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.

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 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.

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.

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.

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.

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.

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.

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.

We aimed to evaluate patient and clinician experiences of advance care planning (ACP) conversations facilitated by an ACP nurse coordinator (ACP-NC).

We used a sequential mixed-methods approach that included a patient survey, patient interviews, and clinician interviews at a family medicine clinic. Patients were invited into the study if they had reached a stable point in their ACP decision-making conversations with the ACP-NC or PCP (i.e. their goals and preferences were considered settled at the time) and were not imminently dying. Invitations to complete a survey were sent within 2 weeks of patients completing their ACP conversations. Patient interviewees were purposefully selected to vary on key attributes such as age, gender, and number of ACP conversations. An iterative sampling strategy was used for both patient and clinician interviews.

Ninety-three patients completed the survey, and 10 patients were interviewed. Six clinicians were interviewed. Sixty percent of patient respondents reported being very comfortable having ACP conversations. At the time of the survey, 79% had completed or revised their existing advance directive. The professional groups that patients most preferred to engage with, regarding ACP, were their primary care provider (87%), ACP-NC (70%), and palliative care specialist (61%). Patient interviews indicated that participants appreciated being referred to the ACP-NC within the clinic, describing her as a motivator and generous with her time, which facilitated thoughtful discussion of preferences and wishes. Clinician interviews identified limited time as a key barrier to conducting ACP conversations and saw a dedicated ACP-NC as a major benefit to allow patients to spend more time having these important conversations.

Patients were open to engaging in ACP discussions. Integrating an ACP-NC within primary care teams may represent an acceptable and effective approach to promote the early initiation of ACP in primary care settings.

Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 “Integrated Home-Based Medical Care” reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of “impending death discharge.”

This nationwide retrospective cohort study utilized Taiwan’s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case–control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed “HBPC Plus” (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.

Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13–1.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34–1.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40–2.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.

HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital–physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.

While there have been reports on the relationship between cancer and depression, reports on the association between cancer and manic states, a reciprocal state of depression, have been relatively few. Therefore, we conducted a systematic review on the relationships between cancer and manic states, focusing on their etiology, clinical course, and impact on cancer treatments.

A systematic review was conducted using four electronic databases, following the PRISMA guidelines. The scope of the study included research on manic or hypomanic states associated with cancer in patients with no prior history of mental illness, published from 1950 to August, 2021. The study protocol was registered with PROSPERO (CRD42020182372).

Fifty-six studies, including 67 cases, were identified. The etiology of manic states in cancer patients was classified into organic, drug-induced, and psychogenic, with steroids being the most predominant causative agent. Approximately half of the patients discontinued cancer treatment following the onset of manic states. This was associated with a low rate of pharmacological treatment during the acute and maintenance phase of mania. The onset of manic states was most frequent during cancer treatment; however, about 15% of the cases exhibit manic symptoms before cancer diagnosis.

This systematic review illustrated the clinical characteristics of manic state regarding differences in the etiology, timing of onset, pharmacological treatments, duration to remission, recurrence, and impact on cancer treatment. Manic states, which are comorbid with cancer, have significant clinical impacts on cancer prognosis. Therefore, appropriate pharmacological treatment for manic states is critical to consolidate appropriate cancer treatment. A substantial proportion of patients exhibit manic symptoms prior to the diagnosis of cancer, warranting further investigation into the possibility of the concept of “premonitory mania.”

The HOPE spiritual assessment tool (HOPE tool), developed by Anandarajah and Hight, is a clinician-administered tool used to support the identification of patients’ existential, spiritual, and religious concerns. In Sweden, a foundational translation exists, but a culturally adapted version suited to a secular and multicultural context is lacking. This study aimed to develop a culturally adapted Swedish version (HOPE-SE) and assess its comprehensibility (face validity) and perceived relevance and coverage (content validity) among specialized palliative care professionals.

Building on an earlier Swedish translation of the original 18-item HOPE, we conducted an observational cross-sectional development and expert evaluation study, in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, to simplify wording, improve item focus, streamline flow, and add prompts addressing non-religious existential concerns, resulting in a 16-item draft (HOPE-SE). Expert evaluation was conducted by 18 interdisciplinary experts in specialized palliative care (nurses, n = 6; physicians, n = 9; social workers, n = 3) who provided structured written feedback and participated in cognitive debriefing interviews. The written evaluation was summarized descriptively. The interviews were analyzed using descriptive content analysis of transcripts of the digitally recorded interviews.

Experts generally perceived HOPE-SE as understandable, acceptable, and clinically useful for initiating conversations about existential, spiritual, and religious concerns. Feedback led to minor wording refinements, clarification of potentially sensitive formulations, and the addition of a brief consent-based introduction to support timing and patient autonomy. The final HOPE-SE was approved by all experts and by the original HOPE author.

HOPE-SE provides the first expert-reviewed Swedish conversation guide addressing existential, spiritual, and religious needs, intended to support spiritual history-taking in a multicultural healthcare context. Patient studies are needed to evaluate content validity and implementation in Swedish settings.