Historically, patients with cancer were referred to palliative care near the end of life. In recent years, the increased integration of palliative care throughout the entire trajectory of illness has helped patients with cancer better manage their symptoms and improve QOL. However, it is unknown how patients think about the presence and role of earlier, integrated palliative care. This study explored how patients and caregivers experience cancer care in the context of palliative care co-management with oncology.

We conducted interviews with 18 patients and 13 caregivers to investigate perspectives, attitudes, and experiences surrounding cancer care, specifically with their experiences of co-management with a palliative care outpatient clinic and oncology. Using grounded theory, we identified a typology of patient and caregiver approaches when discussing the care they received and/or desired.

Our data revealed 3 approaches to thinking about palliative care in cancer care. While some participants embraced the “Cure Centrality” approach, caring only about fighting the disease, others adopted a “Quality-of-Life (QOL) Centrality” approach, desiring their health-care team to prioritize a broader range of concerns. A third approach, The “Dual Centrality” approach, espoused values from both approaches.

While co-management of palliative care and oncology is complementary by design, our data suggest that patients and caregivers take a variety of approaches to their copresence. For some patients, palliative care served as an important legitimizing resource for patients desiring expanded priorities in their care (e.g. higher value on QOL and symptom management) and enabling patient-centered care.

Wishes to hasten death (WTHDs) are common in patients with serious illness. The Schedule of Attitudes Toward Hastened Death (SAHD) is a validated 20-item instrument for measuring WTHD. Two short versions have also been developed based on statistical item selection. However, all existing versions show some limitations with potential for improvement. This study aims to develop and initially validate a theory-driven and statistically sound SAHD short version based on a large multinational sample to advance the WTHD assessment in different countries and with different legislations.

A 3-step procedure was carried out including (1) theory-driven item selection, (2) exploratory, and (3) confirmatory factor analysis. We used a data set collected between 1998 and 2020 across 3 different countries (Germany, Spain, USA). Participants were N = 1156 complete cases (n = 181 German, n = 101 Spanish and n = 874 US) of severely ill adult in- and outpatients. They had to be ≥18 years and give informed consent.

The exploratory factor analysis revealed that 10 of 11 items previously selected theory-driven loaded on either of 2 factors: (1) WTHD and (2) internal locus of control. These factors showed good to excellent reliability according to Cronbach’s α and McDonald’s Ω, as well as an excellent fit of our data as an overall model for the total sample.

The developed SAHD-10 represents a reliable and valid alternative to the SAHD and an efficient means to measure and further investigate a WTHD in cross-cultural clinical and research settings.

This study aims to validate the Palliative and Complex Chronic Pediatric Patients QoL Inventory (PACOPED QL), a new quality-of-life (QoL) assessment tool for pediatric palliative patients with complex chronic conditions. The goal is to create a comprehensive and inclusive instrument tailored to this unique population, addressing the gap in existing tools that do not meet these specific needs.

The validation process included a literature review and consultations with experts. A pilot study refined the items, followed by a cross-sectional study involving pediatric palliative patients and their caregivers. Statistical analyses, such as Cronbach’s alpha for internal consistency and exploratory factor analysis for structural validity, were utilized.

The PACOPED QL, comprising 50 items across 8 domains and 6 subdomains, demonstrated strong reliability with Cronbach’s alpha and Guttman split-half reliability both exceeding .9. Validity assessments confirmed its suitability for children with complex illnesses. The tool was refined through expert consultations and pilot testing, reducing items from an initial 85 to a final 50, ensuring relevance and clarity.

The PACOPED QL shows strong reliability and validity in assessing QoL in pediatric palliative patients. Its comprehensive structure makes it a promising tool for clinical practice and research, addressing a critical need for a tailored assessment in this population. The instrument’s robust psychometric properties indicate its potential utility in improving the QoL assessment and care for children with life-threatening illnesses. Further studies are encouraged to confirm its effectiveness across various settings.

Advance care planning (ACP) supports communication and medical decision-making and is best conceptualized as part of the care planning continuum. Black older adults have lower ACP engagement and poorer quality of care in serious illness. Surrogates are essential to effective ACP but are rarely integrated in care planning. Our objective was to describe readiness, barriers, and facilitators of ACP among seriously ill Black older adults and their surrogates.

