There is a growing need to enhance healthcare providers’ spiritual care competence, including for people receiving palliative care. A preceding study of predictors of spiritual care competence in a general group of nurses found that more competent nurses rated significantly higher in spiritual training adequacy, frequency of spiritual care provision, and personal spirituality than other nurses; like the demographic variables of level of education, length of nursing experience, and sex, confidence and comfort in providing spiritual care were not related to spiritual care competence. The current study aimed to replicate these relationships in a sample of palliative care nurses. This sample also allowed the testing of a hypothesis that palliative care nurses will tend to subscribe to more competent understandings of spiritual care.

Data were collected from a convenience sample of Australian palliative care nurses who completed an anonymous, online survey. The survey provided qualitative data about what spiritual care means for them and quantitative data regarding nurse characteristics. The qualitative data were used to create sub-groups of nurses based on their understanding of spiritual care and the quantitative data were used to construct a profile of nurse characteristics for each sub-group. The replication analysis determined whether a statistical difference in nurse characteristics existed across sub-groups. The hypothesis testing compared levels of spiritual care understanding across the general and palliative care samples of nurses.

While the results of the palliative care sample are largely concordant with those obtained in the general sample, the current study amends “training adequacy” as a predictor of spiritual care competence to “experience (whether on-the-job or training) in caring for the dying.” The study hypothesis was supported.

The results can be used to assess and develop competence in spiritual care for palliative care nurses.

This study explored how end-of-life (EOL) care practitioners in Hong Kong engaged in emotional labor while fulfilling their professional roles in a Chinese cultural context.

A sequential explanatory mixed-methods design was employed. A quantitative survey (n = 32) using validated scales that measured emotional job demands and emotional labor strategies was followed by in-depth interviews (n = 11) with EOL care practitioners from diverse disciplines. Survey data were analyzed using descriptive statistics, while interview transcripts underwent thematic analysis.

EOL care practitioners reported high emotional job demands, with deep acting being their preferred emotional labor strategy over surface acting. Three key themes emerged related to: (1) balancing emotional involvement and professional boundaries; (2) employing strategic emotional engagement; and (3) navigating cultural beliefs and family dynamics. This multidisciplinary workforce developed sophisticated practices to manage their emotions authentically while establishing protective psychological boundaries. These practices integrated the provision of emotional support with the navigation of tensions between Chinese cultural values and professional responsibilities.

This study used mixed-methods to explore how traditional values were integrated into the everyday care practices of EOL practitioners in Hong Kong. The findings contribute to an innovative and culturally sensitive framework for exploring emotional labor in EOL care contexts. This is useful in both Chinese and multicultural care contexts.

As Alzheimer’s disease and related dementias (ADRD) progress, family caregivers may experience grief before the death of the person living with ADRD. This type of grief is commonly referred to as anticipatory grief, which can contribute to increased psychological distress (i.e., depressive and anxiety symptoms) and potentially affect caregivers’ long-term mental health. This scoping review aimed to synthesize evidence on risk and resilience factors associated with anticipatory grief, its relationship with caregiver mental health, and psychosocial interventions targeting anticipatory grief among caregivers of people living with ADRD.

Guided by the Stress Process Model and the Grief-Stress Model, a literature search was conducted in PubMed, CINAHL, Embase, Scopus, Web of Science, and PsycINFO in May 2025.

Thirty articles met the inclusion criteria. Caregiver characteristics, such as being a spousal caregiver and greater caregiving involvement, were associated with higher levels of anticipatory grief. Caregiving-related stressors and relationship changes across the ADRD trajectory were consistently linked to anticipatory grief across studies, while psychosocial resources, such as adaptive coping and social support, were generally associated with lower levels of anticipatory grief. Anticipatory grief was consistently associated with depressive symptoms. Intervention studies were limited, but those focused on acceptance and preparedness showed potential for reducing anticipatory grief.

Anticipatory grief represents an important dimension of caregiver mental health that reflects ongoing loss. Conceptualizing anticipatory grief within caregiving stress frameworks highlights how vulnerability to distress may emerge from the interplay between caregiving stressors, relationship changes, and psychosocial resources. This conceptual framing may inform future research and palliative care interventions to support the well-being of family caregivers across the dementia trajectory.

The increasing presence of artificial intelligence (AI), electronic patient-reported outcomes (ePROMs), and digital infrastructures in palliative care is transforming how clinical encounters are organized and how suffering is interpreted. These technological shifts heighten the risk of relational compression and a reduction of dignity to measurable outputs. This paper proposes the DiRePal model (Relational–Temporal Dignity in Palliative Care) as a philosophical framework to re-examine dignity beyond coherent narrative identity or autonomy-centered ethics, emphasizing relational presence, temporal sensitivity, and structural conditions of care.

