To explore hospital healthcare professionals’ (HCPs) knowledge, attitudes, and experiences on advance care planning (ACP), comparing different professions and care specialties, in a country where ACP is formally regulated.

An online survey involving HCPs from different care specialties involved in ACP working in Italian hospitals. Different tests were used for comparisons among HCPs.

We included responses from 724 HCPs (259 physicians, 86 residents, 339 nurses, 40 physiotherapists). Despite only 29.7% of participants having received education on ACP, the majority (75.5%) had heard of ACP and were aware of its key elements. The main misconceptions concerned legal aspects, while uncertainty regarding ACP practical implementation and correct timing were among the main reported barriers. Virtually all participants favored ACP, and 81.1% considered ACP part of their duty, but ACP is seldom offered to patients and is not always documented. Knowledge and attitudes toward ACP were similar across professional roles, while ACP education and discussion varied across specializations, with the highest levels reported by Palliative Care HCPs. In most specialties, a substantial overlap can be noted between levels of ACP education and ACP discussion among all HCPs, while higher levels of discussion were generally observed among physicians, though the magnitude of the gap between education and discussion levels differed across care specialties.

Despite ad hoc regulation and HCPs’ favorable attitudes, the legal aspects of ACP remain poorly understood and ACP implementation in hospitals is still low. This study supports the need for clear procedures and for inclusion of ACP education and training in the core curricula of all HCPs, suggesting the need for studies integrating social sciences to explore specialty-specific barriers and facilitators to ACP. Due to their unique level of engagement in the process, palliative care HCPs may play a pivotal role in implementing hospital-based ACP.

Withholding or withdrawing life-sustaining therapies (WLST) was introduced in France in 2005 through the Leonetti law to prevent futile treatments and “unreasonable obstinacy.” In France, WLST decisions affect 8.5–14% of ICU patients, according to the literature. The 2016 Claeys–Leonetti law updated the previous legislation, but debates surrounding end-of-life care persist.

To describe WLST patients and practices under current legislation, we conducted a multicenter, prospective, observational study in ICUs across Eastern France. Eligible adult patients facing WLST decisions were included, requiring written consent from the patient or a trusted person. Patients were followed for 1 month. We described the decision-making process and assessed family satisfaction using the FS-24R-ICU questionnaire.

Between May 3rd and October 3rd, 2023, 73 patients were included (mean age 69 years). The majority of admissions were medical (72.7%), and 50.7% of patients had neurological impairments. ICU staff initiated WLST discussions primarily due to poor survival or quality of life prospects. Only 12.5% of patients had written advance directives, and 59.1% had designated a trusted person. External consultation was not involved in 19.1% of decisions. Families were informed in 91.7% of cases. Decisions to withhold therapies occurred in 68.1% of cases, with resuscitation during cardiac arrest being the most commonly withheld intervention (98.0%). Treatment withdrawal occurred in 31.9% of cases. Family satisfaction was generally positive.

WLST management in Eastern French ICUs is partially compliant with the Claeys–Leonetti law. Improved law application and public awareness could enhance end-of-life care management in France.

Amyotrophic lateral sclerosis (ALS) is a rare, progressive, and fatal disease that impacts the lives of affected individuals and their caregivers. Informal caregivers play a crucial role in supporting people with ALS (pwALS), yet they face major challenges. This study aims to analyze caregiver burden and health status among informal caregivers of pwALS in Portugal.

A cross-sectional survey-based study was conducted with adult informal caregivers of pwALS in Portugal, recruited through the Portuguese ALS patient association and healthcare professionals. Data included sociodemographics, caregiving activities, caregiver health (SF-36), patient functional status (ALSFRS-R), and caregiver burden (ZBI).

The study included 113 caregivers. Most were female (61.9%) and the partner (65.5%) or offspring (23.9%) of the pwALS. A quarter of caregivers received no social benefits. Mean ZBI was 32 ± 14.8, with most reporting mild to moderate burden. On the SF-36, general health was 51.1 ± 19.8, with mental health (55 [40; 70]) and vitality (43.8 [31.3; 56.3]) particularly impaired. ZBI scores correlated positively with caregiving hours (r = 0.274, p = 0.003) and negatively with ALSFRS-R (r = −0.411, p < 0.001). High burden caregivers exhibited poorer sleep quality (p =  0.026).

