Predictors of end-of-life care among emergency nurses: A cross-sectional study in Korea.

Quality of death among older adults with and without comorbid dementia: A nationwide mortality follow-back study.

Advance directives (ADs) are intended to document patient preferences for future care, including end-of-life (EOL). Knowledge of the impact of electronic health record (EHR)-documented ADs on actual care experiences is limited. This is a retrospective cohort analysis of 2850 patients aged ≥ 65 years who died during a cluster-randomized trial of the impact of advance care planning (ACP). Subgroups included gender, marital status, patient portal access, dementia, and race. A total of 553 (19.4%) of the deceased patients had an EHR-documented AD 6 months prior to death. The setting was 51 primary care practices in two health systems in the Maryland and Washington, DC areas. To examine the association between EHR-documented ADs and EOL experiences, a retrospective cohort study of older adults who died between September 2020 and October 2023 was conducted. Multilevel logistic regression models analyzed whether an EHR-documented AD at least 6 months before death was associated with potentially burdensome EOL care in the last 6 months of life and in-hospital death. Among 2850 decedents (mean [SD] age 82.5 (8.8)); 311 were women [56.2%]; 203 [36.7%] had a diagnosis of dementia, 787 (27.6%) were Black, and 1883 (66.1%) were White. Patients with an AD in the EHR were less likely to experience potentially burdensome EOL care (110 (19.9%) vs. 616 (26.8%); aOR = 0.75) and in-hospital death (128 (23.2%) vs. 738 (32.1%); aOR = 0.69). Effects persisted both before and after adjusting for demographics, comorbidities, healthcare utilization, patient portal access, organization, and whether the clinic was randomized to the ACP intervention or control. Significant associations were observed in married patients and those with portal access, but not among patients with dementia or Black race. In this cohort study, EHR-documented ADs were associated with reduced potentially burdensome EOL care and a lower likelihood of in-hospital death.

To compare end-of-life (EOL) care quality indicators for patients with gynecologic malignancies whose primary oncologist spoke their preferred language (language-concordant care) versus those who did not (language-discordant care). We conducted a retrospective chart review of patients with gynecologic malignancies who died between March 1, 2020, and May 30, 2024. The primary outcome was performance on National Quality Forum (NQF) quality indicators, a composite of six measures of aggressive EOL care. We used multivariable logistic regression to examine associations between language-discordant care and aggressive EOL care, adjusting for age, insurance status, and cancer stage at diagnosis. Briefly, 83 patients met inclusion criteria; 60 (72.3%) received care from a language-concordant oncologist and 23 (27.7%) from a language-discordant oncologist. Discordant patients were more likely to identify as Hispanic or Asian and to have Medicaid insurance. Aggressive EOL care, defined as an NQF score ≥1, occurred in 87.0% of discordant patients compared with 60.0% of concordant patients (p = 0.0174). After adjusting for age, insurance, and cancer stage, language-discordant care was associated with more than six-fold higher odds of aggressive EOL care (adjusted odds ratios: 6.05, 95% confidence intervals: 1.38-26.53). Language discordance between patients and oncologists was associated with greater likelihood of aggressive EOL care in gynecologic oncology. Addressing language barriers is essential to improving equity and aligning care with patients' goals at the end of life.

Advanced practice registered nurses often feel unprepared for end-of-life (EOL) care due to gaps in training. This study assessed the impact of an EOL simulation on the attitudes and preparedness of 83 students who completed pre- and post-simulation surveys. Results showed significant improvement in post-simulation scores, suggesting that simulation is effective in enhancing attitudes and comfort with EOL care. The findings support integrating simulation into nursing curricula to close educational gaps and foster readiness.

