This scoping review provides an overview of empirical research and practice-based literature that addresses direct clinical practice with chosen families-familial relationships that are not based on biology or law. Given the prevalence of chosen family among sexual and gender minorities as well as the amount of research that underlines chosen family as an important social support, this paper aims to synthesize recommendations for clinical work with chosen families and to highlight gaps in the literature. Using the five-step Arksey and O'Malley (2005) scoping review process, four electronic databases were systematically searched to identify papers that address working with chosen family in care-related fields, including social work, couple and family therapy, and nursing. Twenty-seven articles were included in this review and seven themes were identified by these authors that culminated in recommendations for clinical practice: (a) educate oneself about diverse family forms and address biases; (b) invite self-definition of "family"; (c) proactively include chosen family; (d) consider legal and policy barriers; (e) refer chosen family members to sources of support; (f) encourage people to create or maintain chosen family; and (g) engage in sexual and gender minority affirmative practices generally. The existing literature focuses primarily on individual services that involve chosen family as needed, but do not explicitly focus on dynamic and systemic needs. Further research into systemic work with chosen family is needed.

Approximately one-quarter of the Canadian population will die in long-term care (LTC) homes, highlighting the importance of improving end-of-life (EOL) care in these settings. There is a growing recognition of the need to integrate palliative approach to care in these settings. Central to this approach is compassionate care, which supports the emotional, psychological, and spiritual needs of residents and their families at EOL. Compassion is fundamental to person-centered care and plays a critical role in shaping how staff and families experience dying, death and bereavement. Compassion in LTC settings fosters connection, meaning and dignity at the EOL. This study explored the perceptions of nurses and bereaved family members regarding their experiences with EOL and bereavement practices, and how enacting compassionate care supported residents dying in LTC homes across Canada. This qualitative study was conducted across four LTC homes in Ontario, Manitoba, Saskatchewan, and Alberta. Using an interpretive qualitative design, we conducted semi-structured interviews with LTC nurses and bereaved family caregivers to examine how compassionate care is practiced in LTC settings. The analysis focused on how acts of compassion support both staff and family caregivers during the EOL process and contribute to the experience of a “good death” for residents. A total of 26 family members and 13 LTC staff were interviewed. Three major themes emerged: (1) nurturing compassionate care within relationships, (2) integrating family as a team member to promote compassionate care, and (3) sustaining compassionate care practices in LTC. Several subthemes further elaborated on these core findings. Compassionate care is an essential and highly valued component of EOL care in LTC settings. Findings highlight the importance of supporting compassionate care as an integral part of a palliative approach to care, emphasizing the need for system wide initiatives to sustain and enhance such practices in LTC settings. Not applicable.

INTRODUCTION:Research on dementia caregiving in Africa often prioritizes biomedical and formal health-care services, overlooking broader family and community-based support networks. Addressing this gap, this study explores when and which support services Yoruba families use and how these services shape their caregiving experiences within the dementia care context. METHODS:Guided by interpretive phenomenology and Afrocentric principles, we conducted 15 semi-structured family interviews with 52 participants (2-5 per family), alongside persons with dementia. Interviews were audio-recorded, translated, and thematically analyzed. RESULTS:Help seeking often began when behavioral symptoms became overwhelming. Urban families (n = 11) leaned on hospital services, while rural families (n = 4) turned to faith-based and traditional healers. Support was appreciated for offering reassurance, though hospital services often lacked cultural sensitivity, and traditional options-while fostering hope-could reinforce stigma. DISCUSSION:Enhancing dementia awareness and collaboration between medical, spiritual, and traditional systems may improve caregiver experiences and encourage earlier, culturally appropriate interventions. HIGHLIGHTS:Yoruba families caring for loved ones with dementia do not adhere to rigid care pathways. Instead, they move fluidly between hospitals, religious spaces, and traditional healing practices-not just in search of treatment but to find meaning, reassurance, and continuity with ancestral ways of knowing. Memory loss is not always seen as a medical condition; it is often interpreted through spiritual, cultural, and communal lenses. Families may turn to faith leaders or elders first, delaying formal care until behaviors become disruptive or socially visible. Our interpretive phenomenological analysis, grounded in an Afrocentric lens, reveals caregiving as both an expression of love and a weighty responsibility. The ever-present fear of judgment-from within and outside the family-can lead to silence, isolation, and hesitation in seeking biomedical support. A more compassionate and culturally anchored dementia care model requires health-care professionals, traditional healers, and faith leaders to work together. Through dialogue and mutual respect, they can create care networks that honor Yoruba worldviews, allowing families to navigate dementia in ways that feel both medically sound and spiritually resonant.

