Dynamic Relationship Research Articles

Crosstalk between circadian clocks and pathogen niche.

Circadian rhythms are intrinsic 24-hour oscillations found in nearly all life forms. They orchestrate key physiological and behavioral processes, allowing anticipation and response to daily environmental changes. These rhythms manifest across entire organisms, in various organs, and through intricate molecular feedback loops that govern cellular oscillations. Recent studies describe circadian regulation of pathogens, including parasites, bacteria, viruses, and fungi, some of which have their own circadian rhythms while others are influenced by the rhythmic environment of hosts. Pathogens target specific tissues and organs within the host to optimize their replication. Diverse cellular compositions and the interplay among various cell types create unique microenvironments in different tissues, and distinctive organs have unique circadian biology. Hence, residing pathogens are exposed to cyclic conditions, which can profoundly impact host-pathogen interactions. This review explores the influence of circadian rhythms and mammalian tissue-specific interactions on the dynamics of pathogen-host relationships. Overall, this demonstrates the intricate interplay between the body's internal timekeeping system and its susceptibility to pathogens, which has implications for the future of infectious disease research and treatment.

The Verse Ayah "Affection and Mercy" and its Legal Effects on the Spouses

Objectives: The objective of this discussion is to highlight the importance of marital life as a foundational element in building strong families and cohesive societies. It aims to emphasize the roles of both spouses, with the woman providing passion and tenderness, and the man offering strength and security. Additionally, the discussion seeks to underscore the significance of love, understanding, and legislative systems within Islam in nurturing harmonious marital relationships. Methods: This discussion employs a qualitative approach, drawing upon Islamic teachings and principles to explore the dynamics of marital relationships. It relies on textual analysis and interpretation to elucidate the roles and responsibilities of spouses as outlined in Islamic doctrine. Results: The discussion reveals that Islam places great importance on fostering love, understanding, and mutual respect within marital relationships. It emphasizes the complementary roles of spouses in providing emotional support and security, which are essential for the stability and happiness of families. Islamic legislative systems are designed to promote harmony and prosperity within families, thereby contributing to the well-being of society as a whole. Conclusion: In conclusion, marital life is regarded as a cornerstone of family and societal stability in Islam. The affection and mercy between spouses are considered fundamental to achieving marital bliss and prosperity. By adhering to Islamic teachings and principles, couples can cultivate strong, resilient relationships based on love, understanding, and mutual respect. Ultimately, nurturing healthy marital relationships contributes to the formation of cohesive and thriving societies, reflecting the values of compassion, cooperation, and unity upheld by Islam.

Power dynamics in business relationships in a turbulent environment: focus on anticipated power consequences and value creation

PurposeI aimed to develop a conceptual model of power dynamics focused on an anticipated power consequences in business relationships in a context of high environmental turbulence. I also intended to discuss the theoretical significance of my findings and indicate future research directions.Design/methodology/approachConceptual article indicating future research directions.FindingsThe proposal of the conceptual model of power dynamics focusing on anticipated power consequences in business relationships.Research limitations/implicationsThe limitations of the presented model stem from the critique of the holistic view. My contribution lies in advancing our understanding of power dynamics in business relationships amid significant environmental change. I elucidate how transformative practices relate to power outcomes and value creation in these relationships.Practical implicationsThe model highlights the importance of a mindful approach to managing business relationships in a turbulent environment. It emphasizes considering expected power outcomes from activities and their impact on creating value in these relationships.Social implicationsThe proposed concept resonates with systems theory, which emphasizes how different levels of business relationships are interconnected. It enables the analysis of power dynamics at the individual level, such as employees, consumers and local communities. These groups often include the most vulnerable individuals impacted by relational business structures.Originality/valueThe focus on anticipated power consequences of transformative practices triggered by high environmental turbulences, while considering the impact of power distribution of relationship actors on the sharing of benefits and costs.

Predictors of Marital Satisfaction Among Reproductive-Age Women Based on Personality Traits: A Study in Iran.

