End Of Life Research Articles

Particle swarm optimization for a hybrid freight train powered by hydrogen or ammonia solid oxide fuel cells

All diesel-only trains in the UK will be phased out by 2040. Hydrogen and ammonia emerge as alternative zero-carbon fuel for greener railway. Solid Oxide Fuel Cells (SOFCs) provide an alternative prime mover option, which efficiently convert zero-carbon fuels into electricity without emitting nitrogen oxides (NOx), unlike traditional engines. Superior to Proton Exchange Membrane Fuel Cells (PEMFCs) in efficiency, SOFCs fulfil MW-scale power needs and can use ammonia directly. This study investigates innovative strategies for integrating SOFCs into hybrid rail powertrains using hydrogen or ammonia. Utilizing an optimization framework incorporating Particle Swarm Optimization (PSO), the study aims to minimize operational costs while considering capital and replacement expenditures, powertrain performance, and component sizing. The findings suggest that hybrid powertrains based on ammonia-fueled SOFCs may potentially reduce costs by 30% compared to their hydrogen counterparts, albeit requiring additional space for engine compartments. Ammonia-fueled SOFCs trains also exhibit a 5% higher efficiency at End-of-Life (EoL), showing less performance degradation than those powered by hydrogen. The State of Charge (SoC) of the batteries in range of 30–70% for both cases is identified as most cost-effective.

Hearing, sharing and applying: a qualitative study of the experiences of family caregivers’ end-of-life decision-making in Singapore

ObjectivesThis study aims to describe the caregivers’ end-of-life (EOL) decision-making experience, what made family caregivers feel assured when they were making the right call, and when they felt uncertain or...

Opportunities to Improve End-of-Life Care Quality among Patients with Short Terminal Admissions

ContextLittle is known about Veterans who die during a short terminal admission, which renders them ineligible for the Department of Veterans Affairs (VA) Bereaved Family Survey. ObjectivesWe sought to describe this population and identify opportunities to improve end-of-life (EOL) care quality. MethodsRetrospective, cohort analysis of Veteran decedents who died in a VA inpatient setting between October 2018-September 2019. Veterans were dichotomized by short (<24 hours) and long (≥24 hours) terminal admissions; sociodemographics, clinical characteristics, VA and non-VA healthcare use, and EOL care quality indicators were compared. ResultsAmong 17,033 inpatient decedents, 723 (4%) had short terminal admissions. Patients with short compared to long terminal admissions were less likely to have a VA hospitalization (38% vs. 54%) in the last 90 days of life and were more likely to die in an intensive care (49% vs 21%) or acute care (27% vs 18%) unit. Patients with a short compared to long admission were about half as likely to receive hospice (33% vs 64%) or palliative care (33% vs 69%). Most patients with short admissions (76%) had a life-limiting condition (e.g., cancer, chronic obstructive pulmonary disease) and those with cancer were more likely to receive palliative care compared to those with non-cancer conditions. ConclusionVeterans with short terminal admissions are less likely to receive hospice or palliative care compared to patients with long terminal admissions. Many patients with short terminal admissions, such as those with life-limiting conditions (especially cancer), receive aspects of high-quality EOL care, however, opportunities for improvement exist.

P.097 Glioblastoma treatment, end-of-life resource utilization, and outcomes in Ontario

Background: The end-of-life (EoL) phase of care is pivotal for glioblastoma (GBM) patients. While early integration of palliative care has shown benefits in various cancer types, its role in GBM care remains underexplored. This study aims to characterize EoL care patterns in GBM patients, assessing their temporal evolution, regional disparities, and socioeconomic influences. Methods: This is retrospective study of all patients with GBM treated in Ontario between 1994 and 2018 using the ICES data repository. Variables analyzed included patient demographics, comorbidities, palliative care utilization, and aggressive/supportive care components. Results: We identified 9,013 GBM patients within the study period. There was a gradual increase in palliative care utilization over time, accompanied by a decrease in in-hospital deaths. However, the proportion of patients receiving chemotherapy in the last 14 days of life increased. Multivariate logistic regression found socioeconomic status influenced palliative care access and rural patients also had a higher rate of in-hospital deaths, possibly due to limitations in outpatient palliative care services. Conclusions: The findings in this study clarify the status of EoL care for GBM patients within Ontario, and demonstrates key areas for future research, underscoring the need for standardized EoL care practices to enhance the quality of care for GBM patients.

