Awareness of death shapes our existence; it prompts both distress and a maturation process called existential maturation. Presently, direct quantitative measures of existential maturation are unavailable to study treatments for existential distress that enhance psychological well-being. We examined the effect of a mortality salience stimulus on implicit death thoughts over time. We also examined the associations among existing measures of constructs conceptualized as relevant to an eventual measure of existential maturation in a representative sample.

A cross-sectional Qualtrics panel of 1,000 adults, representative of the United States' urban and rural populations, completed a 20-minute survey. The self-report Human Existence survey included an embedded mortality salience stimulus (Death Anxiety Beliefs and Behaviors Scale) and valid, reliable measures of implicit death-thought accessibility (DTA), existential isolation, existential distress, flourishing, transcendence, attachment, connections, peace, and other related constructs.

The DTA measure did not replicate previous research on mortality salience. We found significant positive correlations between existential isolation and existential distress, and between flourishing and transcendence. However, correlations of death anxiety with isolation, flourishing, and transcendence were surprisingly low. In multivariate analysis, avoidant attachment was negatively associated with existential isolation and distress; death anxiety was positively associated with anxious/ambivalent attachment. Transcendence was negatively associated with avoidant attachment and positively associated with being at peace and connections. Flourishing was positively associated with being at peace and connections.

An ineffective death reminder or the DTA online format may have affected DTA results. Striking relationships between attachment style and EM indicators confirm they are interrelated. Measures for existential maturation and related phenomena still lack implicit measures to assess nonconscious components.

Brain tumors are associated with negative changes in sense of self and increased distress early in the illness trajectory. Dignity Therapy (DT) is a brief 2-session therapeutic intervention for patients at end-of-life (EOL) that helps conserve a patient’s sense of dignity or self. DT has shown positive results for patients at EOL including increased meaning, improved quality of life (QOL), and reduced distress, with limited research to date on patients early in their illness trajectory (non-EOL). This pre-post design pilot study investigated the benefits and feasibility of DT for 2 groups of patients with incurable brain tumors.

A total of 51 participants were recruited, of whom 39 participated. Participants were grouped as EOL (prognosis < 1 year, n = 21) and non-EOL (prognosis > 1 year, n = 18). Participants completed self-report measures to determine changes in QOL, psychosocial well-being (i.e., spiritual well-being, connection, and posttraumatic growth), and death anxiety, at baseline, 1 week, and 5 weeks post-intervention.

The intervention had a high completion rate, with 37 of 39 participants (95%) completing DT. Linear regression models fitted with generalized estimating equations (GEEs) showed within- and between-group significant changes in all domains for both groups, but were particularly beneficial for non-EOL participants.

This study demonstrated that DT effectively enhanced psychosocial well-being in patients with brain tumors, including reductions in death anxiety and dignity-related distress. Non-EOL participants benefited most and had higher completion rates, highlighting the intervention’s feasibility and the need for further research in earlier stages of terminal illness.

This study was conducted to identify dyspnea, anxiety, and death anxiety in patients with Chronic Obstructive Pulmonary Disease (COPD).

The study was carried out with 200 COPD patients who applied to the chest diseases outpatient clinic of a state hospital between December 2022 and June 2023.

A total of 73.0% of the patients with COPD participating in the study were male and their mean age was 66.73 ± 8.45 years. Their mean scores were 5.21 ± 2.46 on Modified Borg Scale, 2.62 ± 1.03 on the Modified Medical Research Council scale, 17.87 ± 7.96 on the Beck Anxiety Inventory, and 10.07 ± 4.02 on the Death Anxiety Scale. Patients with high dyspnea levels also had high levels of anxiety and death anxiety (p < 0.001).

The patients with COPD had high levels of dyspnea, anxiety, and death anxiety. Based on the results of the study, it is recommended to plan evidence-based studies to alleviate dyspnea, anxiety, and death anxiety in patients with COPD.

Autologous hematopoietic stem cell transplant (HCT) cancer caregivers experience significant burden and stress with limited tailored resources. Mindfulness interventions hold promise in alleviating caregiver distress. Predicated on our previous work with allogeneic HCT caregivers, this single-arm trial tested the feasibility and acceptability of a modified mindfulness-based intervention, AutoFOCUS, among autologous HCT caregivers.

