Awareness of death shapes our existence; it prompts both distress and a maturation process called existential maturation. Presently, direct quantitative measures of existential maturation are unavailable to study treatments for existential distress that enhance psychological well-being. We examined the effect of a mortality salience stimulus on implicit death thoughts over time. We also examined the associations among existing measures of constructs conceptualized as relevant to an eventual measure of existential maturation in a representative sample.

A cross-sectional Qualtrics panel of 1,000 adults, representative of the United States' urban and rural populations, completed a 20-minute survey. The self-report Human Existence survey included an embedded mortality salience stimulus (Death Anxiety Beliefs and Behaviors Scale) and valid, reliable measures of implicit death-thought accessibility (DTA), existential isolation, existential distress, flourishing, transcendence, attachment, connections, peace, and other related constructs.

The DTA measure did not replicate previous research on mortality salience. We found significant positive correlations between existential isolation and existential distress, and between flourishing and transcendence. However, correlations of death anxiety with isolation, flourishing, and transcendence were surprisingly low. In multivariate analysis, avoidant attachment was negatively associated with existential isolation and distress; death anxiety was positively associated with anxious/ambivalent attachment. Transcendence was negatively associated with avoidant attachment and positively associated with being at peace and connections. Flourishing was positively associated with being at peace and connections.

An ineffective death reminder or the DTA online format may have affected DTA results. Striking relationships between attachment style and EM indicators confirm they are interrelated. Measures for existential maturation and related phenomena still lack implicit measures to assess nonconscious components.

Supporting a family member with cancer poses significant challenges for family caregivers, who have unmet supportive care needs. Psychosocial oncology professionals (PSOP) are often the primary source of support for cancer caregivers in Iran. Given the lack of supportive care resources, innovative strategies are needed to support caregivers. This study explores the views of PSOP and caregivers regarding the challenges, potential solutions, and the role of digital technologies in supporting caregivers.

Employing a qualitative descriptive design, we conducted individual interviews and focus groups with 30 participants (15 PSOPs and 15 caregivers), recruited from five settings in Tehran, Iran(2023-2024). All sessions were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.

PSOP identified challenges in delivering psychosocial care to caregivers , including inconsistency, uncertainty, and fragmented use of technology. Their recommendations included flexible psychosocial care via blended multi-modal digital technologies, professional development opportunities, and formal recognition and integration within the oncology setting. Caregivers experiencing frustration with the healthcare system expressed a need for family-centered care, flexible psychosocial care, and organized peer support networks.

Current psychosocial care in Iran is insufficient and misaligned with the preferences of PSOP and caregivers. PSOP and caregivers advocate for flexible psychosocial care through blended digital strategies. Public health strategists in Iran, as a low-resource setting with a family-centered context, should optimize resource utilization by prioritizing the training of PSOP, developing blended digital interventions, and leveraging trained peers to provide navigation and support to families, thereby easing the PSOP workload.

Cancer patients often suffer from refractory symptoms near death. The use of sedatives aims to relieve suffering caused by these symptoms. The practice varies broadly. The aim of this study was to evaluate the role and trends of midazolam use in cancer patients dying in a university hospital oncology ward.

The study population of this retrospective registry-based study consists of patients who died in a university hospital oncology ward in Eastern Finland in 2010–2018 (n = 639). Information about treatment decisions, midazolam use, and background factors were gathered.

During the study period, 14.7 % of the patients dying in the ward received midazolam with sedative intent prior to death. 4.7 % (n = 30) of the whole study population had continuous infusion and the rest of the midazolam use was one or multiple single doses. Documented discussion of possible palliative sedation (PS) use was found in almost one third of all patients. Out of those, eventually receiving midazolam with sedative intent, two thirds had had this discussion. The most common symptoms leading to midazolam were dyspnea, pain, and delirium. In continuous use the median midazolam infusion rate was 4.0 mg/h. The continuous infusion started median of 23.25 h and multiple single doses 19 h before death. If only one dose of midazolam was needed, it was given median of 30 minutes prior to death and the most common symptom was dyspnea. Those who received midazolam were more likely to be younger (p = 0.003) and had had a palliative outpatient clinic visit (p = 0.045).

