Specialized palliative care teams improve outcomes for the steadily growing population of people living with serious illness. However, few studies have examined whether the specialty palliative care workforce can meet the growing demand for its services. We used 2018 clinician survey data to model risk factors associated with palliative care clinicians leaving the field early, and we then projected physician numbers from 2019 to 2059 under four scenarios. Our modeling revealed an impending "workforce valley," with declining physician numbers that will not recover to the current level until 2045, absent policy change. However, sustained growth in the number of fellowship positions over ten years could reverse the worsening workforce shortage. There is an immediate need for policies that support high-value, team-based palliative care through expansion in all segments of the specialty palliative care workforce, combined with payment reform to encourage the deployment of sustainable teams.

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Background: The COVID-19 pandemic has created an environment in which existence is more fragile and existential fears or terror rises in people. Objective: Managing existential terror calls for being mature about mortality, something with which palliative care providers are familiar and in need of greater understanding. Methods: Using a case to illustrate, we describe existential terror, terror management, and existential maturity and go on to outline how existential maturity is important for not only the dying and the grieving but for also those facing risk of acquiring COVID-19. Results: Next, we describe how essential components in attaining existential maturity come together. (1) Because people experience absent attachment to important people as very similar to dying, attending to those experiences of relationship is essential. (2) That entails an internal working through of important relationships, knowing their incompleteness, until able to ''hold them inside,'' and invest in these and other connections. (3) And what allows that is making a meaningful connection with someone around the experience of absence or death. (4) We also describe the crucial nature of a holding environment in which all of these can wobble into place. Discussion: Finally, we consider how fostering existential maturity would help populations face up to the diverse challenges that the pandemic brings up for people everywhere.

The goal of this pilot study was to identify naturally occurring, spiritually relevant conversations and elucidate challenges for nurses in home hospice. We examined naturalistic communication data collected during nurse hospice visits with cancer patients and their family caregivers. Using deductive content analysis, guided by Consensus Conference spiritual categories and definition, categorical themes were identified. Thirty-three visits to seven families were recorded by five nurses. Although most spiritual dialogue was brief, analysis revealed five themes: Spiritual Beliefs and Rituals, Connection, Spiritual Comfort, Closure and Acceptance, and Spiritual Distress. Findings demonstrate the range of spiritual issues raised in hospice and challenges nurses face in maintaining boundaries while remaining genuine and family-centered in providing care. This work serves as a foundation for future research and education to help clinicians to engage in more intentional spiritual conversations in the support of families at end of life.

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