Patients with recurrent breast cancer and liver metastases complicated by hepatic failure have limited treatment options and poor prognoses. Narrative-based medicine (NBM) and shared decision-making (SDM) may support patient-centered decisions even in critical clinical situations

To describe the role of NBM and SDM in guiding treatment decisions for a patient with recurrent breast cancer and diffuse hepatic metastases associated with severe liver dysfunction.

We present the case of a woman with recurrent breast cancer who developed hepatic failure caused by diffuse liver metastases. Repeated SDM discussions were conducted among the patient, her family, and a board-certified breast oncologist with certification in palliative care. Chemotherapy with eribulin was initiated together with intensive supportive care despite life-threatening organ failure.

Following the initial onset of adverse effects, the patient’s liver function improved, allowing continuation of outpatient chemotherapy and fulfillment of her goal of spending meaningful time with family. The patient survived for approximately 5 months after treatment initiation.

This case suggests that individualized care guided by NBM and SDM may support safe and goal-concordant treatment decisions, even near the end of life. Integration of oncologic and palliative expertise may help align medical interventions with patient values and preferences in complex clinical situations.

To identify, describe and analytically interpret relational recurrent patterns shaping interactions in PC settings, and to offer practical guidance to haelth care professionals navicating complex end-of-life-scenarios.

This study explores the dynamics influencing relational interactions in palliative care (PC) settings. Building upon 1 author’s extensive clinical experience, reflection, and prior research, we aim to further illuminate the clinical and cultural factors that shape relational interactions and scenarios within PC. By integrating personal observations with scholarly literature and describing specific recurring global patterns of interaction, this article seeks to deepen understanding of PC culture and to provide healthcare professionals with practical strategies to improve engagement with patients and families.

This study aimed to explore and analytically describe recurrent relational patterns shaping interactions in PC settings through an analytic autoethnographic lens. Short evocative phrases were used to define the identified patterns as clinical vignettes. Based on recurrent clinical observations and reflexive positioning, and through an iterative analytic process, patterns were progressively identified, named, and situated within a theoretical framework. Ethical standards were upheld.

Three end-of-life scenarios – “The Palliative Honeymoon,” “The Cousin of France,” and “Do Everything!” – emerged and were analyzed. The findings emphasize the importance of understanding these behavioral patterns in order to educate health professionals and enhance care provision.

This original Portuguese analytic autoethnographic study is grounded in extensive experiential knowledge and addresses a gap in the literature regarding interactional patterns in PC. By integrating long-standing personal clinical experience with scholarly evidence, this autoethnographic study renders explicit what is often tacit in PC practice – the hidden cultural elements that shape clinical interactions. It is part of a continuum of research that willcontinue and be relate to elements of PC identity. By describing clinically relevant phenomena and integrating them with existing literature, this work offers strong practical implications and contributes to better preparing clinicians for the complex realities of PC practice.

Depression in cancer patients is a common condition that poses significant challenges for prognosis, treatment adherence, and quality of life. Its onset reflects the interplay of diverse biological, psychological, and social factors, which has been the focus of numerous studies.

We identified both systematic and non-systematic reviews examining cross-sectional or prospective studies reporting associations between DAFs and depression. We extracted data relative to DAFs, as well as the direction and statistical significance of the reported association. Consistency of findings was assessed by estimating the proportion of concordant studies (PCS) for each DAF. Methodological quality and risk of bias were assessed using a standardized tool.

We identified 73 reviews (26 systematic and/or meta-analyses, 47 narrative) encompassing 514 unique primary studies, reporting the associations between depression and 198 distinct DAFs. DAFs were grouped into six domains (sociodemographic, cancer-related, somatic, psychological, biological-genetic, and other). The strongest associations (PCS ≥ 75% and ≥5 studies) were observed for sociodemographic factors (e.g., high social support, being unmarried), inflammatory markers (IL-6, TNF-α, CRP), psychological factors (e.g., history of depression, distress, anxiety), and somatic factors (e.g., fatigue, low functional status, malnutrition). When restricting analyses to prospective studies, consistent associations emerged for cancer-related physical symptoms and time dedicated to patient communication.

Depression in cancer is multifactorial, with physical and psychosocial factors likely iteracting dynamically. Prospective studies are still greatly needed. Further research on risk and protective factors may facilitate risk stratification, early diagnosis and patient management.

