Advance care planning (ACP) engagement remains low among culturally and linguistically diverse populations, including immigrant communities, where cultural norms, family expectations, and migration may shape attitudes toward healthcare decision-making. Although Thai immigrants represent a growing population in Australia, little is known about how migration influences their perceptions of and readiness for ACP. This study aimed to explore how Thai immigrants in Australia perceive and engage in ACP within a new social and healthcare context.

A qualitative descriptive phenomenological study was conducted in Victoria, Australia. Seventeen Thai immigrants were recruited through purposive and snowball sampling via Thai community networks. Semi-structured interviews were conducted in Thai or English, audio-recorded, transcribed, translated, and analyzed using reflexive thematic analysis informed by phenomenological techniques.

Four key themes were constructed through reflexive thematic analysis of the interviews: (1) the “old Thai way,” characterized by family-centered decision-making, deference to authority, and avoidance of death-related discussions; (2) migration as a disruptive force, with exposure to autonomy-based healthcare prompting reflection and adaptation; (3) tension between cultural values, highlighting challenges in balancing filial obligation with individual autonomy; and (4) reconstructing belief systems, wherein participants developed hybrid identities, integrating Thai and Australian values.

Migration disrupts traditional Thai norms surrounding family roles, communication, and decision-making, thereby reshaping how participants understand and approach readiness for ACP. Thai immigrants reinterpret family roles, faith, and autonomy within a new cultural context, emphasizing the need for culturally responsive ACP approaches that respect family influence, indirect communication, and the role of community mediators.

To identify associations between supportive care needs, perceived peer support, and well-being among unpaid cancer caregivers (UCCs) in regional, rural and remote (RRR) Queensland, Australia.

A cross-sectional online survey was conducted among 202 adult UCCs for individuals with advanced cancer in RRR Queensland. Participants completed validated measures assessing unmet needs, perceived social support, psychological distress, caregiver burden, and spiritual need. Data were analyzed using descriptive statistics, Cronbach’s alpha, Pearson correlations, multiple linear regression, and structural equation modeling (SEM).

CNAT-C, MSPSS, DASS-20, and CDS mean (SD) scores were 1.95 (0.48), 4.63 (1.30), 1.65 (0.59), and 2.66 (0.62), respectively. Practical support was the highest unmet need (M=2.04, SD=0.61), followed by hospital facilities/services (M=1.99, SD=0.59) and healthcare staff (M=1.98, SD=0.59). Internal consistency was high across measures (α=0.806–0.924). Higher unmet needs and perceived peer support were associated with greater distress and poorer well-being (all p<.001). CNAT-C and MSPSS predicted DASS-20 (R2=.236); CNAT-C predicted CDS (R2=.251), whereas MSPSS was not significant. The SEM demonstrated good model fit.

UCCs residing in RRR Queensland reported substantial unmet needs, especially for related to PS and healthcare services. Greater unmet needs were associated with poorer caregiver well-being. The positive association between perceived social support and distress suggests support may be mobilized in response to heightened caregiver strain and highlights the importance of considering the appropriateness and quality of support, alongside availability, for caregivers in RRR settings.

This study aimed to examine the relationships between caregiver burden, depression, suicidal ideation, and quality of life among caregivers of patients hospitalized in an adult palliative care unit and to identify factors associated with depressive symptoms.

This descriptive cross-sectional study included 75 caregivers of patients hospitalized in the Adult Palliative Care Unit of Erzurum City Hospital. Data were collected using the Caregiver Strain Index, Hamilton Depression Rating Scale (HAM-D), Beck Scale for Suicide Ideation, (OPQOL)-Brief, and SF-36 Health Survey. Descriptive statistics, chi-square tests, Pearson’s correlation analysis, and multiple linear regression were performed.

High caregiver strain was reported by 52% of participants. According to HAM-D scores, 24% had mild depressive symptoms, while none had moderate or severe depression. All participants were classified as having low suicidal ideation risk. Significant correlations were observed among physical and mental health, caregiver burden, depression, suicidal ideation, and quality of life (p < 0.05). Mental health was strongly negatively correlated with depression (r = −0.607, p < 0.01) and was the only significant predictor of depressive symptoms in the regression model (β = −0.511, p < 0.001), explaining 40.5% of the variance.