A philosophical–ethical analysis informed by narrative identity (P. Ricoeur), ethics of alterity (E. Levinas), capabilities theory (M. Nussbaum), and care ethics (J. Tronto). Critical readings of dignity frameworks, AI ethics, and digital health literature were synthesized to develop a relational–temporal account of dignity and 2 operational concepts: the temporal dignity indicator and the architecture of prudence.

While digital tools can enhance communication and support anticipatory care, they also risk reducing patients to data profiles, narrowing listening practices, and eroding opportunities for narrative, silence, and relational presence. The DiRePal model reframes dignity as a fluctuating, co-constructed achievement that depends on temporal attentiveness, ethical listening, institutional conditions, and prudent integration of AI and ePROMs. It further expands dignity to include post-biographical dimensions such as memory, grievability, and digital legacy.

End-of-life care in the algorithmic age requires an ethics that recognizes dignity as relational, temporal, and structurally mediated. The DiRePal model offers clinicians and institutions a conceptual grammar to resist technological reductionism, protect time for presence, and safeguard the narrative and post-biographical continuity of persons whose voices may be fragmented, vulnerable, or digitally extended.

Older adults with cancer frequently experience high symptom burden, psychological distress, and reduced quality of life. Integrating palliative nursing interventions into routine oncology care has the potential to improve these outcomes, yet evidence examining their measurable effects remains limited. This study aimed to examine the effects of integrated palliative nursing interventions on quality of life, psychological outcomes, and symptom burden among older adults with cancer.

A quasi-experimental one-group pre-test–post-test design was conducted at King Khaled Hospital, Al-Kharj, Saudi Arabia, including 80 older adults (≥60 years) with confirmed cancer diagnosis. Participants received a structured 6-week integrated palliative nursing intervention comprising 12 sessions (2 sessions/week) addressing physical, psychological, social, functional, and spiritual needs. Outcome measures included the Functional Assessment of Cancer Therapy-General (FACT-G) for quality of life, the National Comprehensive Cancer Network (NCCN) Distress Thermometer for psychological outcomes, and the Edmonton Symptom Assessment System (ESAS-r) for symptom burden. Pre- and post-intervention assessments were conducted, and data were analyzed using paired t-tests, Pearson correlations, and multiple linear regression.

All 80 participants completed the study, and no attrition was observed during the 6-week intervention period. Post-intervention, participants demonstrated significant improvements in overall quality of life (FACT-G total: 39.65 ± 5.51 → 66.41 ± 6.25, p < .001) and all subscales. Distress scores (NCCN) decreased from 21.93 ± 2.49 to 6.99 ± 2.37 (p < .001), and total symptom burden (ESAS) declined from 63.56 ± 6.31 to 41.09 ± 6.88 (p < .001). Regression analysis identified baseline scores as significant predictors of post-intervention outcomes: pre-intervention FACT-G scores and cancer type for quality of life [R2 = 0.660, F (8, 71) = 17.199, p < .001), pre-intervention NCCN scores for distress (R2 = 0.219, F (8, 71) = 2.487, p = .019), and pre-intervention ESAS scores for symptom burden (R2 = 0.757, F (8, 71) = 27.697, p < .001). These results indicated that baseline status strongly predicts post-intervention outcomes, while demographic and clinical variables had minimal impact.

Structured integrated palliative nursing interventions significantly enhance quality of life and reduce psychological distress and symptom burden in older adults with cancer. Incorporating multidimensional, patient-centered palliative care within routine oncology practice can improve clinical outcomes, with baseline status serving as an important determinant of intervention effectiveness.

Patients hospitalized with a life-limiting illness, along with their loved ones, frequently experience anxiety, stress, and pain. Legacy building through storytelling and music may alleviate emotional strain and provide comfort. Musical Rounds is a novel music medicine program designed to reduce distress and support legacy building for adult patients receiving palliative care and their loved ones.

This multisite, mixed-methods, pre–post feasibility study was conducted across 3 hospitals in California, USA. Participants engaged in live bedside recording sessions in which personal stories were shared with real-time musical improvisation provided by a clinician-musician. Afterward, participants received a personalized edited recording combining voice and improvised music. Pain, stress, anxiety, and comfort were assessed before and after each session using a 0–10 numeric rating scale. Perceived mood changes were assessed through directed qualitative content analysis.

