30-Second Takeaway
- EHR-based palliative identification algorithms increase specialty consults and DNR documentation but not downstream utilization outcomes.
- “Unmet palliative need” spans symptom burden, service access, and adequacy of care—each with different planning implications.
- Nursing home palliative models cluster into consultative versus proactive case-management approaches with differing resource demands.
Week ending February 14, 2026
Targeting, timing, and ethics of serious-illness care: how palliative reach, ACP, and end-of-life decisions are changing
EHR algorithms markedly increase palliative consults and modestly increase DNR documentation
Across seven randomized trials including 125,666 patients, automated EHR algorithms identifying high palliative-need patients substantially increased palliative consultations for cancer and noncancer populations. Consults more than doubled in noncancer populations and increased over fivefold among patients with cancer. Algorithms also increased do-not-resuscitate documentation, indicating more frequent code-status and advance care planning discussions. Effects on hospice use and in-hospital mortality were small, and no significant impact appeared for ICU admission, length of stay, or family psychological outcomes.
“Unmet palliative need” is three distinct constructs that are rarely defined explicitly
This scoping review of 70 studies found no consensus definition of unmet palliative care needs in adults with advanced illness. Only a small minority of studies explicitly defined unmet need, undermining comparability across services, tools, and jurisdictions. Three measurement approaches emerged: prevalence of symptoms and concerns, access to services, and sufficiency of services to resolve problems. Each approach targets different gaps—clinical burden, reach of palliative services, or effectiveness of provision—so selection should match the decision context.
Two main specialist palliative models in nursing homes: consultative versus proactive case management
This scoping review of 23 studies mapped models of specialist palliative care integrated into routine nursing home practice. Two primary models were identified: on-demand Specialist Consultation Services and proactive Palliative Case Management approaches. Both rely on interdisciplinary teams that provide resident-specific input, staff training, and quality-improvement initiatives to support facility staff. Consultation models deliver episodic, resident-triggered advice, whereas case-management models use regular rounds and conferences to anticipate ongoing needs.
End-of-life and euthanasia topics are under-discussed with hospitalized patients with dementia
In 11 Dutch hospitals, end-of-life issues were discussed in only 36% of consultations with people with dementia, mainly during diagnostic visits. Euthanasia was discussed in 21% of consultations, most often initiated by patients or family rather than physicians. Family members were present in nearly all encounters and generally valued, yet euthanasia-related input also raised clinician concerns. Physicians reported struggling to initiate end-of-life talks and were reluctant to introduce euthanasia, fearing it narrowed focus from other options.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.