Patterns of care at the end of life: a retrospective study of Italian patients with advanced breast cancer.

To better understand the type of care offered to Italian patients with advanced breast cancer at the End-of-Life (EoL), we conducted a retrospective observational study. EoL was defined as the period of six months before death. One hundred and twenty-one patients with advanced breast cancer (ABC) treated at IRCCS San Martino Policlinic Hospital who died between 2017 and 2021 were included. Data about patient, disease, and treatment characteristics from breast cancer diagnosis to death, along with information about comorbidities, medications, imaging, specialist evaluations, hospitalization, palliative care and home care, hospice admissions, and site of death were collected. 98.3% of the patients received at least one line of active treatment at EoL; 52.8% were hospitalized during the selected period. Palliative (13.9%), psychological (7.4%), and nutritional evaluations (8.2%) were underutilized. Palliative home care was provided to 52% of the patients. Most of the patients died at home (66.1%) and fewer than one out of five (18.2%) died at the hospital. Among the patients who died at home, 27.3% had no palliative support. Our findings indicate that palliative care in EoL breast cancer patients is still inadequate. Only a minority of patients had psychological and nutritional support While low nutritional support may be explained by the fact that typical symptoms of ABC do not involve the gastrointestinal tract, the lack of psychological support suggests that significant barriers still exist. Data on the site of death are encouraging, indicating that EoL management is increasingly home centered in Italy.

End-of-life conversations for the older person: A concept analysis.

The aim of this concept analysis is to seek clarity as to what end-of-life conversations involve by developing a clear working definition and using model cases to conceptualise the defining attributes of an end-of-life conversations with the older person. Walker and Avant's eight step approach to Concept Analysis. Four databases were searched, including PubMed, CINAHL, PsycINFO, and Scopus. A total of 339 publications were identified with 30 papers meeting the inclusion criteria and put forward for the final conceptual analysis. The defining attributes associated with end-of life conversations included (1) an ongoing process of older person empowerment, (2) discussion's concerning values and preferences concerning end-of-life issues, and (3) maintaining an open dialogue between all concerned individuals. Antecedents were associated with the older person is their readiness to talk openly about death and dying. Consequences were identified as having a better understanding of what death and dying may mean to the older person in a more specific manner. End-of-life conversations are vital in understanding an individual's values and preferences at the end of life, and yet, the concept of the end-of-life conversation has not been well defined in the literature. End-of-life conversations with the older person encompass ongoing discussions and maintaining open dialogue around end-of-life care while developing strategies to promote individual empowerment in making informed choices. Using a conceptual model, aides in addressing aspects of end-of-life conversations and an acknowledgment of the dynamic process of end-of-life conversations.

A tandem approach for precipitant-free highly selective recovery of valuable metals from end-of-life lithium-ion batteries using a green deep eutectic solvent

Recently, recycling lithium-ion batteries (LIBs) waste and the efficient recovery of valuable metals has become crucial for the circular economy. Deep eutectic solvents (DESs) have shown immense potential for metal extraction from end-of-life (EoL) LIBs. However, a complicated subsequent separation process is required due to the non-selectivity of the DES components for metal. Herein, we propose a tandem precipitant-free hydrometallurgical process for the selective recovery of Li and other valuable metals (Ni, Co, Mn) from EoL LIBs using a green DES. The process parameters, viz., reaction temperature (T), time (t), pulp density (S/L), and molar ratio (MR) of ethylene glycol to tartaric acid, were optimized via the statistical optimization technique of response surface methodology. The results revealed maximum extraction efficiencies of 99.2 ± 0.5%, 96.1 ± 1.4%, 95.2 ± 1.2%, and 97.8 ± 1.5% for Li, Ni, Co, and Mn, respectively, under the optimized process conditions of T = 118 °C, t = 17 min, S/L = 42 g/L, and MR = 3:1. The kinetic study showed that interfacial reaction governed the extraction process. A plausible mechanism depicting the role of DES constituents in synergistically facilitating the extraction reaction was elucidated. Moreover, Li and other metals (Ni, Co, and Mn) were selectively separated and recovered with an overall efficiency of ∼99%. The reusability of the recovered metal products and the DES were also assessed for a closed-loop recycling process. At the outset, the proposed process paves the way for a greener alternative for recycling valuable metals from EoL LIBs rather than conventional acid-based leaching processes.

