A person-centered outcomes-based quality improvement program is lacking within palliative care in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality.

This study aimed to explore the barriers and facilitators perceived by healthcare providers to integrating the PCOC model in a Chinese hospital-based palliative care unit.

A qualitative descriptive study was conducted using semi-structured focus group and individual interviews. A rapid deductive analysis approach was selected for data analysis. The Consolidated Framework for Implementation Research framework was used to guide the study design, data collection, analysis, and interpretation.

Eighteen healthcare professionals participated in this study, four focus group interviews and five individual interviews were completed. Barriers to the PCOC integration included clinical application and workload concerns (patients in terminal stage, patients’ dialects, workload concerns, and staff shortages); attitudinal barriers (negative attitudes toward PCOC); psychological barriers (numbness to their work) and barriers related to knowledge and self-efficacy (lack of knowledge, capacity, and self-efficacy in palliative care). Facilitators included adapting the program to local contexts, ongoing education and feedback, effective PCOC data use, a supportive work and clinical environment and staff’s perceived advantages of the model across clinical, research and process domains.

The successful integration of the PCOC program hinges on local adaptation, improved data utilization, education, and IT support. In regions with less developed palliative care, enhancing professionals’ knowledge and self-efficacy is crucial. Incorporating assessment and clinical response protocols into technology can accelerate palliative care development and implementation.

Multimorbidity is increasingly common among older adults in Sub-Saharan Africa (SSA), yet the role of social determinants in shaping its prevalence and outcomes remains underexplored.

This review aimed to (a) identify the prevalence, types, and patterns of multimorbidity among older adults in SSA; (b) examine the influence of social determinants such as income, education, healthcare access, and geographic location; (c) evaluate current approaches for prevention and management; and (d) propose directions for future research.

A systematic search of six databases (PubMed, EMBASE, PsycINFO, Google Scholar, CINAHL, and Global Index Medicus) was conducted to identify quantitative studies published between 2000 and 2024 on adults aged 50 and above. Of 841 records screened, 16 studies met inclusion criteria and passed quality appraisal. The review protocol was registered in PROSPERO (CRD42024607875).

Multimorbidity ranged from 5.4% in Botswana to 71% in Nigeria. Cardiometabolic conditions often co-occurred with infectious and mental disorders. Poverty and low education significantly increased risk (OR: 1.44–7.44). Rural residents faced limited healthcare access, while urban dwellers had higher risks from lifestyle factors. Obesity and food insecurity further heightened vulnerability, especially among women and older adults.

Findings indicate that social determinants critically shape multimorbidity risk and outcomes in SSA. Integrated care models, targeted interventions, and policies addressing structural inequalities are urgently needed. Future research should apply longitudinal and qualitative approaches to clarify causal pathways and inform context-sensitive strategies.

This study was conducted to identify dyspnea, anxiety, and death anxiety in patients with Chronic Obstructive Pulmonary Disease (COPD).

The study was carried out with 200 COPD patients who applied to the chest diseases outpatient clinic of a state hospital between December 2022 and June 2023.

A total of 73.0% of the patients with COPD participating in the study were male and their mean age was 66.73 ± 8.45 years. Their mean scores were 5.21 ± 2.46 on Modified Borg Scale, 2.62 ± 1.03 on the Modified Medical Research Council scale, 17.87 ± 7.96 on the Beck Anxiety Inventory, and 10.07 ± 4.02 on the Death Anxiety Scale. Patients with high dyspnea levels also had high levels of anxiety and death anxiety (p < 0.001).

The patients with COPD had high levels of dyspnea, anxiety, and death anxiety. Based on the results of the study, it is recommended to plan evidence-based studies to alleviate dyspnea, anxiety, and death anxiety in patients with COPD.

Autologous hematopoietic stem cell transplant (HCT) cancer caregivers experience significant burden and stress with limited tailored resources. Mindfulness interventions hold promise in alleviating caregiver distress. Predicated on our previous work with allogeneic HCT caregivers, this single-arm trial tested the feasibility and acceptability of a modified mindfulness-based intervention, AutoFOCUS, among autologous HCT caregivers.

