Nursing interns often experience high levels of death anxiety and stress, which can reduce their comfort and confidence in caring for dying patients. This study evaluated the effects of an 8-week Mindfulness-Based Stress Reduction (MBSR) program on death anxiety, perceived stress, and attitudes toward care of the dying among nursing interns during palliative and oncology rotations.

A quasi-experimental pre–post design was used with 120 final-year Bachelor of Science in nursing interns at Prince Sattam Bin Abdulaziz University, Saudi Arabia. Participants completed the 8-week MBSR program following Kabat-Zinn’s original protocol, including weekly 2-hour sessions, a silent retreat, and daily home practice. Pre- and post-intervention assessments were conducted using the Death Attitude Profile-Revised (DAP-R), Perceived Stress Scale (PSS-10), and Frommelt Attitude Toward Care of the Dying Scale Form B (FATCOD-B). Data were analyzed using paired t-tests, effect sizes (Cohen’s d), Pearson correlations, and multiple linear regression to identify predictors of post-intervention attitudes.

Post-intervention, nursing interns showed a significant reduction in death anxiety (DAP-R: 134.67 ± 6.70 vs. 118.46 ± 7.85; t = 33.39, p < 0.001, d = 3.05) and perceived stress (PSS-10: 20.29 ± 2.94 vs. 19.41 ± 3.36; t = 4.25, p < 0.001, d = 0.39). Attitudes toward caring for dying patients improved significantly (FATCOD-B: 84.10 ± 4.99 vs. 90.01 ± 5.64; t = −16.95, p < 0.001, d = 1.55). Baseline FATCOD-B scores were the strongest predictor of post-intervention attitudes (β = 0.778, p < 0.001). Correlations between constructs were weak, indicating that death anxiety, perceived stress, and care attitudes represent distinct dimensions.

These findings highlight that mindfulness training can enhance emotional resilience, reduce anxiety and stress, and positively shape attitudes toward caring for dying patients. Integrating MBSR into nursing education during palliative rotations may better prepare interns to provide compassionate, human-centered end-of-life care, ultimately improving patient and family experiences in terminal illness settings.

Patients with idiopathic pulmonary fibrosis (IPF) and progressive pulmonary fibrosis (PPF) frequently experience respiratory symptoms and declines in activities of daily living (ADL) and quality of life (QOL). However, effective treatment and palliative care strategies remain limited. This study aimed to clarify physical and psychological distress and to evaluate 1-year symptom changes in patients with IPF and PPF.

Consecutive patients with IPF or PPF were recruited and evaluated at registration (T0), 26 weeks (T1), and 52 weeks (T2). Symptoms, ADL, QOL, depressive condition, laboratory findings, and other factors were assessed throughout the 52-week follow-up.

Of the 70 patients, 32 had IPF and 38 had PPF. Repeated-measures analysis of variance showed that dyspnea in patients with IPF worsened from T1 to T2 (p = 0.02). In contrast, cough, which is one of the major symptoms in PPF worsened from T0 to T1 (p = 0.01) and T0 to T2 (p = 0.02). QOL in patients with PPF also declined from T0 to T1 (p = 0.03).

Patients with IPF and PPF demonstrated several clinical signs and symptoms. In this 1-year follow-up study, dyspnea tended to be worse in patients with IPF and cough in PPF patients, and QOL was temporarily worse in PPF patients. Respiratory symptoms are directly related to the patient’s daily life and lead to reduced QOL. Therefore, further long-term studies in this population are required.

Managing Cancer and Living Meaningfully (CALM) therapy may be a beneficial intervention for addressing death anxiety in caregivers yet has not been formally evaluated in this population. The purpose of this Phase 1a Define trial was to evaluate the suitability of CALM for caregivers of patients diagnosed with malignant glioma using qualitative stakeholder interviews prior to pilot testing.

Twenty-two bereaved caregivers participated in a focus group and completed subsequent caregiver-reported outcome measures. During the focus group, caregivers received information about CALM and provided feedback on the intervention’s relevance and recommendations to improve its content and delivery for the caregiving experience. A team of coders qualitatively analyzed responses using thematic, deductive, latent analysis (kappa = 0.86).

Results suggest that CALM is highly relevant to the caregiving experience and may benefit caregivers emotionally, increase preparedness and self-efficacy in their role, improve their communication with the patient, and provide a unique opportunity to receive specialized care. Potential hurdles for participation included limited time and energy, concerns about burdening the patient by sharing their emotions, and worries that their loved one would not be emotionally or cognitively capable of participating. Participants also recommended additional content areas relevant to caregiving (i.e., burden and bereavement) and provided suggestions to improve CALM’s delivery (timing, initial presentation, session format, and logistics).

