Literature Review

Integrating psychotherapeutic concepts to enhance serious illness communication: Assessment of a model curriculumJournal of Palliative Medicine; Danielle Chammas, Keri Brenner, Amanda Moment, Sarah E. Byrne-Martelli, Leah B. Rosenberg, Daniel Shalev; 5/25 Serious illness communication training often focuses on sharing medical information, discussing goals of care, and supporting patients and caregivers. Few communication frameworks explicitly integrate psychosocial concepts to improve therapeutic efficacy. Using Kern’s six-step curriculum development model, we created an interactive workshop focused on psychological formulation and countertransference. Results: Satisfaction was high (92% satisfied or highly satisfied), and most participants reported meaningful impact on their clinical practice (89%), teaching (93%), and team collaboration (93%) at eight-week follow-up. Conclusions: A multisite, half-day workshop significantly enhanced palliative care clinicians’ knowledge and perceived application of core psychotherapeutic concepts.

Providing support to children during the loss of an important adult in the ICUIntensive Care Medicine; Ruth Kleinpell, Bénédicte Gaillard-Le Roux, Jozef Kesecioglu; 5/25Research on bereavement care in the ICU has demonstrated associated benefits, including facilitating emotional adjustments, meaning-making, and resilience. As Rowland and colleagues highlight, helping children process information effectively without feeling overwhelmed is important, as they need supportive adults to provide honest, developmentally appropriate explanations. The strategies highlighted in their narrative review can help ICU clinicians to tailor bereavement care for children to support them through the loss of an important adult in the ICU.

Sex and racial/ethnic differences in end-of-life care preferences in persons with Parkinson's Disease and related disordersMovement Disorders; Whitley W Aamodt, Lynn Eickholt, David G Coughlin, Lisa Solomon, Katharine A Rendle, Carly Marshall, Joaquin A Vizcarra, Nabila Dahodwala; 5/25In persons with Parkinson's disease (PD) and related disorders (PDRD), rates of end-of-life (EoL) hospitalization are greatest, and rates of hospice utilization lowest, among men and persons of color. In adjusted models, women with PDRD were more likely than men to prefer religious/spiritual support at the end of life. Compared with White participants with PDRD, non-White participants were more likely to consider EoL hospitalization, less likely to consider medical aid in dying, and less familiar with palliative care. In four focus groups involving 14 questionnaire respondents, contributors to EoL decision-making included medical knowledge/information, personal experiences, family dynamics, religion/spirituality, and resources/cost. Conclusions: EoL care preferences differ by sex and race/ethnicity in persons with PDRD. These preferences are influenced by multiple factors and may contribute to differential EoL outcomes, emphasizing the need for individualized, culturally competent EoL care. 

Trends in home health care among traditional Medicare beneficiaries with or without dementiaJAMA Network Open; Rachel M. Werner, MD, PhD; Seiyoun Kim, PhD; R. Tamara Konetzka, PhD; 5/25In the US, nearly 7 million people live with Alzheimer disease and other dementias, a number that is expected to increase as the population ages. Although many people with dementia live in nursing homes or other institutional settings, institutional use is decreasing, and a growing majority of people with dementia are opting to live at home and receive care in the community. Home-based care is typically consistent with most people’s preferences and may be particularly important for those with dementia, as institutional settings and transfers can be stressful and disorienting.

Global adoption of value-based health care initiatives within health systems-A scoping reviewJAMA Health Forum; Ayooluwa O. Douglas, MD, MPH; Senthujan Senkaiahliyan, MHSc; Caroline A. Bulstra, DVM, MHSc, PhD; Carol Mita, MS; Che L. Reddy, MBChB, MPH; Rifat Atun, MBBS, MBA; 5/25The value-based health care (VBHC) framework was introduced in the US in 2006 to combat rising health care expenditures that failed to produce improvements in patient quality, safety, and outcomes over the past decades. The framework focuses on 6 elements: (1) organizing care around medical conditions, (2) measuring outcomes and costs for every patient, (3) aligning reimbursement with value through bundled payments, (4) integrating care systems regionally, (5) establishing national centers of excellence for complex care, and (6) using information technology systems to support these elements. This scoping review of 50 initiatives found that the implementation of VBHC globally is still in its early stages, with published scientific literature pointing to small-scale institutional-level implementation within individual departments and hospitals. Large-scale implementation designed to develop high-value health systems is limited.