Marital satisfaction is a complex phenomenon influenced by a variety of factors, including personality traits, communication, conflict resolution, and economic stability. This study aims to examine the relationship between personality and marital satisfaction among reproductive-age women, exploring how these factors interplay and contribute to the overall dynamics of marital relationships. A cross-sectional study was conducted among reproductive-age women to assess marital satisfaction and personality traits using established assessment tools. The demographic data were collected through a structured questionnaire, and the relationship between personality traits and marital satisfaction was analyzed using confirmatory factor analysis (CFA). Regression models were used to identify significant predictors of marital satisfaction, and the fit of the CFA model was evaluated using various indicators. The mean age of the participants was 33.7 (±8.09) years, while the mean age of their husbands was 38.3 (±9.27) years. The results showed that conscientiousness and agreeableness had significant positive associations with marital satisfaction. Communication and conflict resolution emerged as key components of marital satisfaction, with standardized coefficients of 0.894 and 0.818, respectively. Financial management was also found to be strongly related to marital satisfaction, indicating the importance of economic stability in maintaining marital harmony. The study underscores the significance of personality traits, communication, conflict resolution, and financial management in shaping marital satisfaction among reproductive-age women. The results suggest that interventions targeting improved communication and effective conflict-resolution strategies can enhance marital satisfaction. Additionally, addressing financial stressors and promoting economic stability could lead to better marital outcomes. These findings align with previous research, highlighting the need for a holistic approach to understanding and improving marital satisfaction. Further research is recommended to explore these relationships in different cultural contexts and with broader demographic groups.

Fast Attack Detection for Cyber-Physical Systems Using Dynamic Data Encryption.

To defend the cyber-physical system (CPSs) from cyber-attacks, this work proposes an unified intrusion detection mechanism which is capable to fast hunt various types of attacks. Focusing on securing the data transmission, a novel dynamic data encryption scheme is developed and historical system data is used to dynamically update a secret key involved in the encryption. The core idea of the dynamic data encryption scheme is to establish a dynamic relationship between original data, secret key, ciphertext and its decrypted value, and in particular, this dynamic relationship will be destroyed once an attack occurs, which can be used to detect attacks. Then, based on dynamic data encryption, a unified fast attack detection method is proposed to detect different attacks, including replay, false data injection (FDI), zero-dynamics, and setpoint attacks. Extensive comparison studies are conducted by using the power system and flight control system. It is verified that the proposed method can immediately trigger the alarm as soon as attacks are launched while the conventional χ2 detection could only capture the attacks after the estimation residual goes over the predetermined threshold. Furthermore, the proposed method does not degrade the system performance. Last but not the least, the proposed dynamic encryption scheme turns to normal operation mode as the attacks stop.

Looking for the oldest diatoms

Paleontological observations of ancient flora and fauna provide powerful insights into past diversity and relationship dynamics between organisms and their environments. Diatoms are globally distributed protists that influence major biogeochemical cycles and sustain oceanic food webs. The fossil diatom record extends 120 million years back to the Early Cretaceous where rare deposits were discovered worldwide and are occasionally represented by diverse communities. However scarce, the taxonomic richness and geographical spread of these diatom communities suggest prior evolutionary events and therefore earlier deposits. To complement the existing fossil information and to discover diatom deposits predating 120 Ma, we examined 33 study sites from cores and outcrops across oceans and continents. These efforts did not generate new fossil discoveries, however. Our assessment suggests biogenic silica that comprises the cell wall of diatoms was likely dissolved from Mesozoic sediments through diagenetic processes. Altogether, the search for the oldest diatoms must continue but should target sediments that experienced shallow burial and concretions.

Factors influencing the participation of pregnant and lactating women in clinical trials: A mixed-methods systematic review.

Poor representation of pregnant and lactating women and people in clinical trials has marginalised their health concerns and denied the maternal-fetal/infant dyad benefits of innovation in therapeutic research and development. This mixed-methods systematic review synthesised factors affecting the participation of pregnant and lactating women in clinical trials, across all levels of the research ecosystem. We searched 8 databases from inception to 14 February 2024 to identify qualitative, quantitative, and mixed-methods studies that described factors affecting participation of pregnant and lactating women in vaccine and therapeutic clinical trials in any setting. We used thematic synthesis to analyse the qualitative literature and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. We compared quantitative data against the thematic synthesis findings to assess areas of convergence or divergence. We mapped review findings to the Theoretical Domains Framework (TDF) and Capability, Opportunity, and Motivation Model of Behaviour (COM-B) to inform future development of behaviour change strategies. We included 60 papers from 27 countries. We grouped 24 review findings under 5 overarching themes: (a) interplay between perceived risks and benefits of participation in women's decision-making; (b) engagement between women and the medical and research ecosystems; (c) gender norms and decision-making autonomy; (d) factors affecting clinical trial recruitment; and (e) upstream factors in the research ecosystem. Women's willingness to participate in trials was affected by: perceived risk of the health condition weighed against an intervention's risks and benefits, therapeutic optimism, intervention acceptability, expectations of receiving higher quality care in a trial, altruistic motivations, intimate relationship dynamics, and power and trust in medicine and research. Health workers supported women's participation in trials when they perceived clinical equipoise, had hope for novel therapeutic applications, and were convinced an intervention was safe. For research staff, developing reciprocal relationships with health workers, having access to resources for trial implementation, ensuring the trial was visible to potential participants and health workers, implementing a woman-centred approach when communicating with potential participants, and emotional orientations towards the trial were factors perceived to affect recruitment. For study investigators and ethics committees, the complexities and subjectivities in risk assessments and trial design, and limited funding of such trials contributed to their reluctance in leading and approving such trials. All included studies focused on factors affecting participation of cisgender pregnant women in clinical trials; future research should consider other pregnancy-capable populations, including transgender and nonbinary people. This systematic review highlights diverse factors across multiple levels and stakeholders affecting the participation of pregnant and lactating women in clinical trials. By linking identified factors to frameworks of behaviour change, we have developed theoretically informed strategies that can help optimise pregnant and lactating women's engagement, participation, and trust in such trials.