Palliative care has earned its place as a respected approach to medicine that focuses on quality of life, symptom management, a team approach, and family involvement, typically following the diagnosis of a life-limiting illness. To improve health equity, it is important to encourage the adaptation of palliative care practice and philosophy beyond hospices and within a range of care settings. To support further adaptation in long-term care, our research team Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) created the video education resource "SPA-LTC Voices" to explore what a palliative approach entails in a long-term care context and to dispel persistent myths about palliative care. After consulting with palliative care experts and family caregivers, we designed a four-part series using a storytelling approach (i.e., presenting accounts of lived experience) within a three-act narrative structure (i.e., setup, tension, and resolution). We then employed an embedded intervention mixed methods design to pilot-test the acceptability of the video series and the outcome of knowledge transfer during structured interviews with 16 participants, who were either family caregivers (12) or healthcare providers (4). Integrated qualitative and quantitative findings confirmed potential for positive impact on knowledge transfer across both audiences, including an improved understanding of the values and practices involved in palliative care. Integrated findings also confirmed high acceptability of the narrative format and the diversity of the storytellers. Overall, this pilot research suggests that the "SPA-LTC Voices" video series holds promise as a tool to support education within long-term care settings.

The United Nations Convention on the Rights of Persons with Disabilities (2006) suggests that all individuals have the right to participate in decisions about their care. This rights-based framework calls on healthcare professionals such as social workers to prioritize older persons’ rights to participate in care decisions that affect them. Hence, this review examines how social workers in acute care settings are positioned to act as advocates. We conducted a narrative review of literature using five scientific databases—CINAHL, MEDLINE, PubMed, Social Work Abstracts, and Social Sciences Abstracts, and one search engine, Google Scholar. Of 83 articles identified, 26 were selected for full-text review. We performed a thematic analysis to examine how and when social workers advocate for older persons’ rights. Of 26 articles reviewed, 18 included perspectives of interprofessional team members. Thematic analysis revealed three main roles of social workers in acute care: coordinator, mediator, and advocate. While coordinating and mediating roles were widely recognized and valued as they prioritize system efficiency and service navigation, advocacy aimed at promoting older persons’ rights was less visible and harder to enact. Social workers face many challenges in acting as advocates because they are most valued within hospital settings for their roles as coordinators and mediators. Further research is needed to identify how social workers can consistently prioritize their role as advocates. Without these guidelines, older persons’ right to care involvement will not be realized and rights claims will continue to be sidelined by the rhetoric of efficiency and risk protection.

