Unpaid cancer caregivers (UCCs) are the primary caretakers of individuals with cancer, often shouldering caregiver responsibilities without prior preparation, which leads to a sense of isolation, particularly in remote and rural areas where healthcare access is challenging. Thus, this systematic review aimed to explore the perceived and/or received peer support needs of UCCs residing in rural and remote areas with a specific focus on informational, practical, and emotional needs.

Seven databases (CINAHL, ScienceDirect, PUBMED/MEDLINE, PROQUEST, Web of Science, Scopus, and Informit) were searched from 2004 to 2024. Peer-reviewed qualitative, quantitative, and mixed-method studies published in English were considered for this review. Data were extracted using the Joanna Briggs Institute System for Unified Management, Assessment, and Review of Information and presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Quality and bias were assessed with the Mixed Methods Appraisal Tool.

In total, 8 primary studies were included: 4 qualitative, 2 mixed methods, 1 cross-sectional, and 1 prospective survey. Four themes were identified: (1) Emotional, practical, and informational unmet needs; (2) Lack of peer support on the physical and emotional well-being of UCCs in remote and rural areas; (3) Lack of supportive services in remote and rural areas; and (4) Access to flexible peer support.

This review revealed the unique unmet needs of UCCs in remote and rural areas, where a lack of reliable and accessible resources adversely leads to impaired UCCs’ overall well-being. Addressing these unmet needs is essential to enhance the support system for UCCs living in such regions. By identifying the gaps, the review underscores the need for developing a peer support model tailored to the specific needs of UCCs in rural and remote communities.

This study aims to systematically identify patient-reported end-of-life (EOL) care needs of patients with incurable illnesses, and advocate for a person-centered approach to care in Bangladesh.

This cross-sectional study was conducted in four tertiary care hospitals across Bangladesh and included 301 adult patients who had at least one of the following serious and complex incurable conditions: stage III or IV cancer, congestive heart failure (NYHA Class IV), end-stage liver disease, chronic renal failure requiring hemodialysis, stroke, oxygen-dependent pulmonary disease, or any type of dementia. Specific domains of EOL care needs were identified in relation to patients’ functional status using multinomial logistic regression. Differences in EOL care needs across socio-demographic and symptom profiles were analyzed using independent t-tests and one-way ANOVA.

All patients had a Needs Near the End-of-Life Care Screening (NEST-13) score ≥30, indicating a high level of EOL care need. High levels of unmet needs were reported in domains such as doctor–patient communication (89.4%), goals of care (78.1%), spiritual needs (77.4%), and caregiving (66.4%). Patients with longer disease duration (>12 months) and higher symptom burden had significantly higher NEST scores (p < 0.001). Functional status strongly influenced care needs. Multinomial regression confirmed physical care needs (OR = 10.59), caregiving (OR = 3.40), and spiritual needs (OR = 2.81) were most strongly associated with terminal status (PPS ≤ 20%).

This study reveals an overwhelming burden of unmet EOL care needs among patients with incurable diseases in Bangladesh. The findings emphasize the urgent necessity for holistic, culturally sensitive, and person-centered care, alongside the integration of palliative care into mainstream healthcare services.

End-of-life (EOL) care for critically ill individuals is shaped by socioeconomic, legal, and cultural factors for Koreans in South Korea and Korean Americans (KA) in the United States. This scoping review thematically synthesized critical care literature from Korea and community-based literature involving KAs to inform culturally tailored EOL and palliative care research and practice.

Following the updated JBI scoping review guidance, we reviewed English and Korean articles across seven databases. Due to the lack of critical care studies involving KAs, the scope of U.S. studies was broadened to all healthcare settings. We conducted a thematic synthesis to identify cross-context cultural insights that are potentially transferable from Koreans in critical care to KAs with similar needs.

Evidence on EOL care for Koreans in critical care and for KA communities across U.S. settings was limited. Korea-based critical care studies (N = 23) highlighted physician-initiated decision-making, minimal advance care planning, and a lack of direct patient perspectives. U.S.-based studies (N = 26) focused on hypothetical palliative care preferences among older, community-dwelling KAs, with limited attention to critical care. Both contexts revealed shared cultural preferences for family-centered decision-making, physician-led discussions, and indirect communication about diagnosis and prognosis. Further research is warranted to investigate within-group heterogeneity and preference shifts across illness trajectories to inform culturally tailored EOL interventions for KAs.

Findings highlight the need for culturally and structurally informed approaches to improve EOL care in both Korea and the U.S. This cross-context analysis demonstrates how evidence from the heritage country can inform research and practice for immigrant and minoritized populations when domestic data are sparse. Strength-based approaches grounded in community values, combined with culturally specific insights from Korean literature, may enhance culturally responsive support for KA patients and families.

