Catatonic and delirious signs overlap, creating treatment dilemmas when sedation obscures diagnostic assessment. We describe serial assessment and medication decision-making in advanced leptomeningeal melanoma during transition to home hospice.

Inpatient observations, investigations, medication exposures, goals-of-care discussions, and serial Bush-Francis Catatonia Rating Scale (BFCRS) examinations were synthesized.

A man in his late 30s with metastatic melanoma involving the leptomeninges and brain developed fluctuating arousal, inattention, disorientation, mutism, immobility, staring, withdrawal, and waxy flexibility. His Bush-Francis Catatonia Rating Scale (BFCRS) score decreased from 7 to 1 after intravenous lorazepam, although reassessment was limited by sedation and fluctuating wakefulness. Transient improvements in movement and speech did not translate into sustained gains in attention, communication, intake, mobility, or function. Lorazepam was subsequently reduced and discontinued when severe agitation emerged. As catatonic signs became less sustained and agitation threatened safety, scheduled haloperidol was introduced, with improvement in evening agitation and no documented extrapyramidal symptoms, oversedation, or QTc prolongation. A supervised oral-medication trial supported discharge planning, although hospice placement remained delayed by insurance barriers.

A lower BFCRS score after lorazepam does not necessarily indicate meaningful clinical response if arousal, attention, and function remain impaired. In advanced cancer, catatonic signs may occur within a broader delirious or toxic-neurologic encephalopathy. Serial assessment should therefore incorporate wakefulness, attention, mobility, communication, and patient- and caregiver-defined goals. Treatment should be guided by the immediate priorities of interaction, safety, or comfort and continually reassessed in light of prognosis and feasibility of home care.

This study evaluated the effect of structured grief counseling on grief responses in family caregivers of advanced cancer patients from the terminal phase through early bereavement, and may inform bereavement care in oncology and hospice settings.

We conducted a randomized controlled trial from October 2024 to November 2025 among family caregivers of patients with advanced cancer. Participants were assigned to structured grief counseling (intervention group, n = 55) or only psychological materials (control group, n = 56). Counseling began before the death and continued for 3 months after the death. Outcomes were assessed at enrollment, at the end of the intervention, and at 1 and 3 months after the death. Measures included grief, guilt, anxiety, depression, post-traumatic growth, and health-related quality of life. Linear mixed-effects models estimated group differences over time.

Compared with control, the intervention produced lower Anticipatory Grief Scale scores over time (estimates = −9.31, P < 0.001). The intervention also yielded higher Post-traumatic Growth Inventory scores and Short-Form 36 Health Survey scores (estimates = 6.02 and 5.97, respectively; P < 0.001). Between-group differences for Bereavement Guilt Scale scores, Self-Rating Anxiety Scale scores, and Self-Rating Depression Scale scores were not significant.

Structured grief counseling provided to family caregivers from the patient’s terminal phase through the early bereavement period effectively improves grief status, post-traumatic growth, and health-related quality of life. These findings support the integration of standardized, family-centered bereavement support systems into oncology and hospice care services.

To identify factors associated with caregiver burden among caregivers of patients enrolled in a home-based palliative care program in Bogotá, Colombia.

This analytic cross-sectional study included 208 caregivers of patients receiving home-based palliative care in Bogotá between 2022 and 2024. Data were collected on caregivers’ sociodemographic, psychological, and caregiving-related characteristics. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), while depression, anxiety, and stress symptoms were assessed using the Depression, Anxiety and Stress Scale-21. Patient sociodemographic and clinical data were also collected. Multiple linear regression analysis was used to identify caregiver- and patient-level variables associated with caregiver burden.

The median age of caregivers was 56 years. Most caregivers were women (86%) and relatives (74%). Although 69.2% had higher education, 79.8% lacked formal caregiving training and 73.6% provided care without financial compensation. The mean ZBI score was 42.5 ± 12.9, with 40.4% of caregivers experiencing mild to intense burden. Additionally, 40.4% reported depressive symptoms, 38.9% anxiety, and 47.1% stress. Caregiving support (β = −6.31; P = 0.009) was associated with lower burden scores, whereas caregiver motor limitations (β = 4.78; P = 0.045) and caregiver depression (β = 3.81; P = 0.034) were associated with higher burden scores.