Person-centred care (PCC) is increasingly emphasised in end-of-life care (EoLC) for its holistic approach to addressing physical, psychological, social, and spiritual needs. However, its implementation in mainland Chinese hospitals remains challenging due to a range of practical, emotional, and cultural barriers. Understanding these real-world barriers is critical for improving compassionate and dignified care delivery. This article explores how emotional, cultural, and organisational factors influence the application of PCC in hospital-based EoLC, through a reflective case study supported by a targeted literature review. A single clinical case involving a 78-year-old woman with advanced lung cancer was analysed using a dual perspective of the patient and the nurse. Three key barriers were identified. First, the emotional burden on nurses delivering EoLC limited their capacity for sustained compassionate engagement. Second, limitations in tailoring dignity therapy to patients' psychological readiness reduced its therapeutic effectiveness and, in some cases, heightened emotional distress. Third, cultural taboos surrounding death and family-led decision-making often restricted open conversations about end-of-life preferences, reducing patient participation. This study underscores the importance of culturally sensitive, emotionally attuned, and systemically supported approaches when applying PCC at the end of life. It offers practice-based insights for improving humanised care delivery in China and other culturally similar settings.

This study examines healthcare professionals' (HCPs') experiences of implementing digital advance care plans (DACPs) to support information-sharing and decision-making in end-of-life care (EoLC) across an Integrated Care Board in Southwest England. It provides evidence of HCPs' perspectives towards the potential of DACPs to enhance the coordination of patient care. A descriptive qualitative study was conducted. Purposive sampling recruited HCPs from diverse clinical settings. Four focus groups and one semi-structured interview were conducted between November 2024 and November 2025. Data were analysed inductively using thematic analysis. Reflexive practice was embedded throughout, acknowledging the research team's clinical and qualitative experience and potential influence on interpretation. 15 HCPs participated. Three overarching themes were identified: (1) Variations in DACP use-some clinicians acting as creators and others as viewers, shaping perceptions of value and workload. (2) Perceived benefits-improved information-sharing, enhanced decision-making in crises and support for nuanced and patient-centred planning. (3) Challenges-fragmented clinical systems, inconsistent updating, variable understanding of DACP purpose and tensions between detailed content and the need for rapid, actionable information. Participants highlighted that DACPs could guide multidisciplinary team (MDT) discussions and contingency planning but were limited by system integration issues and inconsistent use across settings. DACPs have considerable potential to enhance EoLC by improving communication, supporting personalised decision-making and supporting crisis response. Realising these benefits requires improved system interoperability, clearer role expectations and consistent updating across settings. Strengthening digital infrastructure and embedding DACPs into routine MDT processes may help them function as dynamic, evolving records supporting high-quality EoLC.

Parkinson's disease and atypical parkinsonism are characterized by motor and non-motor symptoms. As the disease advances, planning for end-of-life (EoL) care becomes increasingly important. However, consensus-based European guidelines for advance care planning and documentation of EoL care preferences for parkinsonism are lacking. Understanding current documentation practices for EoL care across Europe is an essential first step towards formulating such guidelines. Provide an overview of the status of EoL care documentation in selected regions of Austria, Estonia, Germany, Greece, Italy and Sweden. Individuals diagnosed with moderate to severe parkinsonism, participating in the PD_Pal trial were enrolled. We reviewed participants' electronic health records (EHRs) and other documentation (eg, advance directives kept at home). A questionnaire was used to extract information on documented EoL care preferences. One hundred eighty nine participants were included (n = 182 Parkinson's disease; n = 7 atypical parkinsonism). Documented EoL care preferences were identified in 70% of the participants in Germany, 21% in Austria, 17% in Sweden, 7% in Greece, 3% in Italy, and 0% in Estonia. Participants more frequently documented their EoL preferences in advance directives than in EHRs. The content of the documentation was largely general, with limited attention to parkinsonism-specific issues. We found considerable variability in the presence of EoL care documentation across European regions. Public awareness and availability of advance directive templates likely contributed to the higher percentage of German participants with advance directives. These should be considered as best practices for enabling individuals with parkinsonism to document their preferences and receive care aligned with them.

Medical practitioners' experiences of and attitudes towards goals of patient care discussions: A cross-sectional survey.

