Literature Review

Hospice use by cause of death: A cohort study using Utah population database American Journal of Hospice and Palliative Medicine - Sage Journals; by Rebecca L. Utz, PhD, Michael Hollingshaus, PhD, Attrayee Bandyopadhyay, MS, Kathie Supiano, PhD, Margaret Clayton, PhD, Katherine A. Ornstein, PhD, Djin Tay, PhD, Eli Iacob, Ken Smith, PhD, and Caroline Stephens, PhD; first published online 4/29/25 Illnesses such as cancer often follow a predictable trajectory of decline, while others, such as Alzheimer’s Disease and Related Dementias (ADRD) and Chronic Obstructive Pulmonary Disease (COPD), follow a more dwindling and protracted decline. ... This study assesses whether hospice use differs by the underlying cause of death and whether current hospice eligibility and practices provide optimal EOL to all causes of death. Major Findings: Non-cancer decedents were more likely to have sub-optimal patterns of hospice care, including minimal use, lasting less than a week, and extended use, lasting more than 6 months. Stroke decedents were the most likely to have minimal-use patterns of hospice, whereas dementia and COPD decedents were most likely to have extended use. Conclusion: New models of hospice-like EOL care that can accommodate both short-term and long-term palliative care needs may help meet the diverse needs of patients and families facing different EOL trajectories associated with common causes of death.Editor's note: Compare this data with your own data of disease-related Length of Stay (LOS), live discharges, disease-related accuity needs, and more. How can we improve disease-related patient care, across the different trajectories of palliative/hospice care?

Medical aid in dying in the state of Colorado: Perspectives, data, and lessons learned in the first years of a uniquely centralized programJournal of Palliative Medicine; Melanie Mandell, Katie Sue Van Valkenburg, Skye O’Neil, Genie E. Roosevelt, Kerri Mason; 4/25 In 2016, Colorado voters approved Proposition 106, “Access to Medical Aid in Dying,” which amended Colorado statutes to include the Colorado End-of-life Options Act. In 2018, Denver Health and Hospital Authority, an urban, county safety-net hospital established a program to provide comprehensive medical aid in dying care via a centralized clinic with a dedicated team including a medical director, social worker, and a network of volunteer consultants. As the program has developed and matured, it has grown exponentially. This is due to its ease of accessibility, statewide educational efforts, and the relatively low cost and need-based, free services it provides. In six and a half years, our centralized program assisted over 650 Colorado patients in their quest for accessing medical aid in dying care, providing a wide continuum of services from initial intake and counseling, visits, and financial aid to specific grief counseling for loved ones. We believe our centralized system may function as a model for other hospitals considering the need to improve aid in dying access and care.

5 risk factors at 50 can steal a decade of life Medscape; by Nadine Eckert; 4/17/25 Five classic risk factors for cardiovascular disease — high blood pressure, high cholesterol, obesity, diabetes, and smoking — at age 50 can reduce life expectancy by more than 10 years. This is the conclusion of an international study led by German researchers and presented at the 2025 American College of Cardiology Scientific Session. These five factors account for approximately 50% of the global burden of cardiovascular diseases. ... The findings, also published in The New England Journal of Medicine, show that lifestyle changes and risk management in middle age can make a significant difference. Lowering blood pressure and quitting smoking had the most significant impacts.

MedPAC identifies low rates of hospice use among kidney disease patients McKnights Home Care; by Adam Healy; 4/17/25 Patients with end-stage renal disease (ESRD) use hospice at far lower rates than patients with other conditions, according to the Medicare Payment Advisory Commission. In 2023, 31% of Medicare decedents with ESRD used hospice services, compared with 52% of all Medicare decedents. Hospice lifetime length of stay is also lower among decedents with ESRD, at a median of six days compared with 18 for all Medicare decedents, MedPAC commissioners said during their April meeting. ...

Integrating social determinants into palliative care Hospice News; by Holly Vossel; 4/16/25 Strong staff education and reimbursement are among the keys to successfully integrating social determinants of health within a palliative care program. Screening tools developed by the U.S. Centers for Medicare & Medicaid Services’ (CMS) include five areas of social determinants of health: food and housing insecurity, transportation needs, utility difficulties and interpersonal safety. Supplemental domains include financial stability, employment and family and social support, among others.

Why good palliative care clinicians get fired JAMA Network - Viewpoint; by Abby R. Rosenberg, MD, MS, MA; Elliot Rabinowitz, MD; and Robert M. Arnold; 4/14/25 Even the most seasoned palliative care clinician gets fired. In the past year, one of us was fired after asking whether a patient endorsing suicidal ideation had access to a gun; the patient requested not to see the palliative care team because we asked intrusive questions and documented the encounter. One of us was fired after supporting a family’s decision to discontinue life-sustaining therapies for their loved one with multisystem organ failure; the primary intensivist suggested palliative care overstepped in discussing options for which the family (and clinical teams) was not ready. And one of us was fired after sharing the impression that a patient with cancer was dying; the family suggested they preferred the oncologist’s version of a more hopeful future.

