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.

The objective of this study is to conduct an in-depth exploration of the psychological well-being, hope, and expectations of cancer patients receiving care in a palliative care unit, utilizing a qualitative research approach.

We employed the methodology of interpretative phenomenological analysis (IPA). Our data collection involved conducting 1-hour semi-structured interviews with the patients. In the subsequent data analysis, we applied investigator triangulation to ensure rigor and reliability.

Understanding patients’ hope and expectations from palliative care is crucial as it can serve as an indicator of the quality of care and motivate care providers to fulfill these expectations as much as possible. Throughout the IPA, 3 superordinate themes emerged from the qualitative data: cancer diagnosis and the spectrum of emotions, hope and cancer patient, and oncology patient expectations of palliative care.

From the patient’s perspective, making sense of their cancer experience involves managing symptoms, redefining their understanding of illness, adapting to functional changes, and fostering open communication among themselves, their families, physicians, and the palliative care team. This underscores the crucial necessity for an interdisciplinary approach and emphasizes the importance of reinforcing positive support systems. In essence, our study delves into the multifaceted psychological aspects of cancer patients in the context of palliative care, shedding light on their hope and expectations as they navigate the challenging terrain of cancer treatment and palliative support.

The recent wave of clinical trials of psychedelic substances among patients with life-limiting illness has largely focused on individual healing. This most often translates to a single patient receiving an intervention with researchers guiding them. As social isolation and lack of connection are major drivers of current mental health crises and group work is expected to be an important aspect of psychedelic assisted psychotherapy, it is essential that we understand the role of community in psychedelic healing.

To explore how psychedelic guides in the United States discuss the role of “community” in naturalistic psychedelic groups.

This is a secondary qualitative data study of data from a larger modified ethnographic study of psychedelic plant medicine use in the US. Fifteen facilitators of naturalistic psychedelic groups were recruited via snowball sampling. Content analysis was used to identify themes.

Participants viewed the concept of community as essential to every aspect of psychedelic work, from the motivation to use psychedelics, to the psychedelic dosing experience and the integration of lessons learned during psychedelic experiences into everyday life. Themes and subthemes were identified. Theme 1: The arc of healing through community (Subthemes: Community as intention, the group psychedelic journey experience, community and integration); Theme 2: Naturally occurring psychedelic communities as group therapy (Subthemes [as described in Table 2]: Belonging, authenticity, corrective experience, trust, touch).

Results suggest that existing knowledge about therapeutic group processes may be helpful in structuring and optimizing group psychedelic work. More research is needed on how to leverage the benefit of community connection in the therapeutic psychedelic context, including size and composition of groups, selection and dosing of psychedelic substances in group settings, facilitator training, and role of community integration. Psychedelic groups may provide benefits that individual work does not support.

Caring for children with solid tumors (STs) can impact caregiver’s physical and mental health. Caregiver mastery, which influences psychological well-being, is vital in improving outcomes for both caregivers and children. The study aimed to investigate the relationship between caregiver mastery, anxiety, depression, fear of disease progression (FoP), caregiver burden, and the quality of life (QOL) of children with ST.

This cross-sectional study was conducted from June 2022 to April 2023 at a Grade A tertiary hospital in Shandong. Family caregivers of children with ST completed several validated measures, including the Pediatric Quality of Life Inventory (PedsQL) 3.0 Cancer Module, the Fear of Progression Questionnaire-parent version (FoP-Q-SF/PR), the Zarit Burden Interview Scale (ZBI), the hospital anxiety and depression scale (HADS), and the Caregiver Mastery Scale. Multiple linear regression analyses assessed the relationships between FoP, caregiver burden, anxiety, depression, caregiver mastery, and children’s QOL. Results were expressed as β and 95% confidence intervals (CIs).

A total of 454 caregivers participated. Caregiver mastery was positively correlated with children’s QOL (β = 0.80, 95% CI: 0.20 to 1.39). Depression (β = −0.64, 95% CI: −0.83 to −0.45), anxiety (β = −0.67, 95% CI: −0.85 to −0.49), caregiver burden (β = −1.20, 95% CI: −1.60 to −0.80), and FoP (β = −0.04, 95% CI: −0.05 to −0.03) were negatively related to children’s QOL. Caregiver mastery moderated the associations between depression, caregiver burden, FoP, and children’s QOL, while also improving the effect of mild anxiety on QOL.

The study underscores the importance of fostering caregiver mastery to mitigate the negative impact of caregiver distress on children’s QOL and improve outcomes for both caregivers and children with solid tumors.