This is the first study to report the trends and practices of midazolam use for refractory symptoms in Finland. Midazolam was used for approximately every 7th dying cancer patient. Applying midazolam was supported by a history of palliative clinic visits and younger age.

This study sought to examine the validity and reliability of the Turkish adaptation of the Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE) scale. The primary objective was to evaluate the scale’s psychometric properties in measuring acceptance and coping among cancer patients.

The study included 90 cancer patients who completed the 12-item PEACE scale. The scale consists of two distinct subscales: the 5-item Peaceful Acceptance subscale and the 7-item Struggle With Illness subscale. Reliability was examined using Cronbach’s alpha and test-retest reliability (r = 0.916). Content validity was assessed using the content validity index (CVI = 0.84). Both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to examine the underlying factor structure and evaluate model fit indices.

The internal consistency for both subscales was satisfactory (Cronbach’s α = .78 for both). EFA indicated that the two subscales explained 53.169% of the total variance. CFA substantiated the two-factor model, demonstrating adequate model fit indices (χ2/df = 1.689,Root Mean Square Error of Approximation = 0.088). These findings collectively establish the Turkish version of the PEACE scale as a psychometrically sound tool.

The PEACE scale is a valid and reliable instrument for assessing levels of acceptance and coping in cancer patients. Its use can help healthcare professionals better understand patients’ emotional states and guide interventions aimed at improving their quality of life.

The concept of total suffering is widely recognized in palliative care (PC), encompassing a range of interconnected and complex factors that collectively shape the evolving and individualized experience of a patient’s illness journey. Studies on will to live (WtL) in terminally ill patients have demonstrated its variability over time and various factors that influence these changes.

To objectively investigate the concept of total suffering and WtL; including their fluctuation over time and associations with sociodemographic, clinical, physical, and psychological symptoms in a sample of individuals with life-limiting conditions receiving PC. This multicenter Iberian study involved 3 centers in Portugal and 1 in Spain. A total of 107 individuals with life-limiting conditions consented to participate. To capture the dynamic and multifaceted components of total suffering, we had each participant completed the Edmonton Symptom Assessment Scale (ESAS) along an additional WtL visual analogue once daily over a 30-day period.

WtL demonstrated various patterns over time. While some patterns reflected relative stability, other demonstrated substantive fluctuation during the course of illness. Significant correlations were observed between WtL and all other ESAS items. Moderate positive correlations were found between WtL and total ESAS score and its physical and psychological sub-scores. Spearman’s correlation coefficients between all physical and psychosocial items on the ESAS were statistically significant across all 45 correlations performed, with only 5 showing moderate strength; the remaining correlations were weaker.

Evidence-based understanding of WtL is critical to improving care for patients who experience suffering toward end-of-life and their families. Further research is needed to inform and refine interventions targeting total suffering.

Expressive writing interventions (EWIs) are associated with important psychological and physical outcomes in patients with cancer. However, EWIs have not been widely integrated into routine psychosocial care of cancer populations. A review of the current literature on EWIs’ impact on the cancer patient experience, including qualitative analyses of patient perspectives, will increase our understanding of barriers and facilitators to adoption in clinical settings.

To bridge existing gaps in the literature by examining quantitative and qualitative studies on EWIs for patients with cancer. To present recent data examining the benefits of EWI’s for patients with cancer.To provide strategies for clinicians engaging in EWI’s for their patients.

Informed by the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, we completed a scoping review of relevant quantitative and qualitative articles published from 2015 to 2025 to assess the impact of EWIs on health-related outcomes (e.g., physical symptoms and quality of life [QOL]) as well as approaches to improve their use in patients with cancer.