Agitation is one of the most distressing behavioral symptoms among hospice-eligible patients with dementia. It compromises patient comfort, increases caregiver burden, and undermines the quality of end-of-life care. Although pharmacologic treatments are frequently used, evidence guiding their safe and effective use in this population remains limited.

To identify and synthesize existing randomized controlled trials (RCTs) that evaluated interventions for agitation in hospice-eligible patients with dementia, and to assess the quality and relevance of current evidence.

A narrative review was conducted using systematic search strategies to identify RCTs published between 1990 and 2024 across 8 databases. Studies were included if they (1) focused on hospice-eligible patients with dementia, (2) targeted agitation as a major outcome, and (3) used an RCT design. Studies lacking eligibility criteria, non-RCTs, and non-English articles were excluded.

Of 44 articles screened, only 3 met the inclusion criteria: 2 studies tested nonpharmacological interventions (Namaste and Balancing Arousal Controls Excesses) and 1 tested a pharmacological intervention (sertraline). Results from the nonpharmacological interventions were mixed, and the pharmacologic trial showed no difference between treatment and placebo. Common limitations included small sample sizes, lack of racial and gender diversity, and absence of home-based hospice settings.

There is a critical gap in high-quality and generalizable evidence to guide agitation management at the end of life for patients with dementia. Addressing this gap is essential to improving not only symptom control but also to preserving dignity and reducing caregiver distress in hospice care. Future trials must include diverse populations, incorporate home-based hospice settings, and rigorously evaluate both pharmacologic and nonpharmacologic interventions to support compassionate, patient-centered care.

This review highlights urgent gaps in research and care delivery, underscoring the need for inclusive and scalable intervention designs to address agitation at the end of life.

Fear of cancer recurrence (FCR), defined as worry about cancer progression or return, is a common concern among patients and survivors. This study aims to identify factors influencing the onset of FCR and to evaluate its impact on emotional distress and quality of life (QoL) in patients undergoing systemic cancer treatment.

A sample of 175 patients undergoing systemic cancer treatment completed self-report questionnaires assessing socio-demographics, clinical factors and fear of cancer recurrence, anxiety, depression and QoL (FCRI, HADS, EORTC-QLQ-C30).

Data analysis using linear and generalized linear models revealed that FCR is inversely associated with QoL and positively correlated with anxiety and depression. These associations were independent of socio-demographic and clinical variables, with anxiety and depression fully mediating the FCR-QoL relationship. Gender and time since diagnosis emerged as significant predictors, with an increase in FCR at 12 months post-diagnosis.

Our results indicate that FCR, anxiety and depression linked, are present after several months post-diagnosis, suggesting that FCR tends to intensify over time. These findings carry important psychological implications, highlighting the need to support patients in recognizing and managing their fear and emotional distress. Implementing a psychoeducational counseling approximately six months after diagnosis – engaging oncologists, psycho-oncologists, and patients within a “stepped-care” framework – may be effective in mitigating FCR and its emotional consequences.

To evaluate the accessibility and acceptability of implementing a telephone-based psychological support intervention for patients with metastatic cancer in the Indian palliative care settings.

The present single centered experimental study was conducted on 181 adult metastatic cancer patients who were referred to the pain and palliative medicine department by medical oncologists at a tertiary hospital, India. The patients were purposely assigned to two groups: In Group-A 90, patients received a combination of palliative and psychological support. In Group-B, 91 patients received only structured palliative care. As per the department protocol, patients in each group were followed up on days 0, 7, 14, 21, and 28. Before each session, patients completed questionnaires that are based on disease-related symptoms and psychological well-being.

It was found out that patients with telephone based psychological support integrated with palliative care has shown gradual improvement in physical and psychological symptoms from day 7 to day 28 when compared to the control group with p-value < 0.05. Additionally, 67% of patients continued their follow-up with the psychologist, indicating the accessibility and acceptability of the treatment. Furthermore, 87% of patients preferred voice calls over video calls because of the limited internet access (N = 72%).

Therefore, it can be concluded that the combined approach of pain management through palliative care and continuous telephone based psychological support has contributed to their holistic well-being.

The findings highlight that integrating telephone-based psychological support within palliative care services is both feasible and acceptable for patients with metastatic cancer in India. This approach not only improves physical and psychological outcomes but also enhances the continuity of care, especially in resource-limited settings where in-person psychological services may not always be accessible.

This study examined the changes in intimacy and sexuality amongst cancer patients at the end of life, including those in the final stage, and the distress they raised while experiencing those changes.

A phenomenological qualitative study, based on interviews with 35 dying cancer patients. The results were analyzed by Constant Comparison Analysis method.