Caregiver mastery moderates the effects of anxiety, depression, FoP, and caregiver burdenon children’s QOL. Supporting caregiver mastery can alleviate caregiver burden and enhance both caregiver and child well-being.

Since physician-assisted dying (PAD) has become a part of the clinical dialogue in the United States (US) and other Western countries, it has spawned controversy in the moral, ethical, and legal realm, with significant cross-country variation. The phenomenon of PAD includes 2 practices: Euthanasia and medical aid in dying (MAiD). Although euthanasia has been allowed in different parts of the world, in the US it is illegal. MAiD has been enacted into law in some jurisdictions. As the practice involves people at the end of life (EOL), often with cancer, and sometimes struggling with psychiatric symptoms; they gain added salience in the field of Consultation-Liaison (CL) Psychiatry in general and Psycho-Oncology in particular.

The current paper reviews a case where a patient did request for MAiD and successfully carried it through, this case became more salient, as the CL Psychiatry department was intimately linked at various stages of care for the patient.

In describing the case several other aspects of EOL care issues were touched upon, and the various debates as well as treatment modalities, for an individual requesting for medical aid in dying were described.

MAiD will possibly remain a sensitive and controversial topic of discussion across the spectrum of healthcare, and as responsible and compassionate advocates for the patients, clinicians need to engage more with the debate surrounding it and facilitate informed decision making. We believe that the present case will throw light on to this enigmatic practice and help in furthering the dialogue surrounding MAiD.

Cancer is associated with physical, social, spiritual, and psychological changes in patients and their caregivers. However, in sub-Saharan Africa, there is lack of evidence on the impact of gender, social norms, and relationship dynamics in the face of terminal illness. The aim of this paper is to explore how gender identity, social norms, and power relations are impacted when a person is living in Uganda with advanced cancer.

Focus groups with adult men and women living with advanced cancer in Uganda were conducted. Interviews explored the social effects of cancer and common challenges, including how both disease and treatment affect the patient and marital relationships within their families. Participants’ recommendations were sought to improve the social well-being of patients and their families. Data were analyzed using inductive thematic analysis.

Men and women experienced negative changes in their roles and identities, often feeling unable to fulfill their marital duties in terms of intimacy, their social roles and responsibilities based on societal expectations. Men expressed loss of a “masculine” identity when unable to provide economically for the household. This led to tension in the familial power dynamics, contributing to relationship breakdown and gender-based violence (GBV) against spouses. Women noted challenges with parenting, relationship breakdowns, and increased GBV.

Gender impacts the patient and the family dynamic throughout the life course, including during advanced cancer. Patients and caregivers experience a change in their roles and identities while coping with existential distress and end-of-life tasks. Given these results, gender considerations and dynamics should be incorporated into overall palliative care provision. In addition, there is a need to integrate GBV screening and support in cancer services to address social health and safety needs in the context of serious illness.

Chronic kidney disease (CKD) is a global health challenge that affects patients’ symptom burden and quality of life. Palliative care interventions show promise in addressing the multiple needs of CKD patients, focusing on symptom management, psychosocial support, and advance care planning. This study aimed to evaluate the effectiveness of palliative care interventions in improving symptom management in patients with CKD.

The study used a quasi-experimental research design with a sample size of 128 participants diagnosed with CKD. Participants were selected based on strict criteria to ensure consistency of palliative care interventions. Non-probability purposive sampling was used to select participants. Data were collected using validated instruments such as the Edmonton Symptom Assessment System, Kidney Disease Quality of Life-Short Form, Palliative Performance Scale, Dialysis Symptom Index and Functional Assessment of Chronic Illness Therapy-Fatigue. These instruments provided robust measures of symptom severity, quality of life, performance status, symptom burden, and fatigue. The intervention consisted of 4 sessions designed to address symptom management, psychosocial support, and advance care planning strategies.

Post-intervention, CKD patients showed significant improvements across multiple measures. Pain decreased from 6.2 to 4.8 (p = 0.002, 23% improvement), and fatigue decreased from 7.5 to 6.1 (p = 0.001, 19% reduction). Depression improved from 5.6 to 4.2 (p = 0.001, 25% reduction) and anxiety decreased from 4.9 to 3.8 (p = 0.004, 22% reduction). Physical functioning increased from 65.3 to 72.1 (p = 0.002, 10% improvement), cognitive function from 72.8 to 78.5 (p = 0.003, 8% increase), and emotional well-being from 60.2 to 65.7 (p = 0.004, 9% improvement). Ambulation improved from 75.2 to 81.5 (p = 0.001, 8% increase), activity from 68.7 to 74.3 (p = 0.004, 8% increase), and self-care from 82.4 to 88.1 (p = 0.003, 7% improvement). Nutritional status improved from 79.6 to 85.2 (p = 0.002, 7% increase) and level of consciousness from 70.3 to 75.8 (p = 0.005, 8% increase). Fatigue scores decreased significantly from 53.2 to 48.6 (p = 0.001, 9% decrease), activities of daily living from 50.1 to 45.8 (p = 0.001, 9% decrease), and well-being from 55.6 to 50.2 (p = 0.001, 10% improvement).