Online dialectical behavioral therapy for emotion dysregulation in people with chronic pain-A randomized clinical trialJAMA Network Open; Nell Norman-Nott, BPsychSc; Nancy E. Briggs, PhD; Negin Hesam-Shariati, PhD; Chelsey R. Wilks, PhD; Jessica Schroeder, PhD; Ashish D. Diwan, MD, PhD; Jina Suh, PhD; Jill M. Newby, PhD; Toby Newton-John, PhD; Yann Quidé, PhD; James H. McAuley, PhD; Sylvia M. Gustin, PhD; 5/25Chronic pain, defined as pain persisting beyond 3 months,1 affects 20% to 30% of the population. Beyond its sensory experience, chronic pain is an intrinsically emotional experience associated with heightened negative emotions, including anger, worry, and low mood, alongside a diminished capacity to regulate emotions. Dysregulated emotions contribute to comorbid psychological disorders; symptoms of anxiety and depression, which are present in 50% to 80% of people with chronic pain; and worsening pain intensity. One emotion regulation–focused intervention being adapted for chronic pain is dialectical behavioral therapy (DBT). In DBT skills training, emotion regulation is improved by encouraging emotion recognition, emotion expression, and reaction evaluation. Results of small in-person trials of DBT for people with chronic pain show promise to improve emotion dysregulation, depression, anxiety, and pain intensity.

Naming the pain: Grief-ism, grief-ist, and the linguistics of lossIllness, Crisis & Loss; Laurel E. Hilliker, Bob Baugher; 5/25This article introduces two new terms, Grief-ism and Grief-ist, to expose some of the behaviors, actions, inactions, and unrealistic expectations of others (from individual support persons to societal institutions) towards bereaved individuals. In this article, we provide examples of subtle prejudice, discrimination, and marginalization involving those adjusting to significant loss. As well, this work draws attention to the medicalization and policing of the process of grief by well-meaning others. We believe these actions accumulate over time, weigh down those who are grieving loss, and tend to make the grief feel unsupported. As a result, people coping with the loss of a loved one may experience feelings of isolation and, in some cases, a lengthening of the grief process.

Where adults with heart failure die: Insights from the CDC-WONDER databaseCirculation: Heart Failure; Farman Ali, Shaaf Ahmad, Aman Ullah, Ali Salman, Adarsh Raja, Faizan Ahmed, Prinka Perswani, Ahsan Alam, Jishanth Mattumpuram, Muhammad Talha Maniya, Hamza Janjua, Tyler J Bonkowski, Aravinda Nanjundappa; 5/25This study underscores the shifting trends in the locations of death among patients with HF [heart failure], with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. Hospice/nursing home deaths increased from 30.95% ... in 1999 to 34.71% ... in 2017, but declined to 29.54% ... by 2023. Young adults (20-34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities. 

An end-of-life nursing education consortium (ELNEC) regional approach to integrating primary palliative care in nursing educationJournal of Professional Nursing; Toni L Glover, Olga Ehrlich, Andra Davis, Megan Lippe, Carrie L Cormack, Theresa Jizba, Amanda J Kirkpatrick, Susan Meskis; May-June 2025With the concurrent movement toward competency-based nursing education and the incorporation of Hospice, Palliative, and Supportive Care as one of the four spheres of care in the latest AACN [American Association of Colleges of Nursing] Essentials, nurse educators face a myriad of challenges in incorporating palliative care content into undergraduate and graduate curricula. The challenges include: a lack of faculty expertise in palliative care education; a lack of administrative or faculty support to include primary palliative care content in nursing curricula; a lack of evidence-based teaching strategies on primary palliative care nursing education; and, a lack of funding to support the development of robust, evidence-based strategies to strengthen primary palliative care nursing education. The purpose of this article is to describe an innovative regional approach advancing primary palliative care nursing education. To ensure nursing students are practice-ready, both undergraduate and graduate programs must provide education that builds knowledge and competency in primary palliative nursing care. 

