ObjectiveTo evaluate spatial access to inpatient hospice units across the UK by analysing travel times and population coverage at national and subnational levels.MethodsA population-based spatial analysis using UK-wide data. Hospice locations were mapped, and motorised travel times to the nearest unit were estimated. Access population coverage was calculated for the following time thresholds: 30, 60, and 120 min. All 199 adult inpatient hospice units operating within the UK were included. High-resolution population data (1 km2) from the WorldPop dataset and administrative boundaries from the UK Office for National Statistics were used to estimate access for the total population.ResultsMedian travel times varied widely: 16.4 min in England, 25.5 in Wales, 40.3 in Northern Ireland, and 70.4 in Scotland. Within a 30-min threshold, 97.6% of England's population had access compared with 78.5% in Wales, 70.3% in Scotland, and 68.5% in Northern Ireland. Even with a 60-min threshold, 15.4% of Scotland's population and 6.4% of Northern Ireland's remained without access.ConclusionsThis study provides the first national spatial analysis of hospice inpatient access in the UK, highlighting persistent regional inequities. Geographic accessibility analysis offers valuable insights to guide equitable service planning and should inform future policy and research.

ObjectivesEarly palliative care (PC) is recommended in pancreatic cancer but remains underutilized. This study assessed whether the timing of the PC decision affected the hospital resource use and access to specialized PC services. The implementation of an integrated PC (IPC) was also evaluated.MethodsThis retrospective single-center cohort study included 440 deceased pancreatic cancer patients treated at the Comprehensive Cancer Center, Helsinki University Hospital (2017-2018). Patients were categorized by timing of the PC decision-defined as withholding or termination of life-prolonging treatment and transition to PC-into early (>30 days before death) or late/no (≤30 days before death) groups. Hospital resource utilization was obtained from electronic medical records.ResultsA PC decision was made for 87% of patients, median of 1.5 months before death. Chemotherapy was given to 8% during the last month. Compared to early decisions, late/no PC decisions were associated with anticancer treatment closer to death (43 days vs 115 days, p < 0.001), higher acute healthcare use, including double the emergency department visits (61% vs 27%, p < 0.001) and triple the hospitalizations (59% vs 20%, p < 0.001) in the final month. Early PC decision was associated with earlier and more frequent use of the outpatient PC unit (3.6 vs 1 month before death, p < 0.001; 84% vs 61%, p < 0.001). Only 36% received PC integrated with oncologic treatment.ConclusionsLate or absent PC decisions were associated with increased end-of-life hospital interventions and reduced access to specialized PC services; both linked to impaired quality of EOL care and increased healthcare costs.

BackgroundDelirium is a frequent and distressing complication in advanced cancer, often multifactorial and refractory to standard agents. Palliative sedation may be required when symptoms remain uncontrolled, and propofol is an emerging option in this context.Case PresentationWe describe a 61-year-old woman with Stage IV lung adenocarcinoma admitted to a hospice-type palliative care (PC) unit. She had multiple comorbidities and a history of polysubstance use, including long-term methadone and benzodiazepines. On Day 7, she developed hyperactive delirium unresponsive to escalating neuroleptics, benzodiazepines, and barbiturates, consistent with "pharmacoresistant" delirium.Management/InterventionAfter multidisciplinary review and discussion with her son, proportional PS was initiated using continuous intravenous propofol infusion. The infusion began at 60 mg/h (1.5 mg/kg/h) and gradually titrated to 320 mg/h (≈8 mg/kg/h). Concurrently, transdermal fentanyl was increased to 300 µg/h for analgesia. Sedation depth was monitored with the "Consciousness Scale for PC," with goals set at Levels 1-3 to allow intermittent interaction.OutcomesAdequate sedation was achieved within 10 min and maintained for 25 days until death, without respiratory or hemodynamic compromise. No adverse effects or signs of propofol infusion syndrome were observed, despite doses exceeding conventional thresholds.ConclusionThis case highlights the feasibility and safety of high-dose, long-term propofol infusion for refractory delirium in advanced cancer. While not routine, propofol may serve as a rescue agent when standard regimens fail, provided decisions are ethically grounded, monitoring is rigorous, and family involvement is prioritized.

