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.

Patients with advanced liver disease (ALD) may benefit from the early integration of supportive care toward the end of life. Engagement with supportive and palliative care could decrease disease-related distress and alleviate pressure on the health system. This trial evaluated whether a transdisciplinary supportive care model, aligned with standard care and guided by patient- and carer-identified needs, could optimize health service utilization and outcomes for patients and carers living with ALD.

A 90-day multicenter, mixed-methods pilot randomized controlled trial, “Liver Life,” was conducted at 1 regional tertiary and 1 rural referral hospital in NSW, Australia. The intervention group received patient- and carer-centered supportive care interventions during 5 scheduled allied health-led outpatient visits, alongside ongoing standard care. This paper reports health service utilization and associated costs, and participant-reported measures.

Over 90 days, emergency department presentations were reduced by 66% (incidence rate ratio: 0.34 [0.13–0.80]), and hospital admissions by 64% (incidence rate ratio: 0.36 [0.12–0.98]). Intervention patients were 5 times more likely to have more days “alive and out of hospital” than those receiving standard care alone (odds ratio: 5.34 [1.43–22.1]). As a result, the overall cost of health service use per intervention patient was less than half that of standard care alone.

The Liver Life trial demonstrated the feasibility, acceptability, efficacy, and potential cost savings of a transdisciplinary supportive care model for ALD patients and their caregivers. Future research should investigate the sustainability and transferability of this approach to other populations and other chronic diseases.

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.

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.

Assessing the multidimensional nature of suffering in palliative care is challenging. The Suffering Pictogram (SP) is a visual instrument developed to facilitate the communication and measurement of this experience in clinical practice.

To translate, cross-culturally adapt, and validate the SP into Brazilian Portuguese (SP-BR) for cancer patients.

A sample of 222 cancer patients completed the SP-BR and the FACIT-Sp-12 scale. Psychometric properties were assessed using exploratory factor analysis (EFA), internal consistency (Cronbach’s alpha), and convergent validity (Pearson’s correlations).

EFA confirmed a unidimensional structure (loadings 0.40–0.73; variance explained 34.42%). Internal consistency was robust (α = 0.80). The SP-BR showed a moderate correlation with the FACIT-Sp-12 (r = −0.50, p ≤ 0.001).

The SP-BR is a validated, unidimensional Brazilian Portuguese instrument suitable for holistic suffering assessment in clinical settings.

The SP-BR is a brief tool for holistic suffering assessment, making it suitable for efficient screening in clinical and research settings, including those with limited resources.

Palliative care seeks to enhance the quality of life for individuals with serious illnesses and their families by addressing physical, emotional, and psychological needs. This phenomenological study examines the lived experiences of 8 caregivers in palliative care settings in Türkiye, focusing on the challenges they face, the coping mechanisms they employ, and their reflections on the caregiving role. Special emphasis is given to both psychological and somatic signs of stress, along with the possible advantages of body-oriented resilience techniques.

Using a phenomenological qualitative design, semi-structured interviews were conducted with 8 caregivers providing care to relatives in a hospital-based palliative care unit. Data were collected between February and April 2023 and analyzed through conventional content analysis.

Four central themes emerged from inductive coding: harmony in healing, navigating difficulties, resilience in palliative care, and reflections on the finite. The findings reveal a dual reality: palliative caregivers derive meaning and satisfaction from compassionate connections, high-quality clinical care, and peer support, yet they also endure significant burdens, including emotional strain, physical exhaustion, disrupted daily routines, and shifting relational dynamics. Anticipatory grief and chronic stress responses were prevalent, frequently manifesting in both psychological and somatic forms (e.g., sleep disturbances, muscle tension, and autonomic arousal). Despite these challenges, palliative caregivers employed spiritual beliefs, peer interactions, and self-care routines as resilience strategies.

The mind–body challenges identified in the study emphasize the need for interventions that focus on self-regulation and resilience, including body-oriented approaches that strengthen internal resources, regulate stress responses, and encourage adaptability. Incorporating such approaches into group-based settings may improve mutual support and enhance both individual and relational well-being. The study highlights the importance of comprehensive, caregiver-centered support systems to reduce burden and improve the overall quality of palliative care.