Of the 28 studies with 3527 patients that we analyzed, 24 were quantitative and 4 were qualitative. Most studies were conducted in the USA (42.8%) or China (28.6%) and included patients with breast cancer (71.4%) or only included women (71.4%). Of the patients in the studies, 46.8% identified as White, 42.8% as Asian, 5.5% as Black, and 4.5% as Latino. Twenty-one of the quantitative studies found that EWIs were positively associated with cancer patients’ QOL and/or physical health outcomes. Of the 4 qualitative studies, themes of narrative reconstruction, cultural disclosure norms, and intervention delivery format emerged. The characteristics of EWI methods can be tailored to maximize therapeutic benefits through cultural adaptation, timing, and privacy.

Despite promising associations between EWIs and health-related outcomes in patients with cancer, EWIs for cancer populations are heterogeneous and randomized clinical trials are limited. Larger trials that establish the efficacy of EWIs in diverse cancer populations are warranted.

The aim of this article is to develop and pilot test a new supportive care intervention, Empower GBM, designed for patients with glioblastoma and their family caregivers to reduce psychological distress and improve quality of life.

Qualitative interviews were conducted with patients diagnosed with glioblastoma and their caregivers to obtain information about their experiences and needs in coping with glioblastoma. We also gathered their feedback about the supportive care intervention we were proposing (Phase I). Following Phase I, we conducted a single-arm pilot to evaluate the feasibility and acceptability of the 6-session intervention (Phase II).

During interviews (N = 14), patients and caregivers reported having the most difficulty and distress surrounding disease progression and management, maintaining dignity and autonomy, negotiation of roles and responsibilities, and maintaining connection with one another. Participants endorsed that an intervention like Empower GBM with skills focused on managing symptoms to increase independence, increasing caregiving efficacy and support, and coping with dyadic challenges would be of potential benefit. Preliminary results from the pilot study (N = 11) suggested the intervention is both feasible (e.g., 82% completed all 6 sessions and post-treatment surveys) and acceptable (88.9% reported a mean satisfaction score of 3 or higher; mean score of 3.57/4.0). Improvements in psychological outcomes, functional well-being, and caregiving efficacy from pre- to post-treatment survey results suggested the potential benefits of the intervention.

We developed a novel supportive care intervention informed by the dyadic illness model that is designed to meet the individual and interpersonal needs of patients with glioblastoma and their caregivers. Unique features include its flexibility to be delivered to patients and/or their family caregivers individually or jointly, while providing skills and strategies to meet the needs of both individuals and the dyad as the unit of care in coping with glioblastoma.

On October 3–4, 2023 and September 30–October 1, 2024, the Memorial Sloan Kettering Cancer Center Department of Psychiatry and Behavioral Sciences and Supportive Care Service hosted the 4th and 5th Annual U.S. Celebration of World Hospice and Palliative Care Day (WHPCD) conferences, respectively. This article describes both events and lessons learned in anticipation of the 6th annual conference to be held October 6–7, 2025.

The 4th and 5th annual events, conference planning team reflection, and attendee evaluation responses are summarized.

Since 2020, the conference has attracted attendees from around the world. Two primary aims continue to guide the event: community building and wisdom sharing at the intersection of art and science. Both the 2023 and 2024 events consisted of 13 unique interactive sessions addressing diverse hospice and palliative care topics delivered by interprofessional experts in palliative care (43 faculty in 2023 and 54 in 2024). Multidisciplinary registrants more than doubled from 764 in 43 countries (2023) to 1678 in 87 countries (2024). Complimentary registration for colleagues in low- and middle-income countries (LMIC), students and trainees, and individuals experiencing financial hardship remains a cornerstone of inclusion and equitable access to the event.

The U.S. WHPCD Conference provides a virtual platform to disseminate high-quality science, honor both clinician and patient and caregiver experiences, and celebrate hospice and palliative care delivery during substantial local and global change across practice and policy domains. We remain committed to ensuring an internationally relevant, culturally diverse, and multidisciplinary and interprofessional agenda that will draw increased participation worldwide during future annual events.