Palliative care for people experiencing homelessness (PEH) is a social issue of increasing importance. Policymakers are best positioned to lead societal responses by naming the issue in policy documents, allocating resources to address palliative care for PEH, and creating frameworks or guiding principles to inform action. This study aims to examine how, if at all, policymakers in Canada are identifying and addressing the issue of palliative care for diverse PEH in policies and frameworks governing the palliative care and/or homelessness sectors. We conducted a content analysis of 75 Canadian policy documents governing palliative care or homelessness for the presence of discussion of homelessness (in palliative care documents) and end-of-life (in homelessness documents). The level of discussion (no, indirect, minimal, significant), the jurisdictional level (municipal/city, provincial/territorial, national), and mention of intersecting identities were also recorded. Of the 75 documents analyzed, 42 contained no discussion of palliative care and homelessness, and only five contained significant discussions by explicitly identifying barriers, describing unique needs, and identifying competencies or innovative practices to promote access and inclusion. All significant or national level discussions were palliative care documents. Intersectional discussions of palliative care for PEH were found in 9 of 75 of documents, with ethnicity and Indigeneity mainly mentioned in palliative care documents, and older age and gender mentioned solely in homelessness documents. There are critical gaps in Canadian policy documents governing palliative care and homelessness. Most policy documents fail to name or address the issues, with the gap most pronounced in homelessness documents, which contained no national level or significant discussions about end-of-life. Additionally, policy documents from both sectors seldomly discussed the unique needs and barriers of older, racialized, and/or gender-marginalized PEH at end-of-life. While competencies and service level solutions appear to be emerging within palliative care policies at the national level, policymakers from both sectors and across all levels of government must collaborate to address the unique needs of diverse PEH at end-of-life.

This study explores the lived experiences of older migrants experiencing homelessness (OMEH) in Canada, a population situated at the intersection of multiple structural vulnerabilities. Drawing on interviews with 22 older migrants across eight housing programs in three Canadian cities, the study applies an intersectional postcolonial framework to examine how migration status, age, and systemic exclusion shape participants' sense of community, access to services, and well-being. Findings reveal that while culturally affirming relationships and activities supported a sense of belonging, participants frequently encountered isolation, racism, and depersonalized care environments shaped by neoliberal policy frameworks. Family relationships were described as both sources of support and tension, complicated by migration expectations and intergenerational differences in values. The paper argues that the current housing system often fails to account for the cultural, relational, and structural needs of OMEH and calls for a shift toward culturally responsive and relationship-cantered care models. This research contributes to a growing body of intersectional gerontology and critical homelessness studies by centering the voices of older migrants and highlighting the systemic forces that shape their exclusion and resilience.

Legislation across the globe has called on social workers and other health professionals to support the rights of persons with dementia to remain as autonomous as possible in all aspects of their lives. Yet, protecting rights can become complex when professionals are also called on to assess for decisional capacity. This study explores social workers’ experiences conducting psychosocial capacity assessments with persons with dementia at long-term and home care settings, and the strategies they use to support decisional inclusion, autonomy, and empowerment. Guided by the principles of constructivist grounded theory (CGT), five in-depth interviews were conducted with social workers, 4 worked at LTC and 1 worked at homecare, and they have been called on to participate in at least one capacity assessment in the last five years in Montreal Quebec Canada. All interviews were transcribed and analyzed thematically. Our findings suggest that social inequities such as ageism, ableism, and racism, the absence of family or community support and scarcity of resources can work together to erode the persons with dementia's sense of autonomy. Social workers emphasized that building trust, engaging families and communities, and addressing broader social issues are paramount to help foster inclusion and empower individuals within decision-making contexts. However, attending to these critical issues can be challenging without the necessary organizational support. Supporting persons with dementia during capacity assessments is a complex process that demands social workers to navigate a web of social, organizational, and interpersonal challenges. While relational strategies—like strengthening social connections and empowering persons with dementia—offer promising ways to address these difficulties, tight organizational budgets and competing priorities can create barriers to this work. Ultimately, social workers’ success in promoting autonomy and inclusion depends not only on their individual efforts, but also on the systemic conditions that shape their work.

Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the "Caregiver Decision Support" (mySupport) study (2019-2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes.

Plusieurs personnes atteintes d'un cancer incurable sont des hommes, âgés de plus de 65 ans. Même si, à notre connaissance, aucune recherche ne porte sur les souffrances de ces hommes, des écrits dévoilent que ces dernières pourraient être considérables. Les réalités du vieillissement au masculin couplées à celles d'être atteint d'une maladie incurable peuvent effectivement engendrer des souffrances particulières. Cette recherche qualitative vise à mieux comprendre les souffrances vécues par les hommes âgés atteints d'un cancer incurable (HACI). Nous explorerons si et comment leurs souffrances se rapportent à des enjeux identitaires de genre et/ou aux transformations de leurs rôles. Dix-sept hommes âgés de 65 ans et plus atteints d'un cancer incurable furent rencontrés en milieu urbain (Montréal) dans le cadre d'entretiens semi-dirigés. L'analyse thématique des résultats a permis de relever des enjeux identitaires et de rôles, la nature des changements affectant l'identité et ses rôles et les enjeux de genre vécus par les HACI.