Decoding the Duterte Doctrine: Understanding Strategic Changes in Philippine Foreign Policy during Duterte Administration

This article employs a sophisticated neoclassical realist framework to conduct a comprehensive analysis of the intricate landscape of Philippine foreign policy under the administration of former Philippine President Rodrigo Roa Duterte, elucidating the contours of the so-called “The Duterte Doctrine”. This encompasses a nuanced exploration of the nation's role as a middle power, focusing on the pillars of national security, economic diplomacy, and the safeguarding of overseas Filipinos. Employing an analytical lens that intricately weaves systemic pressures and domestic imperatives, the study meticulously unravels the historical trajectory of Philippines-USA relations and the evolving dynamics in the Philippines-China relationship. Methodologically, a discerning review of historical events, policy decisions, and diplomatic maneuvers is undertaken to unveil discernible patterns and strategic recalibrations within the nation's foreign policy landscape. The main findings underscore a diplomatic chess game in the Philippines-China relationship, marked by a strategic departure in defense posture with the cessation of joint military exercises with the U.S. Economic diplomacy, encapsulated in the Duterte Doctrine, manifests as a fervent pursuit of diversified economic partnerships, concurrently raising cogent concerns about potential economic dependence. The analysis accentuates the adaptive resilience of Philippine foreign policy in response to the evolving global landscape, thereby substantively contributing to regional stability. As a middle power, the Philippines astutely leverages its agency amid great power competition while assiduously upholding principles of international law and justice, necessitating nuanced and context-specific approaches to maintain a delicate balance between traditional alliances and emerging economic partnerships.

An Orthodox Christian Bridging the Boundaries of Mavlana’s Thought

This essay delves into the phenomenon of the "unveiling of Sufis" and traces Yaman Dede's journey to becoming a dervish within the Mavlavī Order in the Republic of Turkey. The Mavlavī Order, a longstanding Islamic Sufi tradition dedicated to preserving the spiritual teachings of Mevlānā Jalāl ad-Dīn Rūmī and his successors for over seven centuries, faced challenges under Turkey’s secularization policies in 1925. This essay explores the extent to which the Mavlavī Order could practice its religious rituals within the secular framework of the Turkish Republic. Additionally, it examines the compelling appeal of the Mavlavī Order to seekers, worshippers, and intellectuals, a call that resonated deeply with Yaman Dede, a Christian Orthodox individual from Anatolia. Through biographical insights into Yaman Dede's identity quest amidst the backdrop of his conversion story, the essay sheds light on his inner turmoil caused by the clash of two faiths, ultimately leading to personal reconciliation as he embraced the path of a Mavlavī dervish. The latter part of the essay delves into the dynamics of the master-disciple relationship, with a focus on the interaction between Remzi Dede and Yaman Dede as a case study. Furthermore, it explores the enduring intellectual legacy of Yaman Dede and its impact on shaping the contemporary Sufi tradition in Turkey.

Reliability and Validity of the Indonesian Version of the Dual Filial Piety Scale

Filial piety (bakti) is a familiar concept within societies in the Chinese diaspora, including multicultural Indonesian society. This concept describes the relationship dynamics between parents and children. It includes obedience and affection that motivate a range of behaviours, including caring for elderly parents. Filial piety becomes an important construct to be studied in its relationship with the psychological process both in children and parents. A conceptual model commonly used to describe filial piety is the Dual Filial Piety Model, which has been operationalized in the Dual Filial Piety Scale (DFPS). This study aims to evaluate the psychometric properties of DFPS which have been translated into Bahasa Indonesia through forward and backward translation. Data was collected from 202 participants recruited using nonprobability sampling. The result suggests that the Indonesian version of DPFS shows adequate reliability and validity. The instrument was found to be consistent with its theoretical model. It can be used for further research on filial piety in Indonesian society.

