits of hospice care, such as improvement in quality of life and reduced costs, depend on duration of enrollment in hospice services, making timely hospice referral essential. ... Conclusion: Based on a review of hospice referral patterns, the integration of hospice care into subspecialty practices, long-term care facilities, and advanced practice education could be an effective strategy to improve hospice LOS.

Experiences of hospice staff beyond the frontlines during COVID-19: A qualitative secondary analysis study Journal of Palliative Care and Social Practice; by Thanga Harini Sundaramoorthy, John I MacArtney, Abi Eccles; 4/12/25Three main themes were identified: (1) Blurred margins: Participants discussed facing difficulty separating work and home life and taking stresses and thoughts about work home. (2) Isolation, loneliness and social interactions ...  (3) Disruption to family and personal commitments: Some staff felt unable to see or support their parents, partners and children during the pandemic subsequently impacting their psychological and emotional well-being. Conclusion: Hospice staff compromised aspects of their personal life and family responsibilities during the pandemic to carry out their role at work. Workplaces and organisations should aim to support hospice staff more broadly to help with managing work-related pressures and balancing personal commitments in future emergency periods.Editor's note: Use this evidence-based research with your Emergency Disaster Preparedness Plans. Click here for the CMS.gov Emergency Preparedness Rule. Click here for Wisconsin's CMS Emergency Preparedness Rule Toolkit: Hospices.

Kidney transplant fast track and likelihood of waitlisting and transplant-A nonrandomized clinical trialJAMA Internal Medicine; Larissa Myaskovsky, PhD; Yuridia Leyva, MS; Chethan Puttarajappa, MD; Arjun Kalaria, MD; Yue-Harn Ng, MD; Miriam Vélez-Bermúdez, PhD; Yiliang Zhu, PhD; Cindy Bryce, PhD; Emilee Croswell, BA; Hannah Wesselman, PhD; Kellee Kendall, MPH; Chung-Chou Chang, PhD; L. Ebony Boulware, MD; Amit Tevar, MD; Mary Amanda Dew, PhD; 3/25Although it is a seemingly intuitive solution to enabling more patients to complete the evaluation process and be added to the waitlist, to our knowledge, few transplant centers use a health care system–facilitated approach like KTFT [Kidney Transplant Fast Track]. In this nonrandomized clinical trial of 1,118 patients with end-stage kidney disease (ESKD) who underwent KTFT and a historical control group of 1,152 patients with ESKD undergoing evaluation for kidney transplant, the KTFT group had a higher likelihood of waitlisting and transplant than the historical control group. Unlike the historical control group, the KTFT group had no significant differences in kidney transplant by race or ethnicity.

Prevention of acute hospital transfers for long-term care residents at the end of life American Journal of Hospice and Palliative Medicine (AJHPM); by Kirsten Lanpher, DMS, MSPA, PA-C and Kirsten Brondstater, DMS, MSPAS, PA-C; 3/24/25 Findings: Long-term care residents are a vulnerable population with advanced comorbidities who often require high acuity care and are subject to preventable transfers to the hospital at the EOL. These disruptions in EOL care cause harm and complications, negatively impacting quality of care. The consequences of these events can be mitigated with early advance care planning to include documentation of EOL care goals, onsite medical clinicians to make critical decisions and provide care within LTC facilities, and adequate staffing with proper palliative and hospice care training. Conclusion: Immediate action is needed to advocate for this high risk population and implement interventions to prevent hospital transfers at the EOL, therefore improving quality of care and positively influencing LTC residents’ EOL experience.

Belief in an afterlife is increasing in the United States: Even among the non-religious The Association of Religion Data Archives (The ARDA); by Ryan Burge; 4/17/25 This post has been unlocked through a generous grant from the Lilly Endowment for the Association of Religion Data Archives (ARDA). The graphs you see here use data that is publicly available for download and analysis through link(s) provided in the text below. ... I wanted to dig a bit deeper on the variations in those belief metrics today, with a question that I haven’t really probed a whole lot. The General Social Survey, which is available on the Association of Religion Data Archives website, contains a really straightforward question, “Do you believe there is a life after death?” And it has an even simpler set of response options - yes or no. It’s been asked with regularity since 1973, so we have nearly five decades of data on this one specific question. ... Even today, the share of Americans who believe in life after death is 82%. When people ask me, “Is the United States a religious country?” This is the stat that I’m going to trot out.