Caregivers experienced mild to moderate burden, with impaired mental health and vitality, but preserved physical functioning. A higher burden was linked with lower quality of life, poorer sleep, and greater patient disability. These findings underline the need for targeted education and training to support caregivers of pwALS.

Previous studies indicate that African immigrant women in the United States have lower rates of cervical cancer screening and prevention than other racial and immigrant groups, with additional heterogeneity by country of origin, language proficiency, and length of U.S. residence.

This review aimed to (a) summarize barriers and facilitators to screening, (b) examine how existing studies conceptualize African immigrant identity and employ disaggregated analyses, and (c) apply intersectionality and stress process frameworks to highlight structural determinants shaping screening behaviors.

This systematic review, registered with PROSPERO (CRD420251151600), synthesizes evidence on cervical cancer screening and HPV vaccination among African immigrant women in the United States. PubMed, ProQuest, EBSCO, PsycINFO, MEDLINE, Scopus, and Google Scholar were searched for peer-reviewed studies published between January 2010 and December 2024. Seventeen studies met inclusion criteria, including cross-sectional surveys (n = 7), qualitative studies (n = 5), mixed-methods studies (n = 3), retrospective cohort analyses (n = 1), and one randomized controlled trial.

Only 11 of the 17 studies disaggregated African immigrant women by country of origin or related subgroup characteristics. Risk of bias was assessed using the Newcastle–Ottawa Scale for observational studies and the Critical Appraisal Skills Programme checklist for qualitative studies. Across studies, African immigrant women consistently faced barriers to screening, including language discordance, lack of insurance, limited HPV awareness, cultural stigma, and unfamiliarity with the U.S. healthcare system. Interventions such as HPV self-sampling and culturally tailored education showed promise in improving screening uptake.

The findings point to the need for standardized disaggregated data collection, culturally responsive interventions, and theory-driven research to reduce cervical cancer prevention disparities among African immigrant women in the United States.

Psychedelic therapies are gaining attention as a novel therapy for existential distress in cancer patients. However, such treatments are often stigmatized and the views of support networks are unknown. Caregivers play an essential role in supporting the wellbeing and decision-making of people with cancer. In the context of a trial investigating psychedelic therapy for cancer patients, understanding the experience of the caregiver is important.

The objectives of this research were to investigate the hopes, beliefs, perceptions, and experience of caregivers for advanced cancer patients undergoing a trial investigating a psychedelic-assisted therapy.

Semi-structured interviews asked 15 caregivers about their experience at baseline and 1 month after their close associate had completed treatment in a feasibility trial where participants were randomized to receive either lysergic acid diethylamide (LSD) microdoses or placebo alongside meaning-centered psychotherapy (MCP). Blinded to condition, reflexive thematic analysis was used to analyze interview transcripts.

This study demonstrates the importance of bidirectional influences between caregiver and patient; the experience of one influences the experience of both. Caregivers were generally supportive of their close associate participating in a psychedelic-assisted trial, although some admitted hesitancy in them taking part. Caregivers described a desire to make the most of now, referring to the role of LSD microdose-assisted MCP as a means of accessing hope, improving the dyad relationship, and reducing existential distress.

Participation in trials investigating psychedelic-assisted MCP may offer hope for patients and their caregivers. Given the bidirectional relationship in wellbeing between cancer dyads, caregivers should be included alongside patients in such trials.

Holistic nursing care requires considering not only the physical and psychosocial but also the spiritual care needs of the patient.

This study aimed to determine the relationship between nurses’ perceptions of the concept of spiritual care and their attitudes towards death and the care of dying patients.

The sample of this descriptive and correlational study consisted of 383 nurses. Data were collected using the Spirituality and Spiritual Care Rating Scale (SSCRS), the Spiritual Support Perception Scale (SSPS), the Frommelt Attitude Toward Care of the Dying Scale (FATCOD), and the Death Attitude Profile Scale (DAP-R). The predictive role of nurses’ perceptions of spiritual care on their attitudes toward caregiving for patients approaching death and dying was examined using path analysis. The results of the analysis were presented as descriptive statistics (mean ± SD), and frequency (percentage) distributions. The reliability of the scales and subscales was examined using the Cronbach’s alpha internal consistency coefficient.