Challenges of Nursing Students during Clinical Practice in Emergency Department: A Case Study

Background: Transitioning from theoretical studies to practical scenarios, particularly in the Emergency Department (ED), poses significant challenges for nursing students. These challenges include high time pressure, the complexity of cases, and the urgent nature of situations often encountered. The impact can lead to increased stress levels, a higher workload, and a potential lack of confidence in handling situations that require quick and accurate responses. This study investigated the initial adaptation process of these students, known as Ners, emphasising their environmental adjustment, interpersonal skill enhancement, professional development, and emotional coping strategies. Method: This qualitative study engaged 25 nursing students in ED rotations from November 2023 to March 2024. It utilised detailed interviews, participatory observation, and document analysis, employing thematic analysis to unearth key themes. Results: Four central themes emerged: acclimatisation to the clinical environment, dynamics of relationships and interactions, skills and competencies enhancement, and coping with emotional and psychological challenges. Initially challenged, students gradually became accustomed to the ED's demands, enhancing their professional and social skills and developing effective stress management strategies. Conclusion: The findings highlight the necessity for comprehensive preparation and ongoing support and suggest significant implications for improving nursing education and practices within the ED.

Grandparents as custodians of Arabic as a heritage language in the United Kingdom

The phenomenon of three-generation households is typical in many homes across the world, though perhaps less so in North America and Western Europe. When multigeneration families share the same physical space and take part in the same activities, the dynamics of parenting, eating, how time is spent and allocated, and relationships differ from families in which only parents and their children live together. One of the main (relevant) differences is that in these multilingual families there is easy access to the learning of heritage languages and socialisation into and through them. As the article will demonstrate shortly, such ease is also accompanied by relational and relationship challenges which bear on the heritage language learning process. The article describes the language transmission efforts of three Arabic-speaking families in the United Kingdom to teach and use Arabic with their children at home. Data was collected in the form of audio-recorded interactions, family background forms and parental interviews. Interview data was analysed thematically, and interactional data was analysed from the perspective of interactional sociolinguistics. The data reveals that, in addition to parents, grandparents uniquely enhance not only the learning of Arabic but also the experience of learning it. Children have a direct opportunity to learn Arabic and its various, often rare, dialects with help from their monolingual grandparents. Relationship dynamics between parents, their own parents, their parents-in-law, and their own children appear to shape and be shaped by the explicit and implicit language beliefs and practices of family members. Grandparents seem to also contribute to children’s emotional socialisation and their future beliefs of Arabic as an authentic means by which to express emotion. This is the first study to highlight the role grandparents play in the FLP of Arabic as a heritage language.

Identifying physical therapists’ attitudes, beliefs, and barriers toward diagnostic imaging referral: a mixed-methods study

ABSTRACT Objective Ten states, including the District of Columbia, have laws that currently permit physical therapists (PTs) to directly order diagnostic imaging (DI) in the United States. Military and civilian PTs order DI judiciously and appropriately demonstrating optimal patient outcomes and satisfaction when compared to other medical professionals. However, no studies have explored perceived attitudes, beliefs, and barriers to PT DI referral specific to North Dakota (ND). Therefore, the purpose of this mixed-methods study was to identify ND PTs’ attitudes, beliefs, and barriers toward DI referral. Methods A total of 147 participants completed an online survey with a subset of 17 participants agreeing to an interview. Frequency counts of demographic data and perceived barriers were completed. A binary logistic regression was run on demographic data. One-on-one interviews were conducted with a thematic coding process completed within a qualitative analysis. Results Seventy-four percent of PTs reported not currently referring for DI, although 71% felt that it would improve their patient outcomes. PTs with post-professional training (OR = 4.59), a doctorate degree (OR = 3.84), practicing in an orthopaedic or sports setting (OR = 3.55), and practicing within an urban setting of ND (OR = 3.01) were more likely to refer for DI. The main barriers identified in the survey included: (1) the logistics of performing a DI referral, (2) DI referrals only privileged to other medical providers, (3) provider/work relationship dynamics, (4) the cost of continuing education (CE), (5) and the inability to identify CE. One-on-one interviews further identified five main themes related to DI referral. Discussion/Conclusion Several barriers identified resulted in 74.1% of PTs not directly referring for DI, although certain characteristics (post-professional training, doctorate degree, orthopaedic/sports setting, practicing in an urban area in ND) were more likely to refer for DI. This study may help improve future adoption and implementation of DI referral in current and future states.