For AYAs with advanced cancer, study finds serious communication gaps about their care National Cancer Institute; by Daryl McGrath; 4/15/25 Many adolescents and young adults (AYAs) with advanced cancer don’t have discussions with their clinicians about how they want to approach palliative care until the final weeks of life, a study of medical records of nearly 2,000 young patients showed. ... Talking about care and treatment near the end of life is one of the most challenging aspects of caring for AYAs with advanced cancer, said Ashley Wilder Smith, Ph.D., M.P.H., of NCI’s Healthcare Delivery Research Program and co-leader of NCI’s Adolescent and Young Adult Oncology Working Group. ... “When a young person is faced with a disease that may lead to an early death, it’s vitally important to give them the opportunity to think about what’s most important to them and what happens to them in terms of care in the time they have left,” she said.

Hospitalists in a bind when cancer prognosis hasn’t sunk inMedscape; by Jake Remaly; 4/15/25 When a patient with cancer is admitted to the hospital, the reason might not be related to the malignancy. But the hospitalist in charge sometimes becomes aware of a major disconnect: The patient, who they just met, does not grasp the severity of their cancer prognosis. On the one hand, the hospital medicine team and patient have advance directives and goals of care to consider, which may steer the course of the hospitalization and any use of hospice. The cancer prognosis — the patient might only have months to live, for example — could be a key component of those conversations. On the other hand, explaining the cancer situation should fall to the oncologist, right? ...

One of Deserae Turner’s last wishes comes true as family, friends hold small horse show in her honor ABC-4 KTVX, Cache Valley, UT; by Trevor Myers; 4/12/25 For six years, Deserae Turner rode horses and competed in shows alongside her siblings. In 2017, things changed after Deserae was shot in the head and began her journey of recovery. ... Deserae and her family had not been to another horse show since she was shot — that is, until Saturday, April 12. After a recent health complication, Deserae decided to enter hospice care, and one of her last wishes was to ride a horse and see a horse show again.

Antimicrobials in serious illness and end-of-life care: Lifting the veil of silenceThe Lancet. Infectious Diseases; William E Rosa, Shila Pandey, Renee Wisniewski, Craig Blinderman, Mark Wing Loong Cheong, Juan Esteban Correa-Morales, Diego Alejandro Cubides-Diaz, Sharif Folorunso, Nahla Gafer, Mohja Marhoom, Tiffanny Newman, Christian Ntizimira, Temitope Oyewole Obadare, Cihan Papan, Pedro Emilio Pérez-Cruz, Lukas Radbruch, Giri Shan Rajahram, Tomás Alejandro Reyes-Barros, Naveen Salins, Kavitha Saravu, Donald R Sullivan, Edward Christopher Dee; 3/25Global rates of antimicrobial consumption increased by 65% between 2000 and 2015, by 16% between 2016 and 2023, and are estimated to increase by an additional 52% by 2030. Antimicrobial use and misuse remains high among people with serious illness and at end of life, despite scarce evidence of benefit. In addition, the overuse and misuse of antimicrobials at end of life further exacerbate antimicrobial resistance, which is a substantial public and global health concern. These examples are combined with a case of non-beneficial end-of-life antimicrobial use and clinical guidance for patient and family communication regarding antimicrobial treatment. This Personal View also provides recommendations to improve antimicrobial stewardship with the goal of engaging multidisciplinary stakeholders and decreasing inappropriate antimicrobial use at end of life.

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.

Family Hospice partners with Alzheimer’s Association to expand educational outreach EIN Presswire.com, Atlanta, GA; by Brittany Brown; 4/8/25 Family Hospice announces an official partnership with the Alzheimer’s Association, Georgia Chapter, to enhance educational outreach and raise awareness of available resources for individuals facing Alzheimer’s or other dementia.This collaboration will provide families, caregivers, and healthcare professionals with critical information on hospice and Alzheimer’s and dementia-related support. As part of this effort, Family Hospice and the Alzheimer's Association are planning an upcoming statewide initiative in Georgia aimed at expanding awareness and support. Both organizations will share educational materials at community events and through social media to ensure families and caregivers have access to the guidance they need. [Continue reading ...]

Housing instability complicates end-of-life care for aging unhoused populations The Conversation; by Pilar Ingle, University of Denver; 4/7/25 Research estimates that one-third or more of the unhoused population in the U.S. is age 50 or older. Unhoused people of all ages face high rates of chronic and serious illness. They also die at younger ages compared with people who are not unhoused. Yet, there are few options for palliative and end-of-life care for unhoused people. ... In 2024, Colorado saw a 30% increase in the number of people experiencing homelessness from the year before. Nationally, 771,480 people — the highest number ever recorded — experienced homelessness last year. As the number of people experiencing homelessness in the U.S. grows, so too does the need for palliative and end-of-life care for these individuals. ... [Continue reading ...]