Despite the increasing implementation of consultation-based hospice palliative care teams in tertiary hospitals of Korea, there is limited research on their impact on self-determination respect rates. Understanding this impact is crucial for improving end-of-life care practices and respecting patient autonomy. The aim of this study is to assess the trends in self-determination respect rates regarding advance care planning before and after the introduction of a consultation-based hospice palliative care team in a tertiary hospital.

A retrospective observational study was conducted using medical records from a tertiary hospital in Korea from March 2018 to December 2023. The study included all patients aged 19 years and older with medical records at a tertiary hospital during the specified period. We examined the characteristics of patients referred to the palliative care team, the effects of the consultation-based hospice palliative care team on the completion rates of advanced care planning, and changes in self-determination respect rates.

Following the introduction of the consultation-based hospice palliative care team, 411 patients were referred. The proportion of patients with completed advance care planning increased from 27.0% to 60.6% (p < 0.001). The overall number of advanced care planning completions and the self-determination respect rate also showed a marked increase, particularly from 2021 to 2022, when the respect rate spiked from 27.6% to 43.2%.

Introduction of a consultation-based hospice palliative care team improved the respect for patient self-determination in end-of-life care decisions. These findings support the integration of hospice care teams in tertiary hospitals to enhance early and informed end-of-life decision-making.

Nepali widows have a high prevalence of mental disorders, including prolonged grief disorder (PGD). Despite the considerable needs that Nepali widows have for mental health services, resources for mental health in Nepal are limited, amplifying the importance of accurate screening and diagnosis. The objective of this study was to explore the feasibility of implementing a culturally adapted Prolonged Grief Scale (PG-12/17-N) and provide actionable recommendations for its implementation.

Twenty-five mental health service providers in Kathmandu and Chitwan, Nepal were interviewed using a semi-structured guide based on selected constructs from the Consolidated Framework for Implementation Research. Qualitative data were inductively and deductively coded and analyzed to identify prominent themes.

Providers reported that the main advantages of the scale were the need to identify widows at risk, cultural relevance, easy language, and inclusion of detailed and specific symptoms. Perceived weaknesses included the complexity in response options and scoring, length, item redundancy, overlap with depression symptoms, and lack of somatic symptoms. Providers discussed the need for training, supervision, and a referral and detection system required to implement the scale in Nepal. Further development of a brief version of the scale as a routine screener may facilitate detection and referral to care.

Based on the results showing need to address PGD in Nepali widows, further efforts are needed to increase awareness about PGD and develop evidence-supported treatments for PGD, after which screening could be made routine for widows.