The Dawn of AI in End-of-Life Care Discussions

Artificial intelligence (AI) is rapidly becoming a focal point in the healthcare sector, with its potential applications extending into the sensitive and crucial domain of hospice care. As the industry increasingly explores technological advancements, the integration of AI into end-of-life decision-making processes, particularly advance care planning (ACP), is gaining significant attention. While AI promises to revolutionize various aspects of care delivery, its role in ACP is being met with both enthusiasm and a healthy dose of caution.

Exploring the Potential of AI in Advance Care Planning

The prospect of leveraging AI in hospice care centers on its ability to enhance education and streamline processes. AI technologies can serve as valuable tools for disseminating information about end-of-life care options to patients and their families, offering a readily accessible source of knowledge. However, Dr. Karl Steinberg, medical director at Hospice By the Sea, points out that while AI can educate, it currently has limitations in synthesizing information with the accuracy and depth required for complex end-of-life decisions. A significant challenge lies in AI's current inability to fully grasp individual patient preferences, goals, and the intricate nuances of person-centered care.

Dr. Steinberg elaborates on the inherent challenges, stating, "With AI, you have to look out for generalizability and bias — it’s not a one-size-fits all approach." He further questions whether current AI programs possess the capacity for cultural humility or empathy, essential qualities in end-of-life care. The critical task, he emphasizes, is designing AI systems that can genuinely respect diverse cultural, religious, and individual preferences, a feat that remains technologically complex.

AI as a Tool for Goal Identification and Training

Despite these limitations, potential applications for AI in ACP are being actively explored. One promising avenue involves utilizing AI tools to help define goals of care by analyzing a patient's electronic medical record (EMR). Machine learning algorithms, for instance, can be employed to detect and track key phrases within clinical documentation that signify a patient's wishes or highlight common challenges they face. This can provide clinicians with a more comprehensive understanding of the patient's perspective, aiding in more informed discussions.

Furthermore, AI holds potential as an educational resource for medical students and new healthcare workers. AI-simulated advance care planning conversations could offer a safe and effective environment for trainees to practice active listening skills and develop the confidence to engage in sensitive discussions about death and dying. Dr. Steinberg notes, "AI may be trainable to pick up on conversational cues, but that’s a concern on whether it’s nuanced and nimble to really hold great promise." He stresses the importance of ensuring AI remains neutral and factual, acting as a facilitator for informed decision-making rather than a persuasive agent.

Integrating AI Thoughtfully in Hospice and Palliative Care

Dr. Finly Zachariah, a supportive care medicine physician at City of Hope, underscores the importance of a deliberate and thoughtful approach to AI integration in hospice and palliative care. As AI technologies evolve at a rapid pace, hospices must carefully consider how to implement them safely and effectively. Dr. Zachariah advises, "When we’re developing AI solutions, it’s important to really understand what problems we’re trying to solve with AI." This involves a deep understanding of the patient journey and clinical context to identify specific problems that AI can address, ensuring that the technology developed is precisely tuned to solve those issues.

City of Hope has already begun to leverage AI within its Improving Goal-Concordant Care program. This initiative, launched three years prior, aims to enhance the well-being and outcomes for patients with serious illnesses. By integrating AI into their EMR system, City of Hope has been able to identify patients with serious or terminal illnesses who lack advance directives or Physician Orders for Life-Sustaining Treatments (POLST). The technology has also been instrumental in improving the completion rates of goals-of-care conversations. "Our AI model actually helps identify patients as high risk with a threshold of likeliness and predictability of mortality," Dr. Zachariah explains, noting a positive trend of fewer patients dying without documented goals of care. The program has also facilitated the creation of detailed, centralized goals-of-care notes.

Addressing Workforce Shortages and Rising Demand with AI

The advent of AI in hospice and palliative care arrives at a critical juncture, marked by significant staffing shortages and a burgeoning demand for end-of-life services. Donnell Beverly Jr., CEO and co-founder of Eazewell, an AI funeral planning platform, highlights that this innovation is arriving "at exactly the right time for hospice and palliative care organizations." Eazewell, which launched its nationwide services in May 2025, has already assisted over 100,000 families. Beverly notes that in conversations with hospice providers, it

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The Evolving Role of Artificial Intelligence in Hospice and Advance Care Planning