The present study investigated the associations among pre-loss grief, relational closeness, attachment insecurities, continuing bonds (CBs) with the deceased person, and the post-loss adjustment of the caregivers of patients with terminal cancer.

Data were collected in the hospice department of a cancer center in northern Taiwan; 66 bereaved caregivers completed both pre-loss and post-loss scales. The measures used for the pre-loss phase included the Hogan Grief Reaction Checklist (HGRC; pre-loss version), the Experiences in Close Relationship – Relationship Structures Questionnaire (ECR-RS), and the Inclusion of Other in the Self Scale. The measures used 6–12 months after the death of the patients were the HGRC (post-loss version) and the Continuing Bond Scale (CBS).

Pre-loss grief and externalized CBs had a significant impact on the amount of post-loss grief, indicating that pre-loss grief and ongoing transformation of relationships after patients’ death may be predictors of caregivers’ post-loss grieving.

This longitudinal study provides preliminary evidence that pre-loss grief and the relationship with the patient are key to caregivers’ post-loss adjustment, suggesting that psychosocial intervention focuses on caregivers’ pre-loss grief and relationship quality with the patient during palliative care.

The hospital setting is often perceived as slow to change. While employee-driven approaches offer a promising alternative to traditional top-down methods, guidance is limited. This study provides a description and formative evaluation of an employee-driven working group (WG) approach to tailor ward-specific measures to improve care in the dying phase. The aim is to evaluate the WG process and offer practical insights for transferability to other hospitals.

Formative mixed-methods evaluation of a WG process to tailor ward-specific evidence-informed measures on 10 wards outside specialized palliative care at 2 German medical centers. To analyze factors relevant for the WG process, the Consolidated Framework for Implementation Research 2.0 was applied. Data included baseline evaluation (medical record analysis, staff survey and focus groups, informal caregiver interviews), WG protocols, and an online survey with WG participants.

Multiprofessional WGs were established on all hospital wards, with an average of 7 meetings per ward within 1 year and 4 participants per meeting. Adapting the process to participants’ wishes and needs were crucial, particularly regarding the desired degree of external input. We identified 4 barriers (e.g. declining participation, institutional limits) and 7 facilitators (e.g. involvement of staff in leading positions, multiprofessional composition). The WGs tailored 34 measures, e.g. team meetings to improve communication within the team. Participants’ views were generally positive: 91% felt able to share their thoughts, 66% were satisfied with the outcome, and 77% would participate again.

The employee-driven approach was feasible and useful for tailoring ward-specific measures. However, integrating top-down elements proved to be beneficial. The identified barriers and facilitators provide insights for transferring an employee-driven approach to other hospitals to improve care in the dying phase outside specialized palliative care settings.

The study was registered in the German Clinical Trials Register (DRKS00025405).

As cancer incidence and survival rates rise, caregivers responsible for providing diverse support face increased burden and reduced quality of life (QoL). Although research on web-based interventions for this group is expanding, the impact of these interventions on caregiver burden and QoL remains unclear. This study aims to investigate the effects of web-based interventions on the caregiver burden and QoL of caregivers of patients with cancer.

Searches were conducted in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, and PsycINFO from database inception to 10 June 2024. Two reviewers independently assessed each study and extracted data. The risk-of-bias in the studies was evaluated using Cochrane’s Risk-of-Bias tool for randomized controlled trials. The intervention effects were calculated using R package Meta version 4.0.3, utilizing standardized mean differences (SMD; Hedge’s ĝ) to calculate pooled effect sizes with 95% confidence intervals (CI). Publication bias assessment and sensitivity analysis were conducted to ensure the robustness of the results.

We reviewed 13 randomized controlled trials; our analysis indicated a small effect size of web-based interventions on caregiver burden (SMD = −0.19, 95% CI: −0.36 to −0.01). However, sensitivity analysis concluded that the effect was very small or nearly absent. Additionally, there was no statistically significant effect on QoL (SMD = 0.15, 95% CI: −0.05 to 0.36).

