BackgroundSuffering in advanced illness is multidimensional and often includes existential and spiritual distress. Brief interventions that can be tolerated at the bedside may be useful in palliative care, but ultra-brief gratitude-focused mindfulness has not been formally evaluated in this setting.ObjectiveTo determine whether a single 5-minute mindfulness-of-gratitude practice reduces suffering and improves spiritual well-being among palliative care inpatients compared with attention-matched supportive listening.MethodsIn this parallel-group, open-label randomized controlled study, adult palliative care inpatients with an Overall Suffering Score ≥4/10 were randomized 1:1 to a scripted 5-minute mindfulness-of-gratitude practice or a 5-minute supportive-listening conversation, both delivered by the same trained clinician. Overall suffering, total suffering, and spiritual well-being measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12) were assessed immediately before and after the session.ResultsForty patients were randomized, with 20 in each arm, and all completed the protocol. Compared with supportive listening, the mindfulness-of-gratitude arm showed greater reductions in overall suffering (median change -2.5 vs -1.0; P < 0.001) and total suffering (-2.0 vs -1.0; P = 0.037), and greater improvement in FACIT-Sp12 score (+2.0 vs 0.0; P = 0.001). No adverse events were reported.ConclusionsA single 5-minute mindfulness-of-gratitude practice produced immediate reductions in suffering and improvements in spiritual well-being. This brief, low-risk intervention may be a practical adjunct to routine inpatient palliative care, although durability and generalizability require further study.

BackgroundAccurate prognostication during the actively dying phase remains a major challenge in palliative care, particularly in home hospice settings where bedside assessment plays a central role. Neurological deterioration preceding death may provide clinically useful indicators of impending death; however, its temporal progression has not been well characterized.MethodsWe conducted a prospective observational study of terminal cancer patients receiving home hospice care between April 2022 and March 2025. A total of 236 patients who died at home were included. Neurological signs-including newly developed neuropathic pain, urinary retention, loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, impaired consciousness, open mouth posture, hyperpyrexia, apnea episodes, and pupillary dilation-were prospectively recorded. The timing of each neurological sign relative to death was documented.ResultsNeurological signs appeared in a recognizable temporal sequence preceding death. Urinary retention appeared earliest, with a median onset of 4 days before death (interquartile range [IQR], 1-7 days), followed by newly developed neuropathic pain at 3 days (IQR, 1-5 days). Loss of facial expression, dysphagia, neck rigidity, head rotation, seizures, and apnea episodes typically occurred approximately 2 days before death. Impaired consciousness, open mouth posture, hyperpyrexia, and pupillary dilation occurred closer to death, with median onset times of 1 day before death. Loss of facial expression was the most frequent neurological sign (96.6%).ConclusionsNeurological deterioration follows a recognizable temporal pattern in terminal cancer patients receiving home hospice care. Systematic assessment of these neurological signs may support bedside prognostication, facilitate anticipatory guidance, and help families prepare for the dying process at home.

IntroductionHeart failure (HF) is associated with substantial functional impairment and a significant global burden, particularly in rural settings. Health status is a key patient-reported outcome, and palliative care provides supportive care that improves quality of life (QOL).PurposesThe purposes are to assess HF-related health status as a patient-reported outcome and to examine how palliative care and psychosocial factors are jointly associated with HF health status among individuals receiving home-based care in rural Appalachia.MethodsA cross-sectional correlational design was employed using baseline survey data from rural Appalachia. Participants were adults (≥50 years) with advanced HF (N = 79) enrolled in an ongoing clinical trial. Patient-reported HF status was assessed the Kansas City Cardiomyopathy Questionnaire (KCCQ). Also, the Integrated Palliative Outcome Scale (IPOS), psychological and sociodemographic variables were measured as independent variables. Stepwise multiple regression analyses were conducted.ResultsParticipants' mean age was 68.9 years (SD = 7.55); predominantly White (93.7%) and male (58.2%). The model showed strong results (R[2] = .60, P < .001), with greater palliative care needs (β = -.34) and depression (β = -.28) as the main contributors to poorer HF health status, while greater income adequacy (β = .19) was associated with better HF status.ConclusionThe HF-related health status of individuals with HF is influenced by the complex, interrelated effects of physical symptoms, psychological distress, and social factors. Integrating palliative and psychosocial measures helps identification of unmet needs and enables more targeted, patient-centered care in rural, home-based HF populations.