To explore cancer patients’ understanding of Advance Care Planning (ACP) and identify the main barriers hindering its effective implementation in clinical practice.

This qualitative descriptive study included Brazilian women with breast cancer aged 18–75 years, all with preserved functional status, recruited by convenience sampling. Exclusion criteria were difficulty using online calls or significant communication impairment. Data collection involved a sociodemographic questionnaire and a follow-up interview. After receiving an informational brochure, participants were contacted by video call 14 days later and asked, “How do you understand what ACP is?” Interviews were conducted confidentially at home, transcribed, and analyzed according to qualitative research reporting guidelines.

Sixty-one women participated. Most had difficulty understanding ACP; nearly 40% could not define it. Main barriers included cultural resistance to discussing death, reliance on family members or physicians for decision-making, and lack of clear information. Many participants confused ACP with preventive care. A conceptual multilevel model was developed, showing how cultural taboos, family dependence, and systemic inertia interact to sustain barriers through a feedback loop in which cultural avoidance reinforces structural gaps and institutional neglect.

This study provides evidence on how ACP is understood and misinterpreted by cancer patients in a middle-income Latin American setting, an area that remains underrepresented in the literature. By demonstrating that misconceptions, cultural taboos, and systemic barriers operate through a reinforcing multilevel process, the findings offer a conceptual framework that explains why ACP remains marginal in routine oncology care. The model highlights critical points for intervention, including patient education, professional communication, and institutional support, and is directly applicable to similar sociocultural contexts characterized by strong family involvement and biomedical dominance. These results have clear implications, supporting the integration of ACP as a proactive, relational, and value-based process rather than a late end-of-life intervention.

Palliative care development in primary care is crucial worldwide. This study reports on the secondary outcomes of a study that evaluated whether a complex intervention in primary care for patients with palliative care needs impacted their healthcare utilization.

A before-after study was conducted with family physicians and patients with palliative care needs. Physicians received palliative care training and implemented a new primary palliative care consultation model. Healthcare utilization in the 12 weeks before, during, and after the intervention was compared.

We analysed healthcare utilization for 33 patients with advanced disease. Pre-intervention, there were high rates of no medical consultations, emergency visits, hospital admissions, and outpatient referrals (84.8%, 75.8%, 81.8%, and 84.8%, respectively). Despite slight reductions during and after the intervention, the differences were not statistically significant.

The reduction in healthcare utilization was not statistically significant, but the data inform sample size calculations for future economic analyses.

ClinicalTrials.gov ID – NCT05244590. Registration: 14th February 2022.

To evaluate the impact of a tailored organizational intervention on the support for family caregivers.

A convergent mixed-methods study was conducted in 17 organizations (6 hospices, 5 home care organizations, 3 nursing homes, 2 hospitals, 1 transmural organization) between November 2021 and August 2023. The intervention comprised a structured practice improvement trajectory during which each organization conducted a structured workshop to define organization-specific goals to improve their support for family caregivers and to develop an action plan to achieve those goals. The action plan was implemented over 1 year with intermittent evaluations. Pre- and post-intervention surveys were distributed among healthcare professionals (paired) and bereaved family caregivers (non-paired) to assess provided and received support. Data were analyzed with mixed models and regression analyses. Post-intervention focus groups with project team members and final evaluation reports were analyzed with qualitative content analysis.

Survey respondents were 97 healthcare professionals (83% nursing staff), 123 family caregivers pre-intervention, and 99 family caregivers post-intervention. Only healthcare professionals of home care organizations reported a significant increase in attending to family caregivers’ wellbeing and needs (scale 0–20; β = 3.65; 95%CI: 1.33–5.97). Family caregivers’ reports of healthcare professionals attending to their wellbeing and needs did not change (scale 0–2; β = 0.17; 95%CI: −0.04–0.38). Across settings, healthcare professionals evaluated the care they provided more positively post-intervention (scale 0–8; β = 0.65, 95%CI: 0.38–0.97). In home care, family caregivers also evaluated care more positively (scale 0–8; β = 2.12; 95%CI: 0.89–3.34). Four focus groups and 17 evaluation reports indicated improvements at 3 levels: the support for family caregivers (increased awareness of healthcare professionals, changes in work processes, more structured support), the healthcare team (more skills, confidence, available tools), and the organization (fostering sustainability).