The path coefficient between the SSCRS and the DAP-R subscales of Fear of Death (β = 0.232; P = 0.025), Death Avoidance (β = 0.301; P = 0.007), Neutral Acceptance (β = 0.22; P = 0.01), Approach Acceptance (β = 0.444; P < 0.001), and Escape Acceptance (β = 0.659; P < 0.001) was statistically significant. The path coefficient between the FATCOD and the DAP-R subscales of Fear of Death (β = −0.032; P < 0.001), Death Avoidance (β = −0.038; P < 0.001), and Neutral Acceptance (β = 0.02; P < 0.001) was statistically significant.

It was determined that there was a correlation between the nurses’ perceptions of the concept of spiritual care and their attitudes towards death and the care of dying patients. It can be suggested that the nurses exhibited a more positive attitude toward the care of dying patients as their understanding of spirituality, spiritual support, and spiritual care increased.

People with serious illnesses often experience spiritual and emotional pain, manifesting in conditions such as depression, anxiety, and demoralization. Emerging research in psychedelic-assisted therapy has shown efficacy in treating these conditions. Despite evidence that psychedelics frequently occasion mystical/spiritual experiences in participants, there has been little research on support for spiritual, existential, religious, and theological needs, including the use of chaplains on therapeutic teams. Spiritual wellbeing outcomes have been inconsistently used and reported on in current psychedelics studies. The aims of this article are to identify and review patient-centered outcome measures focused on spiritual wellbeing for use in psychedelic research.

A literature review of instruments was conducted, with 286 articles included, identifying spiritual wellbeing measures within the palliative care population.

Three measures were selected for inclusion: Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being 12- Item Scale (FACIT-Sp-12), European Organization for Research and Treatment of Cancer Quality of Life Spiritual Well-being Questionnaire (EORTC QLQ-SWB-32), and the National Institutes of Health Healing Experience of All Life Stressors (NIH-HEALS). Instrument development, psychometric properties, and use in research for each are discussed.

Suitability in the context of psychedelic-assisted therapy with the palliative care population includes strong reliability and validity, and they should be accessible to people with various spiritual traditions, practices, and sources of connection. They should be patient-centered in their development, involve multiple stakeholders, and be appropriate for use with palliative care populations. According to these criteria and its orientation toward identifying spiritual change in the context of serious illness, the NIH-HEALS is recommended for wider use in psychedelic-assisted therapy.

This study examined how repeated exposure to trauma narratives influences professional quality of life, including burnout, secondary traumatic stress (STS), and compassion satisfaction (CS), among end-of-life healthcare providers. The moderating roles of resilience and both organizational and personal support were also tested.

A cross-sectional online survey was completed by 507 healthcare providers working in hospice, oncology, or other end-of-life settings. Participants completed validated self-report measures assessing exposure to trauma narratives (Vicarious Trauma Scale [VTS]), professional quality of life (ProQOL-5), resilience (STARS-6), organizational support (SPOS), and social support (MSPSS). Hierarchical regression and moderation analyses were conducted to evaluate main and interaction effects.

Greater exposure to trauma narratives was significantly associated with higher burnout (β = .37, p < .001) and STS (β = .42, p < .001), and with lower CS (β = −.13, p = .004). Higher resilience and organizational support predicted greater CS and lower burnout and STS. A significant VTS × resilience interaction indicated that resilience buffered the association between exposure to trauma narratives and STS (β = −.10, p = .009).

Repeated exposure to trauma narratives is a meaningful occupational stressor for end-of-life clinicians. Resilience and organizational support appear to protect against the negative impact of trauma exposure and promote CS, highlighting key multilevel targets for trauma-informed workforce interventions.

This study addresses a critical gap by clarifying how repeated trauma narratives specifically influence burnout, Secondary Traumatic Stress (STS), and Compassion Satisfaction (CS) within the unique context of end-of-life care. The results provide a nuanced framework for understanding how clinicians maintain empathic presence despite chronic emotional demands. Furthermore, by identifying specific resilience factors and support systems that buffer against psychological distress, these findings offer actionable insights for developing targeted interventions to mitigate long-term professional harm.

To examine the relationships between patient activation, depressive symptoms, and quality of life among older adults receiving palliative oncology care.

A cross-sectional correlational study was conducted among 145 adults aged ≥60 years receiving palliative oncology care at King Khalid Hospital, Saudi Arabia, using stratified random sampling. Data were collected via a demographic and clinical questionnaire, the Patient Activation Measure-13 (PAM-13), the Patient Health Questionnaire-9 (PHQ-9), and the McGill Quality of Life Questionnaire–Revised (MQOL-R). Descriptive statistics, Pearson correlation, independent t-tests, one-way ANOVA, and multiple linear regression were performed using SPSS version 26.

All participants demonstrated Level 2 patient activation, with a mean PAM-13 score of 50.83 (SD = 1.04). Moderate depressive symptoms were prevalent (mean PHQ-9 = 13.56, SD = 3.48), and overall quality of life was moderate (mean MQOL-R = 55.21, SD = 10.14). Patient activation was weakly but significantly inversely correlated with depressive symptoms (r = −0.179, p < 0.05). No significant associations were found between patient activation and quality of life, or between depressive symptoms and quality of life. Regression analysis showed that patient activation, depressive symptoms, and demographics accounted for only 3.2% of the variance in quality of life (R2 = 0.032, p = 0.714).

Patient activation may modestly reduce depressive symptoms but is not sufficient to improve quality of life in older adults receiving palliative oncology care. Quality of life appears influenced by broader multidimensional factors beyond activation and mood, highlighting the need for comprehensive interventions in palliative care settings.

Despite the urgent need for support interventions for families facing parental life-threatening illness, research is limited – particularly in progressive neurological diseases. This scoping review aimed to systematically map existing interventions to inform the development of tailored support in the neurological context.

A scoping review was conducted, including articles published between 2013 and 2025, identified through searches in PubMed, CINAHL, PsycINFO, and Web of Science, along with manual screening of reference lists. Extracted data were systematically charted and descriptively summarized.

Of 5172 articles, 15 were included, describing 6 unique interventions aimed at supporting children (0–25 years) and/or parents in families where a parent had a life-threatening illness. While cancer was the predominant diagnosis among ill parents, progressive neurological diseases, such as amyotrophic lateral sclerosis (ALS) and Huntington’s disease, were represented to a limited extent. The interventions targeted children (n = 4), parents in their parenting role (n = 4), or the entire family (n = 7) and were primarily based on psychosocial, psychoeducational, or peer support. Overall, the interventions were positively received by both children and parents and perceived as helpful in navigating their challenging life situations in various ways.

This review confirms a particular lack of knowledge and tailored support for families affected by progressive neurological diseases. While support interventions for other life-threatening illnesses are also limited, those that exist may offer valuable insights to inform the development of support within neurological care contexts. The findings underscore the need for early, proactive, and accessible approaches that address both individual and family needs across the disease trajectory, aligning with core principles of high-quality palliative care.

Although patients with lung cancer are at high risk of poor outcomes from COVID-19, little is known about the economic and psychosocial impact of the pandemic on this population. This study had 2 objectives: (1) to identify the prevalence of financial and social disruptions and other adverse COVID-19 experiences in socioeconomically diverse patients with lung cancer; and (2) to examine whether these experiences were associated with physical and psychological symptoms.

Patients with lung cancer (N = 191) were recruited from a cancer center in the midwestern U.S. from August 2021 to April 2022 to participate in a cross-sectional survey of COVID-19 experiences and symptoms. Path analyses tested associations between COVID-19 experiences and symptoms, adjusting for sociodemographic and medical covariates.

Prevalent COVID-19 experiences included disrupted interactions with family and friends (66.0%), inability to perform daily routines (38.5%), and financial difficulties (18.5%). Greater financial hardship and disruptions to daily activities and social interactions were associated with higher levels of all physical and psychological symptoms. Endorsing more COVID-19 experiences (e.g., job loss, death of loved ones) was only associated with greater anxiety. Despite prevalent hardships, mean levels of physical and psychological symptoms were within normal ranges, except for elevated fatigue.

Although adverse COVID-19 experiences were common and related to symptom burden, patients with lung cancer showed notable psychological resilience during the pandemic. Oncology clinicians should consider the impact of COVID-19 experiences when providing financial and support services.