| Summary: | The article focuses on the challenges of reducing low-value care for older adults at the end of life (EOL) in hospital settings, highlighting findings from the InterACT trial, which tested behavioural nudges to improve care for seriously ill patients aged 75 and older. The trial showed that low-cost nudges alone were insufficient to change entrenched clinical practices or increase palliative care referrals, due to systemic incentives, hospital culture, and workflow integration barriers. The authors propose a five-step roadmap for de-implementing low-value EOL care, emphasizing comprehensive assessment, embedding palliative care, aligning financial and organizational incentives, engaging stakeholders including patients and families, and rigorous evaluation. Sustainable improvement in EOL care requires multi-level strategies beyond behavioural nudges, incorporating systemic reforms and collaborative decision-making to enhance patient quality of life.
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