BackgroundPalliative care (PC) optimizes quality of life for individuals and their families by providing care that promotes dignity, respect, and comfort. Some groups experience inequities related to PC, including persons with mental illness, those living with dementia, linguistic minority groups, and living in rural, remote, or northern areas. There is little data on palliative needs among underserved groups in Canada.MethodsWe analyzed anonymized pan-Canadian population-level data on 1,451,135 home care clients. Palliative needs were defined as having a prognosis of six or fewer months to live, having palliative goals of care, or being offered or receiving hospice/palliative services. We examined the prevalence of palliative needs overall and among underserved groups, as well as whether membership in an underserved group was associated with recognition of palliative needs after controlling for other personal, social, functional, and clinical characteristics.ResultsOverall, 5.0% (n = 72,161) of home care clients had recognized palliative needs. Controlling for age, sex, social characteristics, functional, and clinical characteristics, persons aged 85 + years (0.85 OR), living with dementia (0.57 OR), mental illness (0.91 OR), and linguistic minorities (0.88 OR) had decreased odds of recognized palliative needs, while those living in rural areas had slightly increased odds (1.01 OR).ConclusionThese findings highlight that the palliative needs of certain groups may not be recognized, and therefore they may not be receiving the care that they need. Future work on promoting earlier identification and awareness of palliative needs is needed.

BackgroundBereavement profoundly impacts caregivers, especially adult children who lose a parent. Grief may become complicated when cultural, relational, and spiritual conflicts remain unresolved. Rituals rooted in local tradition can serve as powerful psychospiritual interventions, yet they remain underutilised in mainstream palliative bereavement care.Case PresentationWe describe the case of a 32-year-old unmarried man who developed severe grief-related distress following the death of his 60-year-old mother from metastatic ovarian carcinoma. As her sole caregiver and emotionally dependent companion, he experienced intrusive images of her suffering, guilt, insomnia, anorexia, and inability to work. He also expressed a culturally rooted fear that his mother's soul remained in distress, creating profound spiritual dissonance. The Brief Grief Questionnaire (BGQ) score was 9 out of 10, indicating high risk for complicated grief. His bereavement occurred during Diwali, intensifying a sense of incompleteness in shared rituals of light and remembrance. Conventional counselling offered minimal relief, as his grief was anchored in unaddressed cultural-spiritual obligations. A culturally informed intervention, the Pāyā Śhrāddha ritual in Odisha, was recommended to provide symbolic fulfilment of filial duty and spiritual release. Following the ritual, he reported significant emotional relief, cessation of intrusive imagery, restored sleep, and functional recovery. His BGQ score improved from 9 to 3, remaining stable at 6-week follow-up.ConclusionThis case highlights the therapeutic power of culturally grounded rituals in addressing grief sustained by spiritual-moral conflict. Integrating indigenous practices such as Pāyā Śhrāddha into bereavement care can promote meaning-making, resolve guilt, and support recovery where conventional counselling alone may be insufficient. Culturally responsive, ritual-aware approaches should be recognised as vital components of holistic palliative care.

ObjectivesWe investigated the associations of nutrition impact symptoms (NISs) with sleep disturbance among advanced cancer patients receiving palliative care.MethodsA secondary analysis of a self-administered survey was performed. Participants evaluated 3 components of sleep disturbance (ie, difficulty falling asleep, difficulty staying asleep, and early awakening) and 19 NISs using numerical rating scales (0-10). They also used several screening tools, including the Hospital Anxiety and Depression Scale (HADS). Finally, 2 groups were analyzed by multivariate logistic regression analysis using a cutoff score of 4 for each of the 3 components (< 4, lower score group; ≥ 4, higher score group).ResultsUltimately, 184 patients were included. For all 3 components, higher score groups had significantly greater numbers of NISs with a score ≥ 4 and higher anxiety and depression than lower score groups. In the logistic regression model using HADS-Anxiety for difficulty falling asleep, significantly higher adjusted odds ratios (ORs) were observed in the 4-6 NISs (with a score ≥ 4) group than in the no NISs (with a score ≥ 4) group (7.15 [95% confidence interval (CI), 1.24-41.06]). Using HADS-Depression for difficulty falling asleep and difficulty staying asleep, significantly higher adjusted ORs were observed in the 4-6 NISs group than in the no NISs group (7.43 [95% CI, 1.29-42.74]; 4.47 [95% CI, 1.02-19.69, respectively]).ConclusionsHaving 4 or more NISs with a score ≥ 4 was significantly associated with sleep disturbance. Cachexia-related symptom management is essential to improve patients' sleep status.