Caregiver burden was associated with caregiver depression and motor limitations. Interventions aimed at strengthening caregiving networks, providing psychological support, and addressing caregivers’ physical health are essential to reduce burden and improve the well-being of both caregivers and patients.

Family caregivers of terminal cancer patients often experience substantial emotional burden. This study assessed depression, anxiety, stress, and coping–distress associations among caregivers in Eastern India to inform culturally sensitive interventions.

A cross-sectional survey was conducted among 100 adult caregivers of terminal cancer patients at a tertiary care hospital in Kolkata. Participants were recruited via systematic random sampling and interviewed using a structured proforma, the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Brief-COPE inventory. Descriptive statistics summarized demographics and caregiving characteristics. Spearman’s rank correlation was used to assess associations between psychological distress and coping domains, with p < 0.05 considered statistically significant.

Caregivers (median age 43 years; 70% male) were predominantly the patient’s children (67%). Median DASS-21 scores indicated moderate depression (16), anxiety (14), and stress (16). Coping scores indicated low-to-moderate use of problem-focused (1.875 ± 0.321), emotional (1.871 ± 0.269), and avoidant coping (1.865 ± 0.266). Emotional coping correlated significantly with anxiety (ρ = 0.301, p = 0.002), depression (ρ = 0.317, p = 0.001), and stress (ρ = 0.293, p = 0.003). Depression also correlated with stress and problem-focused coping, while stress correlated with avoidant coping.

Caregivers experienced considerable psychological burden, with emotional coping consistently linked to distress. These associations likely reflect reactive adaptation rather than inherent maladaptiveness. Results highlight an urgent need to recognize caregiver distress within oncology settings and to develop culturally informed psychosocial interventions in palliative care, particularly in low-resource environments. Such efforts could enhance both caregiver well-being and quality of end-of-life care.

Grief and bereavement care (GBC) remains an underrecognized component of pediatric palliative care (PPC), contributing to the emotional and psychological burden experienced by patients, families, and healthcare professionals (HCPs). This perspective review examines gaps in GBC, defines key types of grief in pediatric settings, and proposes a framework to improve patient- and family-centered grief support.

We conducted a narrative perspective review using PubMed and Google Scholar to identify literature on GBC in PPC. Search terms included combinations of “grief,” “bereavement,” “pediatric palliative care,” “children,” “caregivers,” “siblings,” “healthcare professionals,” “anticipatory grief,” “complicated grief,” and “prolonged grief disorder.” Publications from 2020 onward were prioritized, with seminal earlier studies included when clinically or conceptually relevant.

GBC in PPC differs from adult models because of developmental considerations, prolonged illness trajectories, and family-centered decision-making. Relevant forms of grief include anticipatory, disenfranchised, complicated, and prolonged grief, affecting patients, families, and HCPs. Effective approaches include early palliative care integration, legacy-making activities, structured communication, and interdisciplinary psychosocial support. However, global disparities persist, and HCPs frequently report inadequate training and institutional support.

GBC should be viewed as a longitudinal, culturally sensitive, system-wide responsibility extending from diagnosis through bereavement. Integrated frameworks emphasizing early communication, patient- and family-centered care, and formal grief training for HCPs may strengthen bereavement support and reduce unmet psychosocial needs across the pediatric illness trajectory.

To estimate the magnitude of caregiver burden and its related factors among informal caregivers of cancer patients.

This cross-sectional study was conducted at a single University Cancer Center. It included primary caregivers of cancer patients ≥18 years who had provided unpaid care for at least 2 months (n = 277). The Zarit Burden Interview, the 28-item General Health Questionnaire, and the Friedemann’s Effectiveness of Family Functioning Scale were used. Multiple binary logistic regression was applied. Odds ratio (OR) and 95% confidence interval (95% CI) were calculated.

The mean burden score was 21.8 ± 12.9; 52% of caregivers reported minimal or no burden, 39% mild, 8.6% moderate, and 0.4% severe. Somatic symptoms (OR = 1.13; 95% CI: 1.02–1.27) were positively associated with caregiver burden. In contrast, greater family functioning was protective (OR = 0.89; 95% CI: 0.82–0.96). No sociodemographic characteristics of caregivers were significantly associated with caregiver burden. Among patient characteristics, stage IV disease, Eastern Cooperative Oncology Group performance status 1 or 2 compared with 0, and male sex were significantly associated with higher caregiver burden.

