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.

The purpose of this integrative review is to synthesize and appraise the research describing culturally tailored factors that may influence advance care planning (ACP) conversations and build a conceptual framework based on reported findings.

Publications in English from 5 databases (PubMed, CINAHL, Web of Science, PsycINFO, and Embase) were included that met the inclusion criteria of Chinese Americans’ ACP. Quality was assessed using the Mixed Methods Appraisal Tool. Categories emerging from findings were developed through iterative analysis and cross-comparison of findings from the studies to ensure comprehensive representation across methodologies.

A total of 531 articles were initially identified; 20 articles met the inclusion criteria, while 19 were of satisfactory quality. Sample sizes ranged from 14 to 18,974. Most included studies were conducted in large metropolitan areas across the United States, with San Francisco most frequently represented (n = 3). The synthesized findings show overarching categories: (1) Psychosocial factors including knowledge, attitudes, and family dynamics; (2) Acculturation factors including language preference and length of U.S. residency; (3) Cross-cultural communication contexts including optimal timing and communication skills; and (4) Outcomes: ACP readiness or advance directive completion.

We identified culturally tailored factors influencing ACP communications among Chinese Americans and present a framework to support healthcare professionals to navigate ACP communication with this community. A greater focus on ACP communication outcomes through intervention studies related to culturally tailored factors is needed.

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.