Timely integration of palliative care (PC) into standard oncology hospital care offers significant benefits to patients with incurable cancer and their families. International recognition of the importance of timely PC has shifted the focus from integration to determining the optimal timing for introducing PC. The specific care responsibilities of oncology clinicians acting as generalists in PC and the optimal timing for involving PC specialists remain uncertain.

This study aimed to (1) explore how the concept of “timely PC” is understood by oncology clinicians and patients with incurable cancer and (2) investigate how PC is provided in a timely manner in daily clinical practice.

An interview study was conducted with 18 oncology clinicians (7 physicians, 1 physician assistant, and 10 nurses/nurse practitioners) and 12 patients with incurable cancer. The interviews were conducted between October 2022 and June 2023 and a thematic analysis of the interviews was performed.

Three main themes emerged regarding “timely PC”: (1) timely PC is individual and situational, (2) identification of the right time is an ongoing challenge, and (3) proactive care is essential. Regarding the provision of timely PC, 3 themes were identified: (1) having a strong collaboration among various clinicians, (2) having the courage to start a clear and sincere conversation, and (3) being sensitive and personal.

Being timely is not a fixed point in time, but depends on the individual patient and their situation. Clinicians should be proactive and gradual in bringing up PC-related topics and be careful to use the right words. Tools such as the surprise question can support in timely integrating PC but being timely PC highly depends on a patient’s individual context. Therefore, clinicians should be aware that timely PC is a constant search for the most fitting moment.

Family caregivers play a critical yet often overlooked role in healthcare, facing the dual challenge of providing clinical care while managing their emotional well-being. Although several studies have investigated the supportive care needs and services for caregivers of advanced cancer patients integrated into specialized palliative care inpatient units, little is known about cancer caregiver integration and support structures in German outpatient cancer care. This qualitative study addresses this gap by exploring the experiences of family caregivers in Germany, using a dyadic approach to assess their needs, identify referral strategies, and evaluate oncologists’ perspectives on improving caregiver integration and support.

Thematic analysis was conducted on semi-structured interviews with 14 advanced cancer patients, 15 family caregivers, and 3 oncologists. MAXQDA software facilitated the identification of key themes and codes.

Three interconnected themes emerged: (1) The Impact of Illness on the Dyadic Relationship, (2) Communication with Physicians and Understanding of Healthcare Information, and (3) Challenges and Preferences in Navigating Healthcare Services and Psychosocial Support.

The findings highlight the need for enhanced support in caregiving to improve cancer care quality, emphasizing that early palliative care integration is vital for addressing caregiver needs as a core component of comprehensive cancer care. Healthcare practices should adopt personalized, proactive support strategies from diagnosis, implement regular needs assessments, and leverage digital healthcare tools to enhance the efficacy and efficiency of caregiver support.

To develop an effective, targeted educational intervention that can serve as a teaching tool to educate African American (AA) populations, especially the elderly, on end-of-life (EOL) options prior to critical care.

A survey was used to assess the level of preparation and determine deficits in knowledge regarding EOL choices in the AA community of Saginaw, Michigan, before and after educational intervention. We used a paired-sample t-test to assess changes in understanding about EOL planning options, McNemar’s to test changes in intention to use hospice and palliative care, and Spearman correlations to identify demographics influencing change of outcomes. Outcome scores associated with multiple demographic variables were regressed on these demographics.

Our data indicated that the intervention was an effective teaching tool in educating the AA population on EOL choices. Significant changes were observed in understanding of EOL options, concerns about palliative and hospice care, and intention to use palliative and hospice care. Age and education were also associated with selected outcome changes.

AA patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL care options. This study provides evidence needed for physicians to increase their educational efforts with the AA population regarding EOL options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Palliative care is a critical component of healthcare, yet its integration into Nigeria’s health system remains limited. Despite the growing burden of life-limiting illnesses, palliative care is underdeveloped, primarily restricted to tertiary institutions. This review examines the evolution of palliative care in Nigeria, key milestones, persistent challenges, and future directions for strengthening its implementation.

This narrative review synthesized historical records, policy documents, and literature on palliative care in Nigeria. It examined leadership roles, institutional efforts, and government policies influencing Palliative care growth, while highlighting implementation gaps and opportunities.

Palliative care in Nigeria has evolved from early grassroots efforts to structured institutional services. Key milestones include the establishment of the Hospice and Palliative Care Association of Nigeria (HPCAN), and policy advancements such as the National Policy and Strategic Plan for Hospice and Palliative Care. Despite these developments, challenges persist, including inadequate funding, workforce shortages, limited opioid access, policy implementation gaps, and socio-cultural barriers. Leadership engagement, targeted policy advocacy, and comprehensive capacity-building are essential to overcoming these barriers.