Participants received the 6-session AutoFOCUS face-to-face via telehealth, with assessments at baseline, end of treatment, and 1-month post-treatment. Feasibility was assessed through recruitment, retention, and session attendance, and acceptability was measured via satisfaction and intent to continue using skills learned. Exploratory outcome measures included distress, anxiety, perceived stress, affect, and post-traumatic growth. Data from the smartphone app that supplemented the face-to-face component of the intervention were collected. In-depth interviews gathered participant feedback.

Twenty-six caregivers (mean age = 57.7 years, 89% female) were enrolled and 19 completed at least 4 sessions, 14 completed all 6 sessions, and 22 completed the 1-month follow-up. High satisfaction (M = 3.56/4; SD = 0.43) and intent to utilize the skills learned in the future (M = 8.58/10; SD = 1.81/4) were reported. Significant reductions in distress (p < .001, (effect sizes [ES]) = 0.99), anxiety (p = .032, [ES] = 0.53), perceived stress (p = .035, [ES] = 0.52), and negative affect (p = .008, [ES] = 0.69) were reported, along with a significant increase in post-traumatic growth (p = .009, [ES] = 0.67) from baseline to end of treatment. App use was moderate. Interview results highlighted positive perceptions and supported quantitative results.

AutoFOCUS was feasible and acceptable. Future studies should explore the efficacy of this treatment on a larger scale with a comparison condition.

Brain tumors are associated with negative changes in sense of self and increased distress early in the illness trajectory. Dignity Therapy (DT) is a brief 2-session therapeutic intervention for patients at end-of-life (EOL) that helps conserve a patient’s sense of dignity or self. DT has shown positive results for patients at EOL including increased meaning, improved quality of life (QOL), and reduced distress, with limited research to date on patients early in their illness trajectory (non-EOL). This pre-post design pilot study investigated the benefits and feasibility of DT for 2 groups of patients with incurable brain tumors.

A total of 51 participants were recruited, of whom 39 participated. Participants were grouped as EOL (prognosis < 1 year, n = 21) and non-EOL (prognosis > 1 year, n = 18). Participants completed self-report measures to determine changes in QOL, psychosocial well-being (i.e., spiritual well-being, connection, and posttraumatic growth), and death anxiety, at baseline, 1 week, and 5 weeks post-intervention.

The intervention had a high completion rate, with 37 of 39 participants (95%) completing DT. Linear regression models fitted with generalized estimating equations (GEEs) showed within- and between-group significant changes in all domains for both groups, but were particularly beneficial for non-EOL participants.

This study demonstrated that DT effectively enhanced psychosocial well-being in patients with brain tumors, including reductions in death anxiety and dignity-related distress. Non-EOL participants benefited most and had higher completion rates, highlighting the intervention’s feasibility and the need for further research in earlier stages of terminal illness.

Awareness of death shapes our existence; it prompts both distress and a maturation process called existential maturation. Presently, direct quantitative measures of existential maturation are unavailable to study treatments for existential distress that enhance psychological well-being. We examined the effect of a mortality salience stimulus on implicit death thoughts over time. We also examined the associations among existing measures of constructs conceptualized as relevant to an eventual measure of existential maturation in a representative sample.

A cross-sectional Qualtrics panel of 1,000 adults, representative of the United States' urban and rural populations, completed a 20-minute survey. The self-report Human Existence survey included an embedded mortality salience stimulus (Death Anxiety Beliefs and Behaviors Scale) and valid, reliable measures of implicit death-thought accessibility (DTA), existential isolation, existential distress, flourishing, transcendence, attachment, connections, peace, and other related constructs.

The DTA measure did not replicate previous research on mortality salience. We found significant positive correlations between existential isolation and existential distress, and between flourishing and transcendence. However, correlations of death anxiety with isolation, flourishing, and transcendence were surprisingly low. In multivariate analysis, avoidant attachment was negatively associated with existential isolation and distress; death anxiety was positively associated with anxious/ambivalent attachment. Transcendence was negatively associated with avoidant attachment and positively associated with being at peace and connections. Flourishing was positively associated with being at peace and connections.

An ineffective death reminder or the DTA online format may have affected DTA results. Striking relationships between attachment style and EM indicators confirm they are interrelated. Measures for existential maturation and related phenomena still lack implicit measures to assess nonconscious components.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment, significantly affecting patients’ quality of life. Current pharmacological treatments are often ineffective or poorly tolerated, necessitating alternative therapeutic approaches. Scrambler Therapy (ST), a non-invasive neuromodulation technique, has shown potential for reducing neuropathic pain, but optimal dosing regimens remain undefined.