BackgroundResearch has shown that people who consider themselves religious have a lower advance directive (AD) completion rate. However, advance care planning (ACP) includes a broader range of activities that are important in determining medical treatments. Little has been published on the relationship between spirituality, religion, and engagement in ACP activities.ObjectiveWe examined whether religiosity and spirituality are associated with ACP engagement.MethodsThis is a secondary analysis of interview data collected at baseline during a randomized controlled trial of a nurse-led ACP intervention. Measures included the 5-item Duke University Religious Index (DUREL), a measure of spirituality, and the 15-question ACP Engagement Survey, which examines engagement in multiple aspects of ACP.ResultsWe found a significant association between higher scores on each domain of the DUREL and higher ACP Engagement scores. In separate multivariable models adjusting for demographic factors, the relationship between greater religiosity (higher total DUREL scores) and greater ACP Engagement scores was significant (P < .0001 for each model). Identifying as spiritual was significantly associated with greater ACP Engagement scores (P = .0038) in adjusted multivariate models.ConclusionsIn contrast to prior findings of lower AD completion in more religious individuals, this study found that higher religiosity and spirituality are associated with higher ACP engagement. These results suggest ACP opportunities offered for religious congregations or spirituality focused communities may be especially successful.

IntroductionHospital readmissions in the US place a considerable burden on patients and their caregivers. Our study will investigate whether spiritual intervention during a patient's hospital stay contributes to lower rates of readmissions 30 days after hospital discharge.MethodsTwo hundred patients receiving palliative care will be randomized into control (n = 100) and intervention groups (n = 100). The control group will receive a standard spiritual support visit, while the intervention group will receive a spiritual intervention consisting of active listening, compassionate presence, assessment of post-discharge resources, and a supportive phone call 5 to 7 days after discharge. The primary outcome will be hospital readmission within 30 days of discharge. Board-certified chaplains will be allowed to use their individual skillsets but within the standardized ACA spiritual care model. Training chaplains to assess patients in the same way will help with this discrepancy as the same form will be used.DiscussionWe hypothesize that patients who receive spiritual intervention with a supportive phone call will experience fewer hospital readmissions. Spiritual intervention will instill.confidence in those patients at risk of readmission by assuring them that the hospital staff remain concerned about their well-being even after discharge.

ObjectiveThis systematic review synthesizes randomized controlled trial evidence on the effectiveness of nurse-led ACP interventions for patients with advanced cancer.MethodsWe searched PubMed, Embase, CINAHL, Web of Science, and the Cochrane Central Register from inception to January 2026. Eligible studies were randomized controlled trials (RCTs) evaluating nurse-led ACP interventions in adults with advanced or metastatic cancer. Two reviewers independently screened records, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2 (RoB 2) tool. A narrative synthesis was performed due to clinical and methodological heterogeneity precluding meta-analysis.ResultsSix studies (7 publications; N = 2816) met inclusion criteria, conducted in the United States, South Korea, and six European countries. Nurse-led ACP interventions consistently increased advance directive completion (adjusted odds ratios 2.5-5.3) and end-of-life conversation rates vs usual care. One trial showed facilitated nurse-led ACP outperformed patient-directed approaches in ACP engagement (adjusted difference 0.25; 95% CI 0.10-0.40; P = .001). Quality of life outcomes were mixed; most trials showed no significant difference at 3 months, though higher-intensity interventions trended toward greater benefit. Overall risk of bias was low to moderate.ConclusionsNurse-led ACP interventions are feasible and effective in improving ACP engagement and end-of-life outcomes for patients with advanced cancer. Successful implementation requires standardized training, adequate intervention intensity, and systematic follow-up. Future trials should use validated patient-reported ACP measures and explore optimal timing and delivery methods.