Sustained efforts are needed to fully integrate palliative care into Nigeria’s healthcare system. Strategic interventions, including enhanced policy implementation, funding mechanisms, workforce development, and community engagement, are critical for ensuring equitable access to PC services. Strengthening collaborations between the government, healthcare institutions, and international partners will accelerate progress, ultimately improving the quality of life for patients with life-limiting illnesses.

Children with life-limiting conditions (LLC) are exposed to frequent hospitalizations, with their parents as indispensable supporters, even in inpatient care. Data on the experiences of parents in a hospital setting are scarce. This study aims to identify the burdens and needs of parents of children with LLC in an inpatient setting to promote family-centered care and thereby strengthen parents as effective partners in care.

Descriptive qualitative interview study with purposeful sampling and analysis conducted according to the coding method of Kuckartz. A total of 10 interviews with parents (7 mothers, 3 fathers) were included in the analysis.

Main topics reported by parents were (1) structural conditions, (2) commitment and competence of health care professionals, and (3) cooperation between parents and professionals. Parents acquire medical expertise during their child’s illness and learn complex medical procedures to be able to competently care for their child at home. However, their competence is often denied in the inpatient setting. Parents felt that the professionals were overburdened by the complexity of the disease and the fate of the child. They perceived a lack of communication and psychosocial care as burdensome and wished for more psychosocial support and specialized inpatient palliative care structures for their child’s care.

Parents should be supported as equal partners in care to improve the quality of their children’s care. Sole medical care is not enough for children with LLC; therefore, a specialized multidisciplinary palliative care team is highly recommended.

To examine the challenges and practical realities of providing end-of-life care in welfare evacuation centers following the Noto Peninsula earthquake in Japan, and to identify lessons for improving disaster preparedness in similar settings.

Case 1: A man in his late 90s was transferred to a welfare evacuation center after contracting COVID-19 in a general shelter. He arrived with fever and marked physical decline. Acetaminophen was administered to relieve his fever and provide comfort. His condition gradually worsened, and eight days after arriving at the evacuation shelter, he died peacefully while being closely observed by medical staff. Case 2: A man in his 60s with a history of smoking and alcohol use was found bedridden and incontinent at home and was subsequently moved to a welfare evacuation center. Two days after evacuation, he complained of leg and back pain, which was suspected to be due to arterial occlusion. He was monitored and provided with supportive care at the center, however, pain control remained inadequate. Four days after evacuation, he was found in respiratory arrest and was confirmed dead.

These cases underscore the need for establishing unified guidelines and external support frameworks for end-of-life care in disaster settings. In a disaster-prone country like Japan, scenario-based training and the integration of trained volunteers are essential to ensuring dignified care for vulnerable evacuees.

This study aims to explore the everyday experiences of people living with Lewy body dementia and their families, to deepen understanding of their care needs. Lewy body dementia is a neurodegenerative condition associated with shorter life-expectancy and poorer quality of life than other forms of dementia. Cognitive fluctuations, visual hallucinations, falls, and motor features of Parkinsonism gives rise to complex and debilitating symptoms. Other prominent features include behavioral and emotional problems, rapid eye movement sleep disorder, and autonomic dysfunction. Improving palliative care for people with dementia continues to be an international priority; however, little is known as to how a palliative care approach could support people living with Lewy body dementia and their families.

Drawing on narrative theory of self and personhood, a qualitative, longitudinal narrative approach provided unique insights into 5 couples’ experiences of living with Lewy body dementia. Analysis was conducted using Murray’s levels of narrative analysis in health psychology to explore stories at the personal, interpersonal, positional, and societal level.

Participants with Lewy body dementia described losses associated with communication, continence, and energy leading to a progressive loss of independence. For their family caregivers a loss of companionship was particularly salient. These losses, compounded by a perceived lack of clinical support, resulted in suffering both for the person with Lewy body dementia, and for those close to them.

There has been a societal and political shift to move beyond loss in dementia, to a focus on abilities and living well. However, acknowledging loss, while supporting symptom management is an important aspect of Lewy body dementia care. Providing person-centered, palliative supportive care throughout the disease trajectory could reduce suffering and enhance well-being.