A tailored organizational intervention can strengthen the support of family caregivers in healthcare organizations.

This study aimed to explore the end-of-life decision-making experiences of bereaved family caregivers of Alzheimer’s disease (AD) patients, focusing on do-not-resuscitate orders. Given the high emotional and ethical burden on caregivers, understanding their challenges and needs is crucial to enhancing palliative care for AD patients.

A qualitative, exploratory study was conducted using semi-structured interviews with 22 family caregivers recruited through purposive sampling in central Taiwan. Participants were primary caregivers for AD patients who had been bedridden for at least a year before death. Analysis employed inductive thematic coding to identify key themes, with rigor ensured through multiple coding, member checking, and reflective journaling.

Three major themes emerged: (1) Decision-making difficulties, where caregivers felt pressure and conflict when making urgent decisions; (2) Willingness to let go, which involved accepting the inevitability of death when recovery was no longer possible; and (3) Embracing the consequences of the decision, reflecting caregivers’ sense of relief and acceptance post-decision. Cultural factors, such as filial piety, were found to influence decision-making processes, often intensifying emotional conflicts.

Findings underscore the importance of early, culturally sensitive discussions around end-of-life care in palliative settings for AD patients. Healthcare providers are encouraged to initiate these discussions, offering clear explanations and emotional support to assist caregivers through decision-making. This study highlights the need for a family-centered approach that respects cultural nuances, helping to reduce caregiver stress and enhance the quality of palliative care in AD contexts.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care (EORTC QLQ-C15-PAL) is designed to measure quality of life (QoL) in cancer patients receiving palliative care. The aim of this study was to translate and validate an Urdu version of the questionnaire, which was previously lacking.

Following formal approval from the EORTC, the QLQ-C15-PAL was translated into Urdu. Patients admitted under the palliative care service at a tertiary care center in Karachi, Pakistan, were enrolled in this cross-sectional study, and the Urdu QLQ-C15-PAL and the Edmonton Symptom Assessment Scale (ESAS) forms were administered. Performance status was assessed using the Palliative Performance Scale (PPS). Cronbach’s alpha and Pearson correlation coefficients were determined to gauge reliability and validity. Concurrent and known-group validity were tested using ESAS responses and PPS assessments.

One hundred patients with varying primary cancer sites were included. Cronbach’s alpha for the overall questionnaire was 0.86 and was >0.8 for all subscales except fatigue, where it was 0.697. All correlations to indicate convergent validity had coefficients >0.8 and 87% of correlations between “unrelated” domains were weak, indicating discriminant validity. Known group validity was established and improved QoL was observed in the high PPS (>40) subgroup of patients across multiple domains. However, concurrent validity was not strongly established.

The Urdu QLQ-C15-PAL is a reliable and valid tool to measure QoL in cancer patients who speak Urdu. However, replication of our results in other settings is warranted.

Acute Palliative and Supportive Care Units (APSCUs) provide unique and tailored care to patients with advanced chronic illness. In an APSCU, patients receive intensive palliative care while remaining in an acute care hospital setting. This allows for physical and psychological suffering to be aggressively treated by a dedicated interdisciplinary team. In the case of our patient, the APSCU changed the trajectory of his expected outcome of in-hospital death to a successful discharge home.

We report the case of a patient with advanced colon cancer who suffered cardiac arrest in the emergency department and was expected to die soon after transition to comfort-oriented care.

After terminal extubation, our patient continued to have agitated delirium and was transferred to our APSCU for aggressive symptom control. He stabilized and progressively became more responsive, prompting a change in his plan of care with a goal of discharge home with hospice. The APSCU’s interdisciplinary team was able to adapt to the patient’s unexpected clinical improvement and provide him and his family with the medical, psychosocial, and spiritual expertise to prepare him for a successful discharge home, where he ultimately died 6 weeks later.

The case report demonstrates that an APSCU, with its skilled interdisciplinary team in the acute care hospital, is an ideal setting to provide patient-centered care for seriously ill patients and their families.

