Quality of life in hospitalized patients receiving palliative care: Do current tools cover all their needs?

Palliative care is an integral part of care for patients with life-limited diseases that focuses on reducing symptoms and maintaining and increasing the quality of life (QoL) for patients and their families. Geriatric patients were more likely to receive palliative care and had unique needs compared to the general population. To improve the quality of palliative care, especially for geriatric patients, it is necessary to have a better understanding of methods and outcomes for geriatric patients when delivering palliative care. This study aims to identify the methods and outcomes of palliative care in geriatric patients across the globe. This scoping review was guided by Arksey and 'O Malley's framework and utilized the Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist for providing transparent reporting to the readers. EBSCO, PubMed, and Scopus databases were used to search the relevant articles with a publication range of 2013-2023. Thematic analysis was used to identify and summarize palliative care methods and outcomes for geriatric patients in this review. Twenty-one studies were included in this review, and it was found that there were many types of methods for delivering palliative care to geriatric patients. In both acute care settings and community settings, a wide range of methods for delivering palliative care to geriatric patients were identified. Outcomes of palliative care in geriatric patients in hospitals and community settings, were reduced pain, depressive symptoms and anxiety, edema, constipation, odds of in-hospital death, and increased spiritual well-being, QoL and well-being, being comfortable, patient readiness, place of death, sleep quality, and quality of dying. Geriatric patients had a variety of methods and outcomes in palliative care. This study suggests that outcomes should be evaluated continuously after implementing methods for delivering palliative care to geriatric patients.

National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for Quality Palliative Care, Executive Summary

BackgroundThe area of palliative care is a setting in which the evaluation of the quality of life (QoL) is fundamental. However, the topic has been covered from many different points of view, and there is a lack of comprehensive synthesis of the evidence drawn from the available literature.ObjectiveWe carried out a meta-review of all available systematic reviews and meta-analyses that have dedicated part or most of the investigation to the assessment of QoL in palliative care to provide the most updated and comprehensive depiction of all available information about measurement and intervention aimed at improving QoL in palliative care.MethodsA meta-review of all recent (5 years) available systematic reviews and meta-analyses on “palliative care” and “quality of life” was carried out. The quality of the extracted studies was assessed with the AMSTAR scale.ResultsThe search extracted 24 systematic reviews, 14 systematic reviews followed by a meta-analysis on a subset of data, and 2 meta-analyses. In many studies, the investigation of QoL represented a secondary or even marginal outcome. In general, the results supported the efficacy of palliative care in terminal patients or patients with a permanent disability. However, the quality of the studies had a strong influence on the chance that some improvement in QoL was found in relation to palliative care. Studies of lower quality were more likely to report some efficacy of palliative care than studies with better quality.ConclusionThe investigation of QoL in palliative care is understudied. In many studies, QoL is a secondary outcome, and there is some tendency to use a disparate range of tools to measure it, whose reliability and validity should still be established in some groups of patients.

Background: While critical care focuses on survival, it may unintentionally overlook aspects of comfort, dignity, and communication that are essential to quality end-of-life care. This scoping review aimed to identify existing outcome indicators, highlight gaps, and propose potential quality indicators for palliative care in ICU settings. Methods: Fifty-seven databases were searched for relevant publications published between January 2000 and December 31, 2024. The inclusion criteria were full-text, peer-reviewed journal articles in English, consisting of final versions of original or review studies conducted in adult ICUs. Case studies, perspectives, editorials, and reports were excluded. This study used the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) approach. We reviewed the literature across multiple databases, including PubMed, ProQuest, EBSCOhost, Scopus, ScienceDirect, and BASE. We carried out the ScR according to the structure suggested by Arksey and O'Malley. Results: This review included 57 studies, with a total of 158 codes representing 122 unique codes, which were grouped into 29 sub-themes (categories of palliative care outcomes) within five main themes: communication and palliative care consultation, end-of-life care decisions, symptom management and comfort, psychosocial well-being of patients and families, and ethics and the role of clinicians in palliative care. Additionally, unique categories were identified to reflect each of these themes. Conclusion: Outcomes have been highlighted as unique and significant palliative care outcomes for adult patients in ICU critical care settings, potentially becoming candidate quality indicators. The candidate outcome indicators for palliative care in the ICU in the future will contribute to more measurable and standardized outcome assessments.