Web-based interventions did not significantly reduce caregiver burden or improve caregivers’ QoL. To improve caregiver burden and QoL in the future, comprehensive and tailored web-based interventions for this population are needed.

Timely integration of palliative care (PC) into standard oncology hospital care offers significant benefits to patients with incurable cancer and their families. International recognition of the importance of timely PC has shifted the focus from integration to determining the optimal timing for introducing PC. The specific care responsibilities of oncology clinicians acting as generalists in PC and the optimal timing for involving PC specialists remain uncertain.

This study aimed to (1) explore how the concept of “timely PC” is understood by oncology clinicians and patients with incurable cancer and (2) investigate how PC is provided in a timely manner in daily clinical practice.

An interview study was conducted with 18 oncology clinicians (7 physicians, 1 physician assistant, and 10 nurses/nurse practitioners) and 12 patients with incurable cancer. The interviews were conducted between October 2022 and June 2023 and a thematic analysis of the interviews was performed.

Three main themes emerged regarding “timely PC”: (1) timely PC is individual and situational, (2) identification of the right time is an ongoing challenge, and (3) proactive care is essential. Regarding the provision of timely PC, 3 themes were identified: (1) having a strong collaboration among various clinicians, (2) having the courage to start a clear and sincere conversation, and (3) being sensitive and personal.

Being timely is not a fixed point in time, but depends on the individual patient and their situation. Clinicians should be proactive and gradual in bringing up PC-related topics and be careful to use the right words. Tools such as the surprise question can support in timely integrating PC but being timely PC highly depends on a patient’s individual context. Therefore, clinicians should be aware that timely PC is a constant search for the most fitting moment.

Family caregivers play a critical yet often overlooked role in healthcare, facing the dual challenge of providing clinical care while managing their emotional well-being. Although several studies have investigated the supportive care needs and services for caregivers of advanced cancer patients integrated into specialized palliative care inpatient units, little is known about cancer caregiver integration and support structures in German outpatient cancer care. This qualitative study addresses this gap by exploring the experiences of family caregivers in Germany, using a dyadic approach to assess their needs, identify referral strategies, and evaluate oncologists’ perspectives on improving caregiver integration and support.

Thematic analysis was conducted on semi-structured interviews with 14 advanced cancer patients, 15 family caregivers, and 3 oncologists. MAXQDA software facilitated the identification of key themes and codes.

Three interconnected themes emerged: (1) The Impact of Illness on the Dyadic Relationship, (2) Communication with Physicians and Understanding of Healthcare Information, and (3) Challenges and Preferences in Navigating Healthcare Services and Psychosocial Support.

The findings highlight the need for enhanced support in caregiving to improve cancer care quality, emphasizing that early palliative care integration is vital for addressing caregiver needs as a core component of comprehensive cancer care. Healthcare practices should adopt personalized, proactive support strategies from diagnosis, implement regular needs assessments, and leverage digital healthcare tools to enhance the efficacy and efficiency of caregiver support.

To develop an effective, targeted educational intervention that can serve as a teaching tool to educate African American (AA) populations, especially the elderly, on end-of-life (EOL) options prior to critical care.

A survey was used to assess the level of preparation and determine deficits in knowledge regarding EOL choices in the AA community of Saginaw, Michigan, before and after educational intervention. We used a paired-sample t-test to assess changes in understanding about EOL planning options, McNemar’s to test changes in intention to use hospice and palliative care, and Spearman correlations to identify demographics influencing change of outcomes. Outcome scores associated with multiple demographic variables were regressed on these demographics.

Our data indicated that the intervention was an effective teaching tool in educating the AA population on EOL choices. Significant changes were observed in understanding of EOL options, concerns about palliative and hospice care, and intention to use palliative and hospice care. Age and education were also associated with selected outcome changes.

AA patients are more likely than other ethnic groups to choose life-sustaining measures at the end of their lives, leading to patients not receiving care to help them die peacefully. This decision is partly based on lack of knowledge of the available EOL care options. This study provides evidence needed for physicians to increase their educational efforts with the AA population regarding EOL options. An educational tool like the one developed in this study may be helpful and lessen the time of education so that physicians can answer questions at the end of the session and empower individuals and communities to take an active role in creating a culture of wellness at the EOL and decreasing morbidity.

