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.

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.

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.

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

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

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

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

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 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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