IntroductionIntensive care units (ICUs) operate at the intersection of advanced technology, complex ethical decision-making and resource-intensive care. While many high-income countries have developed institutional governance mechanisms—such as Clinical Ethics Committees, structured triage policies and formal palliative care consultation pathways—to support ethical deliberation and accountability in ICUs, the applicability, structure and reported outcomes of such frameworks in low- and middle-income countries (LMICs) remain unclear and dispersed across disciplines.ObjectiveThis scoping review aims to map existing governance frameworks and ethical decision-making models guiding ICU practices globally, with particular attention to their relevance and reported application in LMIC contexts.MethodsThe review will follow the Joanna Briggs Institute methodology and be reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) standards. Searches will be conducted across MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Scopus, Web of Science, PsycINFO and Global Health. Grey literature will be identified through Google Scholar, WHO Global Index Medicus and professional society websites (eg, Indian Society of Critical Care Medicine (ISCCM), Indian Association of Palliative Care (IAPC) and European Society of Intensive Care Medicine (ESICM)). Eligible sources will include empirical research, policy documents, guidelines and institutional reports published in English from 2000 onwards. Data will be charted using a structured template and synthesised through descriptive mapping and thematic analysis across domains, including structural design, decision processes, communication pathways, integration with palliative care, ethical-legal considerations and reported outcomes. The review is planned to be conducted between December 2025 and April 2026, including database searches, screening, data extraction and synthesis.Ethics and disseminationEthical approval is not required. Findings will be disseminated through peer-reviewed publications and conference presentations. OSF registration: https://osf.io/tkcav

IntroductionPalliative care is critically important for the world’s aging population and can change illness trajectories and promote advances in health care technologies. As health care team members, nurses have the most contact with palliative care patients. However, misconceptions about which patients need to receive palliative care may be an obstacle to meeting patients’ needs for palliative care.ObjectivesThis study aimed to describe preceding events, characteristics and outcomes of patients in palliative care according to current concept analysis studies.MethodsA literature review was conducted. Inclusion criteria were: (1) concept analysis studies, (2) use of the term palliative care or palliative nursing care, (3) palliative care explanation including antecedents, attributes, and consequences, and (4) articles written in English published between 2004 and 2021.ResultsFour concept analysis studies on palliative care were included in this review. Palliative care was described as an approach to alleviating physical and psychological suffering and improving patients’ and families’ quality of life in the early stages of diagnosed illness. Terminal illnesses, acute or chronic diseases, and actual or potentially life-threatening illnesses were confirmed as the events preceding palliative care. Characteristics of palliative care include holistic care, interdisciplinary teamwork, and compassionate, patient- and family-centered care. Improved patient and family quality of life, enhanced human dignity, improved self-care, and strengthened coping abilities are outcomes of palliative care.Conclusions/Implications for PracticePalliative care is a concept that is related to the early stage of an illness, the timing of illness diagnosis, and the onset of symptoms. Including palliative care terms in nursing education and training and developing palliative care models in clinical practice are recommended to ensure nurses understand the services of the palliative care needs of patients and their families. Future reviews, including grounded qualitative studies on the concept of palliative care, are recommended.

IntroductionAfter-hours services are essential in ensuring patients with life limiting illness and their caregivers are supported to enable continuity of care. Telehealth is a valuable approach to meeting after-hours support needs of people living with life-limiting illness, their families, and caregivers in rural and remote communities. It is important to explore the provision of after-hours palliative care services using telehealth to understand the reach of these services in rural and remote Australia. A preliminary search of databases failed to reveal any scoping or systematic reviews of telehealth in after-hours palliative care services in rural or remote Australia.AimTo review and map the available evidence about the use of telehealth in providing after-hours palliative care services in Australian rural and remote communities.MethodsThe proposed scoping review will be conducted using the Arksey and O’Malley methodological framework and in accordance with the Joanna Briggs Institute methodology for scoping reviews. The reporting of the scoping review will be guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This review will consider research and evaluation of after-hours services using telehealth for palliative care stakeholders in rural and remote Australia. Peer reviewed studies and grey literature published in English from 2000 to May 2021 will be included. Scopus, Web of Science, CINAHL Complete, Embase via Ovid, PsycINFO via Ovid, Emcare via Ovid, Medline via Ovid, and grey literature will be searched for relevant articles. Titles and abstracts will be screened by two independent reviewers for assessment against the inclusion criteria. Data will be extracted and analysed by two reviewers using an adapted data extraction tool and thematic analysis techniques. Diagrams, tables, and summary narratives will be used to map, summarise and thematically group the characteristics of palliative care telehealth services in rural and remote Australia, including stakeholders’ perceptions and benefits and challenges of the services.

