Background:The Global Organization Board of the Cancer Association Network projected global number of cancer cases to reach 35 million by 2050. In Africa, patients with newly diagnosed cancer are projected to double by 2030, underscoring the need for comprehensive strategies encompassing prevention, early detection, treatment, and palliative care (PC). However, PC service in Africa remains fragmented, often lacking holistic and continuous care delivery, with more emphasis on facility-based services.Objective:This scoping review aims to synthesize available evidences on PC approaches for cancer patients in Africa, challenges in PC delivery, and suggested measures to improve PC.Method:This scoping review employed the Joanna Briggs Institute review methodology. Extensive search of published and unpublished literature in English was conducted using databases including MEDLINE (PubMed), Embase (Ovid), Web of Science Core Collection, Scopus, Google Scholar, and Google. Records of 1242 were identified; after removing 309 duplicates, 933 citations were screened for abstract review using Rayyan software. Three reviewers assessed abstracts, and full texts resulting in inclusion of 27 studies.Findings:The findings are organized under three themes. The first theme addressed PC approaches in Africa, including home-based, community-based, facility-based, integrated, and comprehensive models. Despite the availability of multiple PC approaches, most countries in Africa primarily practice pain relief, with limited adaptation of the psychological, financial, spiritual, and end-of-life care need of the patients. The second theme identifies the challenges in comprehensive PC provision that includes restrictive opioid laws, under-funding, shortages of workforce and resources, and gaps between PC needs and available services. The third theme synthesizes suggested measures for improvements which indicate the necessity of a shift toward comprehensive, patient, and caregiver centered models with smooth referral practices. These suggestions also emphasize policy reforms to improve access to medicines and funding, and education for health workers and community volunteers.Conclusion:In Africa, PC remains largely inaccessible, fragmented, and of poor quality despite the existence of different approaches. To bridge this gap, implementation of a comprehensive care model that ensures continuity of care among home, community, and facility is crucial.Review registrations:Open Science Framework (osf.io/np9vq).

Background:Approaches to measuring continuity of care are underdeveloped for the end-of-life context, yet important for understanding the quality of end-of-life care.Objectives:Our objective was to develop a grounded theory of continuity of care at end-of-life through the distillation and synthesis of interviews with bereaved family caregivers, which focused on perceptions and experiences of continuity of care at end-of-life.Design:This qualitative study is phase III of a four-phase mixed-methods sequential explanatory study with the aim of determining which aspects of continuity of care matter most to patients and family caregivers and, accordingly, to develop a novel continuity of care index.Methods:Family caregivers completed one 60-min audio-recorded semi-structured virtual interview. Interview questions explored perceptions and experiences through four categories of questions: Patients’ end-of-life experiences, family caregivers’ desires for end-of-life care, family caregivers’ perceptions of prior quantitative findings, and patients’ and family caregivers’ experiences of continuity of care at end-of-life.Results:Twenty-one family caregivers completed interviews; 33% were aged 19–44, 90% identified as women, 85% lived in urban settings, and 19% identified as a visible minority. Our theory focuses on patterns of continuity and discontinuity of care at end-of-life. Following Corbin and Strauss’ grounded theory method, we identified causes, contextual/intervening conditions, strategies, and consequences. Causes included health-human resource supply and system integration; conditions included tension between preferences and system capacity, and personal resources. Strategies involved aligning care with cultural or religious considerations, identifying a single point of contact, and delivering information appropriately. Consequences included patients and caregivers feeling educated and prepared, a comprehensive approach to care, and the provision of high-quality, consistent care.Conclusion:Combined with prior work, these findings will inform a continuity index for use as a system-level end-of-life care indicator.

