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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

The DiRePal model understands dignity at the end of life as relational and temporal, shaped by recognition, narrative continuity, and prudent listening. This study explores how patients with advanced cancer, informal caregivers, and physicians understand and experience dignity, providing empirical foundations for the model.

A multicentre qualitative study comprised six semi-structured focus groups involving oncology patients (n = 10), informal caregivers (n = 14), and pulmonology/oncology physicians (n = 15), conducted via a secure digital platform between April and November 2025 with IQVIA Portugal. Transcripts underwent reflexive thematic analysis, with independent initial coding, discussion-based consensus, and researcher reflexivity. Given participants’ clinical fragility, member checking was not undertaken; credibility relied on triangulation, thick description, and an audit trail.

Six themes emerged: personal understanding of dignity, narrative flexibility, negotiating technical rationality and relational care, temporal sensitivity, professional reciprocity, and digital/structural integration. Dignity was inseparable from personal recognition, interpersonal gestures, and listening within time-constrained encounters. Physicians’ emotional overload and insufficient institutional support compromised their dignity and, indirectly, patients’; caregivers frequently rendered themselves invisible. Patients associated dignity with respect, autonomy, and relief of suffering, while depersonalised or fragmented care eroded it.

These findings ground a relational–temporal account of dignity in reciprocal recognition between patients, caregivers, and clinicians across shared, unevenly experienced time. Listening, temporal prudence, and recognition of clinicians’ vulnerability should be clinical priorities, alongside cautious, relationally framed integration of digital tools.

To explore how holistic suffering manifests and is experienced by adults with cancer through qualitative inquiry, supported by descriptive quantitative assessment.

This qualitatively driven study combined semi-structured interviews with embedded descriptive quantitative data from the Suffering Pictogram–Brazilian version (SP-BR). A total of 222 adults with cancer completed the SP-BR, and a subsample of 20 participated in interviews. The qualitative component had methodological priority and underwent thematic analysis; SP-BR scores were analyzed descriptively to contextualize self-reported levels and dimensions of suffering.

Overall suffering was moderate (mean=4.44, standard deviation=3.22), with substantial variability; worry and physical discomfort were the most prominent concerns. Thematic analysis revealed 4 interrelated themes: Disruption of the self and the search for meaning after diagnosis; Anchoring suffering: faith, relationships, and the ambivalence of coping; Concealed suffering and the fragile work of acceptance; and Meaning as responsibility: enduring suffering for oneself and others. Suffering coexisted with adaptive processes, including meaning-making, relational commitment, and spiritual coping. Spirituality and social support functioned both as protective resources and, in some cases, as mechanisms for concealing distress.

Holistic suffering in cancer is an integrated, dynamic experience that can be understood as a nonlinear existential trajectory, in which participants moved back and forth between disruption of the self, the anchoring of faith and relationships, emotional concealment, and meaning-making. The proposed interpretive model synthesizes this trajectory and may serve as a conceptual starting point for designing interventions addressing holistic suffering.

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.

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.

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.

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.

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.>