Refractory delirium and agitation in advanced cancer are challenging to manage, particularly when patients have longer prognoses and goals that extend beyond end-of-life sedation. Dexmedetomidine, a highly selective α2-adrenergic agonist, has shown promise for managing refractory symptoms in palliative care. Dexmedetomidine may control agitation while preserving arousability, but prolonged intravenous use limits feasibility.

To describe the use of dexmedetomidine as a stabilizing bridge rather than terminal sedation and transition to oral clonidine to facilitate discharge home in a patient with advanced cancer and a longer prognosis.

A 45-year-old man with metastatic medullary thyroid carcinoma was admitted to the palliative care unit with severe opioid-refractory pain complicated by delirium and agitation, preventing initiation of palliative radiation. A dexmedetomidine infusion was titrated to 0.6 µg/kg/hr. To facilitate discharge home, we implemented a gradual cross-taper to oral clonidine (0.1 mg three times a day titrated to 0.5 mg four times a day) over 1 week while tapering dexmedetomidine by 0.1–0.2 µg/kg/hr decrements.

The dexmedetomidine infusion rapidly achieved symptom control while preserving wakefulness and enabled diagnostic reassessment and completion of radiation therapy. The patient tolerated the transition to oral clonidine without recurrence of agitation or hemodynamic instability, was successfully discharged home, and remained clinically stable 5 months later.

Dexmedetomidine may function as a stabilizing bridge rather than terminal sedation in selected palliative care patients with longer prognoses. Transition to oral clonidine can facilitate discontinuation of intravenous therapy and support outpatient symptom management. Prospective studies are needed to establish standardized transition protocols and identify optimal candidates for this strategy.

Perspectives on advance care planning (ACP) and the perceived roles of healthcare professionals in ACP can differ across cultural and national contexts. As part of a larger study, a theoretical framework of the fundamentals (important aspects) of end-of-life communication by nursing staff with older people was previously developed. We aimed to refine and achieve consensus in an international context on the theoretical framework of end-of-life communication by nursing staff as part of ACP with older people.

A 2-round online Delphi study was conducted with experts in palliative care, care for older people, end-of-life communication, and nursing. Participants evaluated the importance and clarity of the framework’s 20 fundamentals (e.g., self-efficacy, using intuition, and being silent) using a 4-point Likert scale and suggested improvements.

In the first round, 48 experts from 15 countries participated, and 46 in the second. Most had nursing or research backgrounds and lived in Europe. All fundamentals were refined based on the experts’ feedback, which focused on the fundamentals’ applicability to diverse individuals and their suitability for both formal and informal conversations. Consensus with high agreement (≥90%) was reached on 17 fundamentals and consensus with agreement (≥80%) on 2. Two agreed-upon fundamentals were combined into 1.

This study resulted in a refined theoretical framework with broad applicability across diverse individuals and contexts. It deepens understanding of end-of-life communication, provides guidance for nursing staff, and informs education and research. Further research is needed to confirm validity beyond Europe and to inform implementation.

This study examines effects over time of a telephone-delivered 5-session manualized parenting education program for child-rearing parents with advanced cancer. Primary outcomes were parents’ depressed mood and anxiety, parenting skills, parenting self-efficacy, and child behavioral-emotional adjustment.

A total of 84 child-rearing parents diagnosed with advanced, non-curable cancer were recruited from community and comprehensive cancer centers and service providers serving cancer patients. After obtaining signed informed consent and baseline questionnaires, parents were randomized to an experimental treatment group or to an alternative treatment control group. Data (3, 6, and 9 months) were obtained after baseline. Linear Mixed Models were used to compare baseline with 6- and 9-month follow-ups. Outcomes at 3 months were reported earlier.

Of the 84 parents initially randomized, 24 participants completed all data collection time periods. Mixed model analysis showed a significant change in parenting skills over all time periods that benefited the experimental group. There was also a significant improvement in parents’ self-efficacy at 6 and 9 months, which benefited the control group.

This is the first known longitudinal study of child and parent-reported outcomes from a randomized controlled trial of a manualized cancer parenting program for parents with advanced cancer. All results should be viewed with caution given the small sample size and the loss of 71% of the participants from baseline to 9 months. Despite these limitations, Linear Mixed Models analysis showed clinically significant improvements in parenting skills over time compared to an alternative treatment control group.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.