This case study aims to evaluate the effectiveness of Scrambler Therapy in reducing pain levels and improving functional status in a patient with chemotherapy-induced peripheral neuropathy.

A single patient diagnosed with CIPN was treated with Scrambler Therapy over a series of sessions. Pain levels and functional status were measured using standardized assessment tools before, during, and after the therapy to evaluate the impact of ST on symptom relief and daily functioning.

After completing the Scrambler Therapy sessions, the patient reported significant reductions in pain intensity and notable improvements in functional status. These improvements were sustained several weeks and months following the therapy, indicating the potential long-term benefits of ST for managing CIPN.

This case study demonstrates the potential of Scrambler Therapy as an effective treatment option for reducing pain and improving functional status in patients with chemotherapy-induced peripheral neuropathy. These findings suggest that ST may provide a promising non-invasive alternative to current treatments for managing neuropathic pain in cancer patients.

Supporting a family member with cancer poses significant challenges for family caregivers, who have unmet supportive care needs. Psychosocial oncology professionals (PSOP) are often the primary source of support for cancer caregivers in Iran. Given the lack of supportive care resources, innovative strategies are needed to support caregivers. This study explores the views of PSOP and caregivers regarding the challenges, potential solutions, and the role of digital technologies in supporting caregivers.

Employing a qualitative descriptive design, we conducted individual interviews and focus groups with 30 participants (15 PSOPs and 15 caregivers), recruited from five settings in Tehran, Iran(2023-2024). All sessions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

PSOP identified challenges in delivering psychosocial care to caregivers , including inconsistency, uncertainty, and fragmented use of technology. Their recommendations included flexible psychosocial care via blended multi-modal digital technologies, professional development opportunities, and formal recognition and integration within the oncology setting. Caregivers experiencing frustration with the healthcare system expressed a need for family-centered care, flexible psychosocial care, and organized peer support networks.

Current psychosocial care in Iran is insufficient and misaligned with the preferences of PSOP and caregivers. PSOP and caregivers advocate for flexible psychosocial care through blended digital strategies. Public health strategists in Iran, as a low-resource setting with a family-centered context, should optimize resource utilization by prioritizing the training of PSOP, developing blended digital interventions, and leveraging trained peers to provide navigation and support to families, thereby easing the PSOP workload.

Cancer patients often suffer from refractory symptoms near death. The use of sedatives aims to relieve suffering caused by these symptoms. The practice varies broadly. The aim of this study was to evaluate the role and trends of midazolam use in cancer patients dying in a university hospital oncology ward.

The study population of this retrospective registry-based study consists of patients who died in a university hospital oncology ward in Eastern Finland in 2010–2018 (n = 639). Information about treatment decisions, midazolam use, and background factors were gathered.

During the study period, 14.7 % of the patients dying in the ward received midazolam with sedative intent prior to death. 4.7 % (n = 30) of the whole study population had continuous infusion and the rest of the midazolam use was one or multiple single doses. Documented discussion of possible palliative sedation (PS) use was found in almost one third of all patients. Out of those, eventually receiving midazolam with sedative intent, two thirds had had this discussion. The most common symptoms leading to midazolam were dyspnea, pain, and delirium. In continuous use the median midazolam infusion rate was 4.0 mg/h. The continuous infusion started median of 23.25 h and multiple single doses 19 h before death. If only one dose of midazolam was needed, it was given median of 30 minutes prior to death and the most common symptom was dyspnea. Those who received midazolam were more likely to be younger (p = 0.003) and had had a palliative outpatient clinic visit (p = 0.045).

This is the first study to report the trends and practices of midazolam use for refractory symptoms in Finland. Midazolam was used for approximately every 7th dying cancer patient. Applying midazolam was supported by a history of palliative clinic visits and younger age.

This study sought to examine the validity and reliability of the Turkish adaptation of the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) scale. The primary objective was to evaluate the scale’s psychometric properties in measuring acceptance and coping among cancer patients.