Participants received the 6-session AutoFOCUS face-to-face via telehealth, with assessments at baseline, end of treatment, and 1-month post-treatment. Feasibility was assessed through recruitment, retention, and session attendance, and acceptability was measured via satisfaction and intent to continue using skills learned. Exploratory outcome measures included distress, anxiety, perceived stress, affect, and post-traumatic growth. Data from the smartphone app that supplemented the face-to-face component of the intervention were collected. In-depth interviews gathered participant feedback.

Twenty-six caregivers (mean age = 57.7 years, 89% female) were enrolled and 19 completed at least 4 sessions, 14 completed all 6 sessions, and 22 completed the 1-month follow-up. High satisfaction (M = 3.56/4; SD = 0.43) and intent to utilize the skills learned in the future (M = 8.58/10; SD = 1.81/4) were reported. Significant reductions in distress (p < .001, (effect sizes [ES]) = 0.99), anxiety (p = .032, [ES] = 0.53), perceived stress (p = .035, [ES] = 0.52), and negative affect (p = .008, [ES] = 0.69) were reported, along with a significant increase in post-traumatic growth (p = .009, [ES] = 0.67) from baseline to end of treatment. App use was moderate. Interview results highlighted positive perceptions and supported quantitative results.

AutoFOCUS was feasible and acceptable. Future studies should explore the efficacy of this treatment on a larger scale with a comparison condition.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and debilitating side effect of cancer treatment, significantly affecting patients’ quality of life. Current pharmacological treatments are often ineffective or poorly tolerated, necessitating alternative therapeutic approaches. Scrambler Therapy (ST), a non-invasive neuromodulation technique, has shown potential for reducing neuropathic pain, but optimal dosing regimens remain undefined.

This case study aims to evaluate the effectiveness of Scrambler Therapy in reducing pain levels and improving functional status in a patient with chemotherapy-induced peripheral neuropathy.

A single patient diagnosed with CIPN was treated with Scrambler Therapy over a series of sessions. Pain levels and functional status were measured using standardized assessment tools before, during, and after the therapy to evaluate the impact of ST on symptom relief and daily functioning.

After completing the Scrambler Therapy sessions, the patient reported significant reductions in pain intensity and notable improvements in functional status. These improvements were sustained several weeks and months following the therapy, indicating the potential long-term benefits of ST for managing CIPN.

This case study demonstrates the potential of Scrambler Therapy as an effective treatment option for reducing pain and improving functional status in patients with chemotherapy-induced peripheral neuropathy. These findings suggest that ST may provide a promising non-invasive alternative to current treatments for managing neuropathic pain in cancer patients.

Multimorbidity is increasingly common among older adults in Sub-Saharan Africa (SSA), yet the role of social determinants in shaping its prevalence and outcomes remains underexplored.

This review aimed to (a) identify the prevalence, types, and patterns of multimorbidity among older adults in SSA; (b) examine the influence of social determinants such as income, education, healthcare access, and geographic location; (c) evaluate current approaches for prevention and management; and (d) propose directions for future research.

A systematic search of six databases (PubMed, EMBASE, PsycINFO, Google Scholar, CINAHL, and Global Index Medicus) was conducted to identify quantitative studies published between 2000 and 2024 on adults aged 50 and above. Of 841 records screened, 16 studies met inclusion criteria and passed quality appraisal. The review protocol was registered in PROSPERO (CRD42024607875).

Multimorbidity ranged from 5.4% in Botswana to 71% in Nigeria. Cardiometabolic conditions often co-occurred with infectious and mental disorders. Poverty and low education significantly increased risk (OR: 1.44–7.44). Rural residents faced limited healthcare access, while urban dwellers had higher risks from lifestyle factors. Obesity and food insecurity further heightened vulnerability, especially among women and older adults.

Findings indicate that social determinants critically shape multimorbidity risk and outcomes in SSA. Integrated care models, targeted interventions, and policies addressing structural inequalities are urgently needed. Future research should apply longitudinal and qualitative approaches to clarify causal pathways and inform context-sensitive strategies.

A person-centered outcomes-based quality improvement program is lacking within palliative care in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality.

This study aimed to explore the barriers and facilitators perceived by healthcare providers to integrating the PCOC model in a Chinese hospital-based palliative care unit.

A qualitative descriptive study was conducted using semi-structured focus group and individual interviews. A rapid deductive analysis approach was selected for data analysis. The Consolidated Framework for Implementation Research framework was used to guide the study design, data collection, analysis, and interpretation.