Mental health was the strongest determinant of depressive symptoms among palliative care caregivers. Although all participants were categorized as having low suicidal ideation risk, continuous suicidal ideation scores were associated with greater caregiver burden, depression, and poorer quality of life. Routine mental health screening and psychosocial support for caregivers should be integrated into palliative care services.

Studies show that cancer patients consider place of death (POD) an important factor influencing quality of life (QoL) at the end of life. The objectives of this study were to identify characteristics of real-world non-small cell lung cancer (NSCLC) patients based on POD and investigate how changes in health-related QoL (HRQoL) relate to POD.

Newly updated data from a prospective single-center Danish cohort (NCT03870464) of patients with NSCLC who initiated immune checkpoint inhibitors (ICI) as monotherapy between April 1, 2018, and April 30, 2021, at the Department of Oncology, Odense University Hospital, were used for analyses. Clinical data were retrieved from electronic patient records. This included POD, which was categorized as home, hospice/palliative care unit, or hospital. HRQoL questionnaires were completed by patients prospectively at baseline and at predefined timepoints during treatment with ICI.

A higher percentage (63.6%) of patients dying at home were male, and a higher percentage dying in a hospice/palliative care unit were female (63%) (p = 0.041). Patients with hospital as POD had a statistically higher Global health status/QoL (GHS/QoL) at baseline (75.0; p = 0.034). Patients with home or hospice/palliative care unit as POD reported improved QoL during treatment with ICI, as opposed to patients with hospital as POD who had unchanged self-assessed QoL scores.

Sex, baseline GHS/QoL, and change in HRQoL during treatment with ICI differed between patients based on POD. The predictive value of this is unknown, suggesting the need for further research on this topic, as it remains clinically relevant.

This study aimed to examine religious and post-Christian spiritual orientations, types of spiritual and ritual activities, coping strategies of patients with advanced illness and explore associations between spiritual needs, practices, well-being, quality of life, and coping styles.

One hundred and two patients completed validated instruments: Post-Christian Spirituality Scale, Spiritual Needs Questionnaire, Spiritual Practices Questionnaire, Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale, Global Quality of Life Scale, and Brief-COPE Questionnaire. Descriptive statistics summarized participant characteristics and scale distributions. Spearman correlations (Bonferroni-adjusted) examined associations between spiritual needs, practices, and coping modes. Multivariate regression analyses assessed whether ritual practices predicted spiritual needs.

Inner peace (median, 1.4; IQR, 1, 2) and humanistic/prosocial practices (median, 66.6; IQR, 44.4, 83.2) were prominent spiritual needs and frequently used rituals, respectively. Strong correlations were observed between religious needs and religious rituals (rho = 0.87). Existential, inner peace, and giving/generativity needs correlated moderately with existentialistic practices (rho = 0.56–0.69). Humanistic/prosocial spiritual practices were moderately associated with giving/generativity (rho = 0.52) and inner peace needs (rho = 0.42). Emotion-focused coping, particularly acceptance and emotional support, was most consistently associated with spiritual needs and practices, reinforcing the centrality of relational and embodied forms of spirituality at the end of life. Regression analyses confirmed existentialistic practices predicted existential and inner peace needs, while humanistic practices predicted generativity needs.

Findings demonstrate strong alignment between spiritual needs and ritual activity, supporting development of personalized, ritual-based spiritual care frameworks. Determining individual orientations toward embodied, relational, and humanistic practices may offer an adaptable means of addressing spiritual suffering.

Family caregivers play a fundamental role in addressing the spiritual needs of patients receiving palliative care, particularly in cultures where spirituality is deeply embedded in daily life. This study explored how Hindu family caregivers perceived spiritual care, the ways they incorporated spiritual practices into caregiving, and the challenges they experienced while supporting relatives with palliative care needs.

A descriptive qualitative study was undertaken with 12 Hindu family caregivers recruited through purposive and snowball sampling in Kuantan, Malaysia. Individual semi-structured interviews were conducted, and the data were analyzed using Braun and Clarke’s thematic analysis to identify recurring patterns across participants’ experiences.

