American Journal of Hospice and Palliative Medicine®

Collaborative care models that feature care navigation have been found to have a range of benefit for people with dementia (PWD) and their caregivers, but their effect on end-of-life (EOL) outcomes has not been robustly evaluated.

Our primary objective was to evaluate the effect of the Care Ecosystem–a telephone-based collaborative care model for dementia with care navigation–on EOL outcomes for PWD and their caregivers. Our secondary objective was to use qualitative feedback from participants to identify supports and services that would be helpful at end of life, including how the Care Ecosystem and other EOL supports could be improved.

Mixed-methods analysis of the Care Ecosystem trial conducted 2015-2022. Pre-mortem and post-mortem surveys included close-ended validated measures (eg, satisfaction with end-of-life care, caregiver self-efficacy) and open-ended questions about EOL care.

There were 138/124 dyads randomized to Care Ecosystem and 76/65 randomized to Usual Care in the pre-mortem/post-mortem cohorts. Compared to Usual Care, Care Ecosystem caregivers had higher ratings of caregiver self-efficacy prior to PWD death (Adjusted unstandardized Beta 0.94 95% CI 0.23, 1.65, P = 0.01), but caregiver’s satisfaction with EOL care did not differ between groups (Adjusted odds ratio 1.42, 95% CI 0.67, 2.99. P = 0.36). Qualitative analysis revealed Care Ecosystem provided helpful emotional and practical support, but participants wanted more anticipatory guidance, more information about hospice care and earlier referral, and better coordination with the healthcare team.

Our findings highlight opportunities to improve the EOL experience of PWD through collaborative care models and beyond.

This study aimed to examine the factors associated with potentially inappropriate medication (PIM) use and the deprescribing among home hospice patients in Taipei, Taiwan.

We analyzed 101 home hospice patients from a Taipei City hospital from 2016 to 2022, using 2 significant PIMs which are identified by the OncPal guideline and STOPPFrail version 2 respectively. Logistic regression and Cox proportional hazards regression were used to analyze factors associated with PIMs and the deprescribing.

Of the 101 participants, about half of the patients were prescribed at least 1 of the 2 PIM at the beginning of the program. 41.6% had excessive polypharmacy and 29.7% received nasogastric tube feeding. The common drug of the both PIMs included antihypertensives, antiulcer agents, vitamins and statins. We found the factor associated with using both PIMs is excessive polypharmacy, with adjusted odds ratios of 5.87 (95% Cl: 2.14-16.08) for STOPPFrail and 10.39 (95% Cl: 3.38-31.99) for OncPal respectively. The discontinuation rate is about 30%. A negative association was found between nasogastric tube feeding and PIM deprescribing, with adjusted hazard ratios of 0.23 (95% Cl: 0.07-0.82) for STOPPFrail and 0.08 (95% Cl: 0.02-0.46) for OncPal.

This study demonstrates a high prevalence of PIMs among home-hospice care patients, with PIMs being less likely to be deprescribed in those receiving nasogastric tube feeding. The further research may be warranted to minimize use of PIM to enhance medication safety for patients.

Patients with advanced cancer experience a substantial amount of existential and emotional distress. Dignity therapy (DT) is a brief, individualized psychotherapy that aims to relieve existential distress and improve the experiences of individuals impacted by serious illness.

To evaluate the feasibility and acceptability of virtual DT (vDT) among patients with advanced cancer.

This pilot study recruited adult patients with advanced cancer and an expected prognosis >6 months. The vDT intervention consisted of 2 sessions of guided interviews focused on life review, discussion, and development of a generativity document (GD). Feasibility and acceptability were assessed quantitatively and with semi-structured interviews. Effectiveness measures (distress, dignity impact scale, quality of life [QOL]) were administered pre/post intervention.

Thirty-one patients referred from a palliative care clinic were eligible. Twenty-one consented and 15 received a final GD. Patients who completed final assessments (N = 9) reported satisfaction with their experience and would recommend the therapy to others. Patients found the virtual component of the intervention acceptable, and the majority noted an improvement in their dignity. Qualitative analysis revealed themes of study team effectiveness, perspectives on intervention processes, benefits to self, and benefits to loved ones.

Participation in vDT intervention was feasible and acceptable for patients. Patients appreciated the connection with the interviewer, the process, and the benefit of having a document to share with loved ones. Preliminary effectiveness data suggest vDT improves sense of dignity.

Telenovelas are a promising educational mode for teaching hospice family caregivers (HFCGs) to manage distress for themselves and their care recipients. We sought to understand the relationship between HFCGs’ change in anxiety and self-efficacy scores and their feedback regarding the NOVELA intervention (guided viewing of a hospice-related telenovela) using a mixed methods post-hoc analysis.

