Literature Review

‘A playbook for best practices’: ASCO and COA release updated Oncology Medical Home Standards The ASCO Post; by ASCO (American Society of Clinical Oncology); 9/10/25 ASCO and the Community Oncology Alliance (COA) have released updated standards for its Oncology Medical Home (OMH) certification program, which were initially codified and published in 2021. The 2021 systematic literature review focused on the topics of OMH model of care, clinical pathways, and survivorship care plans. Among the 2025 updates are new standards that address “just culture” and safety in oncology, multidisciplinary team management, and geriatric assessment.

[UK] Does non-beneficial nasogastric tube feeding occur during end-of-life care? An audit of outcomes for those with a malnutrition universal screening tool score of 2Journal of Palliative Medicine; by Ross Andrew James Webster, Moitree Banerjee, Rachel King, Rosana Pacella, Antonina Pereira; 8/25The consideration of artificial nutrition and hydration (ANH) is recommended for individuals with reduced nutritional intake. However, placing long-term nonoral feeding tubes is not appropriate in those with advanced dementia or if the individual is likely to die imminently—“within hours or days”. In some instances, the provision of ANH in the weeks leading up to death may be considered a “Non-Beneficial Treatment.” In [this study a] total [of] 40 (47.6%) of 84 NGT [nasogastric tube]-flagged individuals were deceased within six months. Conclusions: NGT insertions in this cohort have a high likelihood of being considered “non-beneficial.”

Risky prescribing and the epidemic of deaths from fallsJAMA Health Forum; Thomas A. Farley; 8/25In 2023, more than 41,000 individuals older than 65 years died from falls. More importantly, the mortality rate for falls among older adults in the US has more than tripled during the past 30 years. Drugs that cause drowsiness or impaired balance or coordination have been called fall risk–increasing drugs (FRIDs). The list of FRIDs is long and includes drugs such as β-blockers and anticholinergics, as well as proton pump inhibitors that may increase the risk of an injury during a fall. Four categories (opioids, benzodiazepines, gabapentinoids, and antidepressants) of central nervous system–active FRIDs are particularly concerning because of a combination of surging use and a strong association with falls. 

Why palliative care is more than just end-of-life support MedPageToday's KevinMD.com; by Dr. Vishal Parackal; 9/1/25 ... Palliative care as a system requires strong interpersonal and cross-specialty communication for smooth functioning, as patients may require expert opinions from different fields to optimize their treatment plan. Patient education for systemic follow-ups and establishing a baseline of knowledge regarding their diagnosis and potential danger signs helps create a better environment for holistic care. While we focus on the physical aspects of care and diagnosis, we often fail to realize the psychological and mental impact that such conditions can have on the patient and their family. ... The opportunity to make a meaningful difference in patients’ lives by easing their suffering and enhancing their quality of life is profoundly fulfilling. ... Editor's Note: Excellent descriptions of palliative care.

DOJ probing UnitedHealth’s Optum Rx, alongside Medicare practicesModern Healthcare; by Chris Strohm, John Tozzi; 8/26/25The U.S. Justice Department’s criminal division is digging into UnitedHealth Group Inc.’s prescription management services as well as how it reimburses its own doctors under an ongoing probe into the firm’s operations, according to people familiar with the matter. The previously unreported areas of the probe show the scrutiny is broader than was known and goes beyond an inquiry into possible Medicare fraud. Investigators are looking into business practices at the company’s pharmacy benefit manager Optum Rx, in addition to the physician payments, said the people, who asked not to be identified discussing a confidential matter.

Proportional sedation for persistent agitated delirium in palliative care-A randomized clinical trialJAMA Oncology; David Hui, Allison De La Rosa, Jaw-Shiun Tsai, Shao-Yi Cheng, Egidio Del Fabbro, Anita Thankam Thomas Kuzhiyil, Kendra Rowe, Ahsan Azhar, Thuc Nguyen, Michael Tang, Chien-An Yao, Hsien-Liang Huang, Jen-Kuei Peng, Wen-Yu Hu, Sonal Admane, Rony Dev, Minxing Chen, Patricia Bramati, Sanjay Shete, Eduardo Bruera; 7/25Neuroleptic and benzodiazepine medications are often considered for patients with persistent agitated delirium in the last days of life; however, the risk-to-benefit ratio of these medications is ill-defined and benzodiazepine medications have not been compared to placebo. The results of this randomized clinical trial indicate that proactive use of scheduled sedatives, particularly lorazepam-based regimens, may reduce persistent restlessness and/or agitation in patients with advanced cancer and delirium in the palliative care setting. 