The results highlight the potential of palliative care interventions to improve outcomes and well-being for people with CKD. By addressing their complex needs, these interventions offer valuable lessons for nephrology and palliative care practice, emphasizing holistic approaches to patient care. The findings add to the evidence supporting the integration of palliative care into CKD management, highlighting its value in improving patient outcomes and quality of life.

Palliative care (PC) professionals confront the suffering and mortality of their patients, adding to the conventional stressors related to work dynamics or personal life. However, the specific stressors inherent in end-of-life (EOL) care and their relation with the mental health of these professionals, remain inadequately explored. This study seeks to examine the respective roles of various stressors encountered by PC professionals and their associations with mental health. Additionally, it aims to elucidate the relationships between specific psychosocial factors (psychological resources or work environment perceptions) and mental health within the context of stress associated with PC.

An online questionnaire was developed and distributed to PC professionals in France (e.g., doctors, nurses, care assistants, psychologists). The questionnaire contained measures of stress experienced in the last 6 months (personal, professional, or EOL); measures of mental health; and measures of psychosocial factors (perceptions of work environment and psychological resources).

Three hundred and seventy-nine participants completed the entire questionnaire in November 2022. Among the various stress factors assessed, the accumulation of EOL care emerged as a robustly linked stressor to poorer mental health. In this specific context of EOL care stress, self-compassion and psychological flexibility are significantly related to well-being and mental health, even when other psychosocial factors related to the work environment are statistically controlled.

This study is the first to highlight the main stressor affecting the well-being of PC professionals – the accumulation of EOL care – along with the key resources – psychological flexibility and self-compassion – that are associated with their well-being.

Palliative care, which was formally established in the Global North, is now recognized globally as part of health care. As part of a larger study, we were interested in how decision-makers at a leading hospice in South Africa understood the changing local context and its influence on the delivery of services. We were interested in how the concept of “total pain,” as outlined by Saunders, applies in a very unequal and under-resourced society in the shadow of a long, oppressive colonial, and apartheid past.

We conducted face-to-face semi-structured interviews with 12 staff at St Luke’s Combined Hospices in Cape Town, South Africa, and analyzed the data following Braun and Clarke’s thematic analysis approach.

Four major themes emerged from the data. First, St Luke’s has faced the challenge of serving a larger and far more diverse population than it had under apartheid. Second, the organization has undergone a process of rethinking holism and holistic services offered to palliative care patients in this context. Third, diversity and cultural sensitivity are key to how services are offered, and finally, the concept of “total pain” in this context is linked to questions of power and empowerment.

This study is small and situated within a particular context, and it is clear that more data are needed. Nevertheless, the study shows that considering the Global South and postcolonial context is important for thinking about total pain and a global system of palliative care which is sensitive to the majority world context.

Spiritual care is essential for the health and well-being of patients and their families, so nursing and midwifery students should have professional competency in this field.

The present study aimed to translate the Spiritual Care Competency Self-Assessment Tool for nursing and midwifery students into Persian and evaluate its psychometric properties.

This study has a methodological study design.

The present study was conducted from July 4 to November 19, 2023, at the Faculty of Nursing and Midwifery in west of Iran. The tool was translated into Persian using the forward-backward translation method. The construct validity was examined using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with a total of 536 nursing and midwifery students. The internal consistency was assessed using Cronbach’s alpha coefficient. Also, the reliability of the tool was evaluated using the test–retest method. SPSS version 26 and Lisrel version 8 software were used in this study.

Face and content validity was confirmed quantitatively and qualitatively. The results of EFA and CFA confirmed the tool with 4 factors and 28 items. CFA results indicated a well-fitting model (comparative fit index [CFI] = .97, Non-Normed Fit Index (NNFI) = .92, goodness of fit index [GFI] = .91, root mean square error of approximation [RMSEA] = .05, Standardized Root Mean Square Residual (SRMR) = .046). Pearson’s correlation coefficient confirmed a significant relationship between items, subscales, and the main scale. Also, Cronbach’s alpha coefficient (.968) and test–retest (.867) confirmed the reliability of the Persian version of the tool.