To quantify the prevalence of cardiopulmonary resuscitation (CPR) in the final 24 hours of life (terminal CPR [tCPR]) and characterize the decision to forego tCPR. Retrospective, mixed-methods datasets. PICU in a United States, midwestern quaternary regional pediatrics-only healthcare system. All children and adolescents (age ≤ 26 yr) who died in the PICU (2013-2022). None. Out of 23,434 admissions, there were 316 deaths (1.35%), consistent with the national PICU reference. In our population, 74% of deaths occurred with one or more end-of-life (EOL) events (i.e., limitation or nonescalation of life-sustaining therapies, discontinuation of nonbeneficial life-sustaining therapies, and altered code status), 9% greater than the national reference (65%; p = 0.001). Out of 234 deaths occurring after 24 hours of admission, tCPR occurred in 18 (8%). Pre-admission pediatric palliative care (PPC) consultation occurred in 80 of 234 cases (34%) and the factors associated with this involvement included baseline disability (assessed using Pediatric Overall Performance Category plus Pediatric Cerebral Performance Category), nontrauma designation, primary admission diagnosis, home medical equipment, not meeting death by neurologic criteria, and sex. In a classification tree analysis, pre-admission PPC exposure was the strongest contributor of the tCPR-related factors. Further thematic, qualitative analysis of provider progress notes in 19 cases identified elements specific to the process of deciding to forego tCPR. Our 10-year retrospective analysis of children dying in the PICU after 24 hours of admission identified pre-admission PPC exposure as a key factor associated with a reduced proportion of tCPR occurrence. The additional qualitative analysis of those choosing to forego tCPR showed that these families experienced EOL care through a temporally and emotionally dynamic decision-making process.

ObjectivesThis study explored how end-of-life (EOL) care practitioners in Hong Kong engaged in emotional labor while fulfilling their professional roles in a Chinese cultural context.MethodsA sequential explanatory mixed-methods design was employed. A quantitative survey (n = 32) using validated scales that measured emotional job demands and emotional labor strategies was followed by in-depth interviews (n = 11) with EOL care practitioners from diverse disciplines. Survey data were analyzed using descriptive statistics, while interview transcripts underwent thematic analysis.ResultsEOL care practitioners reported high emotional job demands, with deep acting being their preferred emotional labor strategy over surface acting. Three key themes emerged related to: (1) balancing emotional involvement and professional boundaries; (2) employing strategic emotional engagement; and (3) navigating cultural beliefs and family dynamics. This multidisciplinary workforce developed sophisticated practices to manage their emotions authentically while establishing protective psychological boundaries. These practices integrated the provision of emotional support with the navigation of tensions between Chinese cultural values and professional responsibilities.Significance of resultsThis study used mixed-methods to explore how traditional values were integrated into the everyday care practices of EOL practitioners in Hong Kong. The findings contribute to an innovative and culturally sensitive framework for exploring emotional labor in EOL care contexts. This is useful in both Chinese and multicultural care contexts.

Patients with hematologic malignancies often receive aggressive treatment until the terminal phase and transition to end-of-life (EOL) care less frequently than those with solid tumors. A 2015 survey compared hematologists' and solid tumor-oncologists' attitudes toward EOL care, revealing differences. A decade later, no similar reports have appeared despite therapeutic advances. Therefore, we repeated the survey with additional questions to examine whether perspectives on EOL care have changed. A 50-item questionnaire was administered to hematologists and gastroenterologists. Responses came from 121 hematologists treating hematologic cancers, 141 gastroenterologists treating gastrointestinal cancer including eight medical oncologists managing both. For analysis, hematologists were compared with 141 gastroenterologists. In both groups, refractory to standard therapy for cancer was the leading reason for initiating EOL care, with no significant differences. However, hematologists were less likely to transition ≥ 21% of patients to EOL care (p < 0.0001), more likely to register relapsed or refractory patients in clinical trials (p < 0.0001), to administer therapy to patients with 1-month expected survival and Eastern Cooperative Oncology Group performance status of 4 (p < 0.0001), and to cite barriers such as limited transfusions and restrictions on referrals to palliative care wards (p < 0.0001). Hematologists' continuation of therapy in terminal patients and difficulty referring to palliative wards persisted since 2015, indicating unchanged attitudes. Additional findings confirmed reliance on clinical trials, and emphasis on transfusions, which may hinder timely EOL transitions in hematologic malignancies.