Establishing Genuine Human Connections Through Digital Entities

This academic inquiry systematically analyzes the cognitive processes that impact the perception of authenticity in human-virtual entity interactions, covering domains such as empathy, emotional involvement, social presence, anthropomorphism, as well as the influence of visual and auditory aesthetics. Drawing from a broad spectrum of recent research and foundational literature, the study explores how these elements fortify the trustworthiness of virtual agents across various fields including education, healthcare, entertainment, and customer service. The primary discoveries underscore the importance of emotional intelligence, encompassing empathy and the capacity to adjust reactions based on user emotions, as vital in heightening the perceived authenticity of virtual entities. Additionally, the analysis reveals that achieving a balanced integration of human-like qualities and functional capabilities, while avoiding the uncanny valley, is crucial in nurturing confidence and involvement. The paper also addresses ethical issues concerning the authenticity and potential manipulation of virtual entities, underscoring the need for robust ethical standards in this rapidly advancing area. The review identifies several gaps in the literature, like the necessity for more extensive research on the dynamics of human-virtual entity relationships and exploration into cross-cultural differences in authenticity perceptions. It recommends that forthcoming studies incorporate a variety of methodologies, including physiological gauges and longitudinal analyses, to enhance our comprehension of these interactions. The implications for the layout and execution of virtual entities are examined, emphasizing the necessity for developers to prioritize emotional intelligence and user-centered design to craft genuinely captivating virtual agents. The inquiry advocates for interdisciplinary cooperation to tackle the ethical dilemmas and ensure that progressions in virtual entity technologies enhance human encounters and engagements.

The Relationships Between Gratitude and Resilience among Nigerian Married Couples

This study investigates the complex connections between resilience and gratitude in Nigerian married couples. Robust literature establishes gratitude as a basic human virtue that contributes to a "good life," while resilience is interpreted as a person's ability to adjust to the difficulties they face in life. With 304 married participants, the study uses a quantitative methodology to measure resilience and gratitude using standardised questionnaires. The hypothesis that there is no association between the gratitude and resilience is rejected by the results, which show a strong positive association between resilience and gratitude (r=0.329). Furthermore, the outcomes of the t-test show a significant difference in means, confirming the effect of gratitude on resilience among married Nigerian couples. It's interesting to note that being grateful has additional benefits, such as improving everyday happiness and flexibility. These results add to the body of literature by highlighting the critical role that gratitude plays in marriages, impacting resilience and the overall quality of the partnership. The study emphasises how gratitude has a good energy and can strengthen close relationships with others. Subsequent investigations may explore more thoroughly the mechanisms by which gratitude enhances relationship dynamics, providing valuable perspectives for therapeutic therapies and relationship-building initiatives. All things considered, this study has important ramifications for strengthening resilience and gratitude among married couples in Nigeria.

Genetic and subjective sensitivity, relationship dynamics, and psychological distress in couples.

Positive and negative aspects of intimate relationships influence mental health and well-being in couples. According to the environmental sensitivity framework, individuals differ in how strongly they are affected by their environment, with some individuals being more or less sensitive to both negative and positive experiences. The present study examined the longitudinal associations between positive and negative relationship dynamics, including marital satisfaction, positive bonding, and negative communication, and psychological distress as well as the extent to which individual differences in genetic and subjective measures of environmental sensitivity moderated the association between relationship dynamics and psychological distress in a sample of couples in the U.S. Army (n = 238 individuals representing 152 unique couples). Sensitivity was measured by self-report and a polygenic score derived from previous genome-wide association study results. Separate three-level multilevel models were conducted for each relationship dynamic and sensitivity variable. Only for subjective (i.e., self-reported) sensitivity did significant cross-level interactions emerge in predicting psychological distress, whereas no such interactions were found for genetic (i.e., polygenic score) sensitivity. Specifically, lower marital satisfaction and positive bonding were associated with higher psychological distress among subjectively highly sensitive individuals, and higher negative communication was associated with higher psychological distress among subjectively highly sensitive individuals. Findings suggest that both low positive and high negative relationship dynamics may have a greater effect on psychological distress among highly sensitive individuals, which may help to inform tailored intervention to meet the unique needs of couples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Supplemental Material for Genetic and Subjective Sensitivity, Relationship Dynamics, and Psychological Distress in Couples