Eighteen healthcare professionals participated in this study, four focus group interviews and five individual interviews were completed. Barriers to the PCOC integration included clinical application and workload concerns (patients in terminal stage, patients’ dialects, workload concerns, and staff shortages); attitudinal barriers (negative attitudes toward PCOC); psychological barriers (numbness to their work) and barriers related to knowledge and self-efficacy (lack of knowledge, capacity, and self-efficacy in palliative care). Facilitators included adapting the program to local contexts, ongoing education and feedback, effective PCOC data use, a supportive work and clinical environment and staff’s perceived advantages of the model across clinical, research and process domains.

The successful integration of the PCOC program hinges on local adaptation, improved data utilization, education, and IT support. In regions with less developed palliative care, enhancing professionals’ knowledge and self-efficacy is crucial. Incorporating assessment and clinical response protocols into technology can accelerate palliative care development and implementation.

Individuals admitted to the Intensive Care Unit (ICU) due to cancer frequently encounter cognitive impairment and alterations in their mental health, which engenders psychological distress and considerably impacts their quality of life. In Mexico, there is an imperative for valid and reliable clinical tools to identify these symptoms, to providing timely and appropriate psychological intervention.

To determine the psychometric properties of the Intensive Care Psychological Assessment Tool (IPAT) in a Mexican population with cancer discharged from ICU.

A cross-sectional instrumental design with non-probability convenience sampling was employed. Data were collected between February 2023 and October 2024 with 75 people discharged from the ICU. Factor structure (confirmatory factor analysis), reliability (internal consistency), measurement invariance, and criteria validity (convergent, discriminant, and known-groups) were assessed. Patients were assessed during oncological hospitalization, following ICU.

The participants were predominantly male, residing in the interior of the country, with an average age of 44 years (range 19–78, SD 16.21). Internal consistency results were deemed to be satisfactory (α = 0.78) for 9 items. The CFA indices were adequate [χ2 (gl) 27.436 (24), CMIN/DF 1.143, CFI 0.96, GFI 0.97, SRMR 0.036, RMSEA 0.044] as were the scalar invariance indices for invasive mechanical ventilation [CFI = 0.871; RMSEA = 0.058; χ2/gl = 20.519 (10)] and for gender, restricted invariance indices [CFI = 0.849; RMSEA = 0.068; χ2/gl = 23.302 (12)].

The Mexican version of the IPAT for people with cancer is a valid and reliable tool for use in oncology and critical care settings in Mexico. It is recommended for use at the time of discharge from the ICU, as it allows the identification of psychological distress for timely intervention. For future considerations, diverse clinical settings and patient populations should be explored to enhance the tool’s applicability and generalizability in the varied contexts of cancer in ICU.

This study explored Australian palliative care clinicians’ perspectives on the legalization of voluntary assisted dying (VAD), aiming to identify variables associated with clinicians’ views and understand challenges of its implementation.

An online survey exploring support for legalization of VAD was sent to palliative care clinicians in Queensland and New South Wales and followed up with semi-structured interviews. Support was categorized as positive, uncertain, or negative. An ordinal logistic regression model was used to identify variables independently predictive of euthanasia support. Interviews were analyzed using grounded theory to understand key concepts shaping views on VAD.

Of 142 respondents, 53% supported, 10% were uncertain, and 37% opposed legalizing euthanasia for terminal illness with severe symptoms. Support was lower for patients with chronic illness (34%), severe disability (24%), depression (9%), severe dementia (5%), and for any adult with capacity (4%). The model showed lower support among doctors than nurses (38% vs. 69%, p = 0.0001), those in New South Wales compared with Queensland (44% vs. 69%, p = 0.0002), the highly religious versus least religious (24% vs. 79%, p = 0.00002), those politically conservative versus progressive (39% vs. 60%, p = 0.04), and those with more healthcare experience (p = 0.03). Seventeen interviews revealed 2 distinct groups: one focused on the event of death and the need to relieve suffering, providing comfort in the final moments; the second on the journey of dying and the possibility of discovering peace despite suffering. Those in the first group supported legal VAD, while those in the second opposed it. Despite opposing views, compassion was a unifying foundation common to both groups.

There are 2 fundamentally different orientations toward VAD among palliative care clinicians, which will likely contribute to tensions within teams. Acknowledging that both perspectives are rooted in compassion may provide a constructive basis for navigating disagreements and supporting team cohesion.