BackgroundExistential distress, marked by hopelessness, loss of meaning, and spiritual suffering, is prevalent among patients with advanced illness, and is associated with psychological burden and a wish to hasten death (WTHD).PurposeThis systematic review aimed to synthesize current evidence on meaning in life (MIL) in adult palliative care (PC) populations, focusing on its associations with quality of life (QOL), mental health, existential and spiritual well-being (SWB), and WTHD.MethodsMEDLINE, Web of Science, Scopus, and the Cochrane Library were searched for eligible studies (English, 2016-2024) involving adult cancer patients receiving PC. MIL was examined as a central intervention component or outcome. Risk of bias was assessed: findings were synthesized narratively. The review was registered in PROSPERO.ResultsEight studies (n = 1733 participants) were included: four cross-sectional, two randomized controlled trials, one longitudinal observational study, and one qualitative study. Several studies had small samples and substantial attrition. Risk of bias was high (n = 7), and moderate in one cross-sectional study. MIL was inversely associated with depression, anxiety, demoralization, and WTHD; and positively associated with QOL and SWB. MIL may also mediate psychological outcomes (eg, purpose, coherence, and personal values). However, heterogeneity in MIL conceptualization and measurement, combined with low methodological quality, limited comparability and certainty of findings.ConclusionMIL may be relevant to psychosocial/existential outcomes in PC. Conclusions are constrained by a small and methodologically weak evidence base. Further high-quality, longitudinal research is needed before MIL-centered interventions can be recommended for routine clinical practice.

Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.

Background: Stroke is a leading cause of mortality and serious long-term disability. Palliative care may enhance overall quality of life among older adults experiencing a stroke, but a limited understanding of these patients' holistic needs exists. Objective: To conduct a scoping review of the literature exploring the palliative care needs of older adults with stroke, with the aim of tailoring holistic nursing interventions to improve quality of life. Methods: The review followed Arksey and O'Malley's five-stage framework: formulating the review question; identifying relevant studies; screening and selecting studies; charting the data; and collating, summarizing, and reporting the results. Three online databases (PubMed, Embase, and CINAHL) were searched for studies published between 2014 and 2024 using key terms such as "palliative care needs," "older adults," and "stroke". Screening and selection were managed via Endnote and Covidence review management software, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Eighteen studies emphasize the need for holistic palliative care nursing in older adults with stroke. Five overarching themes emerged: physical functioning, psychosocial and emotional support, informed decision-making, symptom management, and comfort-based care. Conclusion: Integrating holistic palliative care nursing into patient-centered stroke services is vital for improving the quality of life in older adults. Findings from this scoping review will inform future nursing research priorities, as well as clinical nursing initiatives, addressing the holistic palliative care needs of older adults experiencing stroke in collaboration with patients, families, and interdisciplinary healthcare professionals.

BackgroundAlthough palliative care is very essential for improving quality of life (QOL) by providing relief from pain and other distressing symptoms, its coverage in sub Saharan Africa remains remarkably low. Utilization of mHealth could be a fundamental healthcare system strengthening approach to enhance and promote palliative care in the region. There is paucity of evidence regarding evidence on the use of these interventions in SSA because it is a relatively new concept in the region. Therefore, there was need to identify and map the available/ applied mHealth interventions for palliative care in SSA basing on published and grey literature.AimTo examine the nature and use of mHealth interventions for palliative care and factors influencing their use in sub Saharan Africa (SSA).MethodsThe review was based on the JBI methodology for scoping review. PUBMED, CINAHL, Embase and Google Scholar databases were searched for published articles with no time restrictions. Unpublished and grey literature was also searched for. Data was extracted from the retrieved sources and synthesized. The findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) in a comprehensive and transparent way.ResultsA total of 224 articles were identified and 35 of these met the inclusion criterion and were considered for the review. The results show use of mHealth interventions for palliative care in 12 countries of the SSA. Only 12 (35.3%) were app-based, 9(26.5%) were SMS-text-based, 4(11.8%) were telemedicine-based,5(14.7%) were phone call-based, 3(8.8%) were mixed while 1(2.9%) used wearable-sensor-based mHealth interventions. Key uses of mHealth interventions in palliative care included health strengthening, psychosocial support to patients and families, enhancement of compliance to appointments for patients, promotion of adherence to medication, health education, monitoring, evaluation and research and capacity building for palliative care health professionals. A number of influencing factors were identified and they included wide-spread telephone ownership and access, great robustness of telephone and internet connectivity, high degree of perceived usefulness and ease of use, feasibility and acceptability of mHealth. Also, vital barriers such as low levels of technological advancement/expertise, irregularity and paucity of electric power supply, high likelihood to compromise patients’ privacy and confidentiality and high illiteracy rates among the population were articulated by the articles.ConclusionAbout a quarter of SSA countries have incorporated mHealth interventions for palliative care, underscoring the need for further research and development of the technologies. These approaches are quite beneficial to SSA, where there is a disproportionate disease burden and an inadequate healthcare system.