Many people suffering from incurable cancer are men, over the age of 65. As far as we know, no research has been carried out into the suffering of these men, although the literature suggests that this suffering could be considerable. The realities of male aging, coupled with the reality of living with incurable disease, can indeed lead to particular suffering. This qualitative research aims to better understand the suffering experienced by older men with incurable cancer. Here, we explore whether and how their suffering relates to issues of gender identity and/or transformations of their roles. For this study, 17 men aged 65 and over with incurable cancer were interviewed in a series of semi-structured interviews. This thematic analysis highlight identity and role issues, the nature of changes affecting identity and roles, and gender issues lived by these men.

Background: With a large burden of suffering and death in 2020 due to COVID-19 in long-term care (LTC) homes resulting in restrictions of visitations, there is a need for a formal virtual intervention to support families/friends (i.e., care partners) and residents around palliative care, including planning for end-of-life when outbreaks like these occur. The LTC Palliative Toolkit includes informational resources for care partners, residents, and healthcare providers about the trajectory of life-limiting chronic illnesses (i.e., frailty, dementia, heart failure, kidney disease, lung disease) and Palliative Care Conferences (PCCs). Objective: To evaluate the impact of the LTC Palliative Toolkit on preparedness for end-of-life and satisfaction with information and to explore the experiences of care partners and residents with the virtual delivery of the components of the LTC Palliative Toolkit (i.e., informational pamphlets and PCCs). Methods: A multiple methods design was employed. Three LTC homes, one from each province (Ontario, New Brunswick, and Saskatchewan, Canada), were selected to reflect diverse contexts (e.g., ownership, staff turnover, facility size, and location). Caring Ahead surveys focusing on actions, dementia knowledge, communication, and emotions and support needs were conducted with care partners before and after PCCs to evaluate how prepared they felt about their relative or friend’s end-of-life and their satisfaction. Some care partners and residents completed telephone semi-structured interviews to explore their experiences with care received. Results: Survey findings revealed only one statistically significant improvement after the intervention period, an improvement in the emotion and support needs domain following PCCs, with baseline and follow-up mean scores of 6.08 (SD = 1.06) and 6.35 (SD = 1.16), respectively ( p = 0.016). Qualitative interviews identified that the LTC Palliative Toolkit was a valuable intervention for both care partners and residents. Conclusion: The LTC Palliative Toolkit is suitable for use in any context and demonstrated high acceptability during the COVID-19 pandemic.

The United Nations Convention on the Rights of Persons with Disabilities asserts that all persons with disabilities have the right to receive the support they require to participate in decisions that affect them. This includes accessing support from trusted others, such as family and friends. Yet persons with dementia are often excluded from participating in decisions that matter most to them. This presentation summarizes findings from the thematic analysis of two focus groups with persons with dementia (group 1, n  = 3) and families (group 2, n  = 8) convened as advisory group members to discuss their lived experience with supported decision-making. The presentation also compares these priorities to the results of a scoping review of the literature (55 articles) which were shared with advisory group members to identify research priorities and gaps. Our thematic analysis of deliberations with persons with dementia revealed that time and space to support participation and an emphasis on maintained capacities are critical in empowering people with dementia to express their preferences. Our analysis further suggested that pressure to make immediate decisions and overlooking familial expertise compromises inclusion for both persons with dementia and their families. Decisions regarding daily life and relocation were identified as decisional domains of high importance to persons with dementia and/or their families. The importance of trust, adapted communication and inclusion in daily care featured prominently in our scoping review results. However, the temporal aspects of supported decision, familial exclusion, and supported decision-making around relocation, identified as priorities by advisory group members, were relatively absent from our scoping review findings. Plans for the further development of this work, in light of these results will be discussed.

