The breath counting task (BCT) has shown evidence of validity as a behavioral measure of mindfulness in healthy populations but remains largely untested in clinical contexts. The BCT is a computerized measure of present-moment awareness based on breath-counting accuracy. This study provides a preliminary evaluation of its validity in adults with advanced cancer and their family caregivers.

Fifty-five patient-caregiver dyads were randomized to a 6-week mindfulness intervention or usual care. Participants completed the BCT and self-report surveys at baseline, post-intervention, and 1-month follow-up. The BCT’s construct validity was examined through: (1) sensitivity to mindfulness intervention using linear mixed models, (2) convergent validity via correlations with self-reported mindfulness and theoretically related constructs (e.g., inner peace), and (3) criterion validity via correlations with clinical outcomes (e.g., quality of life).

Findings differed for patients and caregivers. Among caregivers, the BCT demonstrated sensitivity to intervention; breath-counting accuracy on the BCT increased over time in the mindfulness condition and remained stable in the usual care condition. Among patients in the mindfulness condition, greater breath-counting accuracy was moderately associated with better quality of life at follow-ups, including a significant correlation at 1 month (r = .57, p < .05), supporting its criterion validity. Evidence of convergent validity was limited. However, for patients and caregivers, greater breath-counting accuracy was moderately associated with higher self-reported mindfulness facets following intervention.

Preliminary findings suggest the BCT may capture certain attentional aspects of mindfulness in patients with advanced cancer and caregivers; however, patterns varied across groups, highlighting the need for further evaluation of its validity in clinical contexts.

To translate the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-ELD14 (EORTC QLQ-ELD14) into Chinese and validate its effectiveness in China.

The Chinese version was developed through a rigorous translation and back-translation process based on the Brislin model, followed by cross-cultural adaptation through expert consultation. A total of 260 elderly cancer patients from a tertiary hospital in Tianjin were recruited between June 2024 and February 2025 to evaluate the instrument’s reliability and validity.

Among the 248 completed responses, the Chinese version of the EORTC QLQ-ELD14 demonstrated robust psychometric properties. The questionnaire comprises 7 dimensions (14 items), with item-level content validity indices ranging from 0.800 to 1.000 and a scale-level content validity index of 0.980. Exploratory factor analysis identified 7 underlying factors, accounting for 82.913% of the cumulative variance. Internal consistency was excellent, with a Cronbach’s α of 0.958 for the total scale and dimension alphas exceeding 0.800. Test–retest reliability was 0.849 for the total scale and ranged from 0.813 to 0.856 across dimension.

The Chinese version of the EORTC QLQ-ELD14 has good reliability and validity, which is suitable for evaluating the quality of life of elderly cancer patients within Chinese cultural contexts.

Colorectal cancer is a leading cause of cancer mortality in Australia, with many patients requiring complex end-of-life care. Evidence of potentially burdensome end-of-life care specific to colorectal cancer populations in hospital settings is limited. This study aimed to examine factors associated with indicators of potentially burdensome end-of-life care among people who died from colorectal cancer and received hospital-based care in New South Wales, Australia.

A retrospective population-based cohort study was conducted using linked data from the NSW Cancer Registry, hospital, and mortality records (2014–2019). Adults aged ≥20 years whose underlying cause of death was colorectal cancer and who were hospitalized in their final year of life were included. Multivariable logistic regression models examined associations between patient demographics and all indicators. Multinominal logistic regression examined predictors of a composite indicator comprising 4 indicators of potentially burdensome end-of-life care.

Of 9,476 colorectal cancer decedents, 15.7% died in acute care. Within the last 30 days of life, 13.1% had >1 emergency department presentation, 9.2% had >1 hospital admission, and 3.1% had an intensive care unit admission. The composite indicator identified 71.3% of patients with no indicators, 18.9% with 1, and 9.8% with ≥2 indicators of potentially burdensome end-of-life care. Higher odds of potentially burdensome end-of-life care were observed among people who smoke, people living in rural locations, who had a lower socioeconomic status, a prior cancer diagnosis, or their final admission was to a private hospital. Females, people with comorbidities, and people who had a longer survival duration, had lower odds of potentially burdensome end-of-life care.

Findings highlight socioeconomic and system-level disparities that may inform policy and clinical strategies to improve equitable, patient-centered end-of-life care.

To explore the stress experienced by nurses while addressing the needs of families during palliative and end-of-life care for children and young adults.

A meta-synthesis was conducted. Six online databases (PubMed, Medline, EMBASE, Cochrane Library, CINAHL, and Airiti) from 2014 to September 15, 2025 were searched.

Of the 1,841 citations identified, 34 qualitative studies and 12 case reports were included. All included studies had adequate to strong methodological quality. Three themes emerged from the qualitative findings: (1) never seem to feel fully prepared; (2) sense of unfairness in conflicts of values; and (3) sheathing against traumatic bond attachment.

Nurses experience various stresses throughout the nursing process, which evoke avoidance responses. Supporting nurses is as crucial as providing family-centered palliative care to ensure a sustainable healthcare workforce. These findings demonstrate the importance of understanding how nurses perceive their stress in relation to provision of pediatric palliative care to help develop personal and team resilience.

