End-of-life decision-making in palliative care requires timely and compassionate communication to align care with patients’ goals and values. While shared decision-making is regarded as optimal for patient-centered care, its application in collectivist societies, where familial, religious, and social norms predominate over individual likes, remains understudied. This integrative review aims to synthesize the evidence on the dynamics of decision-making in palliative care within collectivist contexts from the perspectives of patients, family caregivers, and healthcare providers. Following Whittemore and Knafl’s (2005) integrative review methodology, a systematic search of four databases (PubMed, CINAHL, PsycINFO, EMBASE) was conducted using the PICo search framework. To enhance the search strategy, reference lists of the review and included papers were scanned, and forward citations were sought. The initial search was conducted in September 2024 and updated in June 2025. The eligible studies were empirical, peer-reviewed, English studies, conducted between 2010 and 2025 in collectivist contexts, as defined by the Inglehart–Welzel World Cultural Map. From the 1084 studies identified, 78 full texts were retrieved for assessment. Twenty studies met the inclusion criteria. Three interrelated themes were synthesized: (1) Patient Preferences in Decision-Making, highlighting varied roles: passive, shared, or active, shaped by age, gender, religiosity, education, and illness stage; (2) Patient-Clinician Communication: often characterized by limited information sharing, asymmetrical power relations, limited institutional support, and marginal nurse involvement; and (3) The Role of Family, depicted by heavy involvement in decision-making, tendency towards withholding prognostic information and the influence of financial constraints and emotional burdens on care choices. In collectivist contexts, end-of-life decisions unfold through complex interactions among patients, families, and clinicians, shaped by the interplay of established interpersonal and sociocultural values within broader institutional and economic systems. A relational decision-making conceptual framework is proposed, emphasizing culturally embedded, ongoing interactions among patients, families, and healthcare providers that accommodate a continuum of decision-making preferences, ranging from full family dependence or clinician-led to greater patient involvement, within the context of shared cultural values and healthcare structures.
Family plays an important role in medical decision-making and advance care planning (ACP) in older individuals with cancer because of the complex medical care choices involved. The perceived pros and cons of ACP, as well as other ACP-related beliefs, can be discordant between patients and their family caregivers, leading to potential conflicts when physicians, family members, and patients want to initiate ACP. This study examined the perception patterns of families of older individuals with cancer regarding ACP-related values and beliefs and the pros and cons of ACP. Older individuals (aged > 60 years) with cancer and their accompanying primary family caregivers were invited to participate in interview- and self-administered questionnaires assessing their perceptions of ACP. Dyadic item-by-item responses were compared using intraclass correlation coefficients (ICCs). A multilevel latent class analysis was employed to identify perception patterns at both the family (higher) and individual (lower) levels. Of 644 eligible patient–caregiver dyads, 279 (43.3
To evaluate changes in undergraduate nursing students’ attitudes toward caring for dying patients following completion of a curriculum-based palliative care programme and, as a secondary, exploratory objective, to describe their self-perceived educational needs in end-of-life-care. The adequate preparation of nursing students for end-of-life care delivery remains a persistent challenge within undergraduate nursing curricula. A thorough understanding of students’ educational needs in this domain constitutes a prerequisite for the development of effective didactic interventions. A quasi-experimental single-group pre–post study. The study was conducted among final-year first-cycle nursing students (124 eligible, 113 consented, 101 included in the final analysis), who were invited to complete a questionnaire comprising 9 items derived from the Polish adaptation of the FATCOD-B scale, alongside an author-developed 15-item instrument designed to assess educational needs pertaining to the care of dying patients. The assessment was performed immediately before and after completing the 3-week curriculum-based course in palliative care supplemented with simulation-based components. Statistical analysis was performed using the Wilcoxon signed-rank test and linear mixed-effects models. The mean total FATCOD-B-PL score (9-item version) increased from 32.1 ± 3.9 to 33.9 ± 4.2 points (p = 0.0002), reflecting a small-to-moderate change in attitudes toward the care of dying patients following the participation in palliative care course (Cohen’s dz = 0.40, 95
Death anxiety is a multidimensional construct related to awareness of mortality and is clinically and socially relevant because it may be associated with psychological distress, avoidance of death-related communication, and difficulties in coping with illness, caregiving, bereavement, and end-of-life decision-making. Death literacy refers to the knowledge and skills needed to understand and navigate death, dying, bereavement, and end-of-life care, and may represent a potentially modifiable domain associated with death-related distress. However, community-based evidence on the relationship between death literacy and death anxiety in Turkey remains limited. This study aimed to examine the association between death literacy and death anxiety in a community sample in Turkey. A cross-sectional online survey was conducted among 526 adults residing in Turkey who were recruited through a non-probability convenience sampling strategy. Participants completed the Turkish Death Literacy Index (DLI), the Templer Death Anxiety Scale (DAS), and a demographic questionnaire assessing age, gender, education level, income, marital status, chronic illness, bereavement history, death-related experiences, and religiosity. Death literacy was moderately and negatively correlated with death anxiety (r = -.30, p < .001), whereas age was positively correlated with death anxiety (r = .16, p < .001). Multiple linear regression analysis showed that lower death literacy, older age, female gender, and lower educational level were associated with higher death anxiety. These findings indicate an inverse association between death literacy and death anxiety in this community sample. Death literacy may represent a potentially modifiable domain associated with death-related distress, but longitudinal and intervention-based studies are needed to clarify the direction and mechanisms of this relationship.