Three interconnected themes emerged: Perceiving Spiritual Care as a Source of Meaning and Hope, Integrating Spiritual Practices into Family Caregiving, and Navigating Emotional and Practical Challenges in Spiritual Caregiving. Participants described spiritual care as fostering inner peace, hope, and acceptance through practices such as prayer, temple worship, chanting, and family support. Caregivers viewed themselves as facilitators of both spiritual and emotional well-being while simultaneously facing emotional exhaustion, caregiving demands, and limited access to spiritual support services.

The findings demonstrate that spiritual care is a shared responsibility between healthcare professionals and family caregivers in palliative care. Recognizing and supporting culturally grounded spiritual practices may strengthen holistic nursing care, promote family-centered care, and enhance the quality of palliative services for culturally diverse populations.

Existential factors such as loss of meaning play a central role in suicide-related vulnerability, yet most prevention interventions target symptom reduction. We aimed to systematically review the effects of meaning-based interventions on suicide-related outcomes and characterize the mechanisms through which these effects operate.

A systematic review was conducted following PRISMA 2020 guidelines. Six databases (PubMed, Web of Science, CINAHL, PsycINFO, Research Information Sharing Service, and Korean Studies Information Service System) were searched from inception to April 2026. Studies were included if they evaluated meaning-based interventions and reported suicide-related outcomes. Risk of bias was assessed using RoB 2 for randomized trials and RoBANS for nonrandomized studies. Given heterogeneity across populations, interventions, and outcomes, findings were synthesized narratively by domain.

Ten studies were included (7 randomized controlled trials, 2 quasi-experimental studies, and 1 secondary analysis). Meaning-based interventions most consistently improved existential outcomes, including meaning in life, spiritual well-being, and quality of life. Emotional outcomes showed partial and heterogeneous effects. Suicide-related outcomes, including hopelessness, demoralization, and suicidal ideation, generally showed reductions, although effects varied across studies. Mechanistically, most studies showed patterns of indirect pathways, whereby improvements in existential variables co-occurred with reductions in emotional and suicide-related outcomes.

Meaning-based interventions may reduce suicide-related vulnerability primarily by enhancing existential resources rather than directly targeting symptoms. These findings support integrating meaning-centered approaches into suicide prevention strategies and highlight the need for longitudinal and mediation-based studies to examine causal mechanisms.

Advance care planning (ACP) is widely implemented in older adults with dementia, yet reports focusing on young-onset dementia remain scarce. Valuable insights may be drawn from studies on younger adults with serious chronic illnesses, as they share similar life stages and challenges. To examine ACP in young and middle-aged adults with serious and chronic illnesses and assess their relevance for young-onset dementia.

A systematic scoping review. Open Science Framework (https://osf.io/cjwy4). A search was conducted in PubMed, EMBASE, and CINAHL until 19 December 2023. Title/abstract screening was conducted using ASReview. Two authors independently performed the full-text screening and quality assessment. Studies were categorized into 2 groups: (1) process (clinical practice and preferences) and (2) interventions.

Fifty-six studies were included, including 26 interventions. Participants preferred initiating ACP either shortly after diagnosis or later, with physicians or general practitioners. In practice, physicians and nurses discussed ACP shortly after diagnosis or later. Preferred topics include end-of-life care and physical, social, psychological, and spiritual/cultural domains. However, in practice, discussions primarily focused on legal representation, end-of-life care, and the physical domain.

ACP should adopt a holistic approach at an appropriate stage of the disease trajectory and is a multidisciplinary process. A multidisciplinary team effort could facilitate the integration of the different aspects of ACP. The findings of this review are applicable to young-onset dementia. However, due to the progressive cognitive decline, it should be initiated earlier and revisited throughout the disease trajectory, with increasing family involvement.

Patients receiving oncology palliative care experience substantial psychological distress, emotional suffering, and complex symptom burden. This study aimed to evaluate the effects of a nursing-led predictive symptom management program incorporating selected laboratory indicators on psychosocial outcomes, symptom burden, quality of life, functional status, and clinical parameters among patients receiving oncology palliative care.

A quasi-experimental study was conducted on 150 adult cancer patients receiving palliative care in a governmental hospital in Al-Kharj, Saudi Arabia. Participants were assigned to an intervention group (n = 75) or a control group (n = 75). Effects were assessed at baseline and after a 6-week intervention by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale, Eastern Cooperative Oncology Group Performance Status, and selected routine laboratory parameters.