Supplemental Material for Genetic and Subjective Sensitivity, Relationship Dynamics, and Psychological Distress in Couples

Analysing lexical semantic changes in chinese educational texts by integrating machine learning methods

Analyzing Lexical Semantic Changes (LSC) in Educational Texts (ET) refers to examining how the meanings of words, terms, or phrases used in ET have evolved. It involves learning shifts in the semantic content, connotations, and language associations within educational resources such as textbooks, research articles, and instructional content. The analysis can reveal how educational models, pedagogical methods, and terminology have transformed in response to technological innovations, societal changes, and pedagogical developments. This analysis provides visions into the dynamic nature of educational discourse, helping researchers, educators, and policymakers understand how language has adapted to reflect changes in educational paradigms and the broader educational context. This research investigates the semantic analysis and classification performance within ET, employing the innovative Decision Tree + Feed Forward Neural Networks (DT + FFNNs) framework. This research shows the dynamic semantic relationships inherent in educational terminology by diverse semantic similarity measures and contextualized embeddings. It looks at how educational language changes to reflect changes in society, technology, and pedagogy. The study uses a DT + FFNN framework for semantic analysis and classification. The study uses several embeddings and semantic similarity metrics, and Spearman’s Correlation Coefficient (SCC) is employed to evaluate their effectiveness. This study highlights the DT + FFNN framework’s capacity to capture complex semantics in an educational setting and offers insights into the adaptive nature of educational discourse. SCC serves as a guiding metric, offering insights into the efficiency of several embeddings and measures. The findings show the pivotal role of fine-tuning in significantly enhancing the accuracy of DT + FFNNs across measures, revealing its remarkable potential in capturing semantics within an educational context.

12 Tips for Centering Patient Voices through "Lived Experience Panels" in Preclinical Undergraduate Medical Education.

Background: Integrating patient narratives into medical education enhances understanding of person-centered care, empathy, and the human experience of illness. This paper explores the implementation of lived experience panels (LEPs) in preclinical medical education. Aims & Description: Twelve strategies for effective LEP integration are presented, emphasizing thoughtful curation of panelists, timing considerations, vulnerability cultivation, and empowerment of marginalized voices. The paper outlines leveraging virtual platforms, skillful facilitation, student and patient preparation, post-session support, and debriefing mechanisms. Experiences from the University of Texas Branch at Galveston are showcased. Conclusion: The incorporation of LEPs into medical education holds immense potential for benefiting both learners and patients. Ensuring intentional and sensitive inclusion of these panels is paramount for the development of impactful curricula. By incorporating patient voices into medical education, we can nurture empathy, reinforce person-centered care principles, and cultivate authentic connections among learners, ultimately facilitating a transformative shift in the dynamics of the physician-patient relationship.

The Paradox of Choice in Palliative Care Decision-Making in Managed Long-Term Care: A Qualitative Study

Palliative care offers undeniable advantages to elderly patients with multiple chronic illnesses in managed long-term care. However, only approximately 14% of those who require palliative care actually receive it. To investigate factors influencing decision-making regarding palliative care acceptance, and healthcare providers’ communication strategies, which patients or family caregivers perceive during managed long-term care. Qualitative thematic content analysis study. Two data sources from home and community-based health care organization in a metropolitical city in the Northeastern United States were used: (a) retrospectively collected 79 phone call audio recordings between patients and/or family caregivers with healthcare providers when initiate palliative care option, and (b) prospectively collected 10 exploratory qualitative interviews with patients and/or family caregivers for this study purpose. From a total of 89 conversations, 7 themes emerged during palliative care decision-making: (a) capability for self-management; (b) symptom severity; (c) perceptions of chronic disease; (d) satisfaction with current health services; (e) code status; (f) caregiver burden and (g) other reasons, including financial considerations and service affiliations. In addition, from 10 qualitative interviews, 4 key themes in healthcare providers’ communication that optimize palliative care conversations were indicated: (i) trust and relationship dynamics; (ii) positive reinforcement and personal connection; (iii) conversation setting and initiator; and (iv) collaborative approach to care coordination. Enhancing decision-making around palliative care and improving acceptance of palliative care services may be improved through the integration of personalized care plans, empathetic communication, use of symptom-inclusive assessments for timely care, and proactively addressing caregiver burden.