Palliative care is a critical component of healthcare, yet its integration into Nigeria’s health system remains limited. Despite the growing burden of life-limiting illnesses, palliative care is underdeveloped, primarily restricted to tertiary institutions. This review examines the evolution of palliative care in Nigeria, key milestones, persistent challenges, and future directions for strengthening its implementation.

This narrative review synthesized historical records, policy documents, and literature on palliative care in Nigeria. It examined leadership roles, institutional efforts, and government policies influencing Palliative care growth, while highlighting implementation gaps and opportunities.

Palliative care in Nigeria has evolved from early grassroots efforts to structured institutional services. Key milestones include the establishment of the Hospice and Palliative Care Association of Nigeria (HPCAN), and policy advancements such as the National Policy and Strategic Plan for Hospice and Palliative Care. Despite these developments, challenges persist, including inadequate funding, workforce shortages, limited opioid access, policy implementation gaps, and socio-cultural barriers. Leadership engagement, targeted policy advocacy, and comprehensive capacity-building are essential to overcoming these barriers.

Sustained efforts are needed to fully integrate palliative care into Nigeria’s healthcare system. Strategic interventions, including enhanced policy implementation, funding mechanisms, workforce development, and community engagement, are critical for ensuring equitable access to PC services. Strengthening collaborations between the government, healthcare institutions, and international partners will accelerate progress, ultimately improving the quality of life for patients with life-limiting illnesses.

Children with life-limiting conditions (LLC) are exposed to frequent hospitalizations, with their parents as indispensable supporters, even in inpatient care. Data on the experiences of parents in a hospital setting are scarce. This study aims to identify the burdens and needs of parents of children with LLC in an inpatient setting to promote family-centered care and thereby strengthen parents as effective partners in care.

Descriptive qualitative interview study with purposeful sampling and analysis conducted according to the coding method of Kuckartz. A total of 10 interviews with parents (7 mothers, 3 fathers) were included in the analysis.

Main topics reported by parents were (1) structural conditions, (2) commitment and competence of health care professionals, and (3) cooperation between parents and professionals. Parents acquire medical expertise during their child’s illness and learn complex medical procedures to be able to competently care for their child at home. However, their competence is often denied in the inpatient setting. Parents felt that the professionals were overburdened by the complexity of the disease and the fate of the child. They perceived a lack of communication and psychosocial care as burdensome and wished for more psychosocial support and specialized inpatient palliative care structures for their child’s care.

Parents should be supported as equal partners in care to improve the quality of their children’s care. Sole medical care is not enough for children with LLC; therefore, a specialized multidisciplinary palliative care team is highly recommended.

To examine the challenges and practical realities of providing end-of-life care in welfare evacuation centers following the Noto Peninsula earthquake in Japan, and to identify lessons for improving disaster preparedness in similar settings.

Case 1: A man in his late 90s was transferred to a welfare evacuation center after contracting COVID-19 in a general shelter. He arrived with fever and marked physical decline. Acetaminophen was administered to relieve his fever and provide comfort. His condition gradually worsened, and eight days after arriving at the evacuation shelter, he died peacefully while being closely observed by medical staff. Case 2: A man in his 60s with a history of smoking and alcohol use was found bedridden and incontinent at home and was subsequently moved to a welfare evacuation center. Two days after evacuation, he complained of leg and back pain, which was suspected to be due to arterial occlusion. He was monitored and provided with supportive care at the center, however, pain control remained inadequate. Four days after evacuation, he was found in respiratory arrest and was confirmed dead.

These cases underscore the need for establishing unified guidelines and external support frameworks for end-of-life care in disaster settings. In a disaster-prone country like Japan, scenario-based training and the integration of trained volunteers are essential to ensuring dignified care for vulnerable evacuees.