Recent advances in first-line therapies for metastatic non-small cell lung cancer (NSCLC) have improved overall survival, yet response rates diminish across successive treatment lines. Oncologists are therefore often confronted with the question of discontinuing systemic therapy, a process that raises medical, relational, and ethical challenges. Despite the recognized detrimental impact of end-of-life chemotherapy on quality of life, few studies have explored physicians’ practices and decision-making processes regarding treatment discontinuation and the integration of palliative care. We conducted a qualitative study based on semi-structured interviews with thoracic oncologists from three hospitals in Normandy, France. Interviews were recorded and transcribed verbatim. A descriptive analysis was conducted, drawing on grounded theory methodology. Data collection and analysis were performed iteratively, allowing categories and a theoretical model to emerge. Due to data saturation, 10 out of 14 interviews were conducted. Analysis highlighted two meta-categories: experiences and perceptions, and responses. - Experiences and perceptions: Physicians described anticipatory communication strategies, introducing the possibility of discontinuation from earlier treatment lines. Decisions were framed using objective clinical arguments to avoid subjective projection. Physicians reported ambivalent experiences: conviction when discontinuation was clearly beneficial, but also doubt, frustration, or a sense of therapeutic failure, particularly in younger patients. Patients’ reactions varied, from acceptance (often facilitated by clinical decline) to resistance or requests for second opinions. Families could act as either facilitators or barriers. The term “palliative care” was consistently associated by patients with imminent death. - Responses: Oncologists developed strategies to prevent perceived abandonment, including continued follow-up after discontinuation, transitional therapeutic breaks, or minimal treatments for symbolic continuity. The role of multidisciplinary tumor boards was considered limited, except for complex or young cases. All participants underlined the supportive role of palliative care teams in managing symptoms, maintaining continuity, and alleviating the burden on oncologists. Early integration was viewed as beneficial, though hindered by territorial disparities and resource limitations. Discontinuation of systemic therapy in thoracic oncology is less a therapeutic withdrawal than a relationally protected transition, conceptualized as a “therapeutic transition that protects relational commitment”. Early and equitable integration of palliative care appears essential to support patients, families, and oncologists during this critical phase, ensuring continuity and mitigating the risk of perceived abandonment.
