Patients facing serious illness may experience ambivalence about important treatment decisions, sharing information with loved ones, or, perhaps most consequentially, living in a way that is aligned with their values. Motivational interviewing (MI) is a collaborative, person-centered communication style that explores ambivalence by eliciting a patient's motivations, values, and goals. MI offers a practical framework for serious illness communication (SIC), when patients and families often experience competing priorities and uncertainty. Through a clinical case, this article explores the four fundamental processes of MI-engaging, focusing, evoking, and planning-and reframes these concepts through a SIC lens. We highlight the application and adaptation of micro-skills (open-ended questions, affirmations, reflective listening, and summaries) to deepen understanding, explore ambivalence, and support values-concordant decision making. Integrating MI-informed communication strategies into serious illness care provides clinicians with practical tools to navigate ambivalence, foster collaboration, and evoke a patient's intrinsic motivation for decisions aligned with their values.

Cardiovascular disease (CVD) remains the leading cause of death worldwide and is a major driver of critical illness, resulting in admission to cardiac intensive care units (CICUs). Patients with acute, life-threatening CVD often experience episodes of acute decompensation characterized by high symptom burden that may portend progressive loss of function, significantly impair quality of life (QOL), and involve high-intensity, technologically advanced therapies to sustain life. Despite these advances, up to 30% of patients die during CICU hospitalizations, and those who survive may subsequently face persistent functional impairment and psychosocial distress. During critical CVD (CCVD), patients often endure prognostic uncertainty and face complex decisions regarding life-sustaining therapies alongside refractory symptoms. Thus, care that focuses exclusively on disease-directed or life-prolonging therapies is often insufficient to address the full spectrum of patient and caregiver needs. When integrated alongside intensive cardiovascular care, palliative care (PC) offers a complementary and essential approach to the management of CCVD to inform therapeutic decisions, improve QOL, and address psychosocial and spiritual well-being. In this article, a multidisciplinary team featuring PC clinicians (physicians, nurse practitioners, social worker, psychologist, and chaplain), cardiologists, cardiac surgeons, cardiothoracic anesthesiologists, and intensivists present evidence-based guidance in a "Top Ten Tips" format to support PC clinicians caring for CICU patients and their caregivers.

Cancer pain significantly impairs patients' quality of life. Although the World Health Organization recommends nonopioid analgesics for pain management in this context, previous systematic reviews have been limited to the qualitative synthesis of oral formulations published up to 2017. To address these limitations and update the clinical guidelines of the Japanese Society of Palliative Medicine (JSPM), we conducted a comprehensive review and a meta-analysis including intravenous formulations with the latest evidence through 2025. We included relevant studies published before 2018 that were cited in the clinical guidelines of JSPM (2020, 3rd edition). Additionally, we searched CENTRAL, PubMed, and ICHUSHI for relevant randomized controlled trials published between January 2018 and December 2025. These combined data were used for an integrated meta-analysis. The review's primary outcome was pain relief. Effect sizes were evaluated using Hedges' g. We included five studies for acetaminophen (n = 253) and 17 for nonsteroidal anti-inflammatory drugs (NSAIDs) (n = 1493). Acetaminophen coadministered with opioids did not show a statistically significant effect on pain relief (Hedges' g = 0.18; 95% confidence intervals [CI]: -0.08-0.44). In contrast, the combination of NSAIDs and opioids demonstrated a medium and significant effect compared to opioids alone (Hedges' g = 0.58; 95% CI: 0.07-1.09). However, considerable heterogeneity was observed in the NSAID combination group (I[2] = 82%), and five of the seven studies were judged to have a high risk of bias. This study summarizes the evidence regarding the use of nonopioid analgesics. While a robust effect of acetaminophen coadministered with opioids was not demonstrated, NSAIDs combined with opioids showed a potentially beneficial pooled effect on pain relief; however, the certainty of the evidence was very low and the findings should be interpreted cautiously. Further high-quality research is warranted to confirm these effects and to optimize personalized pain management strategies.

Comprehensive care of pediatric Pulmonary Hypertension (PH) patients may include multiple subspecialty and supportive services, including specialized pediatric palliative care (PPC). PPC is interdisciplinary, patient- and family-centered care that supports the physical, emotional, and spiritual well-being of children with serious illnesses to promote quality of life. We present a case series of three patients that highlight several of the unique approaches used by specialized PPC in pain and symptom management, assessing patient and caregiver coping, advance care planning, care coordination, complex medical decision-making, end-of-life care, and grief and bereavement support. Our aim is to define the role of PPC in the longitudinal care of PH patients and to initiate discussions on best practices and optimal outcomes in this population.

Unhoused individuals are at high risk for chronic illness and early mortality. For those who have serious or life-limiting illness, being unhoused can negatively impact symptom management, access to disease-modifying therapies, and ability to receive goal-concordant care at the end of life (EOL). Palliative care (PC) clinicians should be prepared to take a thorough housing history, identify barriers to care, and work with patients and teams to devise care plans that are realistic and in line with the patient's preference and values. In this article, an interdisciplinary group of PC, internal medicine, psychiatry, and addiction medicine clinicians and researchers with expertise in caring for unhoused patients present an overview of the assessment and management of patients with serious illness who are unhoused. We outline key considerations for addressing symptoms associated with serious illness, engaging in Advance Care Planning, evaluating for comorbidities and mental health concerns, and coordinating medical therapies for the patient's underlying serious illness.