Background Community-based palliative care is increasingly promoted as an alternative to hospital-centered end-of-life care, yet prior reviews have largely cataloged outcome measures or program components associated with favorable results, without explaining how these components interact to produce those outcomes. Objective To synthesize evidence on the effectiveness of community-based palliative care for life-limiting illness and to identify the mechanisms, rather than merely components, underlying its benefits. Methods Following standard systematic review reporting guidelines, we searched multiple databases for studies evaluating community-based palliative care delivered to adults with life-limiting conditions outside hospital settings. Twenty eligible studies were analyzed using thematic synthesis. Results Findings coalesced into 5 interdependent mechanisms rather than a list of isolated benefits. First, anticipatory, home-based symptom monitoring enabled rapid clinical response, reducing pain, breathlessness, and psychological distress while preserving quality of life despite functional decline. Second, care was structured to conserve patient dignity and autonomy, particularly for marginalized populations, by treating patient-defined goals of care as organizing principles rather than secondary considerations. Third, family caregivers functioned as a mediating variable: structured caregiver education and burden mitigation sustained home-monitoring vigilance that made early symptom detection possible. Fourth, task-sharing between specialist clinicians and trained community health workers or volunteers allowed monitoring and social support to scale without proportional increases in specialist staffing. Fifth, early, structured advance care planning functioned as a leading indicator that plausibly mediated downstream reductions in emergency visits, hospital readmissions, and intensive care unit utilization, with corresponding per-patient cost reductions. Conclusions Community-based palliative care improves outcomes not simply because care is relocated to the home, but because the home is where clinical responsiveness, caregiver capacity, task-shared workforce models, and early care planning converge and reinforce one another. Health systems that shift only the site of care, without investing in these underlying mechanisms, are unlikely to reproduce the effects reported here.
Objectives In palliative care, family caregivers play central roles in supporting patients and might face a burden during this process. The present study aimed to determine the family caregiver burden and well-being in caregivers of palliative care patients, and to investigate the effects of sociodemographic characteristics of family caregivers and patients, and the clinical information and daily living activities dependency status of patients. Methods This descriptive, cross-sectional study was conducted with 102 family caregivers in a palliative care unit in western Turkiye between May 2024 and March 2025. The data were collected using the Zarit Burden Interview (ZBI), the World Health Organization Well-being Index (WHO-5), and the Katz Daily Living Activities (DLA) Index. Results The mean ZBI score was 35.58 ± 14.07, and the mean WHO-5 score was 34.63 ± 23.61. A total of 56.9% of the patients were completely dependent according to the Katz DLA. There was a statistically significant negative relationship between caregiver burden and well-being ( p < .05). Multiple regression analysis revealed that perceived income sufficiency, problems with other responsibilities, and the patient's dependence on daily living activities negatively affected caregiver burden ( p < .05). Additionally, caregiver age of 55 years or older, low caregiver burden, and the patient's independence in daily activities positively affected caregiver well-being ( p < .05). Conclusions This study revealed that increasing the burden of care negatively impacts family caregiver well-being. Interventions aimed at reducing the burden of care and improving well-being should be developed and implemented.
Palliative care (PC) helps to improve quality of life and alleviate suffering for those who are faced with a terminal cancer diagnosis. Music therapy (MT) is a type of expressive arts therapy that may be beneficial for PC patients to help manage physical symptoms as well as address psychosocial, spiritual, and existential needs. The present case report explores the use of MT as an existential form of therapy with Joe, a PC patient with terminal lung cancer. MT addressed Joe's physical and psychosocial needs and provided space to explore existential topics related to death and dying, ultimately leading to transcendence and acceptance.
Objectives Mesothelioma is a rare and fatal cancer with a median survival of about 1 year after diagnosis. Palliative care (PC) becomes important in improving symptom control and quality of life in cancer patients. However, there is no literature regarding specific determinants of PC utilization in hospitalized mesothelioma patients. We studied the trends and determinants in utilization of PC, and its impact on hospital costs using the National Inpatient Sample. Methods A retrospective cross-sectional study was conducted based on data from 2016 to 2020. Adults above 18 years of age hospitalized for mesothelioma (ICD-10-CM C45) were identified. In this set of patients, PC encounters were identified using ICD-10-CM Z51.5. Main outcomes measured were predictors of inpatient PC, hospitalization charges, and clinical outcomes. Results Of 13 745 mesothelioma hospitalizations between 2016 and 2020, 14.2% had an encounter with PC. Utilization was higher among Medicaid-insured patients (7.4% vs 4.0%, P = .005), those with heart failure (17.2% vs 10.4%, P < .001), and acute kidney injury (24.4% vs 12.7%, P < .001). PC was less frequent in large hospitals and obese patients. After adjusting for confounders in the multivariate regression analysis, PC was associated with a $29 259 reduction in hospitalization charges ( P < .001). Conclusions Inpatient PC use in mesothelioma remains low but is associated with lower hospitalization costs. These findings support the need for systematic early PC integration in Mesothelioma management in a hospital setting.
Background Caregivers of individuals with major neurocognitive disorder are often required to participate in decision-making for their loved ones, including the initiation of palliative care and end-of-life care (PEoLC). Yet, it remains unclear whether caregivers are prepared to engage in such decision-making. Objectives This study aims to assess the knowledge, attitudes, and representations of caregivers of individuals with major neurocognitive disorders regarding PEoLC practices, and to examine the extent to which sociodemographic variables influenced these outcomes compared to the general population. Method A community-based cross-sectional questionnaire study was conducted in Quebec, Canada. A non-probability convenience sampling method was used to recruit 572 participants from the general population, who were then divided into two groups according to their experience as caregivers for a person with a neurocognitive disorder until their death. Results Caregivers demonstrated a higher level of knowledge, with mean scores of 10.1 versus 8.7 out of 14 (ranges 0-14, P < .01), as well as generally favorable and similar attitudes and representations toward PEoLC compared to the general population. Individuals’ interpretations of ethical dilemmas at the end of life were also shaped by their religious beliefs. Results further indicate that 8% of caregivers reported having no experience with palliative care, although they all supported a person with a major neurocognitive disorder until their death. Conclusion This study reaffirms the central role of family caregivers in end-of-life decision-making, while underscoring the influence of religiosity on their attitudes and representations. Further research is needed to understand how these factors interact in different cultural and legislative contexts, in order to better support caregivers, guide healthcare practice, and inform public policy, ultimately improving care for individuals with major neurocognitive disorders and their families.