Interventions to reduce potentially nonbeneficial aggressive end-of-life (EOL) care remain limited. Patient-caregiver concordance on death preparedness may offer a novel approach to improving EOL care but remains understudied. This study examined associations between such concordance and EOL care in cancer patients' final months. In this cohort study, associations between last-assessed dyadic-concordance death-preparedness groups (unprepared-concordant, cognitive-concordant, emotional-concordant, and sufficient-concordant vs discordant) and receipt of chemotherapy, life-sustaining treatments (LSTs) (e.g., cardiopulmonary resuscitation (CPR), ICU care, intubation, mechanical ventilation, vasopressors), nasogastric feeding, and hospice care were examined using logistic regression among 694 dyads of cancer patients and their primary family caregivers. Membership in the sufficient-concordant death-preparedness state was associated with a lower likelihood of receiving chemotherapy (adjusted odds ratio [95% confidence interval] = 0.55 [0.31, 0.95]), intubation (0.30 [0.11, 0.83]), and mechanical ventilation (0.27 [0.09, 0.82]) and a higher likelihood of hospice care (1.97 [1.08, 3.60]). In contrast, membership in the unprepared-concordant death-preparedness state was associated with a higher likelihood of CPR (35.28 [3.65, 340.77]), intubation (8.38 [1.14, 61.45]), and mechanical ventilation (8.33 [1.11, 62.38]), and a lower likelihood of hospice care (0.05 [0.01, 0.49]). Patients in cognitive- or sufficient-concordant states were less likely to receive nasogastric feeding (0.59 [0.37, 0.94] and 0.58 [0.36, 0.95], respectively). Dyadic death-preparedness concordance was significantly associated with chemotherapy, aggressive LSTs, nasogastric feeding in the last month, and hospice care at EOL. Supporting open communication to facilitate and align patient-caregiver preparedness may improve EOL care; however, further research is needed to evaluate the effectiveness of such approaches.

BackgroundAlzheimer's disease and related dementia (ADRD) affect nearly half of assisted living (AL) residents, the majority of whom have palliative care (PC) needs at the end of life (EOL). AL staff are well positioned to provide PC with appropriate training; however, little is known about their experiences delivering EOL care.ObjectiveTo explore AL staff perspectives on providing quality PC at the EOL for residents with ADRD.MethodsThis qualitative study analyzed secondary data from 17 staff across six AL communities in southwest Florida who participated in the Palliative Care Education in Assisted Living for Dementia Care Providers (PCEAL-DCP) study (2019-21). As part of the training, staff completed two homework assignments: (1) defining what constitutes a good death for residents with dementia, and (2) identifying one resident and at least one action to address EOL care needs. Responses were analyzed using hybrid deductive-inductive thematic analysis. A priori codes were based on the physical, social, emotional, and spiritual domains of PC.ResultsTwenty-two homework assignments were analyzed. Care planning coordination with family emerged as an overarching theme. Staff described family involvement in all four a priori PC themes physical, social, emotional, and spiritual care, with particularly prominent roles in social and emotional aspects of care.ConclusionAL staff emphasized person-centered PC that is responsive to residents' and families' needs, underscoring the multidimensional nature of EOL care and the central role of staff-family collaboration in meeting residents' PC needs at EOL.

BackgroundCaregiver burden may influence individuals' preferences for their own End-of-Life (EoL) care, but evidence remains limited.ObjectiveExamine the association between caregiver burden and preferred EoL care settings across levels of anticipated care dependency.MethodsA survey was conducted with 297 caregivers of functionally independent adults aged ≥75 in Sukagawa City, Japan. Participants selected preferred EoL care settings ("home/family home" vs. "hospital/nursing home/other") across three hypothetical scenarios reflecting low, moderate, and high levels of care dependency at their own EoL. Caregiver burden was assessed using the Burden Index of Caregivers. Modified Poisson regression was applied.ResultsHigher caregiver burden was significantly associated with preference for non-home settings in high- and low-dependency scenarios.ConclusionCaregiver burden may shape future EoL care setting preferences. Recognizing its influence could help clinicians tailor care planning discussions that reflect individuals' values and preferences. It may also inform policies aimed at reducing caregiver burden.

The roles and responsibilities of an advanced practice nursing team for coordinating extracorporeal life support in intensive care: A qualitative study.