Findings reinforce well-established associations while extending international evidence to a region previously unrepresented in the literature. The absence of associations between caregivers’ sociodemographic characteristics and caregiver burden, together with the finding that male patient sex was associated with greater caregiver burden, may help explain previously reported inconsistencies. Caregiver assessment should be incorporated into comprehensive cancer care.

To determine the correlation between spiritual self-care practices and mindfulness among cancer patients in southeast Iran.

This descriptive, correlational, cross-sectional study was conducted on a convenience sample of 600 eligible cancer patients. Data were collected using three instruments: a demographic and clinical characteristics questionnaire, the Spiritual Self-Care Practice Scale, and the Relaxation, Meditation, and Mindfulness Trait Tracker (RMMtm 3.1). Data were analyzed using SPSS version 26, employing both descriptive and inferential statistical methods, including multivariate regression analysis.

The mean total score for spiritual self-care practice among cancer patients was 3.17 ± 1.15, which was above the questionnaire’s midpoint. Mindful emotion had the highest mean score (3.78 ± 1.67), followed by mindful focus (3.20 ± 1.57) and mindful relaxation (3.14 ± 1.65). Multivariate regression analysis revealed that 63.9% of the variance in spiritual self-care was explained by variables including mindful emotion (β = 0.321, p < 0.001, 95% confidence interval [CI]: [0.122, 0.181]), mindful quiet (β = 0.213, p < 0.001, 95% CI: [0.065, 0.128]), and mindful transcendence (β = 0.163, p < 0.001, 95% CI [0.058, 0.139]). Income level, history of underlying disease, and disease stage also showed significant associations.

The study findings indicate a significant relationship between spiritual self-care practice and dimensions of mindfulness. Nurses can address patients’ spiritual self-care practice needs by implementing the nursing process and empowering them through interventions that enhance mindfulness.

Advance care planning (ACP), including end-of-life (EOL) conversations, helps frail older persons articulate goals and preferences for future treatments and care, ultimately enhancing quality of life. Nevertheless, a substantial gap exists between the many who wish to engage in such conversations and the minority who currently do so. To support earlier and broader engagement, we explored frail community-dwelling older persons’ perspectives and attitudes regarding ACP and EOL discussions.

We conducted a qualitative, purposively sampled, interview study of frail community-dwelling older persons (N = 16), identified from Dutch general practices. We analyzed the transcripts using reflexive thematic analysis.

We developed 5 themes regarding ACP and EOL conversations: (1) Personal identity as the foundation for ACP and EOL decision-making: personal values strongly shaped EOL preferences and decision-making; (2) external factors – including lived experiences, the social environment, and information channels – influenced EOL perspectives; (3) attitudes and motivations shaped engagement with ACP and EOL conversations, ranging from active engagement to reluctance; (4) organization and conditions of ACP and EOL conversations: the content of conversations varied across conversation partners; and (5) expectations regarding involvement of others in ACP, including EOL conversations: participants expressed a need for proximity to family, close friends, and healthcare professionals and for these others to be involved and take responsibility in supporting decision-making.

When asked about ACP, participants focused predominantly on preferences and expectations regarding EOL care and the period surrounding death. These reflections, grounded in personal values and identity, were most often shared with family and close friends and less frequently with healthcare professionals. These findings highlight the central role of informal networks in ACP communication, suggesting that healthcare professionals should actively involve these networks in ACP discussions and decision-making. Furthermore, ACP conversations may benefit from starting from persons’ underlying values and their priorities in life.

Patients with cancer on palliative treatment often have dynamic and multidimensional symptoms like pain, fatigue, anorexia, cognitive changes, and emotional distress that significantly impact functional capacity and quality of life. Traditional symptom management is largely reactive, based on patient self-report or clinician recognition after deterioration, leading to delayed interventions and avoidable suffering.

The aim of this systematic review was to review the evidence on nurse-led predictive symptom-management strategies in oncology palliative care, with a focus on the role of laboratory biomarkers and clinical judgment in the early detection of deterioration and better quality of care.