The intervention resulted in a significant decrease in total symptom burden compared with the control group (ESAS total score: 34.04 ± 8.86 vs. 41.51 ± 8.48; p < 0.001; Cohen’s d = 0.86) and significant improvement in pain scores (p = 0.003). No statistically significant between-group differences in anxiety, depression, quality of life, or functional status were observed post the 6-week intervention. Some laboratory parameters, including hemoglobin, sodium, potassium, and calcium, differed significantly between groups at specific follow-up time points. C-reactive protein correlated weakly and positively with symptom burden (r = 0.180; p = 0.028).

A nursing-led predictive symptom management program incorporating clinical assessment and laboratory monitoring may effectively reduce symptom burden and improve comfort among patients receiving oncology palliative care. However, longer interventions including structured psychosocial support as well as emotional evaluation and supportive care strategies may be required for psychological distress and quality-of-life outcomes.

Spiritual care is fundamental to palliative care, yet little is known about Islamic religious leaders’ (IRLs’) perspectives on supporting Muslim patients with serious illness in Ghana. This study explored IRLs’ understanding, supportive roles, and contributions to developing faith-sensitive palliative care guidelines.

This qualitative exploratory descriptive study was part of a larger multi-method project. Ten IRLs were purposively recruited. Semi-structured interviews were conducted face-to-face or virtually, audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s thematic analysis. Findings were interpreted through Saunders’ Total Pain framework.

Five interrelated themes emerged: (1) conceptualising palliative care as holistic and faith-sensitive care; (2) Islamic beliefs as resources for coping with serious illness and end-of-life care; (3) IRLs as providers of holistic and faith-sensitive care; (4) family-centred care and shared decision-making; and (5) barriers and opportunities for faith-sensitive palliative care. Participants emphasised hope and trust in Allah, prayer, Qur’anic recitation, family involvement, and collaboration between healthcare professionals and religious leaders. Limited awareness, inadequate infrastructure, and weak institutional support hindered the provision of faith-sensitive care.

IRLs play important roles in culturally responsive palliative care. Integrating Islamic spiritual care, collaboration with religious leaders, and family-centred communication into clinical practice and palliative care guidelines may strengthen holistic care for Muslim patients in Ghana and other multicultural African settings.

Grade 4 glioblastoma (GBM) carries a median survival of 12–15 months and confronts patients with rapid functional decline, identity disruption, and existential distress. Dignity therapy (DT) is a brief, empirically supported psychotherapeutic intervention that reinforces meaning, generativity, and personal dignity in life-limiting illness. Its application in primary brain tumors, where neurological impairment may threaten the cognitive capacities DT relies on, has rarely been described.

We describe the psycho-oncological trajectory of a man in his mid-40s with GBM of the corpus callosum. Psychological assessment began at diagnosis, with parallel support pathways for the patient and his caregiver. DT was delivered during the window of maximal cognitive competence, following Chochinov’s standard protocol within a Cognitive-Interactionist framework. The resulting generative document was printed as a book and distributed by the patient to several hundred members of his community, a spontaneous amplification of DT’s generative function not previously documented. As callosal disconnection syndrome advanced, therapy adapted through embodied, musical, and relational modalities, maintaining psychological contact through the terminal phase.

This case demonstrates the feasibility and clinical relevance of DT in neuro-oncology when delivered early and flexibly adapted to cognitive decline.

It highlights the importance of early psycho-oncological integration, shows how the generative document can extend into communal legacy work, and demonstrates that meaningful psychological support can continue beyond verbal communication. Prospective investigation of DT in brain tumor populations is warranted.

Denial in patients with advanced cancer is a common yet poorly understood phenomenon. This case report aims to illustrate the complexity of apparent denial in a psycho-oncology setting and to use it as a clinical anchor to review the concept of denial through multiple theoretical and practical lenses, highlighting key considerations for clinicians.

We present the case of a woman in her forties, originally from Africa, diagnosed with advanced metastatic gastric cancer. The case is examined through a narrative review of the existing literature on denial, encompassing psychological, psychiatric, neurocognitive, cultural, and systemic perspectives.