We invited 100 adult patients hospitalized with a life-limiting illness and their loved ones to participate. If patients were unable to respond, loved ones participated on their behalf. Patients (n = 79) demonstrated statistically significant within-group differences between pre- and post-session assessments, including lower pain (−1.58, p < .001), stress (−2.89, p < .001), and anxiety (−2.73, p < .001), and higher comfort (+1.61, p < .001). Loved ones (n = 42) reported lower stress (−3.14, p < .001) and anxiety (−2.86, p < .001), and higher comfort (+1.83, p = .004). Directed content analysis indicated perceived mood improvement in 59% (47/80) of patients and 68% (30/44) of loved ones.

Musical Rounds, a personalized music and storytelling session for hospitalized patients with life-limiting illness and their loved ones, was associated with lower self-reported stress, pain (patients only), and anxiety, and higher comfort and perceived mood across 3 hospitals. Findings demonstrate the feasibility and suggest potential benefits of music medicine–supported legacy building in palliative care. Controlled studies with independent assessors are needed to further evaluate efficacy.

Integration of home-based palliative care (PC) enables patients to receive care at home, fosters family involvement, and reduces healthcare costs. Despite its benefits, nurses report challenges in delivering competent PC, and limited research has explored how home care nurses perceive their own competence and self-efficacy within this context.

The study aimed to explore Ontario nurses’ perceived competence and self-efficacy in home-based PC delivery. It also examined the relationship between both constructs, perceived competence and self-efficacy.

A cross-sectional design was used with 2 validated survey tools: the 10-domain Palliative Care Nursing Self-Competence scale and the 2-domain Palliative Care Self-Efficacy scale. Ontario home care and nursing organizations were contacted to assist with recruitment by disseminating a Qualtrics survey link via mass email to nurses who had provided home-based PC. A minimum of 219 participants was required based on a G*Power analysis. Data were collected over 2 months with 2 reminder emails. Descriptive analysis and Spearman’s rank correlation were conducted to address the research questions.

Seventy-two registered nurses and 38 registered practical nurses reported the highest levels of perceived competence in addressing functional care, while spiritual care emerged as the most challenging domain. Self-efficacy was higher in psychosocial care than in symptom management. A strong positive correlation was found between perceived competence and self-efficacy (ρ = .69, p <.001), highlighting the interconnected nature of these constructs in home-based PC.

Nurses’ low perceived competence and self-efficacy in spiritual care and symptom management highlight gaps in meeting patients’ holistic care needs. Nurses must be better equipped to manage the psychosocial and spiritual care needs of patients and families. Strengthening training and resources can enhance holistic PC delivery and nurses’ preparedness, thereby supporting nurse retention and the quality and sustainability of home-based PC.

The HOPE spiritual assessment tool (HOPE tool), developed by Anandarajah and Hight, is a clinician-administered tool used to support the identification of patients’ existential, spiritual, and religious concerns. In Sweden, a foundational translation exists, but a culturally adapted version suited to a secular and multicultural context is lacking. This study aimed to develop a culturally adapted Swedish version (HOPE-SE) and assess its comprehensibility (face validity) and perceived relevance and coverage (content validity) among specialized palliative care professionals.

Building on an earlier Swedish translation of the original 18-item HOPE, we conducted an observational cross-sectional development and expert evaluation study, in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, to simplify wording, improve item focus, streamline flow, and add prompts addressing non-religious existential concerns, resulting in a 16-item draft (HOPE-SE). Expert evaluation was conducted by 18 interdisciplinary experts in specialized palliative care (nurses, n = 6; physicians, n = 9; social workers, n = 3) who provided structured written feedback and participated in cognitive debriefing interviews. The written evaluation was summarized descriptively. The interviews were analyzed using descriptive content analysis of transcripts of the digitally recorded interviews.

Experts generally perceived HOPE-SE as understandable, acceptable, and clinically useful for initiating conversations about existential, spiritual, and religious concerns. Feedback led to minor wording refinements, clarification of potentially sensitive formulations, and the addition of a brief consent-based introduction to support timing and patient autonomy. The final HOPE-SE was approved by all experts and by the original HOPE author.

HOPE-SE provides the first expert-reviewed Swedish conversation guide addressing existential, spiritual, and religious needs, intended to support spiritual history-taking in a multicultural healthcare context. Patient studies are needed to evaluate content validity and implementation in Swedish settings.

While there have been reports on the relationship between cancer and depression, reports on the association between cancer and manic states, a reciprocal state of depression, have been relatively few. Therefore, we conducted a systematic review on the relationships between cancer and manic states, focusing on their etiology, clinical course, and impact on cancer treatments.