Medical assistance in dying (MAiD) requires careful attention to suffering, yet clinical practice guidance documents provide variable detail on how multidimensional suffering can be explored and addressed. This Delphi study sought expert consensus on potential improvements to clinical practice guidance documents and research priorities related to suffering in MAiD. A multidisciplinary panel of 54 experts participated in a modified e-Delphi study. Candidate items were developed from a previously published scoping review conducted by members of the research team and discussions from a National Knowledge Dissemination and Research Planning Meeting conducted as part of a broader knowledge-translation initiative. The resulting items were then prioritized through three Delphi survey rounds. Consensus recommendations emphasized the need to move beyond MAiD assessment as a discrete eligibility determination and toward a more longitudinal, interdisciplinary approach to understanding and responding to suffering. The strongest priorities included earlier integration of psychosocial and palliative approaches throughout the illness trajectory, rather than only once MAiD is being considered; continued support for patients throughout the MAiD process, including those deemed ineligible; and greater attention to mental health stigma, social determinants of health, culturally responsive care, and the bio-psycho-social-existential dimensions of suffering. Findings provide a framework for strengthening MAiD guidance documents by supporting consistent, interdisciplinary approaches to exploring and addressing suffering. Embedding palliative and psychosocial care earlier in the illness trajectory may help ensure that potentially modifiable sources of suffering are identified and addressed while respecting patient autonomy and supporting high-quality, patient-centered MAiD care. -Current clinical practice guidance documents on medical assistance in dying (MAiD) do not provide clear guidance on how suffering should be assessed and addressed, particularly beyond physical symptoms. -Findings from our study underline the importance of introducing psychosocial and palliative care early in the illness trajectory, rather than waiting until a MAiD request. -MAiD clinical practice guidance documents would benefit from more systematic attention to psychosocial factors, including mental health, stigma, and social determinants of health, with appropriate involvement of social workers and other members of the interdisciplinary team when these issues contribute to suffering. -Greater clarity is needed in clinical practice guidance documents regarding what constitutes “intolerable suffering,” including its bio-psycho-social-existential dimensions, and how this should be approached in both life-threatening and non-life-threatening conditions.
Understanding the needs of family caregivers of patients with cancer and providing appropriate support are essential to ease the burden of illness, facilitate family management, and reduce the risk of adverse health outcomes. Currently, the unmet supportive care needs in family caregivers of patients with multiple myeloma remain unclear. A cross-sectional study was conducted. We used a self-developed questionnaire to assess the supportive care needs and perceived supply among 227 family caregivers of patients with multiple myeloma in southeastern China. Multiple regression analysis was performed to identify associated factors. The highest need was disease information (need rate = 90.04
Standardized nursing service quality evaluation is crucial to address regional disparities and optimize palliative care outcomes in China, yet a structured indicator framework remains lacking. To develop a preliminary SERVQUAL-informed, consensus-based indicator framework for palliative care nursing services for terminal cancer patients in China. An initial framework was developed through a literature review and structured according to the five dimensions of the SERVQUAL model. A two-round Delphi consultation was conducted with 17 nursing experts with experience relevant to palliative care recruited through purposive sampling. Response rates were 100
Family caregivers (FCs) face numerous challenges and significant stress when caring for patients with terminal illness. Palliative care consultation services (PCCS) provides comprehensive physical, psychological, social and spiritual support for both patients and FCs. This study examined changes in the resilience of FCs of patients with terminal illness following PCCS. This pre- and post-test study involved 30 FCs of patients with terminal illness. A structured questionnaire, including demographics and the Connor–Davidson Resilience Scale, was used to collect data at baseline (immediately before initiation of PCCS) and follow-up (on the day following the initial PCCS consultation) at a medical center in northern Taiwan. Descriptive statistics and generalized estimating equations were used to examine changes in resilience following PCCS. Exploratory univariable and multivariable GEE analyses were further conducted to examine caregiver- and patient-related characteristics associated with resilience. Statistical significance was set at p < 0.05. Resilience scores were significantly higher at follow-up than at baseline (70.2 ± 2.4 vs. 66.1 ± 2.5, p < 0.001). Specifically, age, education level, employment status, relationship with the patient, and self-perceived health status of FCs, as well as education level, marital status, and religious beliefs of the patients were associated with FCs’ resilience. FCs’ resilience was higher following PCCS. However, because of the exploratory single-group pre–post design and limited sample size, the observed increase cannot be interpreted as evidence of a causal effect of PCCS. These findings provide preliminary evidence of an association between PCCS and caregiver resilience. A comprehensive, caregiver-inclusive approach may help support resilience among FCs during end-of-life care. Further adequately powered controlled studies are needed to clarify the role of PCCS in supporting caregiver resilience.