The patient demonstrated behaviors initially interpreted as denial by the treating service, including behaviors such as declining prognostic discussions, refusing to inform her family, and avoiding opioid analgesia, yet she explicitly acknowledged her diagnosis and its severity. Psycho-oncology consultation helped reframe her responses as coherent, value-driven choices rooted in her role as a mother and her cultural background, rather than as impaired insight or maladaptive coping. On the final day of her life, she accepted palliative care and consented to family notification, illustrating the fluid and evolving nature of apparent denial.

This case underscores the importance of individualized assessment and offering care before pathologizing patient disengagement. We discuss how palliative or psycho-oncology practitioners could distinguish adaptive coping from maladaptive denial, identify underlying psychiatric conditions, and screen for neurocognitive impairment if relevant. A multidisciplinary, empathic approach that respects patient autonomy is essential in navigating such complex encounters.

To determine the preliminary feasibility, acceptability, and effects of the “Meaning-in-Life Counseling Program,” a cultural adaptation of meaning-centered psychotherapy for Chinese immigrants with advanced cancer (MCP-Ch).

Mandarin-speaking stage III/IV cancer patients were enrolled in 2 pilot trials of MCP-Ch, a manualized, one-on-one intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, and purpose. Participants completed 6 weekly sessions in Mandarin Chinese with a bilingual interventionist, 45–60 minutes in length, via videoconferencing or phone. Participants were administered measures of spiritual well-being, quality of life (QOL), depression, anxiety, hopelessness, and meaning-in-life pre-intervention (T1) and 1-month post-intervention (T2) and were additionally administered an exit survey at T2. Descriptive data from participants who initiated MCP-Ch sessions (n = 31) were pooled.

In total, 31 of 42 participants across the 2 trials started the MCP-Ch intervention, and 28 completed all 6 sessions. Results showed small to moderate postintervention improvements in spiritual well-being, QOL, anxiety, and depression. Participants provided positive feedback about MCP-Ch (89% expressed satisfaction with the intervention). A majority (50–86%) suggested additional components (i.e., cancer health education, Chinese-language peer support) to increase the intervention’s relevance and acceptability.

Overall, preliminary data suggest that this 6-session, manualized intervention is associated with improvements in psychological functioning. However, feedback from stakeholders suggests additional components could enhance the intervention’s relevance. Future research should examine MCP-Ch with these additional components.

Spiritual care is a key component of holistic palliative care, particularly within Muslim communities where faith plays an important role in shaping illness experiences. This study aimed to explore the perspectives of Muslim family caregivers on spiritual care in palliative settings.

A qualitative descriptive study was conducted among 12 Muslim family caregivers of patients receiving palliative care in Kuantan, Malaysia. Participants were recruited using purposive and snowball sampling. Data were collected through semi-structured interviews and analyzed using thematic analysis to explore patterns and meanings related to spiritual caregiving.

Three major themes emerged: (1) understanding spiritual care as maintaining connection with God through religious practices, (2) caregivers’ roles in providing holistic support, facilitating spiritual engagement, and offering emotional reassurance, and (3) challenges in delivering spiritual care, including patients’ health limitations, practical constraints, and emotional burden. Spiritual care was perceived to enhance patients’ sense of peace, acceptance, and coping.

Findings highlight the central role of family caregivers in sustaining spiritual well-being in palliative care. In the Malaysian context, integrating culturally informed spiritual care into nursing practice and supporting caregivers as partners in care may strengthen holistic and patient-centered outcomes.

Parents navigating a cancer diagnosis are at risk for higher levels of distress and have reported needs including communicating a cancer diagnosis to their young children and preparing them for transition to end-of-life care. There have been few empirically validated interventions in the literature to address this unique population and their needs. Ensuring Children Have Optimal Support (ECHOS) program was developed in our tertiary cancer center to support entire families using strategies from evidence-based psychosocial and family-centered interventions. The program helps patients with cancer and their families communicate about the diagnosis with their children and promote family well-being.

A case study is presented to illustrate the specific needs of a cancer patient with children and demonstrate clinical interventions provided through our ECHOS program.

Specific parental needs addressed included communication of diagnosis, preparation for death, and supporting anticipatory grief.

Our case study illustrates specific needs that cancer patients with children face. We recommend screening and family-tailored interventions for all cancer patients with minor children.