A systematic review was conducted using four electronic databases, following the PRISMA guidelines. The scope of the study included research on manic or hypomanic states associated with cancer in patients with no prior history of mental illness, published from 1950 to August, 2021. The study protocol was registered with PROSPERO (CRD42020182372).

Fifty-six studies, including 67 cases, were identified. The etiology of manic states in cancer patients was classified into organic, drug-induced, and psychogenic, with steroids being the most predominant causative agent. Approximately half of the patients discontinued cancer treatment following the onset of manic states. This was associated with a low rate of pharmacological treatment during the acute and maintenance phase of mania. The onset of manic states was most frequent during cancer treatment; however, about 15% of the cases exhibit manic symptoms before cancer diagnosis.

This systematic review illustrated the clinical characteristics of manic state regarding differences in the etiology, timing of onset, pharmacological treatments, duration to remission, recurrence, and impact on cancer treatment. Manic states, which are comorbid with cancer, have significant clinical impacts on cancer prognosis. Therefore, appropriate pharmacological treatment for manic states is critical to consolidate appropriate cancer treatment. A substantial proportion of patients exhibit manic symptoms prior to the diagnosis of cancer, warranting further investigation into the possibility of the concept of “premonitory mania.”

Although home is frequently the preferred place of death, little is known regarding how home healthcare (HHC) influences this outcome for people with dementia (PWD), particularly within Asian contexts. This study investigates the impact of HHC and its 2016 “Integrated Home-Based Medical Care” reform on home death in Taiwan, explicitly accounting for the cultural phenomenon of “impending death discharge.”

This nationwide retrospective cohort study utilized Taiwan’s National Health Insurance Research Database. We identified PWD decedents from 2011 to 2022 and conducted a nested case–control analysis. Cases (home deaths) and controls (hospital deaths) were matched 1:1 using propensity scores to balance demographics and health status. HHC models included pre-2016 primary HHC, post-2016 primary HHC, and the reformed “HBPC Plus” (Home-Based Primary Care Plus). The outcome was adjusted to include patients discharged terminally to die at home, reflecting distinctive cultural practices.

Among 209,468 decedents, 95,594 were selected after matching. Overall, HHC use was associated with higher odds of home death (adjusted odds ratio [aOR]: 1.17; 95% CI: 1.13–1.21). The reformed HBPC Plus program showed the strongest association compared to pre-2016 primary HHC (aOR: 1.63; 95% CI: 1.34–1.98). Crucially, this association strengthened further when accounting for impending death discharge (aOR: 1.82; 95% CI: 1.40–2.35). Higher visit frequency and services from hospital-based teams were also significantly linked to home death.

HHC significantly increases the likelihood of home death among PWD in culturally influenced contexts. The 2016 reform, particularly the HBPC Plus program, proved highly effective. Policy components like flexible visit frequencies and enhanced hospital–physician coordination appear vital for supporting end-of-life care at home, offering key insights for policy planning in aging societies.

We aimed to evaluate patient and clinician experiences of advance care planning (ACP) conversations facilitated by an ACP nurse coordinator (ACP-NC).

We used a sequential mixed-methods approach that included a patient survey, patient interviews, and clinician interviews at a family medicine clinic. Patients were invited into the study if they had reached a stable point in their ACP decision-making conversations with the ACP-NC or PCP (i.e. their goals and preferences were considered settled at the time) and were not imminently dying. Invitations to complete a survey were sent within 2 weeks of patients completing their ACP conversations. Patient interviewees were purposefully selected to vary on key attributes such as age, gender, and number of ACP conversations. An iterative sampling strategy was used for both patient and clinician interviews.

Ninety-three patients completed the survey, and 10 patients were interviewed. Six clinicians were interviewed. Sixty percent of patient respondents reported being very comfortable having ACP conversations. At the time of the survey, 79% had completed or revised their existing advance directive. The professional groups that patients most preferred to engage with, regarding ACP, were their primary care provider (87%), ACP-NC (70%), and palliative care specialist (61%). Patient interviews indicated that participants appreciated being referred to the ACP-NC within the clinic, describing her as a motivator and generous with her time, which facilitated thoughtful discussion of preferences and wishes. Clinician interviews identified limited time as a key barrier to conducting ACP conversations and saw a dedicated ACP-NC as a major benefit to allow patients to spend more time having these important conversations.

Patients were open to engaging in ACP discussions. Integrating an ACP-NC within primary care teams may represent an acceptable and effective approach to promote the early initiation of ACP in primary care settings.