The present study showed that the Persian version of the EPICC Spiritual Care, with 4 factors and 28 items, was suitable for validation and that its psychometric properties were acceptable according to COSMIN criteria. In general, the results showed that the Persian version of the EPICC Spiritual Care is a valid and reliable tool that students, preceptors, and educators can use in clinical settings as a practical way of discussing and evaluating spiritual care competency in Iran.

Caregivers of those with neurodegenerative disease (ND) manage complex symptoms which impact their wellbeing. Self-compassion can promote maintenance of wellbeing during challenging experiences, including caregiving. Little guidance exists for observationally studying self-compassion or targeted interventions for this population. Our objective was to complete a scoping review of research describing self-compassion in the context of caregiver wellbeing of caregivers of those living with ND.

Following Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) guidelines, 3 online databases identified 350 peer-reviewed articles, 18 of which were included in this study. Eligibility included being written in English, targeting caregivers of those living with ND, and examination of self-compassion. Articles were organized by the incorporation or characterization of self-compassion in the study design.

Alzheimer’s disease predominated study samples of care recipients. Across study types self-compassion appeared as a theoretical concept, emerging theme, variable associated with other outcomes, and main outcome variable. Self-compassion is frequently measured using the Self-Compassion Scale, full or short form .

The study of self-compassion with caregivers of individuals living with ND is growing. Current literature is somewhat unfocussed, leading to gaps in understanding conceptualization to achieve maximum intervention benefits. Clarifying the role of self-compassion in caregiver wellbeing will provide a lens through which non-pharmacologic, psychotherapeutic, and behavioral intervention development may be framed to reduce negative psychological outcomes. The most frequently represented ND is Alzheimer’s disease or other dementia, obscuring other NDs like amyotrophic lateral sclerosis, Parkinson’s disease, and others.

To incorporate a longitudinal palliative care curriculum into obstetrics and gynecology (Ob-Gyn) residency that could become standardized to ensure competencies in providing end of life (EOL) care.

This was a prospective cohort study conducted among 23 Ob-Gyn residents at a tertiary training hospital from 2021 to 2022. A curriculum intervention was provided via lecture and simulation. An inpatient palliative care rotation was also created for the intern class. Scores for knowledge and confidence were compared pre- and post-curriculum. Performance on patient simulations was compared for interns who had the inpatient palliative rotation versus those that had not in a crossover fashion. Number of palliative care consults was also compared before and during the curriculum. A pooled, weighted rank-based test was used for analysis of the data with a p-value < 0.05 considered significant.

One hundred percent of the 23 eligible participants participated in this study. A statistically significant increase in scores on all quizzes (p-values 0.047, <0.001, and <0.001) and confidence surveys (composite score p-value < 0.001) was seen after curriculum completion. No statistically significant difference was able to be identified in standardized patient simulation performance. Palliative care consultation increased by 55%.

EOL care is a critical component of any physician’s practice including obstetrician gynecologists. However, prior studies demonstrate a lack of standardized training. Our study demonstrates that a multimodal palliative care curriculum is an effective method to train Ob-Gyn residents and improve palliative care involvement in patient care.

Family caregivers influence realization of home death among advanced cancer patients. However, little is known about the caregiver factors influencing patients’ preferred and actual place of death. We aimed to assess caregiver factors associated with both caregivers’ and patients’ preferred place of death, and the association between their preferred and actual place of death.

From a prospective cohort of 600 patients with stage IV solid malignancy, and 311 caregivers, we analyzed data for 227 patient–caregiver dyads of deceased patients who responded to the question on preferred place of death for patients at least once within the last 3 years before death. We assessed the association of patients’ and caregivers’ preferred place of death for patients with caregivers’ competency, employment, relationship quality with the patient, their relationship with the patient, family support, and the presence of a domestic helper. We controlled for relevant patient factors and utilized the actor–partner interdependence framework for analysis.

Overall, 67% patients and 74% caregivers preferred a home death for patients during the last 3 years prior to patient’s death. Patients whose caregivers reported greater caregiving competency were more likely to prefer a home death (average marginal effect: 0.02; 95% confidence interval, 0.003–0.04). Spousal caregivers were less likely to prefer a home death (−0.10 (−0.19, −0.004)). Caregivers lacking family support were more likely to prefer an institutional death (0.04 (0.002–0.08)). While caregivers’ preferences had a marginally significant association with patients’ actual place of death (p-value < 0.10), we did not find any association between patients’ preferred and actual place of death.

Caregivers play a crucial role in shaping patients’ preferred and actual place of death. Supporting caregivers, particularly spousal caregivers, and enhancing their caregiving competency could potentially help achieve a home death for the patient.