Background:Person-centred care requires interdisciplinary collaboration. Within palliative medicine, collaboration is further necessary to meet the increasing global demand for palliative care. One area of developing collaboration involves Emergency Medical Services. However, there remains a dearth of research exploring patient and family member perspectives on Emergency Medical Services in palliative situations.Objectives:To explore perspectives of South African patients and family members with palliative needs concerning Emergency Medical Services use in their care.Design:A qualitative design using individual semi-structured interviews was employed.Methods:Patients and family members with palliative care needs who had previously experienced Emergency Medical Services care for these needs were included. Verbatim transcriptions of interviews were subjected to thematic analysis with an inductive-dominant approach.Results:Ten interviews were conducted. One overarching theme, The Dynamic of Control, and three categories were developed: (1) Loss of control: Heavy burdens of living with chronic and end-of-life illness, (2) Maintaining control: Longings and exigencies in times of suffering, (3) Transferring control: Consequential emergency medical services influence on palliative situations.Conclusion:Understanding the Dynamics of Control in palliative situations is fundamental to the Emergency Medical Services’ establishment of a person-centred approach in palliative situations. Practical developments that would allow this approach include alternative care pathways, on-scene information availability, and palliative care education. Including palliative care in Emergency Medical Services education may have benefits beyond improved palliative situation management, as it encourages a cultural shift towards person-centred care.

Death literacy is an emerging concept within academic and social spheres, reflecting increasing recognition that people need to be better prepared for death and dying. The extent to which key features of death literacy are embedded in policies indicates how death and dying are framed and prioritised. Therefore, how the term ‘death literacy’ and its components have been adopted in UK governments’ policies required exploration. This study aimed to analyse post-2015 UK state-level (Westminster) and national (England, Northern Ireland, Scotland and Wales) policies to explore how death literacy is framed and described. A document analysis of policies was conducted using the READ approach, comprising reading materials, data extraction, data analysis and distilling the findings. UK and national governments’ and health services’ websites were searched. A thematic policy analysis was conducted, mapping content to Noonan et al. – features of death literacy (knowledge, skills, experiential learning and social action). Key findings were outlined in a narrative format. Initially, 11,063 records were screened, 59 documents were eligible for data extraction and a final 22 papers were selected. Findings included that death literacy was not explicitly referenced, despite key features of death literacy being present. These elements focused on knowledge and skills relating to death and dying, including publics’, caregivers’ and professionals’ understanding of end-of-life processes, predominantly relating to the skills of healthcare professionals. The policies also incorporated social action through community engagement and support. Elements of experiential learning, including coproduction of health services, were only referred to minimally. Despite no explicit reference to death literacy, key features were evident within UK policies, which focused on knowledge and skills relating to death and dying through palliative and end-of-life care processes. Future policies should explicitly outline a consolidated approach to death literacy, with the aim of improving experiences and preparedness relating to death, dying and end-of-life. These should embed strategies to implement multi-level, cross-departmental, and new public health approaches that addresses systemic inequalities, and to enhance experiential and socially focused initiatives.

Background:The COVID-19 pandemic highlighted the need for innovative approaches to healthcare delivery, particularly for older adults with frailty in crowded settings. In Québec, Canada, the shortage of hospital beds during the pandemic exposed critical gaps in the capacity to provide appropriate end-of-life care for affected residents of residential care facilities (RCFs).Aim:This study aimed to examine the implementation of the COVID-19 Intensive Home Care Team (IHCT) and how it transformed the physical and social environment of RCFs to enable end-of-life care and “dying at home” in an unprecedented time.Design:A qualitative case study design was used. Between September 2020 and January 2021, qualitative data were collected through 30 in-depth interviews with front-line workers of the IHCT, healthcare managers, and academics in the home care sector. Thematic analysis reveals three interrelated themes: the ambiguities of caring spaces, the centrality of medication management, and the reconfiguration of RCFs through new spatial, technological, and relational arrangements that enabled “dying at home” during the COVID-19 pandemic.Results:Findings revealed that the IHCT initiative reshaped RCFs into a necropolitical space, showing the complex interplay between space, care practices, and societal values toward older adults with frailty. The transformation enabled a form of compassionate end-of-life care within familiar settings as well as exposed underlying societal hierarchies that determine whose lives, and deaths, are valued.Conclusion:The IHCT model illustrates how emergency health interventions can reconfigure care spaces and challenge conventional boundaries between home, private, and public care systems. However, it also underscores the ethical and political dimensions of care for frail older adults in crisis contexts.

