Literature Review

Doctors’ own end-of-life choices defy common medical practice Medscape; by Cristina Ferrario; 7/29/25 A new survey revealed that most doctors would decline aggressive treatments, such as cardiopulmonary resuscitation (CPR), ventilation, or tube feeding for themselves if faced with advanced cancer or Alzheimer’s disease, choosing instead symptom relief and, in many cases, assisted dying. ... The researchers conducted a cross-sectional survey of 1157 physicians, including general practitioners, palliative care specialists, and other clinicians from Belgium, Italy, Canada, the US, and Australia. ... Over 90% preferred symptom-relief medication, and more than 95% declined CPR, mechanical ventilation, or tube feeding. Only 0.5% would choose CPR for cancer and 0.2% for Alzheimer’s disease. Around 50%-54% supported euthanasia in both cases.

Casting hope: A last wish by the water The Citizen, Fayette County, GA; by Compassus Hospice; 7/27/25 For Compassus hospice patient Gerry Higginbotham of Fayetteville, GA, the simple act of casting a line into the ocean had long been a dream—one that felt just out of reach. But thanks to a compassionate care team and the support of the Angel Foundation, that dream became a reality. ... The Hospice Angel Foundation generously covered the cost of lodging near Tybee Island, GA. But transportation and food expenses remained a challenge. That’s when the Compassus Fayetteville hospice team did something extraordinary: they personally donated funds to cover the remaining trip costs, ensuring Gerry and his daughter could make the journey. ... This wasn’t just a trip—it was a moment of peace, purpose and joy for someone who had given so much of himself to others. 

Dignity at risk: hospice care faces critical worker shortage amidst policy challenges ABC WCIV-4 News, Charleston, SC; by Webb Wright; 7/23/25 Officials are giving dire predictions for the future of palliative care and hospice care. There's a rapidly growing need for nurses and healthcare workers in those areas, including home healthcare and nursing home workers. Educators and facilitators in those areas of care are working to prevent a crisis that's expected to peak in less than a decade. By 2033, the number of new projected jobs in this area of healthcare is expected to be more than 820,000, according to the Bureau of Labor Statistics. With a median starting salary of under $35,000, recruiters and workers are scrambling to fill the void sooner rather than later.

6 health systems that faced worker strikes this month MedCity News; by Katie Adams; 7/22/25 Healthcare workers at six health systems across the country have launched strikes in July so far. These healthcare employees cite unsafe staffing levels, low wages and retaliation against union organizers as their main reasons for going on strike. From hospice centers to emergency rooms, frontline healthcare workers across the country have been striking this month to protest what they say are unsafe patient care conditions and poor bargaining behavior. Below are six examples of union activity resulting in a strike — all of which occurred in July.

Systems lean into nurse educator initiatives Becker's Clinical Leadership; by Mariah Taylor; 7/18/25 There is a key driver behind the nationwide shortage of nurses: a severe nurse faculty shortage. To solve both shortages, more systems and nursing programs are creating formal venues to enlarge the nurse educator pipeline. Like the nurse shortage, universities and nursing programs are facing a nurse faculty shortage that has reduced their capacity to accept and train students. Too few nurses are pursuing advanced degrees and becoming educators in the field, according to the American Association of Colleges of Nursing. So systems are developing programs that boost interest and remove barriers for nurses who want to teach. These programs — many of which launched in the last year — range in commitment and scale. Here are a few examples: ...

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.

