In recent years, there has been a growing interest in the therapeutic use of psychedelics. In palliative medicine, they are being considered as an alternative approach to treating depression, existential distress, and chronic pain conditions. This review presents current literature on the use of psychedelic substances such as psilocybin, lysergic acid diethylamide, 3,4-methylenedioxymethamphetamine, and ketamine in patients at the end of life. The mechanisms of action of these compounds are discussed in detail, with a particular focus on their ability to enhance neuroplasticity and reorganize neural networks in the brain. The paper also examines findings from recent clinical studies, which suggest that psychedelics can produce rapid and long-lasting antidepressant and anxiolytic effects with a low risk of serious adverse events. However, legal restrictions on these substances in most countries continue to hinder scientific progress. While current evidence is promising, further large-scale clinical trials and the development of precise clinical guidelines are needed before psychedelics can be routinely integrated into palliative care. One area that warrants particular attention in future research is the use of psychedelics in patients with suicidal ideation, for whom rapid antidepressant effects are especially critical.
Ventilatory pump failure (VPF) due to neuromuscular disease or high cervical spinal cord injury commonly precipitates hospital crises involving noninvasive ventilation, tracheostomy ventilation, or withdrawal of ventilatory support. Consultation-liaison (C-L) psychiatrists are often asked to assess depression, decisional capacity, and the meaning of requests to forgo lifesustaining treatment. A recurrent pitfall in such assessments is clinical pessimism, i.e. clinicians' systematic underestimation of quality of life (QoL) in severe disability, a phenomenon related to the disability paradox. This review aimed to synthesize evidence on QoL and psychological adaptation in VPF and to propose a clinically actionable C-L psychiatry framework for assessment, differential diagnosis, interdisciplinary management, and documentation in high-stakes ventilation decisions. We conducted a narrative review of peer-reviewed studies, clinical guidelines, and bioethical literature relevant to ventilator-assisted living, disability adaptation, dyspnoea and anxiety, demoralization, and decisional capacity. PubMed/MEDLINE was searched from 1990 to October 2025 using combinations of VPF and neuromuscular ventilation terms with QoL and life satisfaction, disability paradox, response shift, affective forecasting, dyspnoea, demoralisation, and capacity terms. Reference chaining was used to supplement retrieval. Across cohorts of longterm ventilator users, many patients report satisfactory or good QoL despite profound functional dependence. Foundational work showed that ventilator-assisted individuals rated life satisfaction at approximately 5.1/7, whereas healthcare professionals estimated it at 2.42/7, indicating marked clinician pessimism. Contemporary studies likewise report that many ventilator-dependent patients rate QoL as good or excellent. Modifiable correlates include access to communication, participation outside the home, stable caregiving, and time since ventilation initiation. In VPF, C-L psychiatrists can support preference-concordant decisions by prioritising physiological and communication stability, distinguishing major depressive disorder from demoralisation and dyspnoea-related anxiety, facilitating interdisciplinary alignment, and documenting decisions in a way that minimises bias and symptom coercion.
Introduction: Nurses experience difficulties and face ethical problems especially when caring for this patient group. The aim of this study is to determine the difficulties and ethical problems experienced by nurses working in the field of oncology in palliative care. Material and methods: The sample of the study consisted of 69 nurses. In the data collection form, personal characteristics of the participants' profession and questions about palliative care and Palliative Care Difficulties Scale (PCDS) were included. Descriptive statistics, Mann-Whitney U test, Kruskal-Wallis H test, Bonferroni correction, Spearman correlation coefficient were used to interpret the findings. Results: The mean age of the participants was 32.93 +/- 6.79 years, 78.3% of them were female, 65.2% of them did not receive training on palliative care approach, and 50.7% of them thought that they did not provide adequate palliative care. The mean score of the PCDS was 45.46 +/- 8.44. A statistically significant difference was found between the participants' age, education level, years of experience in oncology and the total and sub-dimensions of the PCDS (p < 0.05). Conclusions: Our study found that nurses working in an oncology hospital experienced moderate difficulty when providing palliative care to patients. We found that nurses most often related palliative caregiving, preparation for the death process, compassion, and improving the patient's quality of life. It was found that participants experienced difficulties in communication and empathy, addressing the psychological issues of patients, dealing with family issues, and dealing with time and equipment shortages.
Sclerosis lateralis amyotrophica (SLA) is a progressive and incurable neurodegenerative disorder leading to degeneration of motor neurons. In most cases, the disease begins with muscle atrophy and limb weakness. As the condition progresses, bulbar symptoms and dyspnea related to respiratory failure may develop. Sclerosis lateralis amyotrophica typically results in death within 3-5 years of diagnosis. Due to its progressive course, symptomatic treatment provided by palliative care services constitutes an essential component of care for patients in advanced stages of the disease. This analysis included clinical cases of patients admitted to an inpatient hospice in 2023 with a diagnosis of SLA (n = 3). Disease severity was assessed using the Polish version of the Sclerosis Lateralis Amyotrophica Functional Rating Scale-Revised (SLAFRS-R). The cases were analyzed and presented descriptively. All patients were male, with a mean age of 62 years. The average duration of hospice stay was 125 days. The mean SLAFRS-R score declined from 26.7 at admission to 9.7 at the end of hospice care. Two patients required transfer to hospital due to acute clinical deterioration (n = 2), while one patient died in the hospice as a result of progressive respiratory failure (n = 1). The findings indicate that the end-of-life course in SLA is highly variable. During this period, symptom burden increases and functional decline accelerates. Advance care planning should be an integral part of SLA management, as early decisions regarding emergency interventions help ensure care consistent with the patient's preferences.