A key barrier for people with a life-limiting illness being able to remain in their home is carer burnout. Carer fatigue also puts more pressure on health services and leads to worse outcomes for carers and their loved ones. However, carers are resistant to using respite care because of concerns around quality of care, the nature of the clinical environment and leaving their loved one behind. There is evidence that greater carer uptake of respite reduces burnout, enhances carer resilience and means that more people get their wish of dying at home. This study reviews a novel respite service in a suburban environment in the Australian capital, Canberra, to assess if a non-clinical home-like setting increases the likelihood of carers taking short-term breaks. Separate, semi-structured interviews, of 10-60 min were conducted with clients, carers, staff and volunteers about their lived experiences at a pilot respite centre, 'Leo's Place', run by Palliative Care ACT (Australian Capital Territory). The question guide was developed for this study, drawing on current literature and the needs of the research and the subject population. This study employed Reflexive Thematic Analysis, an iterative and inductive approach to constructing themes from the data, providing a rich description of the participants' experience. Interviews were conducted with 5 clients (alone), 6 carers (alone) and 12 client/carer dyads (together). We captured 31% of service users with either (or both) a client/carer interview during the study period. The evaluation identified three key themes. First, Leo's Place was a lifeline where carers found the non-clinical, home-style respite welcoming and supportive. Second, this allowed carers to take a break as they felt that they could leave their loved one safely and comfortably. Last, Leo's Place operated as an advice and support hub. Non-clinical respite care in a home-like setting can relieve the burden of care and has the potential to reduce pressure on health services and provide better outcomes for carers and their loved ones. Making respite care desirable and outside of clinical settings increases the willingness of carers to use such services.

Due to the COVID-19 pandemic, various infection control measures were introduced that had a profound effect on caregiving dynamics and created burdens in the daily lives of informal caregivers (ICs). A scoping review was conducted to identify burden and support factors for ICs during and beyond the pandemic. Studies were included when they examined ICs’ care work during the official time period of the COVID-19 pandemic (March 2020–May 2023) and care hours worked per day or week were specified. Only studies with adult participants and studies in German or English language were incorporated. The scoping review considered quantitative cross-sectional and longitudinal studies involving randomized/quasi-randomized controlled trials, cohort studies, case studies, mixed-methods, and qualitative studies as well as reviews and meta-analyses. The electronic databases PubMed, the Cochrane COVID-19 Study Register, and EBSCO Host were systematically searched. The search was limited to articles published between 2020 and 2024. The scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews. Overall, 42 studies with 51,183individuals met the inclusion criteria and were included in the scoping review. Main findings suggested that the pandemic-related measures caused additional care burden for ICs and worsened the already poor situation of informal care. In particular, the lack of support from health services and the increase in care hours were described as burdensome. Additionally, studies indicated an increase in rates of depression and overall poor mental health, particularly affecting female ICs. Social and formal care support were mentioned as main support factors. Consequently, preparation of future crises should focus on formal health services and structures to promote social support and mental health of ICs during pandemics.

