Whitman J, Sudakar H, Sabik L
… +1 more, Schenker Y
J Palliat Med
· 2026 Jun · PMID 42342673
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OBJECTIVE: Recent growth in hospice has raised concerns about variability in access and quality. This study examines U.S. county-level presence of hospice providers. METHODS: Quality was assessed using 2023 Centers for M...OBJECTIVE: Recent growth in hospice has raised concerns about variability in access and quality. This study examines U.S. county-level presence of hospice providers. METHODS: Quality was assessed using 2023 Centers for Medicare & Medicaid Services Consumer Assessment of Healthcare Providers and Systems Hospice Survey Star Ratings. County-level sociodemographic characteristics were obtained from the U.S. Census Bureau's American Community Survey 2023 five-year sample. RESULTS: Of 7024 hospice providers, 29.2% had publicly available ratings, of which 55.3% were high quality (>3 stars). Of 3222 counties, at least one hospice provider was located in 41.4%, and a high-quality provider was present in 23.6%. Counties with high-quality providers tend to be urban and have higher income, larger populations, higher education, and lower poverty and uninsurance rates. CONCLUSIONS: Many U.S. counties have no hospice providers. The presence of high-quality care is markedly lower in rural and poor counties. Missing star ratings limit the utility of public quality data for patient and family decision-making.
Nakamura M, Nagae H, Nasu M
… +4 more, Takahashi Z, Yamada A, Aoyama M, Chiba K
J Palliat Med
· 2026 Jun · PMID 42336772
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In the context of a globally aging society, the concept of a compassionate community-which links societal frameworks with palliative care-has gained increasing attention. We posited that compassionate community initiativ...In the context of a globally aging society, the concept of a compassionate community-which links societal frameworks with palliative care-has gained increasing attention. We posited that compassionate community initiatives should be perceived as sustainable efforts that extend from healthy stages of life. This study is a scoping review designed to define and elucidate how compassionate communities are utilized and practiced IN the health care domain. A systematic search of Medline, the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and PsycINFO was conducted using the keyword "Compassionate Community." Articles were limited to those in English and published between 2015 and 2025. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews guided data extraction and synthesis. A total of 27 articles were included. From these 27 articles, the concept of compassionate community in the health care domain was redefined. Additionally, eight functional aspects of a compassionate community were identified: Supporting, Connecting, Educating, Empowering, Empathizing, Cultivating, Surveying, and Lobbying. In this study, we restructured the concept of a compassionate community in the health care domain and categorized specific initiatives into eight functional aspects. Although the notion of compassionate community as an initiative that integrates society and palliative care aligns with previous research, this study clarified the specific activities required from a more practical approach. The results of our study may provide valuable insights for future research aimed at utilizing compassionate communities as a strategy for primary health care practice.
Silva MD, Adelman RD, Mindlis I
… +3 more, Novas AL, Tucci AS, Reid MC
J Palliat Med
· 2026 Jun · PMID 42332921
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BACKGROUND: Language barriers lead to disparities at the end of life (EOL). How providers work with medical interpreters and meet the needs of patients and families with limited English proficiency (LEP) enrolled in hosp...BACKGROUND: Language barriers lead to disparities at the end of life (EOL). How providers work with medical interpreters and meet the needs of patients and families with limited English proficiency (LEP) enrolled in hospice remains poorly understood. OBJECTIVES: To investigate home hospice providers' experiences when communicating with patients and families with LEP, report the frequency of use of medical interpretation, and ascertain the strategies utilized by respondents to communicate with patients and families with LEP. DESIGN: Cross-sectional survey of U.S. based home hospice providers delivering home hospice care. RESULTS: A total of 138 surveys were collected. The response rate could not be calculated due to the survey dissemination method. On average 22% of the respondents reported caring for patients/families with LEP. Over-the-phone interpreting (OPI) was the most frequent professional interpreter modality utilized to communicate with patients/families with LEP (81%). Adult family members and hospice staff, who spoke the same language as the patient, were also commonly utilized by respondents (83% and 66%, respectively). Provision of video remote interpreting written hospice and bereavement materials in various non-English languages was viewed as a beneficial interventions for this patient population. CONCLUSION: OPI was most frequently utilized by home hospice providers. Having bilingual hospice staff and non-English language bereavement materials was viewed as an important strategy to support patients and families with LEP.