We used an explanatory sequential mixed methods study design. The setting was 2 ambulatory specialty clinics of an academic medical center and 1 community church in Northern California, USA. Participants included older adults and surrogates. Older adults were aged 60+, self-identified as Black, and had received care at 1 of the 2 clinics or were a member of the church congregation. Surrogates were aged 18+ and could potentially make medical decisions for the older adult. The validated ACP engagement survey was used to assess confidence and readiness for ACP. What “matters most” and barriers and facilitators to ACP employed questions from established ACP materials and trials. Semi-structured interviews were conducted after surveys to further explain survey results.

Older adults (N = 30) and surrogates (N = 12) were confident that they could engage in ACP (4.1 and 4.7 out of 5), but many were not ready for these conversations (3.1 and 3.9 out of 5). A framework with 4 themes – illness experience, social connections, interaction with health providers, burden – supports identification of barriers and facilitators to ACP engagement.

We identified barriers and facilitators and present a framework to support ACP engagement. Future research can assess the impact of this framework on communication and decision-making.

Pain is a frequent symptom in cancer patients (CP), and its multidimensional assessment is essential for a comprehensive approach and to establish clinical prognoses. The Short-Form McGill Pain Questionnaire (SF-MPQ) is an internationally recognized tool for the multidimensional assessment of pain, both in clinical and research settings. However, no studies have been reported in Latin America that determine its psychometric properties in CP and chronic pain.

To determine the psychometric properties of the SF-MPQ in adult Mexican cancer patients with chronic pain.

An instrumental design was used with a non-probabilistic convenience sample of 222 cancer patients treated at the pain clinic of a tertiary care hospital. Analyses were conducted to evaluate factorial structure (exploratory and confirmatory factor analysis [CFA]), reliability (internal consistency), measurement invariance, and criterion validity (concurrent and divergent).

CFA verified a 9-item structure divided into 2 factors: (1) Affective-Nociceptive and (2) Neuropathic. A global Cronbach’s alpha coefficient of .82 and a global McDonald’s Omega index of .82 were identified. Configural, metric, and scalar invariance (ΔCFI ≤ .01; ΔRMSEA ≤ .015) were confirmed regarding the sex variable. Finally, the SF-MPQ showed a positive correlation with the Numerical Rating Scale (rho = .436, p< .01) and a negative correlation with the EORTC-QLQ C30 (rho = −.396, p< .01).

The Mexican version of the SF-MPQ presented adequate psychometric properties and fit indices, making it a valid and reliable instrument for use in clinical and research settings in Mexico. Its use is recommended for the comprehensive assessment of pain in oncology in Mexico, as it allows for the understanding of pain characteristics beyond intensity, guiding the establishment of clinical prognoses.

Wernicke encephalopathy (WE) is an acute neuropsychiatric disorder caused by thiamine deficiency. The classical triad of symptoms for WE include mental status changes, ataxia, and ophthalmoplegia. In contrast, more uncommon symptoms include hallucinations. Known risk factors include alcoholism, malignancies, and chronic kidney disease, particularly hemodialysis. However, WE in nonalcoholic adults is often overlooked.

We report a WE patient with lung cancer undergoing hemodialysis who presented with the uncommon symptom of active hallucinations, which were improved by thiamine replacement therapy, despite a borderline whole blood thiamine concentration.

An 81-year-old woman with lung cancer and undergoing hemodialysis was referred to our psycho-oncology department for active hallucinations that appeared suddenly 24 days earlier. She had been diagnosed with lung cancer 6 months earlier and was undergoing chemotherapy and radiotherapy. She had no alcohol dependence or anorexia before or after admission. Physical examination revealed active visual hallucinations and delirium. On suspicion of WE, intravenous thiamine was administered. One day after administration, the hallucinations and delirium improved. Her whole blood thiamine concentration was borderline (24 ng/ml).

WE might be a cause of active visual hallucinations as they disappeared on thiamine administration alone. We need to be aware of risk factors such as malignancies and hemodialysis, and it is important not to overlook WE.