The study included 90 cancer patients who completed the 12-item PEACE scale. The scale consists of two distinct subscales: the 5-item Peaceful Acceptance subscale and the 7-item Struggle With Illness subscale. Reliability was examined using Cronbach’s alpha and test-retest reliability (r = 0.916). Content validity was assessed using the content validity index (CVI = 0.84). Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to examine the underlying factor structure and evaluate model fit indices.

The internal consistency for both subscales was satisfactory (Cronbach’s α = .78 for both). EFA indicated that the two subscales explained 53.169% of the total variance. CFA substantiated the two-factor model, demonstrating adequate model fit indices (χ2/df = 1.689,Root Mean Square Error of Approximation = 0.088). These findings collectively establish the Turkish version of the PEACE scale as a psychometrically sound tool.

The PEACE scale is a valid and reliable instrument for assessing levels of acceptance and coping in cancer patients. Its use can help healthcare professionals better understand patients’ emotional states and guide interventions aimed at improving their quality of life.

The concept of total suffering is widely recognized in palliative care (PC), encompassing a range of interconnected and complex factors that collectively shape the evolving and individualized experience of a patient’s illness journey. Studies on will to live (WtL) in terminally ill patients have demonstrated its variability over time and various factors that influence these changes.

To objectively investigate the concept of total suffering and WtL; including their fluctuation over time and associations with sociodemographic, clinical, physical, and psychological symptoms in a sample of individuals with life-limiting conditions receiving PC. This multicenter Iberian study involved 3 centers in Portugal and 1 in Spain. A total of 107 individuals with life-limiting conditions consented to participate. To capture the dynamic and multifaceted components of total suffering, we had each participant completed the Edmonton Symptom Assessment Scale (ESAS) along an additional WtL visual analogue once daily over a 30-day period.

WtL demonstrated various patterns over time. While some patterns reflected relative stability, other demonstrated substantive fluctuation during the course of illness. Significant correlations were observed between WtL and all other ESAS items. Moderate positive correlations were found between WtL and total ESAS score and its physical and psychological sub-scores. Spearman’s correlation coefficients between all physical and psychosocial items on the ESAS were statistically significant across all 45 correlations performed, with only 5 showing moderate strength; the remaining correlations were weaker.

Evidence-based understanding of WtL is critical to improving care for patients who experience suffering toward end-of-life and their families. Further research is needed to inform and refine interventions targeting total suffering.

Expressive writing interventions (EWIs) are associated with important psychological and physical outcomes in patients with cancer. However, EWIs have not been widely integrated into routine psychosocial care of cancer populations. A review of the current literature on EWIs’ impact on the cancer patient experience, including qualitative analyses of patient perspectives, will increase our understanding of barriers and facilitators to adoption in clinical settings.

To bridge existing gaps in the literature by examining quantitative and qualitative studies on EWIs for patients with cancer. To present recent data examining the benefits of EWI’s for patients with cancer.To provide strategies for clinicians engaging in EWI’s for their patients.

Informed by the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we completed a scoping review of relevant quantitative and qualitative articles published from 2015 to 2025 to assess the impact of EWIs on health-related outcomes (e.g., physical symptoms and quality of life [QOL]) as well as approaches to improve their use in patients with cancer.

Of the 28 studies with 3527 patients that we analyzed, 24 were quantitative and 4 were qualitative. Most studies were conducted in the USA (42.8%) or China (28.6%) and included patients with breast cancer (71.4%) or only included women (71.4%). Of the patients in the studies, 46.8% identified as White, 42.8% as Asian, 5.5% as Black, and 4.5% as Latino. Twenty-one of the quantitative studies found that EWIs were positively associated with cancer patients’ QOL and/or physical health outcomes. Of the 4 qualitative studies, themes of narrative reconstruction, cultural disclosure norms, and intervention delivery format emerged. The characteristics of EWI methods can be tailored to maximize therapeutic benefits through cultural adaptation, timing, and privacy.

Despite promising associations between EWIs and health-related outcomes in patients with cancer, EWIs for cancer populations are heterogeneous and randomized clinical trials are limited. Larger trials that establish the efficacy of EWIs in diverse cancer populations are warranted.

The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life.

Qualitative interviews were conducted with patients diagnosed with glioblastoma and their caregivers to obtain information about their experiences and needs in coping with glioblastoma. We also gathered their feedback about the supportive care intervention we were proposing (Phase I). Following Phase I, we conducted a single-arm pilot to evaluate the feasibility and acceptability of the 6-session intervention (Phase II).