Pediatric palliative care (PPC) plays a crucial role in addressing the needs of children with life-limiting conditions and their families. However, gaps remain in understanding the care trajectories and optimal timing for PPC initiation among children with non-progressive but irreversible neurological conditions (Association for Children’s Palliative Care Classification Group 4, ACT-4). This retrospective multi-center study conducted in Ile-de-France aimed to characterize ACT-4 patients who received subspecialty PPC, the circumstances leading to PPC team involvement, and their initial intervention. Data was collected from electronic medical records of three PPC teams (hospital and community based) between 2020 and 2022. Statistical analyses were performed to identify patterns and differences in care trajectories. A total of 126 ACT-4 patients under 25 years of age were included in the study. Predominant diagnosis were hypoxic/ischemic and epileptic encephalopathy with a median age at diagnosis of 0.5 months (interquartile range (IQR): 0–6 months). Median age at PPC initiation was 3.5 years (IQR 0.5–12.5 months) with about half of patients receiving intensive medical care for an acute clinical episode, most frequently for respiratory distress or neurological symptoms (status epilepticus/dystonicus). The most common indication for PPC referral was defining goals of care during a multidisciplinary team meeting, often leading to withholding/withdrawing treatment, followed by pain management. Community-based patients were often older (median age 6.9 years, IQR 0.7–14.8 years) and referred for end-of-life care, whereas hospital patients tended to be younger (median age 3 years, IQR 0.4–11.2 years) and referred for collegial goals-of-care and advance care planning discussions. One year after referral, nearly a third of patients had died, one third received palliative follow-up, and one third were not followed-up by PPC teams. Despite early diagnosis as a neonate, specialized palliative care is often initiated during a later acute clinical episode. Advance care planning, decision-making, complex and/or refractory symptom burden, and care coordination require opening a space for interdisciplinary dialogue and thus are opportune moments to initiate PPC. Further qualitative studies exploring optimal referral time from families’ and healthcare providers’ viewpoints would be of interest.
Persistent inequalities in access to and engagement with palliative and end-of-life care remain a significant challenge for many ethnic minority and migrant populations across the United Kingdom, despite sustained policy commitments to delivering equitable, person-centred care. With an ageing population and growing prevalence of chronic, life-limiting conditions, demand for palliative and end-of-life care continues to increase, making the reduction of inequalities in access an increasingly urgent healthcare priority. Migrant communities often encounter distinct barriers to accessing and engaging with palliative and end-of-life care services, including challenges related to language, communication and cultural differences. These issues are particularly relevant for Eastern European populations, who constitute one of the largest migrant populations in the United Kingdom, yet their experiences of palliative and end-of-life care remain underexplored. Existing research frequently aggregates ethnic minority populations, obscuring factors that shape engagement within specific communities and limiting opportunities to develop more equitable, person-centred care. To address this evidence gap, this review explored both barriers and facilitators influencing Eastern European populations’ access to and engagement with palliative and end-of-life care, addressing the question: What factors influence Eastern European populations’ access to and engagement with palliative and end-of-life care services? This scoping review followed the Arksey and O’Malley framework, with additional guidance from the Joanna Briggs Institute and was reported in accordance with PRISMA-ScR. The review searched multiple databases and grey literature sources. Studies were screened using predefined Population, Concept, Context eligibility criteria and synthesised the data using a combined Socio-EcologicalModel and Systems Approach framework. Forty-one papers met the inclusion criteria, covering Eastern European populations across diverse international settings. Both barriers and facilitators to access and engagement were identified across all levels of the Socio-Ecological Model, including individual beliefs and knowledge, interpersonal relationships, organisational practices, community norms, and wider structural and policy influences. These factors were shown to interact in complex ways, shaping individuals’ experiences of palliative and end-of-life care. Access to and engagement with palliative and end-of-life care among Eastern European populations is shaped by interconnected individual, interpersonal, organisational and structural influences. Addressing these multi-level factors is essential for developing and delivering person-centred care in practice and to inform policy and service development.