BackgroundPatients are increasingly using cannabis products to manage a wide range of symptoms; however, few studies have examined the symptom burden of patients with cancer receiving palliative care who self-report using cannabis products.ObjectivesThe purpose of this investigation was to compare the symptom burden of palliative care patients with cancer who self-reported using cannabis products vs those who did not.DesignRetrospective study.Setting/Participants100 patients who self-reported using cannabis products and 300 patients who did not were randomly selected as the case and control groups, respectively. All participants were evaluated during their first consultation at a supportive clinic in a tertiary cancer center in the United States between January 1 and December 31, 2024.MeasurementsData collected included self-reported cannabis use, demographics, primary cancer diagnosis, cancer treatment, symptoms, performance status, and medications.ResultsThe proportion of patients who self-reported using cannabis products was 11.14%. Multivariate logistic regression analysis showed that female sex, older age, and Black or African American race were associated with lower odds of self-reported cannabis use. In contrast, living alone, higher levels of pain, anxiety, and appetite disturbance, were associated with increased odds of cannabis use.ConclusionsPatients with higher symptom burden are more likely to report cannabinoid use. Universal screening accompanied by patient education is important in palliative care.

IntroductionDyspnea is a prevalent, debilitating, and distressing symptom in palliative care. This systematic review evaluated the efficacy of oxygen therapy and oxygen delivery modalities compared with room air, medical air (FiO2 21%), pharmacological therapy, or other respiratory support modalities for relieving dyspnea in patients with advanced, progressive, and incurable diseases.MethodsA systematic search of PubMed and Scopus was conducted for studies published up to February 15, 2026, evaluating oxygen therapy or oxygen delivery modalities for dyspnea in palliative care. Risk of bias was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa Scale. Data synthesis was performed narratively.ResultsNine studies encompassing 879 participants were included. Among seven clinical trials, only one presented a low overall risk of bias. In non-hypoxemic patients, oxygen therapy was not consistently superior to medical air. In hypoxemic patients, limited evidence suggested benefit from conventional oxygen compared with room air, while high-flow nasal cannula was associated with greater short-term dyspnea relief than conventional oxygen therapy in one emergency department trial. Opioid therapy was associated with greater dyspnea reduction than oxygen alone in one prospective study.ConclusionOxygen therapy should not be prescribed routinely for dyspnea in non-hypoxemic palliative care patients. Its use should be guided by baseline oxygenation status, delivery modality, expected symptomatic benefit, patient goals, and treatment burden. The certainty of evidence remains limited by small samples, heterogeneity, and risk of bias.

Hospice has become an important component of End-of-life care in the United States. The use of hospice, however, remains subject to many forces, including the patient, providers, families and cultural beliefs. One consequence of these forces is significant variability of survival of patients in hospice. In a recent study, the authors reported a median survival of approximately 24 days after enrollment. However, a significant minority of patients survive for more than 180 days (the target set by CMS for the Medicare hospice benefit). We examine the factors contributing to the variability of hospice patient survival, including demographics, diagnoses, care setting, and patient drug prescriptions. We apply Cox proportional hazards models to assess the effect of covariates on time-to-event (in this case death in hospice). A high hazard ratio is associated with a shorter life expectancy. In addition to these factors we evaluated medication exposure variables. Medications are strongly associated with the mortality hazard: analgesic use is associated with a nearly three-fold higher hazard (HR = 2.977), and anxiolytic use with a roughly two-fold higher hazard (HR = 1.910) when compared with the group without any anxiolytic use. We provide a detailed understanding of medication use near the end of life that serve as an indicator that medication trajectories can serve as an additional indicator of symptom burden and individualized care planning.

