Literature Review

Nursing home residents, family members, and staff members views about a good death and preferred place of death for a nursing home residentOmega-Journal of Death and Dying; Janet Sopcheck, Ruth M. Tappen; 2/25Our study ... revealed that residents, like family members and staff members, had mixed opinions of the place of death for the NH resident, highlighting the importance of having advance care planning sessions with residents and their families to gain an understanding regarding their choices. Our study found the predominant and common qualities across the three participant groups of a good death include painless or pain-free, without suffering, peaceful, quiet, and dying in my sleep. Interestingly, almost one-fifth of the participants disagreed with the term good death, offering that death is not good as the person is no longer alive. Based on this study’s finding, using the term a good death in research and in advance care planning sessions may not be relevant or appropriate and instead focus on what care is necessary to promote a natural death, as mentioned by a few participants.

Disparities in end-of-life symptom burden linked to complex interplay among wealth, health, and social supportJAMA Network Open; Peter A. Boling, MD; 3/25On average, US health care spending in the last year of life alone was $80,000, with 12% ($9,500) being out of pocket and mostly incurred before the final 6 months. This problem worsened in the past decade when the nonspecific diagnosis of failure to thrive was removed as a condition eligible for hospice care and more stringent definitions were applied for dementia, which became the next bubble as the hospice balloon was squeezed. Hospice care is a means of reducing symptom burden, but the Medicare payment model discourages prolonged enrollment during slowly progressing advanced chronic illness and effectively limits funding of social support during hospice care, which is particularly problematic for patients with cognitive and functional impairment and for their friends and families. Considering suffering as a medical condition warranting treatment rather than a social problem requiring support services might help with the evolution of a Medicare policy that might provide a more graduated approach to end-of-life care.

Understanding and addressing the US hospital bed shortage—Build, Baby, BuildJAMA Network Open; Alexander T. Janke, MD, MHS, MSc; Arjun K. Venkatesh, MD, MBA, MHS; 2/25In the study by Leuchter et al, they provide simple yet provocative projections for the future of hospital care. They project that national hospital occupancy will exceed 85% by 2032, a critical threshold where basic hospital operations can become dysfunctional and even unsafe. Leuchter et al begin to quantify the story already felt at the bedside in hospitals across the nation—namely, a trajectory toward inadequate supply of hospital care for the anticipated demand of the coming decade. US residents are older and more medically complex than ever. Technologically sophisticated surgical interventions and medical therapies have transformed the long-term survival rates for serious conditions, such as end-stage kidney disease, heart failure, and chronic obstructive lung disease. The US needs greater hospital bed capacity, particularly for critical care and complex care services.

Palliative care nurse specialists' perspectives on spiritual care at end of life-A scoping reviewJournal of Hospice and Palliative Nursing; Bronagh Dunning, Michael Connolly, Fiona Timmins; 3/25The research demonstrates that specialist palliative care nurses perceive spiritual care as an important element of holistic care at end of life; however, these nurses also agree that spiritual care is lacking. This deficiency results from a lack of education in spirituality; experience of the nurse; the nurses' own spiritual and religious beliefs and values, fears, and difficulties in communication; and the nurse-patient relationship. The findings demonstrate the necessity to increase the level of spiritual care education in nurse programs, educating nurses on the provision of spiritual care, and how to deal with conflicts in spiritual and religious beliefs.

Wealth disparities in end-of-life symptom burden among older adultsJAMA Network Open; Irena Cenzer, Kenneth E Covinsky, Sarah H Cross, Claire K Ankuda, Lauren J Hunt, Melissa D Aldridge, Krista L Harrison; 3/25This cohort study found that lower wealth was associated with a higher symptom burden at the end of life, mediated in part by higher rates of multimorbidity, functional impairment, and dementia. These findings highlight the need for policies and programs to support patients with lower financial resources to improve end-of-life experiences and mitigate wealth disparities. 

The analysis of hospice trends in the United States in 2020 among Medicare beneficiariesAmerican Journal of Hospice and Palliative Medicine; Noor Chughtai, BS; Cortland Brown, MS; Jordan Shelestak, MS; Jared Nichols, DO; 3/25 While hospice care has many benefits, there is variability among the service throughout the United States. Public hospice care data from data.cms.gov were analyzed to explore these trends. Findings indicate that Medicare beneficiaries in the South and West regions of the U.S. experience longer hospice stays, and in contrast, those in the Northeast and Midwest (including Alaska) reflected reduction from this average. Notably, states with shorter hospice durations showed a higher proportion of neoplastic disorders as the primary diagnosis, while those with longer stays showed an inverse relationship with greater prevalence of circulatory system disorders and lower incidence of neoplastic diagnoses. Additionally, the analysis reveals a consistent decline in average hospice length with increasing age among patients aged 80-85 across all U.S. regions, as expected.

Using virtual reality to improve outcomes related to quality of life among older adults with serious illnesses: Systematic review of randomized controlled trialsJournal of Medical Internet Research; Bhagvat Maheta, Alexandra Kraft, Nickolas Interrante, Soraya Fereydooni, Jeremy Bailenson, Brian Beams, Christina Keny, Thomas Osborne, Karleen Giannitrapani, Karl Lorenz; 2/25Virtual reality (VR) has promise as an innovative nonpharmacologic treatment for improving a patient's quality of life. VR can be used as an adjunct or treatment for many acute and chronic conditions, including serious illnesses. Nascent evidence suggests VR's potential in mitigating pain, anxiety, and depression and improving mobility among persons with serious illnesses.