Pain management is considered a fundamental human right and a central aspect of palliative care. However, disparities exist in palliative pain management for populations facing intersecting inequities, such as housing insecurity and poverty, which are rooted in colonialism, racism, and stigma. This study aims to examine how palliative pain management is delivered within a structural vulnerability context, drawing attention to how pain is addressed in care delivery among people who experience disparities in pain management including people who experience housing insecurity, people who experience poverty, and people who use substances. This is a secondary analysis of qualitative data generated from two participatory action research studies, Realizing the Benefits of a Palliative Approach for Vulnerable and Marginalized People Living with Cancer, and Building Palliative Care Capacity in Inner-City Communities. Participants included inner-city community workers (housing staff, outreach support, peer workers), a mobile clinical palliative outreach team (nurses, physicians, social workers), caregivers, clients, and decision-makers (policy makers, managers). A total of 28 interviews, 5 focus groups, and 35 observational field notes and meeting minutes were analyzed following a reflexive thematic analysis process guided by a structural vulnerability lens. Findings highlight how community-based and clinical-based service providers worked with clients who often had unmet chronic pain needs and had developed strategies, such as using illicit substances, to manage their pain within the community. Service providers focused on building trust with clients, addressing social determinants through care coordination, and developing tailored approaches to pharmacological pain management that were responsive to clients’ previous negative experiences with healthcare and the social disparities they faced. Broader social factors, such as housing insecurity, home care, and opioid and hospital policies, complicated the delivery of palliative pain management. This study highlights how palliative approaches can legitimize pain among populations with significant histories of unmanaged pain and systemic barriers to care. Findings underscore the need for a multidimensional strategy integrating pharmacological and non-pharmacological approaches, sustained cross-disciplinary collaboration, and a relational approach (e.g., trust-building) to care. The findings emphasize the centrality of a ‘total pain’ approach and sustained investment in community-based palliative care services to achieve equitable pain management.
Climate change is increasingly recognized as a major global health threat, with disproportionate impacts on vulnerable populations, including women living with breast cancer who are receiving palliative care. These women often experience compounded physical, psychological, and socioeconomic burdens that may be intensified by climate-related stressors such as heatwaves, flooding, and disruptions to healthcare delivery. However, there is limited evidence from low- and middle-income countries, including Ghana, on the effects of climate change on patients receiving palliative care and their quality of life (QoL). A qualitative descriptive design was employed to explore the experiences of women with breast cancer receiving palliative care at Ho Teaching Hospital, Ghana. Thirty participants were purposively sampled between January and March 2026. Data were collected through semi-structured in-depth interviews conducted face-to-face. Interviews were audio-recorded, transcribed verbatim, and analyzed using Graneheim and Lundman’s conventional content analysis approach. Trustworthiness was ensured through credibility, dependability, confirmability, and transferability strategies. Ethical clearance was received before data collection began (HTH-REC/EX/2026/003). Participants described climate-related disruptions as becoming intertwined with their experience of advanced breast cancer and palliative care. They explained that extreme heat, flooding, and unreliable electricity worsened symptoms, disrupted treatment continuity, increased emotional and financial burdens, and limited access to essential care. Despite these challenges, participants relied on family, healthcare providers, spiritual beliefs, and community support to adapt and maintain their wellbeing. This study found that climate-related environmental stressors, including extreme heat, flooding, and unreliable electricity, were perceived to adversely influence the palliative care continuum and the quality of life of women with breast cancer. Strengthening climate-resilient palliative care systems, improving healthcare infrastructure, expanding community-based services, and integrating climate adaptation into oncology nursing practice and policy are essential to enhance continuity of care and improve patient outcomes in the context of increasing extreme weather events.