Patients with cancer frequently experience insomnia that significantly impacts their quality of life, worsens existing symptoms, and potentially hinders treatment outcomes and recovery. Here, we report on 3 cancer patients whose insomnia was improved with low-dose olanzapine.

A retrospective review of medical records was conducted for 3 cancer patients experiencing insomnia treated with olanzapine at Johns Hopkins Hospital. The data collection included the type of cancer diagnosis, the level of insomnia severity experienced by individuals, and treatment results and outcome.

Olanzapine improved sleep in all 3 patients and decreased nausea/vomiting and anxiety in patients 2 and 3.

A low dose of olanzapine has potential to treat insomnia in cancer patients. The ideal dosing regimens and potential risks are unclear, especially for long-term use. More research and clinical trials are needed to evaluate off-label use of olanzapine for insomnia, including its efficacy and risks, and to optimize the dosage to reduce its side effects in cancer patients. Oncology providers should consider olanzapine as a potential treatment for insomnia, especially given its off-label uses and potential benefits.

Cholangiocarcinoma (CCA) is the second most lethal primary hepatic malignancy. It has been well-reported that most cancer patients prefer to die at home or in a hospice facility. However, there is limited data on the place of death for CCA patients. We evaluated trends and disparities in place of death for patients with CCA from 1999 to 2020.

Using the CDC WONDER database (1999–2020), we calculated the frequency of CCA deaths at home/hospice and the average annual percentage change (AAPC) over this period stratified by race, age, gender, and region. We employed logistic regression to assess for associations between these variables and place of death for patients whose death was attributed to CCA.

Among 140,422 deaths, a rise in deaths occurred in home/hospice facilities compared to inpatient medical or nursing facilities across all variables examined. Blacks and individuals ≥ 85 had the highest proportion of deaths outside of home/hospice. However, Blacks showed the highest AAPC (8.56%) in home/hospice deaths, followed by Asians (AAPC 8.44%). In contrast, individuals aged 45–54 saw the lowest AAPC (4.27%). Non-whites were less likely to die at home/hospice, with Blacks demonstrating the lowest adjusted odds ratio (aOR 0.64). Those ≥ 85 were less likely to die in home/hospice (aOR 0.78), whereas individuals aged between 55–64 (aOR 1.11) and 65–74 (aOR 1.12) had increased odds of dying in these settings. Patients from the Western region were the most likely to die at home/hospice (aOR 1.04).

Our study highlights disparities in place of death of patients with CCA amongst races, regions, and ages. Non-whites, extremes of ages, and patients from the Northeast have disproportionately poor outcomes in terms of end-of-life care in the US. These findings emphasize the need for efforts to address sociodemographic disparities in end-of-life care to improve patient-centered health outcomes.

Objective. Witnessing existential suffering in patients is associated with increased risks of compassion fatigue and burnout in palliative care physicians. Finding meaning is a protective factor for burnout and is associated with increased job satisfaction and a sense of purpose.

While the significance of finding meaning through the doctor-patient relationship is widely recognized, less is known about the subjective experience of palliative care physicians, how they ascribe meaning, and how meaning sustains them. The aim of this study was to describe and interpret how palliative care physicians experience meaning when caring for patients.

Method. Hermeneutic-phenomenology, inspired by the philosophy of Heidegger and Gadamer, informed the methodological approach. Ten palliative care physicians, caring for adult patients, completed semi-structured interviews. Van Manen’s “lifeworld existentials” supported our reflexive hermeneutic analysis to interpret participants’ moments of meaning-making.

Results. Our analysis identified two interpretive concepts for meaning-making: moments of connection and moments of transformation. Meaningful connection occurred when physicians and patients together acknowledged existential suffering in death and dying and experienced it on a personal, human level. Often, experiences were fleeting but had a lasting impact. Experiences of connection had a transformational effect on physicians and were associated with a sense of reward and purpose in palliative care work.

Significance of results. Findings are discussed in relation to philosophical literature on the experience of time, contrasting man-made time with the existential experience of time. Moments of connection and transformation experienced by palliative care physicians fueled their commitment to their profession. At a time when burn-out is rife, identifying, describing, and understanding moments of meaning may offer protective benefits for physicians working in palliative care.

Moral distress affects a significant proportion of clinicians who have received requests and participated in euthanasia or physician-assisted suicide (E/PAS) globally. It has been reported that personal and professional support needs are often unaddressed, with only a minority of those reporting adverse impacts seeking support.

This study aimed to review studies from 2017 to 2023 for the perceived risks, harms, and benefits to doctors of administering E/PAS and the ethical implications for the profession of medicine resulting from this practice.

