Literature Review

Why terminal cancer patients still receive aggressive treatment MedPageToday; by M. Bennet Broner; 7/31/25 Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were terminal continued aggressive treatment until their demise. The authors anticipated a decrease in this, but found that the frequency of cancer patients who continued aggressive therapy had not declined. The study did not examine decision-making. Still, the researchers, based on other studies, theorized that the lack of change resulted from a confluence of physician and patient factors. ... [Physicians] might predict a more optimistic prognosis than justified, avoid discussing EOLP, support (over)intensive treatment, and/or overemphasize treatment effectiveness while minimizing its side effects. Oftentimes, given their statements, physicians will offer treatments they know to be of little value, believing that patients expect them to propose something rather than admit there was nothing realistic left to offer.Editor's Note: Pair this with our recent post, Doctors’ own end-of-life choices defy common medical practice.

Physician Orders for Life-Sustaining Treatment in rural VirginiaSage Open Aging; Pamela B Teaster, E Carlisle Shealy; 6/25Physician Orders for Life-Sustaining Treatment (POLST) arose in 1991 to improve end-of life-care for patients with advanced, chronic, and progressive illnesses whose death is imminent within a year. POLST attempted to address problems inherent in advance directives (e.g., poor completion rates, confusing form language, dismal communication with a surrogate). POLST exists in all U.S. states, although each is unique and uptake is inconsistent, particularly in rural areas. The purpose of this study was to investigate current practices and barriers around POLST in a rural area using an online survey and interviews with practitioners. Findings included the need for consistent funding, clarification of goals, and greater and varied opportunities for staff training.

Palliative video consultation and symptom distress among rural inpatients-A randomized clinical trialCritical Care Medicine; Marie A. Bakitas, DNSc, RN; Shena Gazaway, PhD, RN; Felicia Underwood, MSW, MPS, LICSW-S; Christiana Ekelem, BS; Vantrice T. Heard, PhD; Richard Kennedy, MD, PhD; Andres Azuero, PhD; Rodney Tucker, MD, MMM; Susan McCammon, MD, PhD; Joshua M. Hauser, MD; Lucas McElwain, MD; Ronit Elk, PhD; 7/25The triple threat of rural geography, racial inequities, and older age has hindered access to high-quality palliative care for many people in the US. Only 70% of the deep South vs 85% to 94% of the rest of the US has palliative care despite the deep South having the greatest needs due to suboptimal health care access and elevated morbidity and mortality. In this RCT [randomized clinical trial] among Black or African American and White chronically ill hospitalized adults, culturally based specialist palliative care video consultation was not associated with statistically significant reduced symptom distress compared with usual care, but there was a clinically meaningful difference ... between groups. Contrary to our hypotheses, intervention participants’ QOL [quality of life] and resource use (secondary outcomes) also were not improved. Assistant Editor's note: This study reminds us that palliative care delivered virtually, as opposed to in-person, may not be of benefit to some individuals. It also reminds us that palliative care, at its best, is delivered on an ongoing basis by a known, trusted professional, as opposed to a one-time session with a consultant. 

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.

Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United StatesCancer; Shriya K. Garg BS; Khushi Kohli BA; Isha K. Garg BS; Yash K. Garg BS; Lilac G. Nguyen BS; Isabella S. Nguyen BS; Erin Jay G. Feliciano MD, MBA; Yefri A. Baez MD; Brandon A. Mahal MD; Puneeth Iyengar MD, PhD; Daniel R. Gomez MD, MBA; Kaitlyn Lapen MD; Edward Christopher Dee MD; 5/25 This study examines disparities in the receipt of palliative-intent interventions among Hispanic subgroups with advanced lung, breast, and prostate cancer. Among 945,894 total patients, disaggregated analyses revealed reduced receipt of palliative-intent interventions for patients with lung, breast, and prostate cancer of Mexican descent ... compared to non-Hispanic White patients. Receipt for patients of South or Central American descent was reduced in comparison to non-Hispanic White patients for lung and breast cancer ... Uptake of palliative interventions for metastatic lung and breast cancer was reduced for patients of Cuban descent ..., and was lower for patients of Dominican descent with breast cancer, compared to non-Hispanic White patients ... These findings demonstrate disparities in the receipt of palliative-intent interventions among disaggregated Hispanic subgroups. This study highlights the need for disaggregated research to further characterize these disparities and their drivers.

Evaluation of reporting of race and ethnicity in hospice and palliative care researchJournal of Palliative Medicine; Kimberly S Johnson, Karen Bullock, Cardinale B Smith, Deborah B Ejem, Nadine J Barrett, A'mie Preston, Kenisha Bethea, Marisette Hasan, Ramona L Rhodes; 5/25The disproportionate impact of the COVID-19 pandemic on marginalized communities due to structural racism has led to an increased focus on diversity, equity, and inclusion in medical literature. Among the eligible articles reviewed, there were 48 unique racial and ethnic categories [and] the most common groups specified were White (N = 77), Black (N = 52), and Hispanic/Latino (N = 36). Over half of articles (n = 53, 60.2%) combined minoritized groups into a nonspecific category (e.g., "other"), and 30 (34.1%) articles specified White populations alone or White populations with a nonspecific category for other groups. Seventeen (19.3%) articles included over 90% White participants, and only 3 (3.4%) articles had a minority health or health disparity focus. In this review of high impact, practice changing articles, the lack of appropriate representation of minoritized racial and ethnic groups, frequent use of non-standard categories to describe race and ethnicity, and the small number of articles focused on health disparities raise concerns about the generalizability of research findings, equity in research processes, and attention to populations that experience disparities in palliative care outcomes.