Kajiura S, Hayashi T, Hirano M
… +3 more, Koseki S, Murakami N, Hayashi R
J Palliat Med
· 2026 Jun · PMID 42316850
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BACKGROUND/OBJECTIVES: Injectable opioid use in home palliative care requires multiprofessional coordination, but regional implementation data are limited. We conducted a pilot survey to describe experience, task sharing...BACKGROUND/OBJECTIVES: Injectable opioid use in home palliative care requires multiprofessional coordination, but regional implementation data are limited. We conducted a pilot survey to describe experience, task sharing, difficulties, and future willingness. METHODS: We performed an anonymous web-based cross-sectional survey of multidisciplinary professionals involved in community-based palliative care in a Japanese regional health care area. RESULTS: Among 159 respondents, 117 (73.6%) had prior opioid experience for cancer pain, and 73/117 (62.4%) had prior injectable opioid experience. Initiation was mainly attributed to hospital physicians, maintenance dose management to hospital and clinic/home care physicians, and solution or cassette exchange to nurses. Difficulties when starting or modifying injectable opioids were reported by 27/73 respondents (37.0%). Future willingness was higher with prior experience (41/72, 56.9%) than without prior experience (7/83, 8.4%). CONCLUSION: This pilot survey suggests that home injectable opioid practice is a multidisciplinary workflow with an experience-related readiness gap, supporting broader regional evaluation and implementation-focused support.
Pinnow E, Aoki K, Quintiliani LM
… +6 more, Henault LE, Kamaka ML, Delight Davis A, Paasche-Orlow MK, Volandes AE, Mau MK
J Palliat Med
· 2026 Jun · PMID 42316844
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BACKGROUND: Advance care planning has proven to be beneficial to medical care as it elicits patient preferences at the end of life, yet Indigenous populations have low rates of participation. OBJECTIVE: This gap map scop...BACKGROUND: Advance care planning has proven to be beneficial to medical care as it elicits patient preferences at the end of life, yet Indigenous populations have low rates of participation. OBJECTIVE: This gap map scoping review serves to assess the current literature regarding the prevalence of advance care planning and palliative care characteristics in Indigenous populations of North America and Oceania. DESIGN: Articles were identified from searches performed in five databases spanning the period from 2013 to 2023. RESULTS: Twenty-eight articles met the inclusion criteria, representing studies conducted in the United States ( = 15), Canada ( = 2), New Zealand ( = 7), and Australia ( = 4). The included articles varied in study design, comprising qualitative ( = 16), observational ( = 7), mixed method (qualitative and quantitative) ( = 4), and interventional ( = 1). Two major findings endorsed across studies were (1) a high frequency of family involvement in end-of-life decision making and (2) awareness of culturally unsafe end-of-life services, creating hesitancy and mistrust. CONCLUSIONS: These results map the gaps in the existing research literature exploring the needs and preferences of Indigenous peoples in end-of-life decisions, palliative care, and advance care planning while highlighting a paucity of known effective interventions for Indigenous people.
DePew R, Sivertsen E, Rubinson M
… +1 more, DeSandre P
J Palliat Med
· 2026 Jun · PMID 42316827
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OBJECTIVE: This narrative review aims to summarize best practices in palliative care for patients undergoing evaluation for organ donation. BACKGROUND: Palliative care clinicians are uniquely positioned to improve care f...OBJECTIVE: This narrative review aims to summarize best practices in palliative care for patients undergoing evaluation for organ donation. BACKGROUND: Palliative care clinicians are uniquely positioned to improve care for potential organ donors and their families. When ongoing life support is no longer consistent with the patient's/family's goals, inpatient palliative care clinicians should be able to recognize and advocate for the end-of-life (EOL) priorities of patients who are potential organ donors. This includes guiding communication during decision-making, as well as providing symptom management for patients and psychosocial support for patients and caregivers. METHODS: We conducted a narrative review of published literature and policies relating to the role of palliative care in potential organ donors. RESULTS: Families of organ donors report a high rate of satisfaction with the decision to pursue organ donation; however, family distress remains common. Moral distress is also common among clinicians caring for patients undergoing organ donation, which can stem from concern for under-treatment of symptoms, worries that medications for comfort are being used to hasten death, and lack of clear roles and expectations in managing the dDCD process. DISCUSSION: We present strategies for supporting and communicating with patients and families prior to and during evaluation for organ donation. We also outline a framework for symptom management in the setting of potential dDCD, emphasizing that potential organ donors should always receive EOL symptom management in line with current best practices for withdrawal of life-sustaining treatments, though limited guidance exists for applying these practices in the context of anticipated dDCD. Finally, we discuss the role of palliative care in mitigating moral distress among medical teams and Organ Procurement Organization staff caring for patients who are potential organ donors.