During interviews (N = 14), patients and caregivers reported having the most difficulty and distress surrounding disease progression and management, maintaining dignity and autonomy, negotiation of roles and responsibilities, and maintaining connection with one another. Participants endorsed that an intervention like Empower GBM with skills focused on managing symptoms to increase independence, increasing caregiving efficacy and support, and coping with dyadic challenges would be of potential benefit. Preliminary results from the pilot study (N = 11) suggested the intervention is both feasible (e.g., 82% completed all 6 sessions and post-treatment surveys) and acceptable (88.9% reported a mean satisfaction score of 3 or higher; mean score of 3.57/4.0). Improvements in psychological outcomes, functional well-being, and caregiving efficacy from pre- to post-treatment survey results suggested the potential benefits of the intervention.

We developed a novel supportive care intervention informed by the dyadic illness model that is designed to meet the individual and interpersonal needs of patients with glioblastoma and their caregivers. Unique features include its flexibility to be delivered to patients and/or their family caregivers individually or jointly, while providing skills and strategies to meet the needs of both individuals and the dyad as the unit of care in coping with glioblastoma.

On October 3–4, 2023 and September 30–October 1, 2024, the Memorial Sloan Kettering Cancer Center Department of Psychiatry and Behavioral Sciences and Supportive Care Service hosted the 4th and 5th Annual U.S. Celebration of World Hospice and Palliative Care Day (WHPCD) conferences, respectively. This article describes both events and lessons learned in anticipation of the 6th annual conference to be held October 6–7, 2025.

The 4th and 5th annual events, conference planning team reflection, and attendee evaluation responses are summarized.

Since 2020, the conference has attracted attendees from around the world. Two primary aims continue to guide the event: community building and wisdom sharing at the intersection of art and science. Both the 2023 and 2024 events consisted of 13 unique interactive sessions addressing diverse hospice and palliative care topics delivered by interprofessional experts in palliative care (43 faculty in 2023 and 54 in 2024). Multidisciplinary registrants more than doubled from 764 in 43 countries (2023) to 1678 in 87 countries (2024). Complimentary registration for colleagues in low- and middle-income countries (LMIC), students and trainees, and individuals experiencing financial hardship remains a cornerstone of inclusion and equitable access to the event.

The U.S. WHPCD Conference provides a virtual platform to disseminate high-quality science, honor both clinician and patient and caregiver experiences, and celebrate hospice and palliative care delivery during substantial local and global change across practice and policy domains. We remain committed to ensuring an internationally relevant, culturally diverse, and multidisciplinary and interprofessional agenda that will draw increased participation worldwide during future annual events.

The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals.

Formative mixed-methods evaluation of a WG process to tailor ward-specific evidence-informed measures on 10 wards outside specialized palliative care at 2 German medical centers. To analyze factors relevant for the WG process, the Consolidated Framework for Implementation Research 2.0 was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants.

Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants’ wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants’ views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again.

The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings.

The study was registered in the German Clinical Trials Register (DRKS00025405).

The present study investigated the associations among pre-loss grief, relational closeness, attachment insecurities, continuing bonds (CBs) with the deceased person, and the post-loss adjustment of the caregivers of patients with terminal cancer.

Data were collected in the hospice department of a cancer center in northern Taiwan; 66 bereaved caregivers completed both pre-loss and post-loss scales. The measures used for the pre-loss phase included the Hogan Grief Reaction Checklist (HGRC; pre-loss version), the Experiences in Close Relationship – Relationship Structures Questionnaire (ECR-RS), and the Inclusion of Other in the Self Scale. The measures used 6–12 months after the death of the patients were the HGRC (post-loss version) and the Continuing Bond Scale (CBS).

Pre-loss grief and externalized CBs had a significant impact on the amount of post-loss grief, indicating that pre-loss grief and ongoing transformation of relationships after patients’ death may be predictors of caregivers’ post-loss grieving.

This longitudinal study provides preliminary evidence that pre-loss grief and the relationship with the patient are key to caregivers’ post-loss adjustment, suggesting that psychosocial intervention focuses on caregivers’ pre-loss grief and relationship quality with the patient during palliative care.