To Be or To Do? Women and Men's different styles of grievingComposing Life Out of Loss; by Joy Berger; retrieved 6/12/25

Sister Grace spent her life helping the homeless. Now in hospice, she reflects on legacy and lessons WXXI News NPR, Rochester, NY; by Gino Fanelli; 6/6/25Sister Grace Miller smiles as she props herself up in her hospice bed and gently teases her strands of chestnut brown hair. “How does my hair look?” she asks. It’s the type of remark one would expect from Miller. Sister Grace is many things: a radical compassionate, a devout follower of the Catholic faith, a civil disruptor, and a wielder of a sharp, slightly sardonic wit. ... The 89-year-old champion for the homeless and destitute is dying, in hospice care at a congregation home on Carter Street. But her spirit is alive and well. “I would fight with them over whatever, whatever the people needed,” Miller said, referring to the county and city administrations she often tangled with over the years. “I would fight for the people. ... She said it was, ultimately, an undying, uncompromising commitment to the work she does as a fierce and fearless advocate for the poor.

Finding her strength in silence: CSU Pueblo student graduates twice, carring her mother's dream Colorado State University Pueblo, Pueblo, CO; by Soni Brinsko; 5/14/25 The porch was still new when the professors arrived that late November evening. Hand-laid tiles, each one carefully placed by a father during what should have been vacation time. He’d built it for his wife so she could sit outside, feel the Colorado breeze one more time. That night, the porch became something else entirely. It became a stage for a graduation ceremony that wasn’t supposed to happen until May. Alondra Solis Ayala is about to walk across the commencement stage at Colorado State University Pueblo this week. It will be her second graduation. The first one happened in her family’s living room, with her dying mother watching from a chair, too weak to stand but strong enough to declare “esa es mi hija”—that’s my daughter—as faculty members in full regalia handed over a diploma cover and stole in what became an impromptu, deeply personal ceremony.

Newly Available: Improving Dying Hospice Foundation of America, Washington, DC; Press Release, contact Lisa Veglahn; 5/7/25 Virtual reality, physical therapy, music therapy, pet care, and even a haircut are therapeutic, innovative, and practical ways to improve the quality of life for people with terminal illness and are profiled in a new book and continuing education course recently released by Hospice Foundation of America (HFA). “End-of-life care providers are doing amazing work that rarely gets the attention it deserves,” said Amy Tucci, HFA’s president and CEO. “With Improving Dying, HFA’s goal is to recognize their efforts and provide models that can be replicated to enhance care for dying and the bereaved.”

‘I want to pat dogs until I die’: End-of-life planning should be more than just Living Wills Healthy Debate; by Kathy Kastner; 5/4/25 France Légaré, Canada Research Chair in Shared Decision-Making and Knowledge Mobilization, wants to have stimulating conversations and be able to move around with her dog until she dies. Daneil Martin, the Chair of the Department of Family and Community Medicine at Women’s College Hospital, wants to “smell chocolate until I die.” The two doctors are among the 200+ who took the time to fill in the blank on a whiteboard, “I WANT TO__ UNTIL I DIE,” an initiative I undertook after tuning in to a hospice and palliative care medicine Twitter chat in the good old days of Twitter. As a layperson who became an entrepreneur in the health space, I was intrigued by the lament of health-care professionals on the chat: If only people talked about end-of-life wishes more, much grief could be avoided. 

Think you know what nursing research looks like? Think again Boise State News, Boise, ID; 4/30/25 “Research” doesn’t just mean generating new discoveries through experimentation. Boise State supports Boyer’s model of scholarship, which expands the definition of research and creative activity to include applying and integrating knowledge into other settings, as well as teaching it. ... [An] interdisciplinary team is working to improve hospice and palliative care for refugees. ... Clinicians and refugees often do not share common cultures, languages or communication norms, so [Kate] Doyon has been building a community advisory board to create a communication guide. They’re working with stakeholders–including refugees and providers–to develop prompts that will enhance the care refugees receive, starting on the level of communication. Ornelas said the refugees they interviewed “gave us a lot of insight on different cultures and how we can go about and make prompts.” The prompts are short phrases to remind the healthcare team of best ways to interact with refugees and productively approach conversations.

Stark disparities in treatment and survival time for people with pancreatic cancer Cancer Health, Plymouth Meeting, PA; by National Comprehensive Cancer Network; 4/22/25 New research in the April 2025 issue of JNCCN—Journal of the National Comprehensive Cancer Network found significant disparities based on race, socioeconomic status, and other factors when it came to quality of care and outcomes for people with metastatic pancreatic adenocarcinoma (mPDAC)—which is associated with very high cancer mortality. The researchers used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to study 14,147 patients who were diagnosed with mPDAC between 2005–2019.