Literature Review

Grief and the road to resilience Jewish Journal; by Chaim Steinmetz; 8/2/25 Mourning is unfashionable. A popular platitude is that funerals are meant to be a “celebration of life.” This seemingly innocuous phrase is actually a subtle form of peer pressure, demanding the heartbroken mourners remain upbeat so they don’t drag the mood down for the rest. The bereaved are counseled to look for “closure” and find a way to continue with their lives. ... This is a picture of mourning done wrong, an unwillingness to encumber one’s heart with the ugly and unruly emotions of loss and bereavement. Judaism emphasizes the importance of mourning; it affirms an ethics of memory, which obligates us to continue to honor our deceased family and friends. It is unthinkable for someone to pass away and for everyone else to just “move on” afterwards. Love demands that we mourn. Beyond the moral imperative, Judaism recognizes that mourning is transformative. Grieving is the first step towards resilience.

Combining clinical insight and data-driven expertise: The case for morning huddles in primary care HEAL Security; by Becky Trotter and Aliya Ali; 7/1/25 The daily huddle, also called a morning huddle, is a brief standup meeting commonly associated with inpatient and surgical care. In these settings, safety is the predominant focus of the meeting. However, the same idea can be used in primary care settings to get care teams ready for the patients scheduled for that day. Morning huddles are an opportunity to merge clinical knowledge with data and analytics to help ensure primary care teams are aligned and specific care needs are recognized before patients walk into the practice. Editor's Note: Is this practice so new? Back in the 1990's at Hospice & Palliative Care of Louisville, each morning began with going through my hospice voicemail box for our well-oiled system of receiving and replying to voicemails for the whole team or individual members, from on-call staff, from leaders from throughout our organization, or other voicemails. These first-thing-in-the-morning communication/tech "huddles" were so crucial then--and are important today (with better tech and data)--because our patients often die during the night. Or, a new patient must be assessed. Or, the patient was transferred from home to an inpatient unit. Or, you know the common, literally life-changing needs. Is your hospice behind the times or leading the way with today's clinical communications and data?

Hearing loss, loneliness may contribute to cognitive decline in older adults McKnights Senior Living; by John Roszkowski; 7/28/25 Hearing loss and loneliness can contribute to dementia in older adults, and simple interventions to address hearing loss, such as hearing aids, may reduce cognitive decline in some cases, new research finds. ... Results of the study showed that higher levels and worsening self-reported hearing impairment were associated with steeper decline in episodic memory issues and executive functioning (verbal fluency). Further, the researchers found that individuals who were not socially isolated but still felt lonely saw their cognitive decline accelerate if they were deaf.

Hospices navigating ethically complex end-of-life situations Hospice News; by Holly Vossel; 7/25/25 The final stages of life can be filled with challenging, nuanced situations for some patients and their families. Ensuring goal-concordant care and autonomous end-of-life decision-making requires careful ethical, legal and operational considerations. Staff education and proactive policy development are important for hospices to harness in complex situations, according to Jeanne Chirico, president and CEO of the Hospice & Palliative Care Association of New York State (HPCANYS). A number of difficult life circumstances can limit hospices’ ability to provide patients with care that is in line with their wishes, Chirico indicated. Hospices need to have a firm understanding of the possible ethical and legal limitations that staff may encounter, as well as establish procedures that help address them. 

Prairie Doc Perspective: Navigating spiritual pain and grief Rawlins Times - Prairie Doc Perspective, Rawlins, WY; by Rev. Kari Sansgaard, Avera Hospice; 7/23/25 After nearly 20 years of parish ministry, I entered the world of health care, which, I learned, abounds in acronyms. My first clue was in chaplaincy training, known as CPE (Clinical Pastoral Education), the required education for most hospital and hospice chaplains. CNA, SoB (Shortness of Breath), PRN, HoH (Hard of Hearing), and a myriad of other acronyms are now part of my own vernacular. QoL (Quality of Life) is the big one in hospice, sometimes called “comfort care.” When quantity of life becomes diminished, it’s all about quality. ... In hospice, when death is impending, spiritual pain can lead us to ponder existential questions, such as the following:

A woman in hospice granted a wish of one last swim WEAU-13 News, Bloomer, WI; by Danile Gomez; 7/16/25 Often times the small things are taken for granted. Like a dip in the pool. For Barbara Melby, it was on the final list of things to do as she lives out her time in hospice care. “Barbara has been doing pretty well. She has had some fatigue and some tiredness,” said Leah Grace, the registered nurse with St. Croix Hospice assigned to Melby’s case. ... Grace worked hard to make sure Melby’s last dip in the pool would come to fruition. She cleared it with Melby, her family and the managers at the hospice center. The aquatic center helped in granting the wish too. ... “The way the chair put me in down the water was very nice,” said Melby. Of those in Melby’s family that jumped in the pool with her included Stoll and her kids Colby, Sydney and Brody. “I grew up swimming in my grandmother’s pool. ...” said Stoll. She is happy to be there for her grandmother’s last swim. “Just a pretty special memory we will all hold on to for a pretty long time.” Melby was a swim instructor, ... It was something she always loved and it made her happy to have had her wish granted.

