Palliative Care

Acute palliative care for lung cancer: high symptom relief and de-escalation of oncologic therapy

This prospective study compared 159 lung cancer inpatients with a similar group with other cancers admitted to an acute palliative care unit (APCU). Comprehensive palliative care was associated with significant shifts from "on-therapy" to "off-therapy" status at discharge across all patients, supporting treatment de-escalation. Lung cancer patients had higher dyspnea at admission and discharge and higher pain at discharge than other cancers, despite overall symptom improvement. Delirium scores (MDAS) differed at discharge and overall survival was shorter in lung cancer, underscoring their greater vulnerability. Authors conclude APCUs can reduce symptom burden while potentially preventing inappropriate admissions and costly non-specialist interventions. 1

Home end-of-life care in dementia: system and family barriers mapped

This meta-ethnography synthesized 17 qualitative studies on home-based end-of-life care for people with dementia. Six themes highlighted system barriers, including unclear entry points to end-of-life care, unstable support, workforce strain, and financial thresholds limiting services. Family-level challenges included difficulty recognizing end-of-life, navigating services, and reaching the limits of caregiving capacity. The authors propose a conceptual framework showing home death as a "long and challenging journey" requiring reliable, timely support across settings. Most evidence came from high-income countries and non-patient perspectives, limiting generalizability and the voice of people living with dementia. 2

Low-benefit medications commonly continue until death in community-dwelling older veterans

This national VA cohort included 37,193 community-dwelling veteran decedents aged 65 or older with advanced life-limiting conditions. At the start of the last year of life, 73% were taking at least one medication with limited benefit, such as statins or oral antidiabetics. Only 22% of these baseline users had at least one limited-benefit medication discontinued; 78% continued such therapy until death. Specialty palliative care and clinical indicators of limited life expectancy were associated with higher discontinuation rates, while rural residence predicted lower rates. Regional variation suggested system-level prescribing cultures influence deprescribing at the end of life. 3

Web-based decision aid for ESKD older adults reduces caregiver conflict and dialysis uptake

This pragmatic pre–post trial in Singapore evaluated a web-based decision aid integrated into counseling for patients aged 70 or older with end-stage kidney disease. Compared with usual care, caregivers in the decision-aid arm had significantly larger reductions in decisional conflict scores. Patient awareness of conservative kidney management increased more in the intervention group, and patients were less likely to initiate dialysis within six months. Dialysis preference post-counseling also shifted away from dialysis, though not statistically significant, suggesting a trend toward less intensive treatment. Findings support embedding structured decision aids in serious illness counseling to clarify options and support conservative choices. 4