BackgroundWith the rise in cancers, palliative care (PC) is increasingly important for improving the quality of life for patients and families. Systematically assessing PC needs is crucial for providing appropriate services.ObjectiveTo develop and validate an instrument (Palliative-care-Need Assessment-Tool [P-NAT]) to identify PC needs of cancer patients.MethodsMixed-method sequential exploratory design was used. The P-NAT development and validation was done in 3 phases: item generation & reduction, scale development, and scale evaluation. Items were generated in English based on literature and key informant interviews followed by item reduction with expert opinion. Forward and backward translation done (Sinhala/English). Translated Sinhala version was assessed for face and content validity. Exploratory Factor Analysis (EFA) was done with 302 subjects. Construct validity was assessed through Confirmatory Factor Analysis (CFA) on another 309 participants, followed by convergent validity in a subsample of 201. Test-retest reliability and internal consistency were assessed using Spearman r and Cronbach α, respectively.ResultsAfter reduction, 53 items were selected for the scale. The EFA identified 12 factors with 45 items. The CFA confirmed an 8-factor model as the best fit (root mean square of approximation = 0.068, CFI = 0.96, PNFI = 0.85). The overall scale had Cronbach α 0.919, Spearman r 0.986 (P < .01). Spearman r coefficient between P-NAT and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire was 0.668.Conclusions and recommendationsThe P-NAT is a valid, reliable tool to assess PC needs among cancer patients. The P-NAT is recommended for rapid comprehensive assessment at hospital and community settings.

ObjectiveThis study aimed to examine the correlations among caregiver burden, psychological resilience, and quality of life (QOL) in primary caregivers of hospitalized advanced cancer patients receiving palliative care, and to identify factors influencing these outcomes to inform interventions for caregiver well-being.MethodsIn this cross-sectional study, 203 primary caregivers were recruited via cluster sampling between January 2022 and June 2024. Caregiver burden, psychological resilience, and QOL were assessed using the Zarit Burden Inventory, Connor-Davidson Resilience Scale, and SF-12 Health Survey, respectively. Pearson correlation analysis, one-way ANOVA, and multivariable linear regression were performed to explore relationships among variables and identify independent predictors. Mediation analysis was conducted to examine the role of resilience in the burden-QOL relationship.ResultsThe mean caregiver burden score was 45.63, with 29.56% experiencing severe burden. Mean resilience and total QOL scores were 26.74 and 40.53, respectively. Caregiver burden negatively correlated with resilience (r = -.47, P < .001) and QOL (r = -.53, P < .001), while resilience positively correlated with QOL (r = .62, P < .001). Female caregivers, longer care duration, and caring for wheelchair-bound or lung cancer patients were associated with higher burden and lower resilience/QOL. Mediation analysis indicated that psychological resilience partially mediated the relationship between caregiver burden and QOL, accounting for 42.3% of the total effect.ConclusionCaregiving for hospitalized advanced cancer patients is associated with high burden, reduced psychological resilience, and lower QOL. Psychological resilience is positively related to QOL and may partially explain the association between caregiver burden and QOL. These findings highlight the potential value of supporting resilience and addressing caregiver burden, particularly among high-risk caregivers such as females, those providing long-term care, and those caring for functionally dependent patients, within palliative care settings.

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.

ObjectivePatient-reported outcome measures (PROMs) and their integration into clinical practice are important topics in health care. However, little is known about health care professionals' (HCPs) perception and use of PROMs. We therefore investigated the use of PROMs by HCPs in specialized palliative care (SPC) and how PROM data are perceived by these HCPs.MethodA survey was sent to the heads of SPC services in Denmark (N = 41), asking them to distribute the survey to their HCPs with patient contact.ResultsThe survey (N = 160) showed that 75% of the HCPs reported that they looked at PROM responses from at least 75% of the patients in whom PROMs had been performed prior to the first consultation, whereas the proportion of HCPs looking at PROM responses was lower for subsequent contacts (45%-51%). Sixty percent of the HCPs reported that they used PROMs in the first consultation, and around 40% compared a completed PROM from the first consultation with PROMs done in later consultations. Many HCPs experienced that PROMs gave them knowledge about the patient's situation (89%), was meaningful (86%), and that they understood how and why PROMs were used (92%). According to most HCPs, patients understood why they completed a PROM (84%), and patients found the completion meaningful (70%). Few differences between health professions were found.ConclusionsIn Denmark, PROMs are often part of the first SPC consultation and generally used in dialogue with the patient. However, increased integration of PROMs is needed later in the palliative trajectory.