Effectiveness of an educational intervention in enhancing end-of-life care understanding and decision-making in African AmericansPalliative & Supportive Care; Delicia Pruitt, Megan Reilly, Stephen Zyzanski, Neli Ragina; 7/25AA [African American] patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL [end of life] care options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

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:

Alphabet soup: replacing BMI with BRI The Courier, Findlay, OH; by Aidan Hester and Karen Kier; 7/12/25 ... A recent change in how we measure obesity involves a new acronym. Most medical professionals use body mass index (BMI) to assess weight and obesity. ... BMI considers a patient’s weight and height but does not account for fat distribution. It does not take into consideration a person’s muscle mass or different types of fat throughout the body. ... A recent study published by JAMA Open Network used a patient’s BRI to measure potential mortality. ... Patients in the Q1 group were considered underweight and Q4 and Q5 were evaluated as overweight. Patients in the Q1, Q4, and Q5 groups were found to have an increased risk of death. So, both being underweight and overweight were risk factors for death. Those in Q5 were 50% more likely to pass away, while Q1 and Q4 were 25% more likely when compared to Q2 and Q3.

[Germany] A Berlin doctor goes on trial, accused of murdering 15 patients who were under palliative care U.S. News & World Report; by Associated Press; 7/14/25 A German doctor went on trial in Berlin Monday, accused of murdering 15 of his patients who were under palliative care. The prosecutor’s office brought charges against the 40-year-old doctor “for 15 counts of murder with premeditated malice and other base motives” before a Berlin state court. The prosecutor’s office is seeking not only a conviction and a finding of “particularly serious” guilt, but also a lifetime ban on practicing medicine and subsequent preventive detention. ... Parallel to the trial, the prosecutor’s office is investigating dozens of other suspected cases in separate proceedings. The man, who has only been identified as Johannes M. in line with Germany privacy rules, is also accused of trying to cover up evidence of the murders by starting fires in the victims' homes. He has been in custody since Aug. 6.

CDC reports rise in unintentional fall deaths among older adults JAMA; by Samantha Anderer; 7/11/25 The US Centers for Disease Control and Prevention (CDC) reported that deaths from unintentional falls among adults aged 65 years or older increased over the past 2 decades. Falls are currently the leading cause of injury for older adults, reaching 70 per 100 000 in 2023. As age increases, so does the likelihood of death due to a fall. And data from the National Vital Statistics System indicate that from 2003 to 2023, adults aged 85 years or older experienced the greatest increase in fall deaths. Rates for men, who are more likely to die from an unintentional fall, doubled from 178 to 373 per 100 000 people among those 85 years or older. For women in the same age group, deaths from falls increased 2.5 times, from 129 to 320 per 100 000. 

Health equity starts at home: Renewing the heart of nursing  Minority Nurse; by Michelle Cortez Adams; 7/10/25 ... I started my nursing career in the ICU, told (as many of us are) that hospital experience was a must. And while the work was meaningful, it wasn’t fulfilling. My patients were often unconscious. My goal was to stabilize and transfer them. I never got to know their stories, their families, or whether they ever found healing beyond discharge. That changed when I moved into home hospice and then home health care. This shift taught me that home nursing is not only a career path—it’s a calling. I saw the impact of my work every day. I helped clients reach personal goals, not just clinical benchmarks. I was welcomed into their lives by name. I wasn’t just preserving life—I was restoring it. Home health care reminded me why I became a nurse in the first place: to form real connections, to bring comfort and dignity, and to care for the whole person—body, mind, and spirit.

HPCC strengthens commitment to DEIB across credentialing programs Hospice & Palliative Nurses Association / Foundation / Credentialing Center (HPNA/HPNF/HPCC); Press Release; 7/10/25 In 2025, the Hospice and Palliative Credentialing Center (HPCC) has continued its implementation of strategic initiatives that advance diversity, equity, inclusion, and belonging (DEIB) across its credentialing programs. From in-depth exam item reviews to national outreach and inclusive resource development, HPCC remains committed to ensuring fairness and inclusivity in all certification processes. The following strategic initiatives reflect the progress HPCC has made and showcase the future direction of its DEIB efforts. ... This work is part of HPCC’s broader goal to strengthen the inclusivity of its credentialing programs. As HPCC explores the expansion of DIF analyses across additional certification exams, the organization remains rooted in its mission.