Carers are critical to support discharge home from hospital at end of life yet remain under-represented in health service initiatives to assist this transition. A carer-focused intervention embedded into practice may facilitate hospital discharge. This open-labeled, single-arm phase 2 study aimed to determine the feasibility of (1) delivering a multi-staged intervention (CARENET) to carers of advanced cancer patients in a hospital setting and (2) the study design to inform a phase 3 trial.

CARENET, delivered before and after discharge to address carer support needs, was tested in an Australian specialist cancer hospital. Eligible participants included carers of advanced cancer inpatients with planned discharge home. The primary outcome was intervention and trial feasibility (recruitment and adherence). Secondary outcomes were eligibility and effects of intervention on outcomes including carer preparedness.

Of the 382 potential patient–carer dyads, 25 were recruited within required time frames. The intervention adherence outcome feasibility threshold of 80% of carer participants completing all 3 core components of CARENET was not achieved (60% completion). Trends in improvement in overall carer levels of preparedness were observed from baseline to discharge home (n = 12; mean [95% CI]) 0.5 [−0.0007, 1.007]). However, a downward trend in preparedness to provide emotional care after discharge was observed (n = 12; mean [95% CI] 0.25 [−0.30, 0.80]).

Delivering all elements of the CARENET intervention to address carers’ needs in the discharge planning context was not feasible. However, some elements were feasible, including identifying and responding to carer need, whilst completing elements after discharge were less feasible. Findings can be explained by problems with adherence, eligibility, and clinician barriers to fitting a multi-staged carer intervention into an acute healthcare setting. Future research should test a more adaptable intervention and delivery model that is accessible to all carers across and compatible with acute care settings.

Family caregivers (FCGs) may experience numerous psychosocial and practical challenges with interpersonal relationships, mental health, and finances both before and after their care recipient (CR) dies. The specific challenges affecting rural FCGs who often have limited access to palliative care services, transitional care, and other community resources are not well understood. The purpose of this paper is to quantify the challenges rural FCGs experienced immediately before the death of a CR and continuing into the bereavement period.

A secondary analysis of data from a randomized controlled trial was conducted. The 8-week intervention included video visits between a palliative care research nurse and FCGs caring for someone with a life-limiting illness. Data were from structured interviews during nurse visits with FCGs in the intervention arm whose CR died during the intervention period.

Ninety (41.8%) of the 215 FCGs experienced the death of their CR. The majority of FCGs were female (58.9%), White (97.5%), spouses or partners (55.6%) and lived with the CR (66.7%). Most FCGs (84%) continued with intervention visits by the study nurse after the CR’s death. Visits resumed on average 7.2 days post-death. The majority of FCGs experienced challenges with grief/coping skills (56%) and interpersonal relationships/support systems (52%) both pre- and post-death of the CR. FCGs also experienced practical challenges with income/finance, housing, and communication with community resources both pre-and post-death.

Bereavement support should extend beyond a focus on grief to include practical challenges experienced by FCGs. Because challenges experienced in the bereavement period often begin before a CR’s death, there is benefit in continuity of FCG support provided by a known clinician from pre- to post-death. When given an option, many rural FCGs are open to bereavement support as early as a week after the death of a CR.

This study aimed to investigate healthcare professionals’ experiences with using the PRO Palliative Care questionnaire (PRO-Pall) to identify palliative care symptoms and problems in non-specialized palliative care settings among patients with heart, lung, and kidney disease, and cancer. The study also investigated the PRO-Pall’s potential to ensure further initiatives and care.

A national, multicenter, observational study employing a mixed-methods approach. It includes quantitative analysis using an evaluation survey (n = 286) and qualitative analysis from workshops (n = 11). Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically.

Quantitative and qualitative data were organized according to 3 a priori-defined themes: Theme 1: Assessment of palliative symptoms, Theme 2: Support for dialogue, and Theme 3: Timely initiation of initiatives and care. The evaluation survey and qualitative interviews with healthcare professionals indicated that it was valuable to use PRO-Pall in a non-specialist palliative context to screen for symptoms and problems, as well as to initiate actions. PRO-Pall helped to structure the dialogue and had a positive effect on the quality of the conversation.

The findings highlight that it can be valuable to utilize the PRO-Pall in general palliative care settings for patients with heart, lung, or kidney diseases as well as cancer. When implementing PRO-Pall in practice, it is crucial to carefully consider the entire process, from administering the questionnaire to planning initiatives informed by patients’ PRO responses.