Literature Review

Bereavement service deserts: A 2024 statewide assessment of  bereavement services Death Studies, open access; by Christopher W. Giang, Luisa Kcomt, Joshua Truchan, Kara Dickinson, Rebecca J. Evans-Polce & Sean Esteban McCabe; 12/5/25 ... This paper introduces the term “bereavement service desert” to describe geographic areas with high mortality and little to no access to bereavement services. Bereavement services deserts are especially concerning where elevated death rates are met with an absence of formal grief supports, trained providers, or community-based resources. As these trends in death have continued to rise over the last decade, the social and economic costs of unresolved grief are becoming more apparent in families, schools, com munities, workplaces, and healthcare systems. ...Editor's Note: Though this research focuses on bereavement agencies across Michigan's 83 counties, its methodologies and outcomes provide data, references, and insights relevant to examining bereavement care in all U.S. states. What are the "bereavement service deserts" in the your state(s)? In the areas you serve?

From compliance to cultural consciencePharmaLive.com; by Adela King, Inizio Evoke; 12/1/25 If patients can’t see themselves in your ads, they won’t see themselves in your brand. ... But don’t mistake this as a call to diversify casting alone. It’s a call to dig deeper and connect with cultural relevance, not just appearance.

NCPA and USC launch first publicly available tool to identify pharmacy shortage areas across America National Community Pharmacists Association (NCPA), Alexandria, VA; Press Release; 11/4/25 The National Community Pharmacists Association (NCPA), in collaboration with the University of Southern California (USC), unveiled an interactive, user-friendly pharmacy shortage area mapping tool available to the general public for the first time. Previously accessible only to select individuals and organizations, the public [can now] identify pharmacy shortage areas and understand access challenges in their local communities. ... The mapping tool reveals that approximately one in eight U.S. neighborhoods — representing millions of Americans — persistently lack convenient access to pharmacy services. In rural areas and underserved urban communities, the problem is far more severe, with some states and counties experiencing shortage rates approaching 50 percent.

Why Black, Hispanic, and Asian patients hesitate to opt for palliative care: Deep metaphors from patients, community leaders, and clinicians with shared cultural identities to shape more effective outreachJournal of Palliative Medicine; by Anthony L Back, MaryGrace S King, Kathy C Shaw, Kelly Willis, Malcolm Brooks, Arigun Bayaraa, Leon He, Vanessa Herman, Ivan Sanchez, Lindsay Zaltman, Marian S Grant; 9/25In the United States, national data show that Black, Hispanic, and Asian patients are less likely than White patients to receive palliative care (PC) despite comparable or greater symptom burden. We enrolled 15 patients (5 Black, 5 Hispanic, 5 Asian), 8 community leaders (5 Black, 3 Hispanic, 1 Asian), and 6 palliative care clinicians (2 Black, 2 Hispanic, 2 Asian). Patients' images about their experiences of being offered PC revealed the metaphor of "inside/outside"-a sense of simultaneous inclusion and exclusion with regard to their community and also the medical system. The patients' sense of belonging and protection felt from their communities was demonstrated in images that evoked the metaphor of "home," as a physical and emotional place with a sense of belonging. The metaphor of home as a place of belonging was mirrored in community leader and PC clinician interviews.

LGBTQ+ history project: The need to preserve LGBTQ+ histories of rural America Watermark Out News; by Lauren Rowello; 10/14/25 ... Resources importantly emerged as people formally organized — bringing critical health care and hospice networks during the HIV/AIDS crisis, for instance, and launching LGBTQ+ voices into expansive advocacy careers. Across the US, some of the most impactful voices for change have come from rural regions. ... Editor's Note: For more on this interface with the birth of hospice care in the US, examine "The AIDS Epidemic’s Lasting Impact on Hospice Care for LGBTQ+ Populations," by Holly Vossel, Hospice News, 6/28/24. Pair these with today's post, "Inside the hospice that feels like home: How Omega House catches those who fall through the cracks." 

For this doctor, LGBTQ+ care is about the mission and the moment American Medical Association (AMA); by Timothy M. Smith; 10/8/25 ... [Shail Maing, MD] is a hematology-oncology and palliative care physician at Dana-Farber Cancer Institute (DFCI), in Boston, where she is also the inaugural DFCI Network health equity and inclusion liaison. In addition to her work caring for patients, Dr. Maingi’s passion is advocacy, particularly on health inequities for LGBTQ+ patients. She was the founding chair of the American Academy of Hospice and Palliative Medicine’s LGBTQ Special Interest Group. “We’re living in a very diverse world, with much more acceptance and acknowledgement that health care is for everybody—that there are differences that are unexplored, and we can't pretend everybody has the same set of needs,” said Dr. Maingi ...

Developing competencies to advance health care access and quality for Latino, Hispanic, and Spanish origin populations-A consensus statementJAMA Network Open; by Débora H. Silva, John A. Davis Rodríguez, Hector Rasgado-Flores, Pilar Ortega, Deion Ellis, Fernando Sánchez Mendoza, Victor Cueto, Fabiola Quintero-Rivera, Norma Iris Poll-Hunter, Minerva Romero Arenas, Kenneth Lee Dominguez, Juan Emilio Carrillo, José E. Rodríguez, John Paul Sánchez; 8/25Question: What competencies and milestones are essential for advancing health equity for Latina, Latino, Latinx, Latine, Hispanic, and Spanish Origin (LHS+) populations? Since the 1970s, the LHS+ population has increased 6-fold and grown to be the largest ethnic or racial group in the US and accounts for approximately 20% of the US population. The LHS+ health equity competencies and milestones resulting from this study add to prior work by creating a blueprint for standardization and broader application of such educational experiences on a national level. As a tool to enhance CBME [competency-based medical education ] efforts aligned with care for LHS+ populations, the competencies may aid educators and institutions through an LHS+–informed lens in conducting gap analyses for the development of local curricula, developing teaching and assessment materials, supporting the professional development of learners and faculty, and facilitating educational scholarship. 

