Palliative Care

Lower‑SEP patients with advanced lung disease are significantly less likely to receive palliative care

This mixed‑methods systematic review of 54 studies (4.2 million participants) examined socioeconomic inequities in palliative care for advanced lung disease. Across six lung cancer studies, patients in the lowest socioeconomic group were 18% less likely to receive palliative care than the highest group (OR 0.82). Qualitative data highlighted financial hardship and insurance barriers limiting access to pain relief and oxygen among deprived patients. Studies that examined intersecting factors found worse access for ethnic minorities and rural populations on top of socioeconomic disadvantage. These findings support proactively targeting low‑SEP, minority, and rural patients for palliative assessment, resource navigation, and outreach. 1

Home-based palliative care in dementia linked to early increases in hospital and ICU use

This Ontario cohort included 50,961 community‑dwelling people with dementia starting homecare, followed for one year. Initiation of home‑based palliative care was associated with a 43% higher risk of palliative‑intent hospitalization in the first 90 days (HR 1.43). Palliative care recipients had higher 90‑day cumulative incidence of hospitalization, death, or nursing home admission than non‑recipients. Palliative care was associated with a markedly higher ICU admission risk in the first 30 days but not thereafter, and no difference in ED use. Results suggest current home‑based dementia palliative models are reactive and hospital‑centric, requiring redesign rather than simple scaling. 2

Palliative Performance Scale ≥60% predicts longer survival after palliative radiotherapy for bone metastases

This single‑center retrospective study evaluated 153 patients receiving palliative radiotherapy for bone metastases. Median overall survival after radiotherapy was about 3.6 months for the overall cohort. Patients with PPS ≥60% had significantly better survival than those with lower PPS (HR 0.62), supporting its prognostic value in this setting. Completion of the prescribed radiotherapy course was very strongly associated with improved survival (HR 0.06), independent of other factors. These findings support using PPS to guide fractionation choices, prognostic communication, and decisions about whether patients will complete radiotherapy. 3

A card-game–based, nurse‑led intervention boosts ACP documentation in dialysis patients

This single‑center study tested a three‑step ACP intervention for dialysis patients using the Anticip'action conversation game and nurse training. Twelve dialysis nurses received 10 hours of ACP and game training and then conducted the intervention with eligible patients. Of 33 enrolled patients, most initiated and completed the intervention, with withdrawals mainly due to death rather than refusal. The intervention increased uploaded advance directives by 30% and surrogate designation by 80%, and improved ACP documentation quality scores. Patients’ ACP engagement scores and their evaluation of their own documentation also improved, despite reported organizational challenges. 4