The intersection of medicine and Buddhist spiritual care in institutional end-of-life settings remains underexplored, particularly regarding post-death rituals. This qualitative study examines how Buddhist assisted chanting (zhunian, 助念) – a 24-hour continuous recitation of Amitabha Buddha’s name – functions as a model of holistic end-of-life care that addresses the spiritual, emotional, psychological, and relational dimensions of dying.

Semi-structured, in-person interviews were conducted with 34 participants (18 volunteers, 8 patients, and 8 family caregivers) at the Lotus Assisted Chanting Association housed within Cihai Hospital in Shenzhen, China, between June 22 and July 5, 2025. Interviews were conducted in Mandarin, transcribed, and anonymized. Coding was performed in NVivo N15 using an iterative thematic framework developed by open-coding an initial subset of transcripts.

Three care frameworks emerged: (1) spiritual care, including adherence to end-of-life Buddhist practices, acceptance of death, belief in rebirth, and release of worldly attachments; (2) emotional and psychological care, encompassing companionship, peace and tranquility, and financial burden alleviation; and (3) reverse care, in which dying patients exercised personal agency and tended to those around them by resisting over-medicalization, expressing concern for caregivers, and transforming caregiving into an opportunity to practice filial piety and strengthen faith.

These findings characterize Buddhist assisted chanting as a reciprocal model of end-of-life care that extends care beyond the moment of death. Dying patients act as moral agents who tend to those around them, challenging the unidirectional caregiver–recipient model that underlies most palliative care research. These contributions show how culturally and spiritually informed palliative care prepares families for loss and shapes how patients find meaning at the end of life. More broadly, this study illustrates how Buddhist ritual frameworks can render dying as a humanistic and mindful process.

To (1) identify clinical situations that may contribute to the experience of moral distress (MD) among professionals working with motor neuron disease (MND), (2) measure the occurrence and intensity of MD, and (3) explore associations with professional quality of life, turnover intention, and associated risk and/or protective factors.

A cross-sectional online survey was distributed to healthcare professionals working in MND services across Europe. Data were analyzed using descriptive and inferential statistics.

In total, 230 responses from professionals across 17 European countries were analyzed from the international survey. And 67% of respondents indicated that MD resonated with their experience of working with MND. Those who considered leaving or changing their position due to the challenges associated with caring for this patient population were also more likely to report resonance with MD (χ2 = 7.772, p = 0.020). The intensity of MD was associated with reduced professional quality of life (burnout [β = 0.106, p < 0.05], and secondary traumatic stress [β = 2.881, p < 0.001]). A total of 24 clinical scenarios were identified as potential contributors to experiences of MD in this population. Across all professional groups, service-/organization-level factors were the most common and distressing barriers to providing effective MND care.

This study demonstrates that MD is experienced by healthcare professionals working with MND across Europe. MD was associated with reduced professional quality of life and increased intentions to leave or change positions, underscoring its potential implications for workforce retention and sustainability. The findings show that system/organization, patient/condition and family-level causes are the primary drivers of MD in this population. Future research should focus on evaluating the effectiveness of interventions designed to address these key drivers and mitigate the impact of MD among healthcare professionals working with MND.

To raise awareness of fertility preservation and counseling in palliative care and explore considerations for practice.

This case report describes the rapid decline and death of a 36-year-old man with astrocytoma. Despite early fertility discussions with the palliative care team, sudden clinical deterioration prevented semen collection prior to death. Following death, the spouse requested post-death sperm retrieval.

Post-death sperm retrieval and cryopreservation were successfully completed within the viability window. To achieve this, urgent interdisciplinary coordination across palliative care, emergency medicine, reproductive specialists, and hospital legal and executive teams was required.

The case highlights the importance of early and ongoing fertility counseling for patients of reproductive age in palliative care. It demonstrates that clear pathways and coordinated systems can enable post-death sperm retrieval when aligned with patient and partner wishes. The development of evidence-based policies, training, and patient resources may reduce barriers and support clinicians to conduct sensitive, informed fertility discussions.

Although it is known that parents caring for adolescent and young adult (AYA) cancer patients experience physical and psychological stress, to our knowledge, there are no reports regarding thiamine deficiency (TD) in this population.

From a series of cancer patient caregivers, we identified TD in a mother caring for an AYA cancer patient and report our experience with this case, as treatment enabled the prevention of Wernicke encephalopathy (WE).

A 49-year-old woman who had been caring for her 18-year-old son after he developed graft-versus-host disease following bone marrow transplantation for leukemia visited our psycho-oncology department at the recommendation of her son’s attending physician after witnessing her son experience a seizure. Thirteen months after the initial consultation, she developed difficulty climbing stairs, suggesting a possible physical abnormality. Blood tests revealed a markedly decreased hemoglobin level of 5.7 g/dL, and subsequent evaluation led to a diagnosis of iron deficiency anemia. Five days later, her thiamine level was found to be markedly reduced at 19 ng/mL (reference range: 24–66 ng/mL), and oral thiamine at a dose of 75 mg was initiated. No progression to WE, such as disturbance of consciousness, was observed.

Parents caring for AYA cancer patients are profoundly affected both physically and psychologically by their child’s condition. In the future, attention should be paid to the nutritional status (including TD) of families caring for AYA cancer patients, as this may contribute to improving quality of life for both patients and their families.