BackgroundOlder adults living with serious illnesses face challenging decisions with illness progression. Advance Care Planning (ACP) presents an opportunity to explore values and goals, absent the pressure of time-sensitive decisions.ParticipantsCommunity-dwelling adults ≥65 with an estimated 33% mortality risk, and if invited by the participant, the person who would serve as their surrogate decision maker (SDM).SettingPrimary care practices in a Midwest metro area. Interviews occurred in the patient's home or other preferred location.MethodsQualitative, descriptive study analyzing ACP conversations that used the Respecting Choices Advanced Steps (RCAS) framework, which includes the opportunity to complete an Indiana POST form. Interviews were conducted at baseline and 1 year later. Interviews were digitally recorded, transcribed, and then analyzed using an inductive content analysis approach.FindingsParticipants included 22 patients and 8 potential surrogates. Themes included reasons for ACP, living well, and impact of serious illness. When expressing preferences for future treatment, many participants selected limited interventions until they realized this did not include cardiopulmonary resuscitation. After learning this, participants often selected full intervention and full code because they wanted a chance to re-establish an acceptable quality of life.ConclusionSome older adults with a high mortality risk desire resuscitation and ICU care because they want a chance at getting back to a preferred state of living well. If a patient survives these interventions, SDMs are likely to encounter decisions about whether further life-sustaining treatment can achieve a patient's goals and values and their perspectives on what living well means.

ObjectiveTo identify and synthesize the available evidence on the impact of advance care planning on decision-making and end-of-life care.DesignA scoping review was conducted following the Joanna Briggs Institute methodology. The results were grouped into thematic categories and presented in accordance with the PRISMA-ScR guidelines.Inclusion CriteriaDocuments published between 2006 and 2026 in English, Spanish, and Portuguese were included, provided they were available in full text and addressed the research question.Information SourcesThe PubMed, Scopus, Web of Science, and BIREME databases were used. Additionally, the snowball sampling method was employed to expand the search.ResultsA total of 2816 records were identified through database searches and secondary tracking, of which 30 were selected for the final review. The identified impacts were organized into a conceptual framework comprising five interrelated dimensions: care congruence, healthcare utilization, economic and cost outcomes, family and caregiver impact, and patient quality of life. Each category is enriched by a set of interrelated components that describe various clinical, psychosocial, and financial outcomes reported in the literature.ConclusionsAlthough advance care planning is not a new concept, this review provides an updated and integrated framework that highlights five interrelated domains of impact fundamental to the quality of end-of-life care. These findings suggest the potential value of considering ACP within patient-centered and value-based care models, while underscoring the relevance of future research aimed at informing the sustainability and humanization of end-of-life care.

ContextHospice care is intended for the final phase of life, but trajectories after admission vary widely. Some patients die within days, whereas others stabilize and live longer than expected. Very short stays may limit comprehensive care, while prolonged stays may involve socio-existential concerns and practical challenges. Early symptom profiles may reveal differences between trajectories.ObjectivesTo describe multidimensional symptom profiles at admission and during the first month of hospice care among patients with short, average, and prolonged survival.MethodsPatient-completed Utrecht Symptom Diary-4 Dimensional (USD-4D) data from 15 Dutch hospices (2017-2025) were analyzed. Survival was grouped as short (0-3 days), average (4-93 days), or prolonged (≥94 days). Physical/psychological prevalence (>0) and clinically relevant prevalence (>3) were calculated, and intensity (0-10) was summarized for all items at admission and across five predefined 3-day windows during the first month.ResultsAmong 2112 patients, 82 had short survival, 1825 had average survival, and 205 had prolonged survival. Physical and psychological burden were highest in short survival, intermediate in average survival, and lowest in prolonged survival; in prolonged survival, physical symptoms improved within two weeks and then stabilized. Socio-existential concerns were more prominent in the short and prolonged survival groups than in the average-survival group.ConclusionMultidimensional symptom and concern profiles differed across survival groups, with differences visible at admission and more pronounced within two weeks. Routine multidimensional evaluation within two weeks may help identify emerging prolonged trajectories and align care with changing physical and socio-existential needs.