Communication is central to palliative care, spanning patients, family caregivers, and institutions across diverse care situations. Digital technologies are increasingly discussed as a means of supporting palliative care delivery, yet quantitative evidence on how communication technologies are actually used in routine practice — with which partners, in which situations, and whether use differs between professional groups — remains limited. This study examined patterns of communication technology use in routine palliative care and assessed differences between professional groups. We conducted a cross-sectional survey of healthcare professionals working in palliative or hospice care in Brandenburg, Germany. A self-administered questionnaire, developed from prior qualitative work and pilot-tested, was completed online (LimeSurvey) or on paper between September and November 2023. For each combination of communication partner and care situation, participants indicated which of six channels they typically used (telephone, email, fax, messenger services, PalliDoc/documentation software, video consultation). Descriptive statistics were calculated, and Pearson chi-square tests compared physicians, nurses, and other healthcare professionals (90 tests; Bonferroni-corrected α = 0.00056), with effect sizes reported as Cramér’s V. Reporting followed the CROSS guideline. Of 162 completed questionnaires, 71 (43.8
Traditional approaches examining isolated symptoms fail to capture dynamic network structures in palliative care. This study aimed to decompose physiological and psychological symptom networks across multiple levels and identify central symptoms that may inform hypothesis-generating targets for future intervention studies in advanced cancer patients. This secondary retrospective longitudinal study utilized diary-based design and multilevel network analysis at a tertiary cancer hospital in mainland China. 166 advanced cancer patients receiving palliative care completed ≥ 20 consecutive daily assessments using standardized PCOC tools: Symptom Assessment Scale (SAS), Palliative Care Problem Severity Score (PCPSS), and Resource Utilisation Group-Activities of Daily Living (RUG-ADL). Multilevel vector autoregressive (mlVAR) models estimated temporal networks (lag-1 effects), contemporaneous networks (same-day associations), and between-subjects networks. Network centrality was quantified using expected influence (EI), with stability evaluated through bootstrap procedures. Time-series stationarity was confirmed via Augmented Dickey-Fuller (ADF) tests, and autocorrelation function (ACF) analysis was conducted to assess temporal persistence patterns across symptom domains. Four distinct network patterns emerged. In SAS networks, nausea showed highest temporal centrality (temEI = 0.102) with cross-lagged associations with appetite loss and bowel distress, while sleep distress (conEI = 0.836) and appetite (conEI = 1.018) were contemporaneously central. PCPSS networks revealed psychological/spiritual issues were associated with subsequent family/carer problems (r = 0.059) with highest between-subjects centrality (0.891). ADL networks identified toileting dependency as temporally central (temEI = 0.199), associated with subsequent changes in functional decline. The comprehensive network highlighted psychological/spiritual problems with strongest temporal influence (temEI = 0.251) and six significant connections, particularly associated with ADL deterioration. Autocorrelation analysis revealed distinct persistence patterns: ADL measures showed strongest persistence; SAS demonstrated moderate decay; PCPSS exhibited scale-specific patterns with psychological/spiritual concerns showing greater persistence (0.814 → 0.258) than pain (0.544 → 0.020). This study identified distinct symptom network patterns across temporal, contemporaneous, and between-subjects levels. Findings provide preliminary evidence that may guide future intervention studies targeting central symptoms to investigate potential cascading effects and optimize monitoring strategies based on symptom persistence characteristics.
Neuroendocrine neoplasms (NENs) can be divided into well-differentiated neuroendocrine tumors and poorly differentiated carcinomas (NETs and NECs, respectively). Although the incidence of NENs is increasing globally, reports on palliative care in affected populations are scarce. This study aimed to describe the state of palliative care team (PCT) interventions for patients with NENs referred to tertiary care centers’ PCTs. Among the patients with neoplasms referred to tertiary care centers’ PCTs during January 2017–June 2025, those histopathologically diagnosed with NENs were included. They were classified as having NETs or NECs, and baseline characteristics, reason for PCT referral, and outcomes after PCT intervention were investigated. Additionally, for patients referred to a PCT because of pain, the numerical rating scale (NRS) score, cause of pain, pain type, pain management details, and the equivalent oral morphine dose (EOMD) were also investigated. These parameters were compared between patients with NETs and NECs. Among 3,190 patients with neoplasms referred to tertiary care centers’ PCTs, 48 (1.5
Despite, its benefits, palliative care, especially in oncology, remains underutilized globally. The COVID-19 pandemic posed several challenges that may have further exacerbated the timing of referrals and access to care. This descriptive study examines hospice referral patterns and patient characteristics among advanced cancer patients admitted to an inpatient hospice center in urban India during the COVID-19 pandemic, including demographics, commonly reported cancer types, referral sources, and the timing from referral and admission to death. A retrospective study was conducted using admission records from January to April 2021 (second wave), September to December 2021 (intermediate period), and January to April 2022 (third wave) of the pandemic. Descriptive and quantitative analyses were performed to analyze patient characteristics and the timing of admission and referral to death. The study included 740 new admissions of advanced cancer patients to the hospice across the three pandemic periods. Carcinoma breast was the most common cancer type referred to the hospice with doctors being the primary referral source. The median time from admission to death remained consistent across the three waves, and was less than 30 days. This suggests late transition to inpatient hospice care in the final weeks of life. No significant differences were observed in referral timing by age group or socioeconomic status. Advanced cancer patients in our study sample were consistently referred late to hospice care, irrespective of age or socioeconomic status. This highlights the urgent need for improved and timely referral systems, especially given that advanced cancer patients comprise the majority of cancer patients in India. Addressing gaps in access to care and awareness of the benefits offered by end-of-life care, particularly for younger patients and men, is crucial for ensuring equitable and cost-efficient palliative care delivery.