Background:Emergency medical services (EMS) encounters with palliative care patients present unique operational challenges. As EMS providers increasingly care for individuals with life-limiting illnesses, understanding the intersection of emergency care and palliative medicine has become essential to optimizing healthcare delivery.Objective:This study examines EMS operational metrics, resource allocation patterns, and clinical outcomes among palliative care patients in Thailand.Methods:This retrospective analysis study investigated operational times, resource utilization, and clinical outcomes in palliative care patients utilizing EMS services, derived from electronic medical records and EMS documentation. This study was conducted at the Srinagarind Hospital EMS unit from October 2019 to September 2024. All patients diagnosed with palliative care (ICD-10 code Z51.5) who utilized EMS services were included.Results:Palliative care patients represented 6.9% (N = 340) of total EMS utilization (N = 4520), with cases increasing from 51 patients (15.0%) in 2019–2020 to 89 patients (26.2%) in 2023–2024. The median age was 72 years, with 62.9% male patients. Palliative care patients demonstrated significantly prolonged EMS operational times: activation (1.51 min vs 1.27 min), response (10.21 min vs 9.35 min), and scene time (22.05 min vs 10.02 min, p < 0.001). Resource utilization showed higher rates of pain medication administration (30.88% vs 7.79%) and exclusive use of comfort-focused interventions. Patient outcomes revealed significantly higher discharge rates.Conclusion:Palliative care patients utilizing EMS services represent a distinct population requiring specialized operational approaches. Extended scene times reflect appropriate symptom-focused care delivery rather than rapid transport protocols. Higher discharge rates validate the EMS role as a symptom management bridge.

Grief is universal, yet very isolating. Every culture has rituals, every family its stories of loss, and every individual their private struggles with absence. Very often, grief is treated as something to be repaired, resolved, replaced, or moved beyond. Yet what the bereaved most need is not solutions, but companionship—someone willing to notice, listen, and stay present. This article reflects on bereavement companionship through stories shared during monthly workshops that I lead. The narratives—a child mourning a lost pen that symbolised her absent father, a woman grieving the death of a neighbourhood cat dismissed as “just an animal,” and a husband given the gift of a final private conversation with his deceased wife—highlight the many forms grief can take. They remind us that grief is not confined to death, but is interwoven with everyday losses, symbols of love, and the fragile bonds that give life meaning. The lessons from these stories reflects what participants in the Bereavement Companionship Program repeatedly affirm: grief is personal, unique, and never small. What helps is steady presence, emotional support, and space to grieve. What harms is dismissal, rushed condolences, or attempts at replacement.

Background:Patients with advanced non-small-cell lung cancer (NSCLC) frequently experience severe symptoms and functional decline, underscoring the need for early end-of-life (EOL) care discussions to improve care quality. Additionally, enhancing patients’ death literacy may strengthen these discussions. However, how patient characteristics influence death literacy in this population is largely unknown.Objective:This cross-sectional study explored baseline levels of death literacy and examined associated patient characteristics in advanced NSCLC.Design:A cross-sectional study was conducted.Methods:A total of 103 patients aged ⩾18 years with stage IIIB or higher NSCLC who had completed at least first-line cancer treatment were recruited using convenience sampling. Data were collected between June 2024 and June 2025 using structured questionnaires assessing sociodemographic, medical conditions, prior EOL care experience, and death literacy (using the traditional Chinese version of the Death Literacy Index, score range = 29–145). Descriptive statistics, Pearson’s correlation, independent t test, and stepwise regression were used to analyse associations between patient characteristics and death literacy.Result:The mean participant age was 61.62 ± 10.86 years, and the mean Karnofsky Performance Score was 67.57 ± 12.48. Many had prior experience of EOL care provision (58%) and had lost a relative (90%), but few had discussed EOL care with a physician (29%). Overall, death literacy was moderate (94.08 ± 16.45). Higher death literacy was significantly associated with experience of EOL care (β = 13.390, p < 0.001), having had an EOL care discussion with a physician (β = 10.901, p < 0.001), and being a women (β = 8.671, p = 0.001). These factors explained 37.1% of the variance in death literacy (F = 21.030, Adjusted R2 = 0.371).Conclusion:Healthcare providers should recognize patients’ lived experiences as important contributors to fostering open conversations around EOL care preferences. Interventions such as the Life Journey Tea House or broader public health strategies may help stimulate reflection and encourage dialogue.