Cutaneous paraneoplastic syndromes play an important role in the detection of malignant neo plasms and may represent the first clinical sign of an underlying malignancy. The skin is the second most frequently involved organ, after the endocrine system and endocrine syndromes, capable of indicating the presence of cancer. Malignant neoplasms, regardless of their type, constitute one of the leading causes of death worldwide. Their early diagnosis is a key component of oncological strategy. Early identification of paraneoplastic syndromes is of critical importance, as it accelerates the recognition of the malignancy and the initiation of effective treatment, thereby increasing the patient's chances of survival. The aim of this publication is to present information on the occur rence, pathomechanisms, clinical course, and treatment of cutaneous paraneoplastic syndromes.
The article focuses on the role of new technologies, particularly two-way mobile applications, in improving palliative care. With increasing demands in caring for chronically and terminally ill patients, digital tools are becoming invaluable for both patients and their caregivers. These apps enable systematic monitoring of symptoms such as pain or shortness of breath, facilitating faster response from medical staff. They also provide access to educational materials, home care guidance, and communication channels with the care team. For caregivers, this translates to a greater sense of security, improved task organization, and emotional support during difficult situations. The article also emphasizes the importance of tailoring applications to individual needs and ensuring the protection of patient data. The findings suggest that technology can significantly enhance the quality of life for palliative patients and support more effective interdisciplinary care.
The diversity of available tools for risk assessment and classification of pressure injuries presents a challenge in selecting methods appropriate for the needs of patients receiving end-of-life care. Despite the development of assessment tools specifically designed for palliative care and the limited validation of traditional scales in this population, the Norton, Braden, and Waterlow scales remain commonly used in clinical practice. General Performance status tools, such as the Palliative Performance Scale, are also used in this group to assist in the prognostic evaluation of pressure injury risk. However, despite the use of validated assessment methods and appropriate preventive strategies, unavoidable pressure injuries may occur in patients at the end of life, reflecting the natural course of advanced disease. Upon the diagnosis of a pressure injury, staging is essential and is most commonly performed in accordance with the international EPUAP/NPIAP classification. In clinical practice, other older classification systems, such as the Torrance scale, as well as supplementary tools, including the color-based model, remain in use. An important complement to classification is the longitudinal assessment of wound healing using instruments such as the Pressure Ulcer Scale for Healing. Technologies based on artificial intelligence are increasingly being used to support both risk assessment and classification, representing a promising direction for the future of care for patients with pressure injuries.
Bereavement support, as a form of family assistance, is an integral component of palliative care. Because the grieving process can sometimes become prolonged and dysfunctional, disrupting the daily functioning of mourners and potentially developing into prolonged grief disorder (PGD), it is worth exploring the latest tools to support the grieving process. Rapidly advancing artificial intelligence (AI) is an example of modern technology that has found numerous applications in predicting, diagnosing, treating, and supporting individuals coping with the loss of a loved one. A quasi-systematic review was conducted by searching the PubMed and Scopus databases using specific MeSH terms. A total of 12 sources were included in the review. The literature used AI for conversational agents and deepfake technology (n = 6), prediction models (n = 3), identification of factors correlating with grief severity (n = 1), clustering grief and major depressive disorder (n = 1), and personalised assignment to an adequate therapy (n = 1). Most of the analysed techniques achieved good performance rates; however, conversational agents and deepfake technology have raised serious ethical and legal concerns. AI in bereavement support is mainly used for interactive deepfake technologies; however, this field should be thoroughly examined before its widespread implementation. A potentially valuable future application of AI in the grieving process lies in identifying individuals at increased risk of PGD, facilitating their diagnosis, and tailoring personalized therapeutic interventions for bereaved individuals. Under appropriate legal oversight and the supervision of a human therapist, these tools could be extremely helpful.
Palliative care is a specialised branch of medicine aimed at improving the quality of life for patients and their families facing chronic and often terminal diseases. To achieve this goal, healthcare providers must focus on patients’ needs, including pain management and mental, emotional, and spiritual well-being. While conventional medicine – both pharmacological and non-pharmacological treatments – plays a primary role, modern palliative care increasingly integrates complementary and alternative medicine (CAM) as part of a holistic approach to patient care. CAM includes a wide range of treatments such as aromatherapy, acupuncture, music therapy, hypnosis, meditation, and mindfulness. Despite ongoing controversy surrounding these methods, recent research indicates their potential effectiveness in holistic palliative care.