The most effective approach for patients and healthcare professionals to manage multiple symptoms during treatment or care is palliative care support focused on symptom control. This study aimed to evaluate the validity and reliability of the Turkish version of the Person-Centered Palliative Care Nursing Instrument. A methodological and descriptive cross-sectional study was conducted at a city hospital in Istanbul. The sample included 200 nurses who worked in the intensive care unit. Data were collected using the Person-Centered Palliative Care Nursing Instrument and the Frommelt Attitude Toward Care of the Dying Scale. The content validity index of the scale was calculated as 0.84. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.918, and Bartlett’s Test of Sphericity yielded a χ² value of 8395.116 (p < 0.001). Item-total correlation coefficients ranged from 0.519 to 0.762, while factor loadings varied between 0.514 and 0.866. Confirmatory Factor Analysis revealed acceptable goodness-of-fit indices: χ² = 2355.612, df = 0.8, RMSEA = 0.07, GFI = 0.92, CFI = 0.97, and AGFI = 0.87. The internal consistency reliability of the subscales ranged from 0.905 to 0.965, with a Cronbach’s alpha coefficient of 0.98 for the overall scale. Exploratory Factor Analysis confirmed the original structure of the scale, consisting of 37 items and four factors. Families of people with chronic illness often struggle to provide adequate care, increasing the demand for professional support. Poor satisfaction levels of palliative patients, families and health care providers indicate the need for improvements in the palliative care system. Assessing the quality of palliative care provided by nurses is essential to improve the quality of patient care. The Turkish version of the scale was found to be a valid and reliable instrument for clinical use, enabling nurses to deliver palliative care tailored to patients’ needs and preferences.
Despite growing global recognition of palliative care’s importance, access to adequately trained professionals and high-quality services remains highly unequal across countries. Nurses’ knowledge and attitudes are critical determinants of end-of-life care quality, yet evidence from diverse institutional settings in China remains limited. This study aimed to assess palliative care knowledge and attitudes toward end-of-life care among nurses in Guangzhou, China, and to identify the key factors influencing these attitudes. This cross-sectional study recruited 1196 registered nurses from 17 institutions across seven administrative districts of Guangzhou between January 2019 and June 2023 using convenience sampling. Data were collected using a general information questionnaire, the Palliative Care Quiz for Nursing (PCQN), and the Frommelt Attitudes Toward Care of the Dying Scale Form-B (FATCOD-B). Multiple linear regression was performed to identify independent predictors of attitudes toward end-of-life care. The sample included nurses from tertiary general (n = 424, 35.5
Adolescence and young adulthood is characterised by complex developmental and psychosocial changes. The diagnosis of a life-limiting condition adds complexity and stress to this already turbulent period of life. Provision of developmentally appropriate palliative care to this group necessitates an understanding of the palliative care needs specific to this group. The aim of this study is to identify existing evidence about the palliative care needs of adolescents and young adults with a life-limiting condition (both cancer and non-cancer conditions). This systematic review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines. Six databases were searched from time of inception until 18th December 2025. The databases searched included Pubmed, Scopus, CINAHL (EBSCO), Ovid MEDLINE, PsycINFO (EBSCO) and the Web of Science Core Collection. Articles were screened and extracted. Key themes were identified within and across articles. In total, twelve articles (nine qualitative and three quantitative studies) were included. Nine of the included studies focused on adolescents and young adults with cancer, while the remaining three studies focused on non-cancer conditions. Analyses generated five themes: (i) Shared core palliative care need domains, (ii) Parent and peer relationships, (iii) Normalcy, (iv) An adapted approach to communication and decision making, and (v) Continuity and coordination of health services. This systematic review outlines the evidence on palliative care needs specific to adolescents and young adults with a life-limiting condition. These findings will support advancement of developmentally appropriate palliative care supports for this group.