Participants’ feedback was largely positive and supports piloting an optimized CALM protocol among malignant glioma caregivers. Further research is needed to determine CALM’s effectiveness in caregivers of patients with malignant gliomas.

This study aimed to identify the enablers and barriers to accessing primary and specialist palliative care services for Cook Islands Māori in New Zealand, and to collaborate with community members to explore the practical application of a tailored palliative care model

Three focus group interviews were held with Cook Islands Māori community members (n = 18). A culturally responsive research methodology, Tivaevae, was used to guide data collection and analysis. An advisory group was established to provide cultural and clinical oversight.

This study presents the findings from the first phase of model validation, exploring Cook Islands Māori peoples' use of palliative care services in New Zealand. The study identified key moments when families needed clear and accessible health information, during prognostic disclosure and during moments of responsibility transfer. These key moments provide opportunities for families to develop the tools to care and plan. This, in turn, enables family members to choose their preferred place of care and to develop family or community-guided care pathways based on Cook Islands Māori culture and faith.

While improvements in cultural safety and cross-cultural communication have been made, there are still groups who experience barriers to accessing palliative care. Identifying key moments when care can be enhanced is key to developing systems that can deliver culturally responsive care for minority groups. Conceptual models show the beliefs, motivations, and values that guide care. However, models must be usable for both community members and clinicians, and critically, must support meaningful and positive outcomes.

Treatment satisfaction is an important patient-reported outcome reflecting patients’ perceptions of treatment effectiveness, tolerability, and overall experience with care. Valid and culturally adapted instruments are needed to assess treatment satisfaction among Arabic-speaking patients with cancer in Lebanon. This study aimed to validate the Arabic version of the Functional Assessment of Chronic Illness Therapy–Treatment Satisfaction (FACIT-TS) Scale among Lebanese patients with cancer.

A cross-sectional study was conducted among patients with cancer from Lebanon. Participants completed the Arabic FACIT-TS along with measures assessing quality of life, psychological distress, and perceived social support. Confirmatory factor analysis (CFA) was performed to evaluate the factorial structure of the scale.

CFA supported a unidimensional structure of the Arabic FACIT-TS with satisfactory fit indices. The scale demonstrated good internal consistency (Cronbach’s α = 0.87; McDonald’s ω = 0.87). Measurement invariance across gender was supported at configural, metric, scalar, and strict levels. No significant difference in treatment satisfaction scores was observed between male and female patients. Higher treatment satisfaction was associated with better quality of life, greater perceived social support, and reduced psychological distress.

The Arabic version of the FACIT-TS demonstrated satisfactory reliability and validity among patients with cancer. The instrument appears to be a psychometrically sound tool for assessing treatment satisfaction among Lebanese patients with cancer and may support the integration of patient-reported outcomes into clinical practice and research within Lebanese oncology settings and potentially similar Arabic-speaking clinical contexts pending further validation.

Antiretroviral therapy has transitioned human immunodeficiency virus (HIV) into a manageable chronic condition. As such, advance care planning is critical to providing patient-centered care for aging persons with HIV. The objectives of the study were to determine the proportion of adults living with HIV in Southern Alberta with a documented goals of care designation and explore factors influencing this documentation.

This was a cross-sectional study conducted at Southern Alberta HIV Clinic in Alberta, Canada. Participants were adults ≥18 years receiving HIV care during the study period (January 1, 2022, and December 31, 2023). Age, sex, family physician status, emergency department (ED) visits, hospitalizations, and goals of care documentation were extracted from the electronic health record. Descriptive statistics and chi-square tests were used to analyze associations.

Ten percent (255/2567) of adults with HIV had a goal of care documentation in the electronic health record. Documentation did not differ by age, sex, or family physician status. Among patients with an ED visit in the prior year, 21% (225/1065) had a goal of care documentation compared to 2% of those without (p < 0.0001). Among those hospitalized in the prior year, 56% (203/364) had a goal of care documentation, compared to 2% of those without (p < 0.0001).

A minority of adults living with HIV had a goal of care documentation.. These findings highlight missed opportunities and areas for improvement for advanced care discussions. There is an urgent need to enhance advanced care planning in this population.