Knowledge of and preferences for medical aid in dyingJAMA Network Open; Elissa Kozlov, PhD; Elizabeth A. Luth, PhD; Sam Nemeth, BA; Todd D. Becker, PhD, LMSW; Paul R. Duberstein, PhD; 2/25In the US, approximately 74 million people (22%) live in a jurisdiction that allows medical aid in dying (MAID), a legal practice that allows terminally ill patients to obtain a prescription for medication to end their life. In this online survey study of 3,227 US adults, 51.3% did not know if MAID was legal in the US, and 50.8% did not know if MAID was legal in their state. In the full sample, 44.0% expressed interest in using MAID if terminally ill. This study suggests that there is substantial interest across all demographic groups in using MAID, but significant knowledge gaps exist about its legality, which may be associated with observed racial and ethnic and educational differences in MAID’s use. These findings highlight the need for public education, policy initiatives, and patient-clinician discussions to ensure equitable access to patient-centered end-of-life options and informed decision-making. 

Pulmonary embolism–related mortality in patients with cancerJAMA Network Open; Marco Zuin, MD, MS; Anju Nohria, MD; Stanislav Henkin, MD, MPH; Darsiya Krishnathasan, MS; Alyssa Sato, BA; Gregory Piazza, MD, MS; 2/25This cohort study ... found that despite decreases in cancer-related mortality rates, temporal trends demonstrated an increase in age-adjusted PE [pulmonary embolism]-related mortality from 2011 to 2020 among patients with cancer, with a significantly higher rate of increase observed in younger patients aged 15 to 64 years, Black, Hispanic, and White individuals; and the Southern region of the US. Recognition of such patterns may inform further research into thromboprophylaxis and treatment of PE as a complication of cancer and cancer-directed therapy.

Mitigating moral injury for palliative care cliniciansPalliative Medicine Reports; by Anne G. Pereira, Mark Linzer, Leonard L. Berry; 2/23Palliative care clinicians (PCCs) in the United States face the combination of increasing burnout and a growing need for their services based on demographic changes and an increasing burden of serious illness... We propose three solutions to address moral distress and moral injury in PCCs to reduce burnout. These solutions are grounded in the dilemmas particular to palliative care and in best evidence: first, to create space for PCCs to confront moral challenges head-on; second, to integrate ethics consultations into care of some patients cared for by PCCs; and third, to reassess care models for PCCs. These approaches can mitigate burnout and thus address the growing gap in our ability to provide high-quality palliative care for those patients in need.

Increasing awareness and access to integrated behavioral health and palliative care: An introduction to the American Journal of Hospice and Palliative Medicine'sAmerican Journal of Hospice and Palliative Care; James Gerhart, Michael Hoerger, Stacie Levine, Sean O'Mahony; 2/25Mental health symptoms are common in the general population and are overrepresented in patients receiving palliative care and hospice services. This introduction to the special issue on Mental Health in Palliative Care and Hospice highlights the ongoing need for research and training to prepare our palliative care workforce to address the concerns of patients experiencing serious illness and mental health concerns. Multilevel approaches are needed to enhance understanding of mental health needs among people with serious illness. Public health outreach is needed within our communities, targeted support is needed for family caregivers, and structured training for palliative care and hospice clinicians is needed to enhance competent mental health in these settings.

WVU nursing faculty aim to enhance rural home care for chronically ill through NIH award WVU Today - West Virginia University, Morgantown, WC; Press Release; 2/26/25 Three West Virginia University nursing faculty know firsthand the difficulties faced by family caregivers and their chronically ill loved ones. With a $2.7 million award from the National Institutes of Health’s National Institute of Nursing Research that is one of the largest ever for the WVU School of Nursing, the faculty researchers aim to support these families while increasing access to care in the rural reaches of the Mountain State by testing an integrated, nurse-led intervention for family home care management of end-stage heart failure and palliative care. ... Through their lived experiences, as well as their previous studies using nursing science to develop and test nurse-led interventions, the three said they hope to improve family caregivers’ and their loved ones’ overall health and well-being, including reducing depression and anxiety, and monitoring and managing end-of-life symptoms.

New FDA policies could limit the full value of AI in medicineJAMA Health Forum; Scott Gottlieb, MD; 2/25Some experts within the [AI] field predict that in the next several years, developers may realize artificial general intelligence (AGI)—a revolutionary form of AI capable of understanding, learning, and applying knowledge across various tasks with human-like proficiency. Unlike today’s narrow AI systems that excel at tasks such as image recognition or language translation, AGI can tackle any intellectual challenge a human can, demonstrating a deep comprehension of diverse disciplines. Artificial intelligence tools with advanced analytical capabilities used in clinical practice, especially tools that synthesize complex clinical information from distinct sources, may automatically be classified as medical devices ... [by the US Food and Drug Administration]. This could deny health care clinicians access to AI tools that have the potential to transform the productivity and safety of medical care.