Some of the dying patients reported absence of essential change in their sexual needs and ability. while others reported about changes. The changes caused seven various forms of distress to the majority of patients, for example grief due to diminution of sexuality, impact on the partner due to lack of sex and distress resulting from consciousness of the end of life. A minority did not experience distress from the sexuality changes. About a third of the interviewees were interested in sexual counseling during their dying period, and about 80% considered it important for the palliative care team to raise the issue of sexuality.

End of life patients and even those in final stages may have needs related to their intimate and sexual life. As long as the person breathes, even towards death, he can continue to live, even in the intimate aspect, so the palliative team has an important role in answering the specific and complex needs related to sexuality at the end of life. Recommendations were formulated specifically based on this research, for professional intervention regarding sexuality at the end of life, by a PASSION model.

Patients’ involvement in the decision-making process is essential for shared decision-making and optimal patient-centered care. However, when there are concerns about a patient’s cognition and judgmen, the complexity of providing patient-centered care increases. It is often necessary to evaluate patients’ decision-making capacity (DMC) to determine whether they are able to make a particular decision or whether to rely on their previously expressed wishes or the patient’s caregivers.

In this article, we present a case of an older adult with colon cancer who presented to the emergency room.

We describe how multidisciplinary care can enhance the evaluation of DMC and improve quality of care for older patients with advanced cancer.

Multidisciplinary discussions and good communication skills are essential for navigating these complex situations, reducing potential harm and maximizimizing quality of life.

This study aimed to explore the many roles of palliative care (PC) nurses in addressing the needs of patients with life-limiting illnesses in the acute inpatient setting in New Zealand.

A scoping review was undertaken, informed by the Joanna Briggs Institute guidelines and utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. In December 2024, a comprehensive search using Pubmed, Scopus, and CINAHL was conducted for peer-reviewed articles published in English between the years 2014 and 2024, with full text available, that focused on PC nursing in the acute setting in New Zealand, Australia, Canada, Ireland, or the United Kingdom. These countries were chosen because their health care systems are similar. Citation searches were undertaken. Grey literature from New Zealand hospitals was also searched.

After selection, 25 pieces of literature were eligible for the review. Nine key areas were found where PC nurses and teams play key roles in the ongoing management of patients and their coordination of care within the last months to last days of life in the acute inpatient setting. The areas were care-coordination, communication facilitation, decision-making, goals and expectations, discharge planning, physical symptom management, holistic symptom management, finances, environment, education, and rapid review. The findings suggest that PC nurses in the acute setting are no longer involved in single episodes of symptom management and ward-based end-of-life nursing, but are responsible for multiple facets of care, facilitated across several different services.

Understanding the complex roles involved in PC nursing can impact the health care outcomes of patients with a life-limiting illness. The scoping review can help inform future staffing requirements and the skill mix and knowledge levels required to provide timely and appropriate PC in the acute environment in New Zealand hospitals.

An effective communication seemed to be crucial in all the cancer care phases, like diagnosis, prognosis, and treatment options.

To analyze and interpret structured and open-ended questionnaire responses, focusing on the communication of bad news in onco-hematology: health care professionals’ attitudes, communication methods, and perceived stress levels.

By employing a free Large Language Model, we identified and summarized the main emotions and perspectives shared by professionals.

A total of 221 Italian nurses and physicians employed in onco-hematology field were enrolled. The analysis revealed key emotional themes, offering insights into the professionals’ emotional states and coping mechanisms when delivering difficult news.

Data highlighted the duality of emotions experienced by nurses when delivering bad news – balancing professional composure with emotional distress, underscoring the critical role of empathy, team support, and adequate preparation in helping nurses navigate these challenging conversations.

This study was conducted to examine the relationship between cancer patients’ spiritual needs and their quality of life and depression levels.

This cross-sectional, exploratory study was conducted between March 2023 and November 2024. The study population consisted of cancer patients hospitalized in medical oncology departments at a university hospital in eastern Turkey. The sample consisted of 250 patients, determined by power analysis. To collect data, the “Demographic Information Form,” “Spiritual Needs Assessment Scale,” “EORTC QLQ-C30 Version 3.0 Quality of Life Scale,” and “Beck Depression Scale” were used to evaluate the patients’ sociodemographic characteristics and disease process.

There was a weak, negative, statistically significant relationship between patients’ spiritual needs and the subdimensions of the quality of life scale, specifically the general perceived health status (r = −0.297, p < 0.001), physical (r = −0.446, p < 0.001), role (r = −0.423, p < 0.001), emotional (r = −0.472, p < 0.001), cognitive (r = −0.458, p < 0.001) and social (r = −0.443, p < 0.001) functions, and finally, a weak positive correlation was found between the symptoms experienced (r = 0.376, p < 0.001) and depression levels. Additionally, a weak positive correlation between spiritual needs and depression level (r = 0.374, p < 0.001) was identified. Functional areas, depression, education level, diagnosis duration, and symptoms were identified as variables predicting spiritual needs.

