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.

This study was conducted to determine the relationship between death anxiety, spiritual well-being, and social support in patients with gynecological cancer.

This descriptive study consisted of 519 patients with gynecological cancers. Data were collected using a “Personal Information Form,” the “Death Anxiety Scale,” the “Spiritual Well-Being Scale,” and the “Multidimensional Perceived Social Support Scale.”

The mean total score of the Death Anxiety Scale was 6.8 ± 2.95, the Spiritual Well-Being Scale was 31.16 ± 5.24, and the Multidimensional Perceived Social Support Scale was 62.46 ± 13.76. A positive correlation was found between the scores of the Multidimensional Perceived Social Support Scale and the Spiritual Well-Being Scale. However, death anxiety levels were not influenced by spiritual well-being or social support levels (p < 0.001). As the level of perceived social support increases, spiritual well-being also increases; however, no significant relationship was found between death anxiety and either spiritual well-being or perceived social support.

The findings of this study highlight the importance of social support as a key factor associated with higher levels of spiritual well-being in women with gynecological cancer. Strengthening patients’ support systems may contribute to better psychological and spiritual adjustment during cancer treatment. Although death anxiety was not significantly related to either spiritual well-being or perceived social support, this result suggests that death anxiety may be influenced by other clinical or personal factors beyond these psychosocial variables. These findings provide guidance for developing supportive care programs that prioritize social support enhancement to improve overall patient well-being.

Meaning-Centered Psychotherapy (MCP) has shown significant promise in reducing existential distress and improving wellbeing in people with advanced cancer. Research is yet to explore the applicability and translation of MCP into an Indigenous Aotearoa New Zealand cultural context.

This research sought to explore the applicability of MCP within Aotearoa New Zealand. The objectives of this study were to investigate Indigenous patients’ experiences of an MCP trial and Indigenous therapists’ experiences of recruitment and MCP delivery within the trial.

Semi-structured interviews were conducted with 2 Indigenous patients with advanced cancer receiving MCP, 1 Indigenous support person, and 4 Indigenous health psychologists delivering MCP about their experience in the research trial. Participants were also asked their views on recruiting Indigenous populations into research trials, and on the applicability of MCP in Aotearoa New Zealand. Reflective thematic analysis was utilized to analyze interview transcripts.

This study showed that trust is central to recruiting Indigenous populations into research trials and contributed to the overall success of MCP delivery. Participants highlighted community trust and organizational mistrust as potential contributors toward recruitment challenges. Trust in the self, in others, and in culture was central to finding meaning through MCP. When conducted in a safe patient-centered therapeutic space, MCP concepts and meaning-making can integrate effectively into Te Ao Māori and an Indigenous context.

MCP concepts and delivery may integrate well into a Te Ao Māori framework. Care should be taken in future delivery of MCP within Aotearoa New Zealand, ensuring the patient-focused nature of the therapeutic modality is maintained, and the patient’s own connection with culture is the highest priority.

This mixed-method study examined whether the Integrated Palliative Outcome Scale (IPOS) can support the identification of palliative care needs and inform individualized care planning in hospice settings.

Thirty-eight terminally ill patients admitted to a hospice in Northern Italy completed the IPOS. Quantitative analyses described the frequency and intensity of physical, psychological, relational, spiritual, and practical needs at the first administration and, where available, compared scores across 2 administrations using non-parametric tests. Spearman correlations were used to explore associations between awareness of diagnosis/prognosis and symptom burden. In parallel, semi-structured interviews explored the subjective meaning of “being at peace with oneself”; responses were examined through thematic content analysis.

IPOS administration highlighted frequent needs related to constipation, oral discomfort, weakness, drowsiness, anxiety, and concerns about family members. Awareness of diagnosis and prognosis were positively correlated. Anxiety and not feeling at peace showed negative associations with awareness, particularly awareness of prognosis. Across administrations, most physical symptoms remained stable, while anxiety and depressive feelings increased. Qualitative findings showed that inner peace was mainly associated with calmness, satisfaction with life, relational fulfilment, not having harmed others, and acceptance of one’s condition.

The integration of IPOS into routine hospice care may help multidisciplinary teams identify patients’ evolving needs and translate them into more responsive individualized care plans. Combining structured IPOS scores with patient narratives can also make existential and psychosocial concerns more visible in clinical decision-making.

Terminally ill immigrant patients may wish to return to their homeland to die. However, the challenges and repatriation experiences faced by terminally ill Latinx immigrants who return to their country of origin (COO) remain underexplored. This study examines bereaved caregiver accounts of end-of-life (EOL) care and repatriation experiences of Latinx immigrants who returned to their COO following a terminal diagnosis.

Bereaved caregivers were interviewed via telephone. Primary outcomes were patient repatriation prior to death and caregiver perceptions of patient quality of death (QOD). Secondary outcomes included repatriation barriers, symptom burden and management, health-care utilization, and location of death. Caregivers of deceased patients treated at a U.S. urban tertiary medical center from 2013 to 2020 who requested and returned to their COO for death were included. Deceased patient clinical and sociodemographic information was obtained from the chart review.

Nineteen caregivers of patients who returned to their COO were included, most (n = 15/19, 78.9%) from the Dominican Republic. Two patients experienced logistical challenges during travel to their COO. None received supplementary nutrition or ventilatory support. Most patients had well-controlled symptoms (12/19 had pain, 11/12 pain was controlled) and died peacefully with dignity (84.2%) at their preferred location (73.7%). Most caregivers reported that their loved one was happy with repatriation (89.5%) and that repatriation improved EOL quality of life (84.2%). QOD was rated favorably (average score of 4.2/5).

QOD was favorable after repatriation. Successful repatriation is feasible and an important component of QOD that should be included in goals of care discussions.