To understand how the Go Wish Cards Game (GWCG) can support the expression of values, wishes, and preferences at the end of life among women living with advanced breast and/or gynecological cancer.

This descriptive qualitative study was conducted as part of a larger randomized clinical trial. Participants were recruited from a leading cancer center in Brazil and invited to sort the GWCG cards into three categories: “very important,” “somewhat important,” and “not important.” The 10 cards rated as “very important” were discussed individually to explore their meanings. At the end of the session, participants were asked: “What did it mean for you to play the cards?” Narratives associated with the “very important” cards were analyzed using content analysis based on Bardin’s methodological framework.

Thirty-three women completed the GWCG. Participants described the game as a meaningful opportunity for reflection, communication, and expression of personal values and end-of-life wishes. Discussions of the “very important” cards elicited narratives focused on trust-based relationships, emotional and spiritual support, dignity, and relief from suffering. The most frequently selected cards included wishes such as “to have a doctor I trust and nurses who care about me” and “to have my family and friends with me,” reflecting shared priorities across narratives. Values and wishes were organized into three overarching dimensions: emotional and existential connections; dignity and autonomy; and care and comfort at the end of life. The GWCG was perceived as a valuable tool for facilitating the expression of biopsychosocial and spiritual values.

The findings indicate that the GWCG supports reflection and the articulation of end-of-life values, wishes, and priorities, particularly those related to dignity, autonomy, comfort, and emotional connection. The tool shows potential to promote meaningful conversations and care aligned with what gives purpose and meaning to women living with advanced cancer.

The importance of palliative care in cancer care is underscored, yet there is a significant gap in research specifically focusing on the role of social workers in palliative cancer care. This qualitative study aims to better articulate the specific roles of social workers within palliative oncology settings.

Data were collected by semi-structured Zoom interviews with social workers in palliative cancer care between November 2023 and January 2024. Thematic analysis was used to identify unique themes.

Ten social workers in palliative cancer care were recruited for this study. Eight key themes related to social workers’ role emerged from the interviews. These were the following: (1) mapping out holistic needs through a biopsychosocial–spiritual assessment, (2) providing individual and family counseling, (3) patient and family psychoeducation, (4) resource identification and referral, (5) building communication bridges between patients, families, and oncology teams, (6) promoting patient and family engagement and voice in shared decision-making in cancer care, (7) providing anticipatory grief and bereavement counseling, and (8) strengthening team resilience and fostering well-being.

This study builds upon prior work by focusing specifically on the roles of palliative care social workers in oncology. The findings highlight the multifaceted roles of social workers, demonstrating their capacity to deliver holistic care to cancer patients, families, and healthcare providers to enhance quality of care. The findings may help inform the development of training curricula and practice standards for the subspecialty of oncology-focused palliative social work.

Clinical pharmacists are increasingly recognized as essential members of multidisciplinary palliative care teams, yet their specific roles and impact have not been comprehensively summarized. This scoping review aimed to systematically map and synthesize published evidence on the clinical roles, interventions, and professional contributions of pharmacists within multidisciplinary palliative care services for patients with non-communicable diseases.

A scoping review was conducted by searching PubMed, Embase, Web of Science, and Scopus from January 2000 to May 2024. Eligible studies reported clinical pharmacist interventions in palliative care. Data were extracted on study characteristics, pharmacist activities, and clinical outcomes.

Twelve studies were included, predominantly from the United States. Pharmacist-led interventions encompassed medication reconciliation (91.7%), symptom management (83.3%), adverse drug event prevention (75.0%), patient and caregiver education (58.3%), and policy-level contributions (33.3%). High physician acceptance rates (≥90%) were consistently reported. Outcomes included improved symptom control, reduced drug-related problems, and enhanced patient-reported quality of life.

This scoping review synthesizes current evidence on the roles of clinical pharmacists in palliative care teams. The findings highlight their essential contributions to medication safety, symptom management, deprescribing, and opioid stewardship, reinforcing the need for pharmacist integration into multidisciplinary palliative care models to improve patient-centered outcomes. Future research should focus on implementation models, cost-effectiveness analyses, and service expansion in community-based settings.