Esce AR, Cescon J, Koren M
… +5 more, Meyerson E, Biewald MA, Arnold RM, Bharani A, Belland L
J Palliat Med
· 2026 Jun · PMID 42304694
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INTRODUCTION: Physician-assisted dying (PAD) is legal in an increasing number of jurisdictions across the United States. Despite this, formal hospice and palliative medicine (HPM) fellowship curricula on PAD are lacking....INTRODUCTION: Physician-assisted dying (PAD) is legal in an increasing number of jurisdictions across the United States. Despite this, formal hospice and palliative medicine (HPM) fellowship curricula on PAD are lacking. To address this, a neutral (nonadvocacy) PAD pilot curriculum was developed and implemented in one large HPM fellowship program. METHODS: A five-lecture curriculum was developed by an interdisciplinary group using Kern's six-step method. Comfort, knowledge, and satisfaction were assessed. RESULTS: 17 fellows were eligible to complete curriculum assessments with a 76% response rate on the postcurriculum survey ( = 13). Self-reported comfort improved significantly across all measured domains. Ninety-two percent of respondents were very or somewhat satisfied; 85% of respondents agreed the curriculum maintained a neutral tone. CONCLUSION: HPM fellows value PAD education, even when practicing in a state where it is illegal. A neutral curriculum is feasible, improves comfort, and is well received. This offers a model for integrating PAD education into HPM training.
Tarbi E, Sofronas M, Chammas D
… +3 more, Brenner K, Galchutt P, Chochinov HM
J Palliat Med
· 2026 Jun · PMID 42297601
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Existential concerns are common in serious illness and may include confronting questions about meaning, purpose, and mortality. The salience of these issues can vary between patients and throughout illness, and can oscil...Existential concerns are common in serious illness and may include confronting questions about meaning, purpose, and mortality. The salience of these issues can vary between patients and throughout illness, and can oscillate between existential suffering, demoralization, normative processing, and even existential growth. Through analysis of a clinical composite case, this article illustrates dimensions and cues of existential suffering during serious illness. Recognizing the sources and manifestations of existential distress can help expand therapeutic imagination in serious illness care. Guided by existential principles, we draw on the tenets of Intensive Caring and Dignity in Care to offer practical language and psychotherapeutically informed communication strategies for general palliative care practice. These techniques aim to ease existential suffering, strengthen relational connection, and support patients in living meaningfully through the end of life.
J Palliat Med
· 2026 Jun · PMID 42281421
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OBJECTIVES: To provide detailed characteristics of advanced malignant bone and soft tissue tumors at the end of life. DESIGN: A retrospective case series analysis. SUBJECT: We included 24 patients who presented to our de...OBJECTIVES: To provide detailed characteristics of advanced malignant bone and soft tissue tumors at the end of life. DESIGN: A retrospective case series analysis. SUBJECT: We included 24 patients who presented to our department between 2014 and 2024, were diagnosed with malignant bone or soft tissue tumors, and died from tumor-related causes. RESULTS: The mean age was 57.8 ± 15.6 years at death. Acute-onset events requiring emergency admission within three months before death occurred in 91.7%. The reasons for emergency admission included dyspnea due to malignant pleural effusion, sepsis, paraplegia, gastrointestinal bleeding, bone marrow dysfunction, difficulty moving due to pain, acute renal failure, and pulmonary thromboembolism. CONCLUSIONS: Patients with advanced sarcoma experience an exceptionally high rate of acute-onset events and emergency admissions in their final months. Emergency hospitalization provides an opportunity to consider transitioning to palliative care.
Herbst LA, Kadden D, Weber DE
… +2 more, Overla S, Turner L
J Palliat Med
· 2026 Jun · PMID 42267893
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BACKGROUND: Serious illness conversations (SICs) are an important part of medical care, yet trainees continue to express discomfort. Educational opportunities are time and resource-intensive. This pilot study's aim was t...BACKGROUND: Serious illness conversations (SICs) are an important part of medical care, yet trainees continue to express discomfort. Educational opportunities are time and resource-intensive. This pilot study's aim was to explore the experience of artificial intelligence (AI) technology deployed for SIC practice and feedback. METHODS: 2-Sigma, an AI-based simulation platform, was deployed as a tool for medical students to practice SICs utilizing skills taught through a dedicated Advance Care Planning (ACP) curriculum. Eleven medical students completed 27 cases and full transcripts were reviewed to describe (1) student interactions with AI, (2) AI responses, and (3) AI-provided feedback. RESULTS: Students interacted with AI utilizing skills taught in the ACP curriculum. AI responses displayed emotion, however, quickly resolved negative feelings. Feedback addressed important components of SICs but varied in its specificity. CONCLUSION: AI technology represents a potential tool for practicing skills necessary for SICs.
Piscitello G, Durant D, Minnier T
… +3 more, Haranis M, Arnold RM, Schell J
J Palliat Med
· 2026 Jun · PMID 42253054
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BACKGROUND: Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur. OBJECTI...BACKGROUND: Clinicians place comfort measures only (CMO) orders for hospitalized patients at the end-of-life when a decision has been made to focus on patient comfort and allow the natural dying process to occur. OBJECTIVES: Our primary aim was to assess the associations of specialty palliative consults (SPC) or documented goals of care conversations (GOCC) with in-hospital mortality among patients with CMO orders. DESIGN: We completed a retrospective cross-sectional study of data from the electronic medical record. SETTING/PARTICIPANTS: We assessed all adult patients with CMO orders admitted to four hospitals in the United States between 2022 and 2024. MEASUREMENTS: We used descriptive statistics and multivariable logistic regression and linear regression models to identify the association of SPC and documented GOCC with patient outcomes. RESULTS: Of 6789 hospitalized patients with CMO orders, 48% were female, and these patients had median age 71 years. Seventy-three percent died in-hospital, and 22% were discharged with hospice. SPC placed anytime during hospital admission were associated with lower in-hospital mortality (aOR 0.4, 95% CI 0.3-0.6, < 0.0001) and higher discharge with hospice (aOR 2.4, 95% CI 1.8-3.2, < 0.0001). In contrast, documented GOCC anytime during admission were associated with higher in-hospital mortality (aOR 1.8, 95% CI 1.3-2.4, = 0.0004) and lower discharge with hospice (aOR 0.5, 95% CI 0.4-0.7, = 0.0003). CONCLUSIONS: For patients with CMO orders, SPC, rather than documented GOCC, were associated with lower in-hospital mortality and higher receipt of hospice. Future research should explore reasons why only SPC, and not documented GOCC, were associated with these findings.
Um YW, Kim HE, Hwang JE
… +3 more, Kang SH, Lee JH, Jo YH
J Palliat Med
· 2026 Jun · PMID 42252896
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BACKGROUND: The Life-Sustaining Treatment (LST) Decisions Act in South Korea was implemented to promote patient-centered end-of-life (EoL) care. OBJECTIVES: To evaluate the impact of this legislation on LST practices for...BACKGROUND: The Life-Sustaining Treatment (LST) Decisions Act in South Korea was implemented to promote patient-centered end-of-life (EoL) care. OBJECTIVES: To evaluate the impact of this legislation on LST practices for patients dying in the emergency department (ED). DESIGN: A single-center retrospective study using interrupted time series (ITS) analysis. SETTING/SUBJECTS: Adult nontraumatic deaths in the South Korean ED between 2014 and 2024. MEASUREMENTS: Changes in LST practices were assessed between pre- and post-Act groups (implemented February 4, 2018). Subgroup analyses by advanced cancer status were conducted, and interaction terms between ITS variables and advanced cancer status were evaluated using analysis of variance. RESULTS: Among 1,058 patients (median age 77.0), rates of cardiopulmonary resuscitation (CPR) (26.8% vs. 15.1%, < 0.001) and intubation (31.6% vs. 22.1%, = 0.002) decreased after the Act, whereas antibiotic administration (60.6% vs. 69.3%, 0.009) and LST withdrawal (0.7% vs. 5.2%, = 0.002) increased. The Act was associated with a decreasing postimplementation trend in intubation ( = 0.046). In patients with advanced cancer, CPR and intubation rates were similar before and after the Act, while a significant interaction between the Act and advanced cancer status was observed for CPR ( = 0.007). CONCLUSIONS: Following the legislation, the provision of invasive LST, such as CPR and intubation, at the EoL phase in the ED decreased. These shifts, primarily observed in patients without advanced cancer, indicate that the Act successfully catalyzed EoL discussions and promoted goal-concordant care for this population.
Ogino B, Kajiura S, Hayashi N
… +11 more, Kawanaka H, Sakamoto J, Entani T, Sakumura M, Nakayama Y, Ueda Y, Motoo I, Ando T, Yoshida A, Hayashi R, Yasuda I
J Palliat Med
· 2026 Jun · PMID 42237597
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BACKGROUND: Monitoring data for anamorelin in pancreatic cancer are limited. OBJECTIVE: To descriptively examine week-three documentation-derived dietary intake category, observed body weight, laboratory-derived prognost...BACKGROUND: Monitoring data for anamorelin in pancreatic cancer are limited. OBJECTIVE: To descriptively examine week-three documentation-derived dietary intake category, observed body weight, laboratory-derived prognostic nutritional index (PNI), and treatment continuation after anamorelin initiation. METHODS: We retrospectively included week-three-evaluable patients with unresectable or recurrent pancreatic cancer who initiated anamorelin at a Japanese hospital (July 2021-October 2024). Dietary intake category was derived from routine documentation. Paired changes used the Wilcoxon signed-rank test. RESULTS: Among patients ( = 40; PNI, = 39), dietary intake was classified as increased in 17, stable in 21, and decreased in 2. Median observed body weight was higher at week three than baseline (51.1 vs. 50.2 kg; = 0.026), whereas median PNI was lower (38.5 vs. 39.8; = 0.006). The median time-to-discontinuation was 60 days; 16 patients (40.0%) continued ≥84 days. CONCLUSION: These descriptive findings require cautious multidimensional interpretation; causal treatment effects cannot be inferred.