Spirituality and religion play an important role in helping individuals cope with life-threatening illnesses and end-of-life experiences. However, qualitative evidence exploring how relatives of palliative care patients perceive religion, spirituality, and death remains limited. This study aimed to explore the perspectives of relatives of palliative care patients regarding religion, spirituality, and death. A qualitative descriptive design was employed. Semi-structured interviews were conducted with five relatives of patients receiving care in the palliative care unit of a university hospital in Türkiye. Data were analyzed using Braun and Clarke's inductive thematic analysis. The analysis generated five overarching themes and ten subthemes, capturing participants' experiences of the emotional journey of caregiving, religion and spirituality as multidimensional coping resources, transformation in perceptions of death and life, spiritual care needs and expectations, and meaning-making beyond the caregiving experience. Participants described caregiving as emotionally demanding yet meaningful, with religion and spirituality fostering resilience, emotional relief, acceptance, and hope. The palliative care experience also contributed to a transformed understanding of death as a natural transition and increased appreciation of life. Despite recognizing spirituality as an essential component of holistic care, participants perceived institutional spiritual care as insufficient and expressed the need for greater spiritual support from healthcare professionals. Religion and spirituality were central resources that helped relatives cope with the emotional and existential challenges of the palliative care process while facilitating meaning-making and adaptation to death. The findings also highlight important unmet spiritual care needs, emphasizing the integration of structured, person-centered spiritual care into routine palliative care practice. Given the small, context-specific sample, these findings should be interpreted as exploratory and warrant confirmation in larger and more diverse qualitative studies.
Home-based hospice care extends palliative care into patients’ homes and requires nurses to provide clinical, emotional, practical, and existential support within family contexts. Although home-based hospice nurses play a central role in this model of care, little is known about how they develop professional identity and sustain commitment while managing the emotional and relational demands of end-of-life care. This study explored how home-based hospice nurses developed professional identity and sustained commitment across their career journeys while negotiating the emotional and relational responsibilities of end-of-life care. This qualitative narrative inquiry adopted a life-course perspective. Between November 2021 and March 2022, in-depth interviews were conducted with 10 certified home-based hospice nurses in Taiwan who were recruited through purposive and snowball sampling. Interviews lasted 50–195 min and were analyzed using Polkinghorne’s narrative analysis, supported by Kelly and Howie’s procedures for narrative organization and cross-case interpretation. Participants’ career stories revealed a developmental journey from entering nursing and searching for professional direction to becoming trusted relational caregivers within patients’ homes and family contexts. Four themes were identified: searching for a place in nursing; finding meaning beyond clinical tasks; walking through the valley with patients and families; and sustaining self while caring for others. Relationships with patients and families were central to participants’ professional identity formation and sustained commitment over time. Two participants used driftwood imagery, including one who described being the family’s “last piece of driftwood,” reflecting a broader pattern of emotional responsibility, family trust, and boundary negotiation across the narratives. Professional identity in home-based hospice nursing is shaped through relational caregiving, repeated encounters with suffering and death, reflective practice, team support, and lifelong learning. These findings highlight the importance of educational and workforce support strategies that strengthen emotional boundary-setting, communication, relational ethics, and interprofessional collaboration to sustain the home-based hospice nursing workforce.
The Palliative Care Outcomes Collaboration (PCOC) provides a standardized framework for measuring and improving palliative care outcomes. Taiwan began implementing PCOC in 2020, requiring a culturally and linguistically adapted Taiwan-Chinese version. This study developed and culturally adapted a Taiwan-Chinese version of the five core PCOC tools and conducted a preliminary evaluation. This multiphase methodological study included preparation and multidisciplinary reconciliation of preliminary Taiwan-Chinese versions, four modified Delphi rounds with 12 multidisciplinary experts, independent back-translation by two bilingual experts blinded to the original instruments, and item-level qualitative review by a representative of the Australian PCOC team. Clinical quality-improvement audits examined interrater agreement for the Palliative Care Phase and PCPSS and clinician-rated appropriateness and ease of use; a separate retrospective audit assessed documentation completion in 67 patient records. Final-round I-CVI values for wording clarity ranged from 0.83 to 1.00, and scale-level indices using the average method ranged from 0.96 to 1.00. The Taiwan-Chinese PCPSS retained four scored domains; the social/psychological/spiritual label represented one combined domain with a single 0–3 severity rating. There were 55 valid paired assessments for the Palliative Care Phase and 27 for each PCPSS domain. Exact agreement was 74.5
Head and neck squamous cell carcinoma (HNSCC) has a poor prognosis, particularly in recurrent or metastatic settings. Conventional radiotherapy may cause substantial toxicity, especially in previously irradiated or heavily pretreated patients. The hypofractionated QUAD SHOT regimen has demonstrated palliative activity, but its efficacy, symptom palliation, quality-of-life (QoL) outcomes, and safety have not been comprehensively quantified. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a protocol prospectively registered in PROSPERO (CRD420251119819), we searched PubMed, Embase, and the Cochrane Library for randomized controlled, prospective single-arm, and retrospective studies evaluating QUAD SHOT in HNSCC. Studies enrolling at least ten patients and reporting eligible efficacy or safety outcomes were included. The primary outcome was objective response rate (ORR). Secondary outcomes included disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (AEs). Symptom relief and formal QoL outcomes were evaluated in a post hoc extension of the original analysis. Pooled estimates were calculated using random-effects models. Twelve studies involving 764 patients were included. The pooled ORR was 58