Live hospice discharge of individuals with cognitive disabilities: A systematic reviewJournal of the American Medical Directors Association; by Victoria M Winogora, Christine E DeForge, Kimberlee Grier, Patricia W Stone; 4/25This systematic review is the first to focus on live discharge from hospice for individuals with cognitive disabilities. All studies focused exclusively on individuals with dementias. Although the term cognitive disability was absent from the literature reviewed, cognitive disability was associated with live discharge. Future research should aim to include the greater cognitive disability community to assess hospice and other end-of-life outcomes to identify potential targets for future intervention.

Provision of end-of-life care in austere environmentsWilderness & Environmental Medicine; by Jason W. David, Hui Z. Feng, Danny Lammers, Russell Day; 6/25End-of-life care presents unique challenges in austere or resource-limited environments where traditional medical resources are scarce or absent. This review explores the complexities of providing end-of-life care under such constraints, including recognition of the dying patient and techniques to alleviate suffering and allow death with dignity in under-resourced or expeditionary environments. Moreover, it presents these techniques in an accessible manner for providers without formal hospice training to use. Based on a literature review of hospice and palliative medicine, insights from the body of literature in wilderness and austere medicine, and the authors’ experiences in practicing in austere environments, this paper discusses practical approaches to symptom management, ethical considerations in end-of-life decision making, and accessible interventions with limited resources.Publisher's note: An interesting article for all healthcare professionals to consider...

Granting permission: Toward embracing griefJournal of Social Work in End-of-Life and Palliative Care; by Rennie Bimman; 3/25Grief, unavoidable and often excruciating, is rarely sufficiently acknowledged or supported in Western society. It is not granted permission to exist without barriers. By considering and evaluating grief experiences through the lens of their access to permission, clinicians can collectively imagine and promote inclusivity in grief. Permission is presented as a conceptual framework and clinical tool, with broader micro- and macro-level applications for both professional and layperson engagement, offering a foundation for further implementation and research.

Timing and outcomes of palliative care integration into care of adolescents and young adults with advanced cancerOncology Practice; Jeremiah Bonnet, BA; Colin Cernik, MS; Hajime Uno, PhD; Lanfang Xu, MS; Cecile A. Laurent, MS; Lauren Fisher, MS; Nancy Cannizzaro, BA; Julie Munneke, BA; Robert M. Cooper, MD; Joshua R. Lakin, MD; Corey M. Schwartz, MD; Mallory Casperson, BA; Andrea Altschuler, PhD; Lawrence H. Kushi, ScD; Chun R. Chao, PhD; Lori Wiener, PhD; Jennifer W. Mack, MD, MPH; 5/25Adolescent and young adult (AYA) patients with cancer frequently receive intensive measures at the end of life; many also express care goals that align with a palliative approach. [In this study] nearly three quarters (73%) [of  AYA patients] were referred to palliative care before death. Thirty-six percent of palliative care referrals took place before the last 90 days of life; 30% were in the last month of life. Palliative care referrals and their timing were associated with care received at the end of life, with earlier referrals associated with fewer intensive measures near death, including chemotherapy in the last 14 days of life ... as well as intensive care unit admissions, emergency room visits, and hospitalizations in the last month of life ... Patients who were referred to palliative care were more likely to have symptoms assessed in the last 90 days of life, including pain, dyspnea, nausea, diarrhea, constipation, depression, and anxiety ...