Serious illness and end of life in LGBTQIA+ older adultsDelaware Journal of Public Health; by Sarah Matthews; 7/25Gender-affirming care is just as important during serious illness and end of life. Typically, gender-affirming hormone therapy is maintained throughout life to provide masculinizing or feminizing effects as desired. At end-of-life, it may be the person’s wish to continue hormones even if the medication poses additional risk. Whenever possible, gender expression preferences of LGBTQIA+ elders should be honored. TRANSforming Choices Healthcare Decisions Starter Guide is an excellent resource for transgender, gender-diverse, and gender-expansive people to make choices about their healthcare including gender-affirming care. Funeral directives are available to ensure that LGBTQIA+ elders’ funeral wishes are followed, including name, pronouns, and presentation of the body.

Hospice was meant to offer dignity in death — but it fails the most marginalized. We need hospice programs that go to the streets, into shelters, behind barsSTAT; by Christopher M. Smith; 8/26/25I’ve spent more than a decade in hospice care, sitting at the bedsides of people facing the final days of their lives. I’ve held hands in hospital rooms, in tents, in prison cells, and in homes that barely qualify as such. And over time, I’ve come to see that dying in America is not just a medical event — it’s a mirror. It reflects everything we’ve failed to do for the living. Hospice was created to bring dignity to the dying — to manage pain, provide emotional and spiritual support, and ease the final passage for people with terminal illness. But the systems surrounding hospice care are riddled with inequity. The very people most in need of compassion — the unhoused, the incarcerated, people of color, LGBTQ+ individuals, and people with disabilities — are systematically excluded, underserved, or erased. Access to a good death is too often reserved for the privileged, while everyone else is left to navigate a system that wasn’t built for them — or worse, actively works against them... The truth is, hospice care cannot achieve its mission unless it actively addresses the inequities built into the structures around it. We need hospice programs that go to the streets, into shelters, behind bars. We need training rooted in cultural humility, in antiracism, in trauma-informed care. We need to reimagine what it means to offer dignity to someone whose life has been defined by abandonment... Because dying is universal. But justice, even at the end of life, is still not.Publisher's note: STAT also references Dr. Ira Byock's article "The hospice industry needs major reforms. It should start with apologies, 8/22/23".

Medicaid payments and racial and ethnic disparities in Alzheimer disease special care unitsThe Journal of the American Medical Association - JAMA Network Open; by Huiwen Xu, PhD, Shuang Li, PhD, John R. Bowblis, PhD, Monique R. Pappadis, PhD, Yong-Fang Kuo, PhD; James S. Goodwin, MD; 8/4/25 In this cohort study of 13, 229 nursing homes, those with higher proportions of Black or Hispanic residents were less likely to have Alzheimer disease special care units. The disparities among nursing homes serving high proportions of Black residents, however, narrowed and even disappeared in states with higher Medicaid payment-to-cost ratios. ... This study suggests that more generous Medicaid payments may be associated with improved availability of specialized dementia care in nursing homes that serve primarily marginalized Black residents.

Bipartisan bill offers ‘meaningful’ immigration reform that could help address senior living workforce needs, leaders say McKnights Senior Living; by Kimberly Bonvissuto; 7/1/25 A bipartisan immigration reform bill proposing a pathway to legal resident status for certain undocumented immigrants — including direct care workers — is earning the support of the senior living and care industry. The recently re-introduced Dignity Act of 2025 “offers the solution to our immigration crisis: secure the border, stop illegal immigration and provide an earned opportunity for long-term immigrants to stay here and work,” sponsor Rep. Maria Elvira Salazar (R-FL) had said in introducing the bill. [Its co-sponsor is] Rep. Veronica Escobar (D-TX).

Understanding the influence of culture on end-of-life, palliative, and hospice care: A narrative review Cureus; by Veena Hira, Sainamitha R. Palnati, and Saajan Bhakta; 7/15/25 ... This narrative review included 25 relevant publications related to influence of culture and patient demographics on end-of-life care, hospice, and palliative care. As each culture has its own unique views on death and dying, it is crucial to note these cultural differences when assisting with end-of-life care to best align with patients’ beliefs and values. Themes such as cultural barriers, communication preferences and family roles emerged from the publications. ... This narrative review offered a snapshot of how culture influences end-of-life decisions worldwide, specifically in East Asia, South Asia, the Middle East, Europe, and North America, while highlighting themes of 1) truth disclosure and communication preferences, 2) patient autonomy and family involvement, and 3) perception of illness and death. ... Central to providing effective end-of-life care is open, culturally tailored communication that respects patients’ and families’ values, facilitated through shared decision-making discussions. ... Ultimately, integrating cultural understandings of death and dying into end-of-life care planning is not simply a matter of sensitivity, but it is a matter of quality and equity. Health systems must not only provide choices but ensure those choices are intelligible, meaningful, and respectful within the patient’s worldview.Editor's Note: Pair this today's post, My health and my politics walk into a doctor’s office …