This study investigates differing aspects of wishes to hasten death (WTHD) distinguished by the extent to which WTHD were linked to patients’ agency: desire for hastened death (DHD), defined as general wishes for death to come sooner, and hastening death intentions (HDI), defined as thoughts about ending one’s life. In particular, this study aims to examine the differences between DHD and HDI in patients with amyotrophic lateral sclerosis (pALS) and identify predictive factors for both.

A cross-sectional nested study was conducted within a multi-center longitudinal study involving pALS from 5 European countries. Data collected included DHD (Schedule of Attitudes toward Hastened Death), HDI (“could you currently imagine ending your life?”), sociodemographic and clinical characteristics, psychological distress, quality of life, and social and spiritual-existential aspects.

In our sample of 121 pALS, 12.4% (15/121) expressed DHD, and 28.1% (34/121) expressed HDI. Of the 38 patients reporting any WTHD, only 11 experienced both DHD and HDI simultaneously. 23 patients reported HDI without DHD, while 4 patients expressed DHD without HDI. Multivariable logistic regression identified loneliness (OR = 1.33, 95% CI 1.03–1.71, p = 0.028) and reduced meaning in life (OR = 0.89, 95% CI 0.84–0.95, p < 0.001) as independent predictors of DHD. For HDI, independent predictors were female gender (OR = 3.31, 95% CI 1.37–7.98, p = 0.008) and lower spirituality (OR = 0.92, 95% CI 0.88–0.95, p < 0.001).

One in 3 pALS expressed WTHD. Our separate analysis of DHD and HDI supports the existence of distinct manifestations of WTHD and varying underlying factors. While DHD and HDI were associated with different predictors, our results point to the crucial role of spiritual-existential factors in the experience of WTHD, identifying these aspects as target points for intervention. This study highlights the importance of a nuanced understanding and communication regarding WTHD.

We aimed to translate and cross-culturally adapt the Supportive and Palliative Care Indicators Tool-4ALL (SPICT-4ALL) for use in the Tamil healthcare context.

The translation and cross-cultural adaptation of the SPICT-4ALL (2023 version) were conducted using the TRAPD model (Translation, Review, Adjudication, Pretesting, and Documentation). Cross-cultural adaptation used a modified Delphi-technique. Twelve participants, including mid-level healthcare workers from primary care and palliative care settings and lay people from India and Sri Lanka, scored the items on the tool. Agreement on scores was assessed, and focus group discussion (FGD) was used to reach consensus.

Delphi panel agreement was 34% initially but reached 100% with minor changes to items in the translated version after the FGD. Thematic analysis found SPICT-4ALL in Tamil is user-friendly and accessible for proactive identification of palliative care needs, facilitates person-centered care planning, and enhances interdisciplinary coordination.

SPICT-4ALL-Tamil 2023 is the translated and cross-culturally adapted version for use in the Tamil healthcare context. This will enable and empower mid-level health workers within the primary and secondary care settings and people not in the healthcare field to identify individuals with palliative care needs. Further research to validate and study acceptability of the tool and its impact on patient outcomes is warranted.

The relationship between frailty, self-efficacy, and advance care planning (ACP) remains unclear in Asia. This study examined how frailty status relates to decisional self-efficacy, ACP engagement, and advance directive completion among older adults receiving home healthcare in Taiwan.

A cross-sectional analysis was conducted using baseline data from a nationwide cohort in Taiwan. Participants (N = 358) were categorized by Clinical Frailty Scale (CFS): mildly frail (CFS 4–5, n = 60), moderately frail (CFS 6, n = 83), severely frail (CFS 7, n = 147), and very severely frail (CFS 8–9, n = 68). ACP engagement and decision-making self-efficacy were assessed using Likert scales.

Patients with greater frailty had lower odds of high decisional self-efficacy (CFS: 8–9: odds ratio [OR] = 0.38, 95% confidence interval [CI] = 0.14–1.07) but higher odds of ACP engagement (CFS: 6: OR = 3.38, 95% CI = 1.40–8.17; CFS: 7: OR = 2.52, 95% CI = 1.08–5.89) compared with mildly frail individuals. However, this increase did not extend linearly to the very severely frail group. Advance directive completion remained low across all frailty levels (4.8–10.0%) and was not significantly associated with frailty status.

Frailty was associated with lower decisional self-efficacy but higher readiness for ACP, revealing a divergence between perceived confidence and planning motivation. Despite greater engagement, advance directive completion remained low. Stage-sensitive, values-based approaches may help bridge the gap between intention and documentation across the frailty spectrum.