How to perform a Regret Audit: A simple question that can help you live with purpose and have fewer regrets. Psychology Today; by Jordan Grumet, MD; 7/20/25 As a hospice doctor, I’ve spent countless hours sitting at the bedsides of dying patients, listening to the echoes of lives well-lived and those haunted by regret. As Bronnie Ware described in The Five Regrets of the Dying, many end-of-life reflections center around missed chances to live more authentically, joyfully, and meaningfully. But we don’t have to wait until our final moments to face these truths. I’ve long advocated for the hospice life review as a proactive tool. It’s a structured set of questions used by hospice professionals to help patients process their lives and find peace. The questions are simple but profound:

Ok, please help calm my anxiety. My mother has drastically improved in the last couple of days since goin on hospice. Aging Care; by Oedgar23; 7/17/25 So in the hospital, my mother was in kidney failure. The last couple days after stopping vancomycin for about five days, her GFR had come up to 19. That’s the most recent Number and then they stopped drawing labs because we placed her on Hospice. We consulted with palliative care team. They wanted to do a feeding tube and we said no. They said she had advanced dementia. [Describes improvements since hospice.] ... What if she gets taken off hospice? ... What if she no longer qualifies for hospice, passes as normal cognitively, starts demanding to go home, does not qualify for long-term care, Medicaid, etc. ... But I am super unnerved because she looks a whole lot better than she has been looking. ...Editor's Note: Yes, we all know that the person can get better with hospice care, because of holistic person-centered care, caregiver education and support, and many more factors. This can be confusing. The dying trajectory may have been interrupted or simply calmed with better symptom management and quality of life. This daughter is asking normal, crucial questions which the hospice team needs to be addressing with her. Examine your live discharge data, Policies and Procedures, communication practices with the patient and family about recertifications, Incident Reports from upset caregivers/families, and CAHPS Hospice scores.

Collective leadership in home-based palliative care: Advancing APRN roles to enhance successHome Health Care Management & Practice; Nicole DePace, MS, APRN, GNP-BC, ACHPN; Rebecca Souza, DNP, ANP-BC, ACHPN; Therese Rochon, MA, MS, FNP-C; Paula Rego, DNP, AGPCNP-BC; Constance Dahlin, MSN, ANP-BC, ACHPN, FPCN, FAAN; 6/25Palliative advanced practice registered nurses are instrumental in responding to the opportunities and challenges in home-based palliative care through advocacy, practice, education, program development, and leading interprofessional teams. Collective leadership is proposed as a framework to address these tensions in home-based palliative care. Two cases are presented to compare and contrast collective and traditional leadership models, illustrate the role of the palliative advanced practice registered nurse leader, demonstrate how to avoid the pitfalls of a traditional leadership model, and build sustainable success through collective leadership principles. Finally, strategies to engage advanced practice registered nurses in leadership roles and address the tensions of the policy gaps in home-based palliative care are provided.

Opinion: My health and my politics walk into a doctor’s office … The Washington Post; by Kim Fellner; 7/16/25 [Note: Access is behind a paid firewall, with an option to set up a temporary free account]... My palliative care doctor and I have almost nothing in common. We’re still learning from each other. ... It began simply enough. By October, my sarcoma had moved from possibly curable to definitively terminal, and, since metastasis to the bones can be painful, my anchor oncologist offered to connect me with a palliative care doctor to help with the physical and conceptual aches and pains of dying. Which seemed like a good thing to do. ... I did not anticipate, however, that the personal and the political would collide in my doctor’s office. ... [Descriptions unfold of significant, conflicted dialogue between (1) this Jewish daughter of holocaust survivors whose life-long vocation was social justice and (2) this Christian palliative care physician who asked about mental health and then dismissed this person's primary concerns that were affecting her dying.] ... Clearly, my doctor and I shared some beliefs about the importance of the palliative approach. ... But as the doctor noted, the best palliative care goes beyond the purely physical to address the more cosmic questions of life and death, and I was uncertain we were well matched as partners for this intimate process. ... I had no idea how to proceed. ... [More descriptions.] ... And that’s where the magic happened. Within a few days, my palliative care doctor sent me back a transparent, thoughtful and moving response. ... Her courage and openness, her willingness to risk a forthright response, have precipitated a remarkable dialogue about what each of us brings into the room, and how we can honor the space and each other once we get there. ... Editor's Note: Whatever one's political or religious stance, this article is sure to spark fireworks—of conflict, dissonance, and, hopefully, powerful insight. I encourage readers to engage with it attentively, attuned to three things:

Time and location of specialty palliative care for women dying with metastatic breast cancer Breast Cancer Research and Treatment; by Andrea King, Cynthia Ortiz, Rachna Goswami, Tara L Kaufmann, MinJae Lee, Lynn Ibekwe-Agunanna, Navid Sadeghi, Donghan M Yang, Lindsay G Cowell, Timothy P Hogan, Lauren P Wallner, Megan A Mullins; 7/15/25 online ahead of print Background: Despite guideline recommendations, evidence suggests many women with metastatic breast cancer (mBC) do not receive specialty palliative care services despite high morbidity burden. ... Results: ... Most palliative care encounters were inpatient and occurred within ~ 1 month of death. ...Conclusion: Palliative care for women with mBC is infrequent and often late, with referrals seemingly driven by the imminence of death rather than metastatic diagnosis. Strategies to better identify and triage specialty palliative care needs and make timely referrals are needed.

Grieving the living: How Hospice of St. Lawrence Valley helps caregivers cope North Country Now, St. Lawrence County, NY; by Kate Favaro, Hospice of St. Lawrence Valley; 7/10/25 With caregiving comes grief, there’s no way around it. You will grieve two important things that you’ve lost: who the person you’re caring for used to be, and the things that will never be. Take the time to explore the grief you’re experiencing so you can provide the best care possible. If you’re not taking care of yourself, you won’t be able to take care of anyone else. Hospice of St. Lawrence Valley offers the following on the grief of caregiving: