BackgroundHospitalized patients with cancer face complex medical challenges, including longer stays, higher readmission rates, and increased in-hospital mortality. To address these needs, many institutions have adopted co-management models involving oncology-focused hospitalists ("onco-hospitalists") working alongside oncology specialists. While this model offers benefits, differences in training between hospitalists and oncologists can affect medical management, and divergent perspectives on prognosis and goals of care may stall interprofessional collaboration.MethodsAt our institution, hospitalists managing a dedicated inpatient oncology service reported increased stress and communication challenges. In response, a needs assessment evaluated hospitalist perceptions of these domains to inform targeted quality improvement efforts in the inpatient care of advanced cancer patients. Through structured discussions with oncologists, nurses, and palliative care providers, 3 key domains were identified: (1) Medical Management, (2) Patient Communication, and (3) Interprofessional Collaboration. Surveys were distributed to all hospitalists on the oncology service pre-intervention (n = 25).ResultsAmong all respondents (n = 19), confidence was high in pain and symptom management but lower in managing therapy side effects and basic oncologic pharmacology. Confidence in communication was high in breaking bad news and general goals-of-care discussions but lower for discussing the radiation oncology process or when asked about prognosis by the patient or family. Strong collaboration was noted with nursing, case management, pharmacy, and palliative care, but weaker with oncology and radiation oncology consultants.ConclusionThese results provide a clear framework for our institution in developing a strong novel onco-hospitalist program with goals to close knowledge gaps and enhance collaboration for improved patient care.

BackgroundArtificial intelligence (AI) is increasingly integrated into hospice and palliative care to support clinical decision-making across clinicians, patients, and caregivers. Applications include risk prediction, symptom monitoring, needs identification, and communication support, yet synthesis of its role in interprofessional shared decision-making (IP-SDM) across care levels remains limited.AimTo synthesize evidence on AI in hospice and palliative care, focusing on its role across IP-SDM levels and its influence on decision processes and outcomes.DesignSystematic review guided by the IP-SDM framework. Methodological quality was assessed using the Joanna Briggs Institute hierarchy. The review was registered with PROSPERO.Data SourceSix databases (CINAHL Complete, MEDLINE via ProQuest, PubMed, Scopus, PsycInfo, and IEEE Xplore) were searched to January 2026 for English-language empirical studies of AI in hospice and palliative care.ResultsFourteen studies were included. AI applications primarily functioned as decision-support tools supporting early palliative care identification, advanced care planning (ACP), serious illness communication, and palliative referral processes. Most interventions operated at meso level of the IP-SDM framework through predictive models, automated prompts, and communication tools integrated into workflows. Although AI was associated with improved process measures, including ACP documentation and clinician behaviors, these improvements did consistently translate into downstream patient-centered outcomes. AI demonstrated limited involvement in deliberative aspects of shared decision-making.ConclusionAI currently functions primarily as a facilitator of early identification, communication, and workflow coordination within hospice and palliative care. Future research should prioritize multi-site implementation studies evaluating whether AI-supported processes translate into sustained patient-centered outcomes and equitable end-of-life care.

Despite comprising 19% of Rockingham County's population, African Americans represent only 12% of hospice users, reflecting broader disparities in end-of-life care. Cultural mistrust, spiritual concerns, and knowledge gaps contribute to underutilization, and few interventions leverage faith leaders' influence. This preliminary quality improvement project evaluated a culturally tailored, pastor-endorsed hospice education intervention in two African American Baptist churches (n = 49). Guided by humanistic nursing theory, pastors used the African American Outreach Guide for End-of-Life Care to dispel myths and explain hospice services. Willingness to accept hospice (AARP End of Life Survey) increased from 60.4% to 93.6% (51.7% relative increase), and uncertainty decreased from 39.6% to 6.4% (84.2% reduction). Medicare hospice coverage knowledge increased from 29.2% to 89.8% (214% relative increase). A paired t-test among matched pairs (n = 46) showed a meaningful pre-post change (t = 4.899, P < .001) with a medium-to-large effect (d = 0.72). The preliminary quality improvement project suggests pastor-endorsed education delivered in faith settings may improve hospice acceptance and advancing health equity.

Spiritual care is a core component of high-quality palliative care, yet persistent gaps remain between health care systems, professional chaplaincy, and patients' home religious communities. While patients and families frequently desire spiritual support at the end of life, evidence suggests that spiritual needs are often insufficiently addressed by medical teams and inconsistently supported by local congregations. Moreover, spiritual care delivered by community clergy when disconnected from contemporary palliative care principles may, in some cases, unintentionally contribute to delayed hospice referral and increased use of aggressive, nonbeneficial treatments near the end of life. Drawing on interdisciplinary literature in palliative care, chaplaincy, and sociology of religion, this paper examines structural, educational, and cultural barriers that limit collaboration between palliative care teams and Catholic clergy in the United States. Engagement is analyzed at national, diocesan, and parish levels, with attention to opportunities for strengthening clergy formation, institutional partnerships, and lay ministry involvement. The paper argues that systematic collaboration between palliative care professionals, Catholic clergy, permanent deacons, and lay ministers represents an underutilized strategy for improving holistic end-of-life care. It concludes with evidence-informed recommendations aligned with Catholic moral theology and palliative care best practices.

Objective: Malignant bowel obstructions (MBOs) are common sequelae of advanced gynecologic malignancies, accompanied by significant morbidity and mortality. Little evidence exists to guide optimal management. We aimed to describe contemporary outcomes for gynecologic oncology patients with MBOs to inform prospective management strategies. Methods: We conducted a retrospective chart review of gynecologic oncology admissions for malignant small bowel obstructions at a single academic institution from 1/2019 to 12/2023. Variables included cancer type, treatment phase, management interventions, goals of care conversations, readmissions, hospice utilization and death. Descriptive statistics were utilized for analysis. Results: Sixty-nine patients (119 admissions) were included. Most patients had ovarian cancer (82%), in treatment for recurrence (65%) or diagnosed with a new recurrence (17%). Bowel decompression occurred during most admissions (nasogastric tubes 50%, gastrostomy tubes 18%). Use of total parenteral nutrition (TPN) (30%), chemotherapy (12%) and surgery (2.5%) were less common. Return of flatus was noted in 76% of admissions, but only 39% were discharged on a regular diet as opposed to full or clear liquids or TPN. Goals of care conversations were documented for 34% of admissions. Readmission within 30 days was common (39%), typically for recurrent obstructions. Of 69 patients, from initial MBO admission, 28% utilized hospice within 30 days, 13% died within 30 days and 61% died within 6 months. Conclusion: MBOs were associated with high rates of readmission, hospice utilization and death, with variable management strategies employed. Given the poor prognosis, evidence-based strategies to optimize care for these patients is warranted.

IntroductionIn patients with tumor-related airway obstructions, there are unique challenges for the medical team to deliver quality palliative care and meet end-of-life goals.Case DescriptionAn elderly woman with oropharyngeal cancer was hoping to qualify for a clinical trial. However, after multiple admissions for airway obstruction, she elected to pursue a palliative tracheostomy so that she may die comfortably at home, in a state several hours away.DiscussionPatients with unique complications at the end-of-life benefit from interventions that seem "unnecessarily invasive" that allow them to achieve their goals at the end of life. Potential perceived barriers to patients receiving these interventions include code status, lack of adequate support at home, and a misunderstanding of the true nature of palliative care. It is the ethical duty of the interdisciplinary medical team to honor the patient's autonomy while balancing beneficence and nonmaleficence.

Despite a consensus in the medical community that clinicians should not offer non-beneficial treatments (NBTs) to their patients, little guidance exists on the particular communication needs around this fraught topic. While intended in the spirit of non-maleficence, setting limits around NBTs can be seen by patients and families as abandonment, resulting in conflict.In this paper, we propose a framework to guide Palliative Care clinicians in communicating about these complex issues with patients and families. We offer 2 cases illustrating requests for treatments deemed non-beneficial, along with language to aid clinicians in navigating similar instances in their own clinical practice. Our framework emphasizes proactive relationship building with patients and families, close attention to their values, and compassionate limit-setting when medically appropriate. We propose approaching these discussions with a "breaking bad news" framework rather than one of shared decision-making. By carefully attending to their communication in these matters, clinicians can build trust with patients and families and avoid burdening them with false choices. This will ultimately minimize conflict, allay fears of abandonment and result in higher quality care for seriously ill patients.

BackgroundPalliative radiotherapy is an established symptom-directed treatment, but the treatment process may also reveal gaps between clinical intent, patient understanding, and family expectations.ViewpointThis Commentary places the radiotherapy room within the broader palliative oncology agenda of integrating tumor-directed treatment with patient- and family-centered palliative care. We argue that repeated radiotherapy encounters can help teams recognize possible goal-of-care misalignment before it becomes clinically disruptive.Practical implicationsConsistent goal language, early attention to family understanding, and simple pathways for recognition, reporting, and referral may support timely interdisciplinary reassessment. Radiation therapists should not replace physicians or palliative care teams in formal goals-of-care conversations, but their daily contact with patients can help identify early signals that further conversation is needed.ConclusionIncluding the radiotherapy room in palliative care communication may help align symptom-directed treatment with patient-centered goals.

BackgroundFamilies of critically ill patients frequently experience intense grief and psychological distress in the intensive care unit (ICU). Bereavement support can mitigate prolonged grief, anxiety, depression, and PTSD, yet interventions are inconsistent and rarely multidisciplinary across a wide range of disciplines.PurposeTo explore multidisciplinary ICU providers' perceptions, experiences, and recommendations regarding family member grief at the bedside in the ICU.DesignSemi-structured interviews were performed with 20 ICU providers, including registered nurses, physicians, nurse practitioners, respiratory therapists, and hospital chaplains. Interviews were recorded, transcribed, and analyzed using thematic analysis to identify patterns related to perceived needs, recommendations, and barriers to communication.Results3 main themes emerged: (1) Perceived Grief Needs: families require clear, consistent communication and emotional/spiritual support; (2) Recommendations: participants emphasized system-wide improvements, peer modeling, and targeted education to enhance grief care; (3) Barriers to Effective Grief Communication: structural constraints, message delivery failures, misunderstandings, and intense family emotions hindered support.ConclusionParticipants identified that grief in the ICU is shaped by negative emotions, ineffective communication, and systemic structures. Findings underscore the need for structured palliative communication training and plain-language messaging, while persistent gaps point to the importance of future interdisciplinary interventions that embed these practices into routine ICU care and evaluate their impact on family outcomes, clinician well-being, and culture change.

BackgroundNeurologists frequently care for patients with serious neurological illnesses such as stroke, yet formal training in palliative care (PC) during neurology residency remains limited. Educational interventions may improve patient-centered care in acute neurological settings.ObjectiveTo evaluate whether integrating structured PC training into neurology residency is associated with changes in clinical outcomes of patients admitted to a stroke unit.MethodsWe conducted a retrospective matched case-control study analyzing medical records of stroke patients admitted to a Stroke Unit in Brazil before (2018-2019) and after (2020-2021) implementation of a structured PC training program for neurology residents. Patients were matched using coarsened exact matching based on age, sex, admission NIHSS, and pre-stroke modified Rankin Scale (mRS). Primary outcomes included total hospital and Stroke Unit length of stay (LOS). Secondary outcomes included opioid use, discontinuation of clinically-assisted nutrition and hydration (CANH), family meeting documentation, and PC consultation.ResultsAmong 270 matched patients (141 pre-training; 129 post-training), patients treated by residents who had completed PC training had shorter total hospital LOS (median 6 vs 8 days, P = 0.002) and shorter Stroke Unit LOS (median 6 vs 7 days, P < 0.001). No significant differences were observed in opioid use, discontinuation of CANH, or PC consultations. Among patients with unfavorable outcomes (mRS 4-6), PC training remained associated with reduced Stroke Unit LOS.ConclusionsPalliative care training was associated with shorter hospital stays among stroke patients but limited differences in specific PC practices. These findings suggest that primary PC education may influence care processes in acute neurological settings.

IntroductionProviding palliative care to patients reduces the need for aggressive treatment, hospitalizations, and emergency room visits, thus decreasing the need for patient transportation.ObjectiveTo estimate the amount of carbon emissions and indirect costs related to the transportation of cancer patients receiving palliative care in a tertiary hospital in Brazil.DesignRetrospective cohort study. Setting/participants: patients followed by the palliative care service in a tertiary hospital, with an advanced-stage cancer diagnosis and over 18 years of age, from January 1, 2024 to December 31, 2024.ResultsA total of 327 patients were treated by the Palliative Care Service in 2024, all patients required at least one hospitalization and 215 (65.7%) patients died as a result of the disease in the same year, of which 198 (60.6%) died during hospitalization. An estimated 105,310.4 kg of CO2 emissions were generated, equivalent to the carbon sequestration of approximately 1,700 tree seedlings grown for 10 years. The time involved in travel was 6,727 hours, equivalent to 280 days. The estimated indirect transportation costs ranged from US$184,293 to US$263,276.ConclusionsThe integration of telemedicine into palliative care services is an urgent planetary health strategy and a means of financial sustainability for patients, families, and public or private health systems.

This qualitative descriptive study explored nursing perspectives on end-of-life care quality across 3 distinct community settings: long-term care facilities, patients' homes, and social model hospice homes. Nurses provide most of the direct end-of-life care in these settings, yet their perspectives remain understudied. Their perspective is essential for improving end-of-life care quality and supporting patients and families during this critical time. Semi-structured interviews were conducted with 11 licensed nurses who had provided end-of-life care across all 3 settings. Participants were recruited through the Omega Home Network and professional nursing networks. Thematic analysis using constant comparative methods was employed. Member checking and independent secondary analysis ensured trustworthiness. Analysis revealed 4 major themes: (1) setting-based care disparities, (2) nurses as educators and translators, (3) mediation of caregiver burden across settings, and (4) relationship-based care as foundational for peaceful deaths. Care setting profoundly influenced these nurses' ability to deliver quality end-of-life care. Findings may have global relevance for hospice and palliative care practice, highlighting the need for systemic changes in institutional long-term care, enhanced support for family caregivers and staff caregivers across settings and recognition of social model hospice homes as a viable alternative for patients lacking adequate home resources.

BackgroundFamily caregivers provide essential support to patients receiving home hospice care, often assuming complex clinical and personal care tasks that may impact caregiver mental health. Although hospice caregivers experience high prevalence of anxiety and depression, there is a lack of studies connecting these findings to caregivers' lived experiences, coping strategies, and openness to mental health interventions during hospice care.ObjectiveTo (1) characterize hospice caregivers' mental health symptoms and stressors, (2) identify coping strategies used during hospice, and (3) assess caregivers' receptiveness to mental health interventions during the hospice period.MethodsWe conducted semi-structured interviews with caregivers who completed the Improving Home hospice Management of End-of-life symptoms (I-HoME) study. Eligible caregivers were ≥18 years, English-speaking, and provided weekly care to a home hospice patient aged ≥65. From July to October 2025, 80 caregivers were contacted, and 26 participated. Interviews were audio-recorded and analyzed using qualitative methods.ResultsParticipants' mean age was 58; most were female (77%) and adult children (85%), providing an average of 12 caregiving hours/day. Caregivers commonly described anxiety around caregiving responsibilities and depressive symptoms associated with impending bereavement. Key stressors included witnessing a loved one's decline, caregiver burden, and the unpredictable end-of-life trajectory. Coping strategies included support from family/friends, hospice staff, and religion. Most caregivers expressed interest in mental health services.ConclusionsHome hospice caregivers experience substantial anxiety and depressive symptoms driven by patient decline, high burden, and prognostic uncertainty, yet are receptive to flexible, individualized mental health interventions during hospice care.

BackgroundAlthough palliative care competencies appear on USMLE examinations, pre-clinical curricula devote minimal time to end-of-life education. Traditional lectures cannot cover foundational knowledge and clinical application in a single hour. A flipped classroom approach-where students learn core content before class, and use face-to-face time for application-offers a solution. We redesigned a one-hour Introduction to Palliative Care session using this model.ApproachWe created a 30-minute interactive online module in Articulate 360™ for first year students covering palliative care definitions, eligibility criteria, and care settings. The module incorporated matching, sorting, multiple-choice questions with feedback, process maps, and flashcards. In-class time was restructured to small group case discussions distinguishing primary palliative care, specialty palliative care, and hospice. Students received the module one week before class and were reminded that material could appear on examinations.EvaluationThrough a quasi-experimental, retrospective cohort study using a pre-post design, we compared examination performance and student perceptions across four academic years (2020-2024, N = 371). Correct responses on a palliative care examination question improved from 57% (2020-2021, virtual lecture) to 66%, 67%, and 80% in subsequent years with the flipped intervention. The pre-work engaged students in learning (79-89% agreement), enabled focus on advanced topics during class (73-77% agreement), and was described as interactive and helpful in teacher evaluations.ImplicationsThe flipped classroom successfully transformed a content-heavy lecture into interactive learning and is transferrable to other institutions. The results are only suggestive of an impact on knowledge-based outcomes. Resources are freely available from the corresponding author.

BackgroundPractice standards recommend early integration of perinatal and pediatric palliative care (PC) with seamless transitions across settings. Little is known about the proximity between these services nationally.MethodsThis study utilized data from the National Plan and Provider Enumeration System (NPPES) and a publicly-available directory of perinatal PC programs to investigate geospatial variations between services. Infant mortality rates per perinatal PC programs in the community were calculated.Results418 pediatric PC physicians and 296 perinatal PC programs were included. Five states (CA, TX, NY, FL, OH) had the highest concentrations of pediatric PC physicians. Five states had none in the NPPES system (AL, DE, NM, ND, WV). Three states (CA, NY, TX) contained the largest share of perinatal PC programs, each accounting for over 5% of programs. Perinatal PC programs were more widely dispersed with a lower mean concentration per community (m = 1.37, SD = 0.83, range: 1-6). Omaha and Kansas City contained the largest state-level proportions of programs (57.1% and 50.0%). Median drive times to the nearest pediatric PC physician for programs lacking on-site expertise reached approximately 5 hours in NM and SD; 3 hours in ND and MT; and 2 hours in AL, CO, WV, and TN.ConclusionThe distance between perinatal and pediatric palliative care services warrants further exploration into partnerships and patient care implications.