This single-group pretest-posttest clinical trial included HFCGs from three hospices in the U.S. Mid-Atlantic region. At baseline and following each session, participants completed a web-based survey assessing two outcomes: anxiety and self-efficacy. Descriptive statistics, including t-test and chi-square, were computed. We also used semi-structured interviews to compare perceptions of HFCGs with improved vs non-improved outcome measures.

Participants (N = 50) were mainly home-bound, well-educated, White, female, adult children of people with an advanced non-cancer diagnosis. In total, 44 participants completed the outcome measures, with 12 in the non-improved group and 32 in the improved group. As shown by between-group differences comparing those with improvement and those without improvement, we identified three mixed-methods themes: (1) NOVELA participants valued interventionist interactions, but video content was not always relevant; (2) NOVELA enhanced understanding of hospice caregiving tasks, but timing was critical and caregivers with prior experience may have benefited less; and (3) barriers to NOVELA such as telehealth challenges and needing flexibility for caregiving demands (including more self-care content) must be addressed.

NOVELA’s acceptability among HFCGs differed by improvement status and called for intervention adaptations that could potentiate NOVELA’s impact.

Improving Self-Efficacy Through a Telenovela: Feasibility Study (NOVELA), NCT04533594, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000A6QU&ts=0&selectaction=Edit

The objective of the current study is to evaluate the feasibility and effectiveness of adapting a communication curriculum for pediatric residents into recurring half-day sessions based in existing rotations.

Pediatric residents participated in a half day communication training session that was incorporated into existing clinical rotations. Participants completed post session and 3-month follow up surveys evaluating self-perception of competence and use of the communication skills.

There was a statistically significant (P < 0.01) improvement in perceived ability to delivery serious news and express empathy. 57.5% of participants report using the skills at least weekly at 3-month follow-up.

This iteration of a communication curriculum is both effective and able to be integrated into existing clinical rotations with fewer resources required.

Despite national improvements in hospice care, utilization remains low among Asian American (AA) communities. This scoping review aims to systematically map the literature on barriers to hospice use in this population, focusing on the roles of communication, cultural beliefs, and healthcare system factors.

A scoping review was conducted on studies published in English between January 2010 and December 2024 to capture recent trends. Seven databases (Academic Search Complete, CINAHL Complete, Medline with Full Text, PubMed, Web of Science, Cochrane, and Scopus) were systematically searched. The review followed Arksey and O’Malley’s methodological framework for scoping studies.

Out of 644 publications initially screened, 25 studies, including two literature reviews, met the inclusion criteria. Most employed cross-sectional surveys or qualitative descriptive designs. Identified barriers to hospice utilization included language and communication challenges; cultural values and beliefs surrounding death; family-centered decision-making and filial piety; religious influences such as beliefs in karma and suffering; and broader issues like low acculturation and mistrust of the healthcare system.

Enhancing culturally competent hospice care is a promising approach to addressing disparities in end-of-life care for AAs. Comprehensive cultural competence training is needed for healthcare providers, especially physicians, nurse practitioners, registered nurses, and social workers involved in hospice and palliative care. Further research is recommended to identify the core components of hospice care and develop effective interventions tailored to diverse AA subgroups.

Artificial Intelligence (AI) is increasingly integrated into healthcare systems, presenting opportunities to improve clinical outcomes. In the context of palliative care, AI holds potential to enhance quality of life through improved symptom management, effective communication, and greater prognostic accuracy. For this review, AI refers to computational systems capable of learning, reasoning, or predicting outcomes. As integration advances, a critical examination of its applications, practical challenges, and ethical implications in palliative care is warranted.

A scoping review was conducted using 4 major databases: PubMed, Google Scholar, Scopus, and CINAHL. A total of 7 studies were included, each addressing the use of AI technologies in palliative care settings, with a focus on clinical implementation, ethical challenges, and system integration. Both quantitative and qualitative studies were considered.

AI applications in palliative care include predictive analytics, symptom control, and enhanced patient-caregiver communication. These tools demonstrate potential in facilitating early identification of patient needs and supporting timely interventions. However, significant challenges persist, particularly around data privacy, patient autonomy, algorithmic bias, and the “black box” nature of many AI models. Additional practical limitations include integration into clinician workflows, clinician trust, and concerns about the depersonalization of care.

AI offers substantial potential to improve palliative care, but implementation must be grounded in ethical frameworks prioritizing dignity, compassion, and patient-centeredness. Multidisciplinary collaboration is essential to ensure that AI augments rather than replaces the humanistic core of palliative care. Ongoing research and development of transparent, equitable algorithms are critical to responsibly harnessing AI’s transformative potential.