A systematic search was performed in PubMed, CINAHL, Scopus, Embase, and the Cochrane Library through November 2025. Keywords included “nurse-led,” “predictive symptom management,” “palliative care,” “oncology,” “biomarkers,” and “clinical judgment.” Both qualitative and quantitative studies were included in the review. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram: 1,482 records identified, 346 duplicates removed, 1,136 screened, 128 full texts assessed, and 14 eligible studies selected based on PRISMA 2020 statements. The review protocol was registered in advance in the International Prospective Register of Systematic Reviews (PROSPERO; Registration No. CRD420261432500).

The included studies (Randomised Controlled Trials (RCTs), cohorts, modeling studies, and telehealth interventions) demonstrated that biomarkers such as C-reactive protein, neutrophil–lymphocyte ratio, albumin, ferritin, and electrolytes predicted symptom exacerbation and clinical decline. Nurse-led approaches including biomarkers with clinical assessment improved the management of symptoms, decreased emergency department visits, and improved continuity of care. Predictive models were promising but limited in clinical integration.

Nurse-led predictive approaches support a shift from reactive to proactive palliative care. Further research is needed to embed predictive tools into routine practice and to validate their effectiveness in real-world settings.

To explore how holistic suffering manifests and is experienced by adults with cancer through qualitative inquiry, supported by descriptive quantitative assessment.

This qualitatively driven study combined semi-structured interviews with embedded descriptive quantitative data from the Suffering Pictogram–Brazilian version (SP-BR). A total of 222 adults with cancer completed the SP-BR, and a subsample of 20 participated in interviews. The qualitative component had methodological priority and underwent thematic analysis; SP-BR scores were analyzed descriptively to contextualize self-reported levels and dimensions of suffering.

Overall suffering was moderate (mean=4.44, standard deviation=3.22), with substantial variability; worry and physical discomfort were the most prominent concerns. Thematic analysis revealed 4 interrelated themes: Disruption of the self and the search for meaning after diagnosis; Anchoring suffering: faith, relationships, and the ambivalence of coping; Concealed suffering and the fragile work of acceptance; and Meaning as responsibility: enduring suffering for oneself and others. Suffering coexisted with adaptive processes, including meaning-making, relational commitment, and spiritual coping. Spirituality and social support functioned both as protective resources and, in some cases, as mechanisms for concealing distress.

Holistic suffering in cancer is an integrated, dynamic experience that can be understood as a nonlinear existential trajectory, in which participants moved back and forth between disruption of the self, the anchoring of faith and relationships, emotional concealment, and meaning-making. The proposed interpretive model synthesizes this trajectory and may serve as a conceptual starting point for designing interventions addressing holistic suffering.

The DiRePal model understands dignity at the end of life as relational and temporal, shaped by recognition, narrative continuity, and prudent listening. This study explores how patients with advanced cancer, informal caregivers, and physicians understand and experience dignity, providing empirical foundations for the model.

A multicentre qualitative study comprised six semi-structured focus groups involving oncology patients (n = 10), informal caregivers (n = 14), and pulmonology/oncology physicians (n = 15), conducted via a secure digital platform between April and November 2025 with IQVIA Portugal. Transcripts underwent reflexive thematic analysis, with independent initial coding, discussion-based consensus, and researcher reflexivity. Given participants’ clinical fragility, member checking was not undertaken; credibility relied on triangulation, thick description, and an audit trail.

Six themes emerged: personal understanding of dignity, narrative flexibility, negotiating technical rationality and relational care, temporal sensitivity, professional reciprocity, and digital/structural integration. Dignity was inseparable from personal recognition, interpersonal gestures, and listening within time-constrained encounters. Physicians’ emotional overload and insufficient institutional support compromised their dignity and, indirectly, patients’; caregivers frequently rendered themselves invisible. Patients associated dignity with respect, autonomy, and relief of suffering, while depersonalised or fragmented care eroded it.

These findings ground a relational–temporal account of dignity in reciprocal recognition between patients, caregivers, and clinicians across shared, unevenly experienced time. Listening, temporal prudence, and recognition of clinicians’ vulnerability should be clinical priorities, alongside cautious, relationally framed integration of digital tools.