Updating the PRISMA reporting guideline for scoping reviews: a scoping review.

Introduction: Palliative care (PC) outcomes in the ICU serve as indicators of the quality of care. However, the variability in outcomes presents a challenge in maintaining a clear focus on the goals of palliative care in the intensive care unit (ICU). This study aimed to map the outcomes of palliative care as potential quality indicators for PC in ICU settings.Method: This study followed the PRISMA-ScR approach, conducting a systematic search across multiple databases, including PubMed, ProQuest, EBSCOhost, Scopus, ScienceDirect, and BASE. The methodological framework was structured according to the guidelines suggested by Arksey and O'Malley.Result: A total of 57 studies were mapped to examine PC outcomes in the ICU. These outcomes were categorised into five thematic groups, with Spiritual Support being the least diverse, comprising only one outcome category: emotional and spiritual well-being.Conclusions: The outcomes of palliative care (PC) in the ICU could serve as potential quality indicators for assessing the effectiveness of palliative care in intensive care settings.

Pediatric palliative and/or hospice care is provided across a broad spectrum of settings, ranging from inpatient to outpatient to a child's home. Pediatric home-based hospice and/or palliative care teams offer a specialized, interdisciplinary approach to care, allowing children to stay in the home while offering comprehensive support. This scoping review seeks to summarize what is known about pediatric home-based hospice and/or palliative care and to identify gaps in the current research. Following Arskey and O'Malley's scoping review framework, we searched four databases for studies focused on pediatric home-based hospice and/or palliative care programs. Studies were included if they were published between 2000 and 2024, available in English, and focused on children and young adults receiving palliative or hospice care at home, including via telehealth, in the pediatric system. Of 2,552 results initially identified, 96 met our inclusion criteria and were included in this review. Common themes emerged including studies analyzing models of care, characterizing the population, end-of-life decision making, clinical outcomes of home-based hospice and/or palliative care, costs and economic impact, family experiences, quality domains, specific treatment modalities, and the use of telehealth. Overall, the available literature supported home-based hospice and/or palliative care as an effective model of care, reducing the burden on families, improving quality of life, and allowing families to stay in their preferred setting for care without sacrificing clinical outcomes. Key research gaps included small sample sizes, limited use of control groups and scarcity of randomized clinical trials, difficulties including the perspective of the ill child in research, and a need for longitudinal studies on the effects of home-based hospice and/or palliative care on children and families. Given the compelling evidence for the benefits of pediatric home-based hospice and/or palliative care, further research into disparities in care access, best models of care, and novel payment models are critical.

BackgroundInnovative small-scale facilities for dementia focus on providing quality of life and maintaining the functional abilities of residents while offering residents a home for life. To fulfill the home-for-life principle, palliative care approaches are necessary to maintain quality of life in these facilities. Few studies have reported on how palliative care is provided to residents in small-scale facilities. The aim of our review is to determine the extent to which palliative care approaches are reported in small-scale facilities.MethodsA scoping review of the literature using recommended methods from the Joanna Briggs Institute. Four databases, CINAHL, PubMed, PsycINFO, and Web of Science, were searched for studies published from 1995 to 2023. One reviewer completed the title, abstract and full-text screening and data extraction; two additional team members piloted the screening and extraction process and met with the main reviewer to make decisions about article inclusion and ensure consistency and accuracy in the review process. The extracted data was open-coded and analyzed using thematic analysis. The data was then synthesized into themes using palliative care domains for dementia.ResultsOf the 800 articles obtained in the search, only ten met the inclusion criteria: six from Japan, two from the Netherlands, and one each from Austria and the United States. In most small-scale facilities, palliative care is important, with facilities prioritizing family involvement and person-centred care, minimizing resident discomfort and enhancing residents’ remaining abilities until the end of life. The included studies did not discuss palliative care policies or professional staff training in depth.ConclusionsThis study provides an overview of the literature on palliative care in small-scale facilities for individuals with dementia. Most facilities focus on residents’ wishes at the end of life to enhance comfort and provide a home-like environment. However, more research is needed to further understand the quality of palliative care approaches in these homes.