Professional bereavement is a frequently overlooked yet significant experience among nurses, particularly in contexts involving serious illness and end-of-life care. Its impact on professional quality of life remains insufficiently understood. This study aimed to examine the relationship between professional bereavement and professional quality of life among nurses.

This descriptive correlational study was conducted with 176 nurses working in three hospitals in Ankara, Türkiye, between January and June 2022. Data were collected using the Professional Bereavement Scale and the Professional Quality of Life Scale. Pearson correlation and multiple linear regression analyses were performed to examine relationships and predictive effects.

Nurses’ short-term reactions to professional bereavement were moderate, whereas cumulative effects were above average. Nurses with postgraduate education had significantly higher accumulated global change scores than those with a bachelor’s degree. Short-term bereavement reactions showed weak positive correlations with compassion satisfaction, burnout, and compassion fatigue, whereas cumulative changes showed moderate positive correlations with compassion satisfaction and compassion fatigue. Regression analysis indicated that both short-term and cumulative dimensions of professional bereavement significantly predicted professional quality of life, with cumulative changes explaining 30–38% of the variance in compassion fatigue.

Professional bereavement is a significant predictor of nurses’ professional quality of life, highlighting the need for bereavement-focused support to promote psychological well-being and sustainable care. This study uniquely demonstrates differential effects of short-term versus cumulative professional bereavement on compassion satisfaction, burnout, and compassion fatigue and suggests that postgraduate education may paradoxically increase vulnerability to cumulative grief among nurses.

A knowledge gap persists regarding how patients with cancer requiring opioids and their caregivers perceive a co-prescription of naloxone. This study aims to understand caregivers of cancer patients’ perceptions, beliefs, knowledge, and confidence regarding naloxone.

This prospective cross-sectional survey study was conducted at an outpatient palliative and supportive care clinic in a tertiary cancer center in the US between May 2020 and April 2022. Survey questions were based on an in-depth review of previous literature and opioid studies. Patients at risk for opioid overdose received naloxone prescriptions from our team. The survey study examined the proportion of caregivers who perceived a prescription of naloxone benefits the cancer patient and assessed the association between the patients’ and caregivers’ perceptions. We collected patient demographics and clinical information data. The survey was administered via telephone interview based on the caregivers’ availability.

A total of 150 cancer patients and 29 caregivers were included in the analysis. A total of 100/150 (67%) patients and 23/29 (79%) caregivers perceived naloxone as beneficial. Cohen’s κ showed fair agreement between the patients and their caregivers (Cohen’s κ = 0.34, p = 0.034). A total of 26/29 (89.7%) caregivers felt confident in administering naloxone and calling for help. A total of 29/29 (100%) caregivers agreed that concurrent use of alcohol with pain medications increases risk of overdose.

Cancer patients and caregivers perceived naloxone as beneficial and not likely to cause harm. Agreement between patients and caregivers was only fair, suggesting that better communication regarding naloxone is needed. More research is needed to identify barriers toward safe opioid prescription and increase awareness toward naloxone.

To culturally adapt and validate the Spanish version of the Subjective End-of-Life Health Literacy Scale (S-EOL-HLS) through community-based workshops in Argentina.

The S-EOL-HLS was translated following the forward–backward method and iteratively refined through community workshops conducted in urban and rural settings. Initial testing took place in 5 workshops (n = 57), followed by face validity assessment by an expert panel (n = 11). Based on this feedback, additional workshops were conducted alongside cognitive interviews, and a subset of participants completed a test–retest assessment. Participants completed the adapted scale and a brief sociodemographic questionnaire. Psychometric evaluation was performed using exploratory factor analysis on the initial sample and confirmatory factor analysis on a second sample (n = 120), together with assessments of internal consistency and construct validity.

The analyses supported a 3-factor structure representing functional, interactive, and critical dimensions of end-of-life health literacy. Factor loadings ranged from 0.57 to 0.91, with items loading primarily on their intended domains. The model demonstrated acceptable fit and high internal consistency (Cronbach’s α = 0.89). Qualitative feedback from participants and experts improved the clarity and contextual relevance of the Spanish version. While most participants reported ease in understanding technical end-of-life terminology, greater uncertainty was observed for interactive and decision-making items, indicating challenges in applying information to personal treatment choices.

The Spanish S-EOL-HLS demonstrated evidence of content validity, construct validity, and good psychometric performance in an Argentine context. Beyond its measurement properties, the scale also served as a structured prompt for reflection and dialogue in community settings.