In conclusion, it was determined that as the spiritual needs of cancer patients increased, their quality of life decreased and the severity of depression increased.

Behavioral health needs are highly prevalent among individuals receiving long-term services and supports (LTSS), yet palliative care (PC) models in these settings often underemphasize psychiatric symptom management. This study explores interdisciplinary staff perspectives on behavioral health as a core domain of PC across nursing home and Program of All-Inclusive Care for the Elderly (PACE) sites.

We conducted a secondary analysis of a multi-site survey assessing PC needs across 13 LTSS sites within a large health system in New York State. We examined 5 survey items related to psychiatric symptom management, analyzing frequency, comfort, perceived benefit, and training interest. Multivariable logistic regression was used to assess associations between staff characteristics and behavioral health-related outcomes.

Among 597 respondents, 60.5% reported that over half of their patients could benefit from psychiatric symptom management, and nearly half (49.2%) reported managing such symptoms weekly or more. Forty percent identified psychiatric symptom management as one of the top three ways PC specialists could help their patients, and 44.6% expressed interest in further behavioral health training as part of further PC training. Prior professional experience with PC was associated with greater recognition of behavioral health needs among patients (aOR 1.6), greater likelihood of managing psychiatric symptoms (aOR 2.0), and greater comfort doing so (aOR 1.5).

Behavioral health emerged as a salient and frequently encountered domain of serious illness care among LTSS staff, particularly in nursing home and PACE settings. Staff with prior PC experience were more engaged and confident in addressing psychiatric symptoms. Findings underscore the need for PC models in LTSS to better integrate behavioral health – through training, interdisciplinary collaboration, and care delivery redesign – to meet the complex needs of medically and psychiatrically vulnerable populations.

Despite the increasing implementation of consultation-based hospice palliative care teams in tertiary hospitals of Korea, there is limited research on their impact on self-determination respect rates. Understanding this impact is crucial for improving end-of-life care practices and respecting patient autonomy. The aim of this study is to assess the trends in self-determination respect rates regarding advance care planning before and after the introduction of a consultation-based hospice palliative care team in a tertiary hospital.

A retrospective observational study was conducted using medical records from a tertiary hospital in Korea from March 2018 to December 2023. The study included all patients aged 19 years and older with medical records at a tertiary hospital during the specified period. We examined the characteristics of patients referred to the palliative care team, the effects of the consultation-based hospice palliative care team on the completion rates of advanced care planning, and changes in self-determination respect rates.

Following the introduction of the consultation-based hospice palliative care team, 411 patients were referred. The proportion of patients with completed advance care planning increased from 27.0% to 60.6% (p < 0.001). The overall number of advanced care planning completions and the self-determination respect rate also showed a marked increase, particularly from 2021 to 2022, when the respect rate spiked from 27.6% to 43.2%.

Introduction of a consultation-based hospice palliative care team improved the respect for patient self-determination in end-of-life care decisions. These findings support the integration of hospice care teams in tertiary hospitals to enhance early and informed end-of-life decision-making.

Palliative care enhances life, but rural Australia faces significant inequities, and psychosocial distress, an important yet often overlooked aspect, is under-recognized in these settings. This study examines how psychosocial distress evolves in rural palliative patients using the Death and Dying Distress Scale (DADDS).

A longitudinal study was conducted with palliative care patients in rural hospitals on Australia’s east coast. Distress levels were measured using DADDS at multiple timepoints. Mixed-effects models assessed distress trajectories, while survival analyses (Weibull model) examined whether average distress changes predicted survival duration. For comparability, DADDS scores in mixed-effects models were standardized (0–100%), whereas survival analyses used raw total score changes.

Adjusted mean total DADDS was 37.14 ± 22.67, with highest distress in fear of suffering and pain (49.95 ± 26.56) and lowest in fear of sudden death (30.26 ± 30.24). Distress followed a U-shaped trajectory: peaking early (52.68), declining mid (29.85) and late stages (28.26), then rising near death (53.05) (EMMs). Statistically significant changes included declines from early to mid-stage (β = −22.84, p = 0.007) and increases from late to near-death (β = 24.79, p = 0.003). Distress increased most from late to near-death in fear of suffering and death (β = 27.38, p = 0.006) and declined most from early to mid-stage in fear of dying (β = 28.01, p = 0.007). Higher distress correlated with shorter survival; each one-point increase in distress linked to a 6.97% survival reduction (time ratio = 0.930, β = −0.070, p < 0.001).

Psychosocial distress peaks in early palliative care and near death and is associated with reduced survival. Support should prioritize fears of suffering and pain during these stages, address fear of the dying process earlier, and remain attentive to persistent concerns such as loss of time and opportunity.