Palliative and end of life care in older major trauma - A point prevalence evaluation in England, Wales and Scotland.

As population aging accelerates, the demand for high-quality end-of-life (EOL) care continues to rise. However, a substantial proportion of patients with terminal cancer still experience death in acute-care hospitals without adequate palliative care. Consultative palliative care (CPC) represents a feasible model for delivering palliative care without requiring dedicated inpatient units, yet evidence evaluating its clinical impact remains limited. In this study, we developed a structured hospital-based CPC model tailored to the Korean healthcare system, the Korea Holistic Optimized Palliative care for End-of-life (K-HOPE) model, and prospectively evaluated its clinical impact. K-HOPE was delivered by an interdisciplinary CPC team in a tertiary hospital. Unmet needs were assessed using the Integrated Palliative care Outcome Scale (IPOS), and longitudinal changes were analyzed using mixed-effects models for repeated measures. Among patients who died during hospitalization, quality of death was evaluated using the Good Death Scale (GDS). A total of 84 patients with terminal cancer received K-HOPE. The total IPOS score significantly decreased over time (β = -10.4, 95% CI -12.8 to -8.0; p < 0.001), indicating reduced overall burden and unmet needs. Significant improvements were observed in psychological distress (p = 0.010) and communication and information needs (p < 0.001), whereas changes in physical symptoms and practical concerns were not statistically significant. Among 22 patients who died during hospitalization, 59.1% achieved a good quality of death (GDS ≥ 12). Longer duration of CPC involvement was significantly associated with higher quality of death and remained an independent predictor in multivariable analysis. These findings suggest that the K-HOPE CPC model improves communication and overall EOL care experiences among hospitalized patients with terminal cancer, indicating that meaningful improvements in EOL care can occur even during short periods of CPC involvement. Structured CPC integrated into routine oncology practice represents a feasible strategy for improving EOL care in tertiary hospitals, and a standardized CPC framework may enhance the consistency and reproducibility of care delivery within the Korean healthcare system.

ABSTRACTIntroductionDespite reduced life expectancy and high rates of comorbidity, individuals with severe persistent mental illness (SPMI) face significant disparities in healthcare access and quality, which extends to palliative and end‐of‐life (EOL) care. Literature shows that this population is 3.5 times less likely to be referred to specialist palliative care services. Limited access to palliative and EOL care with suboptimal quality of care increases vulnerability and exacerbates suffering for both patients and their families.MethodsThis retrospective case series examines the challenges encountered by older adults with SPMI, upon transitioning from curative to palliative approaches of care.ResultsAnalysis of three cases using deductive thematic analysis revealed key themes: delayed recognition of psychiatric treatment futility, late or denied access to palliative care, fragmented models of service delivery and ethico‐legal complexities. Referrals to palliative care occurred late—often days before death—thereby limiting opportunities for proactive care planning, caregiver support and preparation for EOL care.ConclusionsEarly recognition of treatment futility and poor prognosis could have prompted earlier palliative care involvement, enhancing patient comfort and family support. A dynamic interplay between multimorbidity, frailty and dementia in the context of SPMI is observed, with these co‐occurring conditions collectively influencing clinical trajectories and service responses. This study emphasises the importance of improved clinician training, clearer referral pathways and integrated care models in addressing this disparity. Implementing these measures will aid in addressing longstanding inequalities and ensure individuals with SPMI receive appropriate and timely palliative and EOL care.

A<sc>bstract</sc>Over the last two decades, many legal developments and professional recommendations notwithstanding, end-of-life practice on the ground is limited by physician hesitancy, lack of commitment to ensure appropriateness in decision-making, persistent fear of legal liability, and inadequate attention to quality of dying. This commentary attempts to spell out the salient messages in the recent Harish Rana vs Union of India judgment and reiterates the essential components of end-of-life care (EOLC) in intensive care unit (ICU) practice. Thoughtful and compassionate care is integral to critical care practice.How to cite this articleMani RK. The Essentials of Compassionate End-of-life Care in the Intensive Care Unit: Lessons from the Harish Rana Case. Indian J Crit Care Med 2026;30(4):270–271.