Palliative care plays an essential role in heart failure care Cardiovascular Business; by Michael Walter; 8/13/25 Palliative care should play a significant role in the day-to-day management of heart failure (HF) patients, according to new recommendations from the Heart Failure Society of America (HFSA). HF patients are associated with high mortality and a considerably worse quality of life, the group wrote. Care teams should be doing everything in their power to help patients control their symptoms and live the best lives possible. The HFSA guidance is available in full in the Journal of Cardiac Failure. ... “When using a guide, conversations are more likely to be feasible, acceptable and associated with positive experiences for both patients and clinicians,” the authors wrote.

Caring for every breath: Carolina Caring Advanced Lung Care Program launched August 1st Carolina Caring, Newton, NC; Press Release; 8/8/25 A specialized lung care program providing care for complex respiratory conditions will bring needed comfort and support to many individuals. Launched on August 1st, 2025, Carolina Caring’s Advanced Lung Care Program helps patients receive the personalized care they need for their advanced respiratory illness at end of life, while remaining comfortably at home—leading to a reduction of hospitalizations and improved quality of life for patients and their families. 

Lorazepam reduced restlessness, agitation in cancer patients with delirium: Patients were also less likely to require any rescue medications MedPage Today; by Mike Bassett; 8/5/25Use of lorazepam-based regimens reduced persistent restlessness and agitation associated with end-of-life delirium in cancer patients, a randomized study showed.Key Takeaways:

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. A prescribing cascade example cited in the research involves older patients taking calcium channel blockers for blood pressure control, which can cause ankle swelling side effects. Instead of first adjusting the blood pressure drug, some doctors immediately prescribe a diuretic to reduce the swelling — which for some, can create an unnecessary drug pair.

BetterRX receives strategic investment from BVP Forge to transform hospice pharmacy care nationwide and appoints Tim Tannert as CEOBusinesswire press release; 7/25/25BetterRX, the leading hospice pharmacy platform, today announced a strategic growth investment from BVP Forge, to accelerate its future growth. BetterRX also announced the appointment of Tim Tannert as its new CEO.

[Canada] Electronic decision support for deprescribing in older adults living in long-term care-A stepped-wedge cluster randomized trialJAMA Network Open; Emily G. McDonald, MD, MSc; Justine L. Estey, MSc; Cody Davenport, MSc; Émilie Bortolussi-Courval, RN; Jeffrey Gaudet, MSc; Pierre Philippe Wilson Registe, MSc, MPH; Todd C. Lee, MD, MPH; Carole Goodine, PharmD; 5/25Potentially inappropriate prescribing (PIP) occurs when medications that carry a higher risk of harm than benefit are prescribed. It occurs more often among older adults in the setting of polypharmacy (taking multiple medications) and is costly and harmful. PIP and potentially inappropriate medications (PIMs) contribute to excess adverse drug events, such as falls, fractures, cognitive decline, hospitalization, and death [and] the problem is more pronounced for older adults living in nursing homes (long-term care [LTC] homes). Depending on the screening criteria used, in some studies, the prevalence ranges from 67.8% to 87.7% of nursing home residents. Electronically generated, individualized reports that contained prioritized opportunities for deprescribing in older adults were paired with preexisting quarterly medication reviews [and] this study found that electronic decision support paired with the usual workflow could render the deprescribing process scalable and effective.

The role of an inpatient hospice and palliative clinical pharmacist in the interdisciplinary team Texas Medical Center Documents, published by the American Journal of Hospice and Palliative Medicine; by Jetavia Jones Moody, Ivy O. Poon, and Ursula K. Braun; 6/30/25 Palliative care is a specialized health care service for individuals with serious illness at any stage and can be provided in any setting. Current national consensus developed by palliative care experts recommends the inclusion of pharmacists in an interdisciplinary team (IDT) to provide quality palliative care. However, national registry data report that less than 10% of inpatient palliative teams in the U.S. have a clinical pharmacist. Clinical pharmacists have an impactful role in palliative patients' quality of life by optimizing symptom management, deprescribing, and providing education to the palliative care team as well as patients and their families.