BackgroundPalliative care is an essential component of high-quality cancer care; however, limited research has examined the multilevel barriers to and facilitators of social workers' ability to deliver palliative care for patients with cancer. Guided by ecological systems theory, this qualitative study identifies such barriers and facilitators perceived by social workers providing palliative cancer care in the United States.MethodsUsing an exploratory qualitative design, we conducted semi-structured Zoom interviews with 10 social workers practicing in palliative cancer care settings. We identified themes in participant responses using reflective thematic analysis and interpreted those themes within an ecological systems framework.ResultsParticipants identified barriers and facilitators across societal, organizational, interpersonal, and individual levels. Societal barriers included stigma, misunderstandings about palliative care, and financial constraints, whereas integration into care teams and continuity across care settings facilitated coordinated care. Organizational barriers included excessive workload demands and delayed referrals; social workers' community connections facilitated enhanced resource access and care coordination. Interpersonal barriers centered on unclear role delineation, while interprofessional collaboration, proactive role education, and positive patient experiences strengthened social work practice in palliative care settings. At the individual level, insufficient role preparation and administrative burden constrained patient-centered care; however, a strong sense of professional meaning and clinical competence supported social workers' practice in these settings.ConclusionEnhancing role clarity, palliative care education, interprofessional collaboration, and organizational support may strengthen social workers' integration within palliative care settings and advance person- and family-centered cancer care.

BackgroundPeople with cancer often experience strong emotions at the time of diagnosis and when informed that their cancer has metastasized. Whereas the expression of emotions is often healthy, the fear of emotional expression can impede adaptation by undermining motivation and social support and contributing to pain and somatic symptoms.AimThis study aimed to assess the relevance of fear of emotional expression to cancer-related pain and somatic complaints, particularly as the disease progresses.DesignThis cross-sectional secondary analysis examined the association between fear of emotional expression and somatic symptoms. Moderation analysis tested whether the association between fear of emotional expression and somatic symptoms was more pronounced among patients with metastatic cancer than among patients with remitted or localized cancer.Setting/ParticipantsData were collected online from 633 participants with remitted, localized, and metastatic cancer diagnoses.ResultsModels indicated significantly stronger associations between fear of emotional expression and somatic symptoms among patients with metastatic cancer compared to those with localized or remitted cancer. These results held after adjusting for depression and other putative confounders.ConclusionsTaken together, these findings suggest that difficulties expressing emotions could impede quality of life if physical manifestations of stress layer upon other metastatic cancer-related symptoms and side effects.

Patients with advanced hematological malignancies often have red blood cell (RBC) transfusion needs at the end of life (EOL) to improve debilitating anemia-related symptoms. Given that patients with hematologic malignancies and their caregivers find that transfusions improve energy and quality of life, access becomes a critical factor influencing hospice enrollment decisions, given variable access to transfusions in hospice settings. Additionally, because blood is a finite resource, this raises important questions about its availability in hospice care. This paper aims to explore the clinical, ethical, financial considerations surrounding RBC transfusions at the EOL for patients with hematological malignancies by drawing on literature in hematology, bioethics, and palliative care. One notable clinical consideration is that RBC transfusions improve anemia-related symptoms, such as fatigue, weakness, and dyspnea. At the same time, ethical considerations include the scarcity of blood. Moreover, some financial factors to consider include the cost of blood transfusions and reimbursement rates. These complex considerations impact hospice agencies' capabilities to provide RBC transfusions at EOL. As a result, patients often delay enrolling in hospice, resulting in more aggressive treatments at the EOL and poorer EOL outcomes. Having a better understanding of such considerations will help create protocols that balance justice for all patients while improving EOL care for patients with hematological malignancies.