The search explored original research papers published in peer-reviewed English language literature between June 2017 and December 2023 to extend prior reviews. This included both studies reporting quantitative and qualitative data, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. The quantitative review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The qualitative review used the Critical Appraisal Skills Programme to assess whether studies were valid, reliable, and trustworthy.

Thirty studies (quantitative n = 5, qualitative n = 22, mixed methods n = 3) were identified and fulfilled acceptable research assessment criteria. The following 5 themes arose from the synthesis of qualitative studies: (1) experience of the request prior to administration; (2) the doctor’s role and agency in the death of a patient; (3) moral distress post-administration; (4) workload and burnout; and (5) professional guidance and support. Both quantitative and qualitative studies showed a significant proportion of clinicians (45.8–80%) have been adversely affected by their involvement in E/PAS, with only a minority of those reporting adverse impacts seeking support.

Participation in E/PAS can reward some and cause moral distress in others. For many clinicians, this can include significant adverse personal and professional consequences, thereby impacting the medical profession as a whole.

Standardized measures to evaluate neurological patients in palliative care are missing. The Integrated Palliative Outcome Scale, a self-report tailored for neurological patients (IPOS Neuro-S8) helps identify symptom burden but lacks validation in German. This study aimed to validate the IPOS Neuro-S8 in severely affected multiple sclerosis (MS) patients.

This validation study is a secondary analysis of data from a clinical phase II intervention study with severely affected MS patients. The original study enrolled German-speaking patients aged 18 with severe MS who receive an escalating immunotherapeutic agent and/or exhibit a high level of disability were recruited from the administrative district Cologne (#DRKS00021783). In this validation study, we evaluated construct, discriminant, and convergent validity, internal consistency, test–retest reliability, and sensitivity to change of the IPOS Neuro-S8, using the “Hamburger Lebensqualitätsmessinstrument” (HALEMS), and the Hospice and Palliative Care Evaluation supplemented by neurological symptoms (HOPE+) as comparison measures.

Data from 80 MS patients (mean age 56, SD = 11) were analyzed. Exploratory and confirmatory factor analyses revealed a 3-factor structure (r = 0.34–0.63), reflecting distinct clinical patterns, i.e., breath-mouth connection, pain-sleep cycle, and nausea-vomiting link. Significant convergent validity to hypothesized total score of the HOPE+ (rs(78) = 0.71, p < 0.001) and good discriminant validity using the HALEMS total score (rs(78) = 0.48, p < 0.001) were observed. Correlation with physical symptoms of the HALEMS was stronger than with nonphysical aspects. Internal consistency (Cronbach’s α = 0.67) and test–retest reliability (intraclass coefficient = 0.75) were acceptable.

IPOS Neuro-S8 displays promising psychometric properties for assessing palliative care symptoms in severe MS, a model for other severe neurological diseases due to MS's broad central nervous involvement, allowing findings to be transferable to other neurological diseases. A criterion for minimal clinically important difference was established to evaluate the sensitivity to change. Additional validation across different neurological conditions and disease severities is warranted to enhance generalizability and clinical utility.

End-of-life care poses significant ethical challenges for nurses, requiring a deep understanding of moral empathy and ethical decision-making. This study examines the impact of these factors on end-of-life decision-making among nurses in oncology and pain management units in Egypt.

A cross-sectional design was employed to gather data from participants at a single point in time, facilitating an analysis of the relationships among ethical principles, moral empathy, and nursing practice. The study involved 246 registered nurses with at least 6 months of experience, selected through stratified random sampling from oncology and pain management units in Damietta, Egypt. These settings were chosen due to their central role in palliative care, as Damietta serves as a regional healthcare hub with specialized units addressing chronic and end-of-life conditions. This selection allows for an in-depth exploration of the ethical dimensions involved in providing palliative care. Informed consent was acquired from all participants, ensuring confidentiality and the right to withdraw from the study at any time.

The findings indicated that 72% of participants reported high levels of moral empathy, which positively correlated with ethical decision-making scores (r = 0.65, p < 0.01). However, 58% of the nurses also reported experiencing moderate to high levels of moral distress in various clinical scenarios. Additionally, nurses in supportive ethical climates experienced significantly lower moral distress than those in less supportive settings (p < 0.05).

This study highlights the importance of integrating ethical training and moral empathy into nursing education and practice. The findings underscore the need for policy reforms to embed ethics and empathy training in nursing curricula and professional development programs, fostering ethical competence and enhancing patient care quality.