Bereavement care is integral to oncology but seldom formalized in residency curricula. We assessed bereavement education, self-perceived preparedness, and emotional burden among oncology residents, and explored associations between formal training and preparedness.>

We conducted an anonymous web-based cross-sectional survey of 165 oncology residents from 25 countries. Items assessed demographics, training characteristics, formal bereavement education, caregiver interactions, preparedness, challenges, and emotional consequences. Associations between formal training and 4-level preparedness used χ2; a binary contrast (≥“Somewhat prepared” vs <“Somewhat prepared”) estimated odds ratios (ORs). Pearson’s assessed correlation between caregiver-interaction frequency and preparedness.r

Respondents were 55.2% female; 47.9% worked in academic centers; 44.2% had ≥5 years of training. Formal bereavement education was uncommon (17.0%). Preparedness was “Somewhat/Very” in 53.3% and “Not very/Not at all” in 46.7%. Training was associated with higher preparedness (χ2=13.03, df=3, =0.0046); being at least “Somewhat prepared” was more likely with training (OR 3.94, 95% CI 1.51–10.33). Interaction frequency correlated weakly with preparedness (=0.15). Common challenges were emotional fatigue (64.8%), fear of overstepping professional boundaries (56.4%), lack of training (53.3%), and time constraints (50.3%). Emotional consequences were frequent: 54.5% occasionally and 27.3% deeply affected; 36.6% had considered leaving residency. Nearly all endorsed bereavement education as integral to oncology training (99.4%).

Training gaps co-exist with substantial emotional burden. Structured bereavement curricula, mentorship, and reflective practice may strengthen preparedness and resilience and improve caregiver support. Prospective studies should evaluate implementation strategies and effects on clinician well-being and care delivery.>

This study investigated the predictive relationship between self-compassion and spiritual well-being among palliative care caregivers, exploring internal resources to mitigate care burden and existential distress in end-of-life settings.

This descriptive, cross-sectional, and correlational study was conducted between March and September 2025 with 138 family caregivers in a palliative care unit. Sample size was determined via a priori power analysis ensuring 95% power. Data were obtained using the Introductory Characteristics Form, the Self-Compassion Scale (SCS), and the Spiritual Well-Being Scale. Data analysis involved descriptive statistics, Pearson correlation analysis, and simple linear regression.

The mean self-compassion score was 79.94 ± 11.68, and the mean spiritual well-being total score was 109.26 ± 13.59. Subscale scores were 63.05 ± 9.93 (transcendence), 28.10 ± 3.91 (harmony with nature), and 18.11 ± 5.28 (anomie). A positive, moderate correlation existed between total self-compassion and spiritual well-being (r = 0.349, p < 0.001). Significant associations were also identified across the transcendence (r = 0.217, p = 0.011), harmony with nature (r = 0.213, p = 0.012), and anomie (r = 0.333, p < 0.001) subscales. Regression analysis confirmed that self-compassion positively predicted spiritual well-being (β = 0.349, t = 4.349, p < 0.001), accounting for 11.2% of the total variance (R2 = 0.112, F = 18.910, p < 0.001).

Self-compassion is a critical internal resource for finding spiritual meaning amidst end-of-life stressors. Fostering compassionate attitudes can alleviate anomie and emotional burnout among caregivers. Palliative care nurses should integrate mindfulness-based self-compassion interventions into support programs to bolster caregiver well-being and enhance care quality.

Existential distress is common among patients with advanced cancer receiving palliative care and is associated with hopelessness, loss of meaning, spiritual distress, and desire for death. Meaning-centered psychotherapy (MCP) has shown potential in reducing existential suffering and improving psychological well-being in patients with advanced cancer. This article presents a case report describing the application of MCP in a young woman with advanced cancer experiencing depressive symptoms, trauma-related distress, hopelessness, and loss of meaning near the end of life.

We report the case of a 24-year-old Vietnamese woman with advanced cancer who was referred for psychological intervention because of severe depressive symptoms, emotional instability, passive wishes for death, and childhood relational trauma. Sixteen psychotherapy sessions were delivered within a multidisciplinary palliative care team. The intervention followed a phased approach, beginning with Trauma-Focused Cognitive Behavioral Therapy-informed stabilization and subsequently transitioning to adapted Individual MCP. Clinical outcomes were evaluated using the Depression Anxiety Stress Scale-21, Beck Depression Inventory-II, and qualitative clinical observations.

