Palliative Care

EHR-documented advance directives linked to less burdensome end-of-life care

In 2,850 decedents aged ≥65, 553 (19.4%) had an EHR-documented advance directive at least 6 months before death. Presence of an AD was associated with reduced potentially burdensome end-of-life care (aOR 0.75) and fewer in-hospital deaths (aOR 0.69). Associations persisted after adjustment for demographics, comorbidity, utilization, portal access, organization, and trial arm. Benefits were more evident in married patients and those with patient portal access, but not observed for patients with dementia or Black race. 1

Modifiable ICU factors associate with co-occurring prolonged grief and psychiatric symptoms

Prospective cohort of 291 bereaved ICU family members identified four symptom states over two years, including a high-burden co-occurring state. Lower odds of the co-occurring PGD/PTSD/depression/anxiety state were linked to social worker involvement and presence of a do-not-resuscitate order. Conversely, palliative care involvement and family presence at death were associated with higher odds of some higher-burden states in this cohort. Quality of dying and death (QODD) showed graded associations: moderate-to-poor QODD increased odds of higher-burden symptom states. 2

Stakeholders report knowledge gaps and provider shortages for psilocybin in palliative care

Cross-sectional survey of 121 Canadian palliative stakeholders found 61% held predominantly non-favourable attitudes toward psilocybin-assisted therapy overall. Physicians were more favourable, with 95% reporting positive attitudes, while only 43% reported good knowledge of benefits and risks. Primary implementation barrier was a lack of trained healthcare providers; facilitators included more research and standardised protocols. Sixty-eight percent endorsed early-stage illness adoption, but respondents highlighted regulatory and interprofessional education needs. 3