Background and Objectives Older homeless persons can experience relief when accessing housing. However, becoming housed can also elicit the (re)emergence of loss and grief. Building on the notion of disenfranchised grief, this study sought to better understand how grief works together with relief to shape older persons' experiences living in long-term transitional housing.Research Design and Methods 11 older persons with experience of homelessness participated in up to 3 photovoice interviews in Montreal, Canada. Informed by the principles of interpretative phenomenology, their accounts and photos were analyzed to capture the nuances and depth of their lived experiences.Results Analysis showed that relocation to long-term transitional housing allows for the reemergence of grief associated with past losses, while also provoking new forms of grief related to housing conditions and anticipated losses. Analysis further revealed that a failure to recognize these losses, alongside a lack of resources to support the grieving process, can result in an accumulation of losses that widens the gap between older homeless persons' experiences and the world around them.Discussion and Implications If left unattended, grief and loss can threaten older homeless persons' reaffiliation when relocating to transitional housing. Adopting a humanistic-existential grief perspective could go a long way in supporting the development of housing policies, programs, and practices that nurture the time and space required to attend to grief and truly address precarity in the final stages of life.

Background:Despite high mortality rates in long-term care (LTC), LTC homes continue to struggle to implement a palliative approach to care. Objectives:The objective of this research was to implement and evaluate the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC; www.spaltc.ca) program. Specifically, we explored its feasibility, acceptability, and preliminary effects on resident comfort, use of emergency department at end-of-life (EOL), and location of resident death. Design:This study used an explanatory mixed method design in four LTC homes; one in each of four provinces (Ontario, Manitoba, Saskatchewan, Alberta) in Canada to assess acceptability, feasibility, and preliminary effects of the program. Methods:Quantitative and qualitative data were collected whereby the qualitative component was used to help explain or elaborate on the main quantitative components. Results:Of the 102 participating residents, 74.5% (76/102) had a Palliative Care Conference (PCC). However, of those who died, only 68.8% of them had a PCC. Rates of hospital use were reduced for study participants in terms of emergency department visits at EOL (relative risk reduction (RRR): 46%; 95% CI: -1.12, -0.10) and hospital deaths (RRR: 88%; 95% CI: -4.06, -1.12) compared to baseline. However, there were no significant differences in resident comfort. Family members stated that the PCCs were informative and thought that good communication was critical in providing quality care. They highlighted that close relationships and mutual respect among staff, residents, and families led to more meaningful care while the resident was alive as well as into bereavement. Staff stated that they found the SPA-LTC resources helpful and recognized the importance of having strong leadership using a Palliative Champion Team. Conclusion:The SPA-LTC program appears to be feasible on some key activities and supports a family-centered approach to care, which relies on strong communication. Future research is needed to confirm these initial results.

Abstract Despite the high mortality rates in long term care (LTC), most LTC homes do not have a formalized palliative program. Communication with family members or care partners is critical to prepare them for end-of-life and promotes shared decision-making. The aim of this study was to explore family perceptions about engaging in Palliative Care Conferences (PCCs) which were held for their loved one who was dying in LTC. This study was conducted in four provinces in Canada (Ontario, Manitoba, Saskatchewan, Alberta) and utilized a qualitative description design. Of the 36 family members who were interviewed, 12 were bereaved and 24 were non-bereaved. Overall, they felt that PCCs provided a venue for learning and appreciated the interdisciplinary approach. It gave them some time and space to develop stronger, more caring relationships with staff that sometimes was difficult to do during normal day-to-day activities. Family stated the PCCs were informative and promoted quality communication. They also described how the timing of PCCs and other discussions is important so they don’t feel rushed and can ‘go at their own pace’, allowing them to receive the information that they need when they are ready for it. PCCs appear to feasible and support a family-centered approach to care, which relies on strong communication. Future work needs to include a more rigorous evaluation that builds PCCs into everyday practice.