Psychological reassessment demonstrated marked reductions in depression, anxiety, and stress, accompanied by improved emotional regulation, interpersonal functioning, illness acceptance, and relational reconnection. As her condition deteriorated, psychotherapy increasingly emphasized spiritual reflection, reconciliation, and preparation for death. Before death, she reaffirmed her Christian faith, received baptism, and fulfilled her wish for a Protestant funeral ceremony.

This case illustrates the feasibility of integrating adapted MCP within multidisciplinary palliative care to address existential distress, facilitate meaning reconstruction, support spiritual integration, and promote end-of-life preparation in patients with advanced cancer.

Personal, self-selected goals are important determinants of behavior in work settings. The present study aimed to elicit palliative care nurses’ personal self-set goals of spiritual care and to test whether these goals were related to their spiritual care understanding.

Data were collected from a convenience sample of palliative care nurses who completed an anonymous, online survey asking qualitative data about how they understand spiritual care and their goals for spiritual care. We conducted content analysis on the goal data to create categories of goals and created sub-groups of nurses based on their understanding of spiritual care. We constructed a co-occurrence table showing the frequency with which goals and spiritual care understandings co-occur across nurses and used a goodness-of-fit test and visual inspection to assess the relationship between goals and understanding.

Four categories of goals emerged: patient well-being, patient’s family well-being, task performance, and self-oriented goals. There was no apparent relationship between goals and spiritual care understanding.

Palliative care nurses’ goals for spiritual care are characterized by greater variety than implied by prescriptive spiritual care models/guides that assume some type of patient well-being goal. That there was no relationship between goal and spiritual care understanding may be due to the goal-elicitation question evoking higher-order goals that are unrelated to specific spiritual care behaviors, which may be more influenced by lower-order goals.

To better understand the palliative care needs of people with serious and/or chronic conditions, and their families, in humanitarian settings in low-and middle-income countries between 2012 and 2022.

A systematic scoping review methodology was employed to enable a wide-ranging search of this under-researched area. Databases and websites were systematically searched, in addition to correspondence to key experts.

Eighty-eight documents were included, comprising 63 publications in peer-reviewed journals, 5 conference abstracts, 4 conference posters, 7 case reports, 5 reports, 2 research snapshots, 1 survey report, and 1 master’s thesis. The majority of literature was from the Public Health Emergency setting including 42 documents related to COVID and 30 to Ebola. Significantly less literature was identified from other settings: refugee populations (n = 10), multiple settings (n = 3), natural disaster contexts (n = 2), and conflict settings (n = 1). Sixty-four documents considered patient needs, 17 considered combined patient/family needs and 7 focused on family needs. Forty-six documents focused on adults, 25 on adults/children, 6 on children with 11 having no age specification. Findings from individual humanitarian contexts were mapped to palliative care domains and themes presented narratively.

The literature from Public Health Emergencies (Ebola and COVID) overshadowed other humanitarian contexts, demonstrating the comparative paucity of research in refugee, natural disaster, and conflict settings. The voice of children appeared under-represented, as did the perspective of family/caregivers. While there was strong research on pain and physical symptoms, holistic needs were also identified, highlighting the diversity of palliative care needs in humanitarian settings.

The complexity of hope in serious childhood illness can be underestimated in clinical practice. We sought to explore the lived experience of hope among bereaved parents to help clinicians interpret and engage with parents’ varied and changing expressions of hope over the course of their child’s illness.

Semi-structured interviews were conducted with bereaved parents of children known to a statewide pediatric palliative care service who died aged 16 years or younger from any medical condition. A phenomenological framework underpinned the study, and reflexive thematic analysis was employed. Institutional ethics approval was obtained.

Twenty bereaved parents, including 6 fathers, participated. Their children ranged in age from 1 day to 16 years. Overall, parents’ hopes were personal, multidimensional, and changed over time. Four main themes emerged: (1) Objects of hope, including survival, experiences in life, day-to-day normality, memory-making, and experiences at end-of-life; (2) patterns of hope, including hope’s dynamic nature, alignment between parents, and hope and prognostic awareness; (3) factors that influence hope, including hope’s intrinsic nature, clinical information, and clinician communication; and (4) the value of hope, both positive and negative.

The study’s findings support existing research describing hope as multidimensional, dynamic, and potentially coexisting with prognostic awareness. We share new insights into how clinicians can work with parental hope in ways that can be both beneficial and detrimental. Additionally, we describe how some parents may perceive hope as potentially harmful.