The potential contribution of end-of-life fishing nets, lines and ropes to a circular economy: the Namibian perspective

Using data collected through survey questionnaires with fleet managers of 16 (61.5%) Namibian fishing companies, we explored the current practices, challenges, and opportunities in promoting Circular Economy (CE) in the context of End-Of-Life (EOL) fishing gear. Most fishing companies (56.2%) have been in operation for more than 25 years. A majority of fishing companies (62.5%) are involved in demersal trawling, mostly targeting hake (Merluccius species). Survey findings reveal that the companies import fishing gear mostly in a semi – complete format (50.0%). The current durability of fishing nets and lines/ropes is about 3 and 2 years respectively, highlighting a continuous generation of fishing gear waste. We estimated (that) approximately 104 tons of EOL fishing gear, lines/twine and ropes (are) generated annually by the Namibian fishing industry, however about 10% of some parts of the EOL fishing gear are recovered and reused. None of the fishing companies recycle EOL fishing gear, which is mostly attributed to a lack of recycling facilities. Current standard practices of EOL fishing nets, lines and ropes management include selling to employees, donating to other institutions, or disposal at dumping sites. Although some of the EOL fishing nets, lines and ropes are sold at open markets, they are not converted into value-added products, thus they are not fully utilized to significantly contribute to the CE. We recommend the implementation of circular practices such as converting EOL fishing nets, lines and ropes into value-added products such as clothing, shoes, and accessories, i.e., sunglasses, thereby reducing environmental pollution, minimising energy usage, and promoting sustainable production and consumption.

Factors associated with family decision-making self-efficacy among family members of patients with advanced cancer in mainland China.

In Chinese culture, family members are the main decision maker on end-of-life (EoL) issues for patients with advanced cancer. Yet little is known about Chinese families' confidence in making EoL decisions and its associated factors. This study aims to investigate the status and associated factors of Chinese family members' confidence in making EoL decisions for patients with advanced cancer. This cross-sectional study used a convenience sample of 147 family members of patients with stage III or stage IV cancer from a tertiary cancer center in Guangzhou, China. The questionnaires included demographic information of patients and their family members, patients' EoL preferences, and the Chinese version of the Family Decision-Making Self-Efficacy (FDMSE) Scale. A total of145 family members (98.64%) completed the questionnaires. The average score of FDMSE was 3.92 ± 0.53. A multiple regression analysis showed that the factors associated with FDMSE included patients' duration of disease, health insurance, participation in EoL decision-making, the expression of unfilled wishes, and family members' employment status. Chinese family members were not confident enough in making EoL decisions for patients with advanced cancer. It is recommended to develop cultural-tailored advanced care planning models to clarify patient preferences and to enhance the family members' self-efficacy in making EoL decisions with or for patients with advanced cancer.

The difficult discussion on the deactivation of implantable cardioverter devices at the end of life: a systematic review.

Implantable cardioverter defibrillators (ICDs) reliably prevent death due to life-threatening arrhythmias; this may become less relevant in people with more severe heart failure who are reaching the end of life (EOL). This review aimed to explore the ICD deactivation process and identify ethical issues, especially around the initiation of relevant discussions among professionals and patients. Available literature was reviewed using four electronic databases to identify issues that may deter healthcare professionals from having important deactivation discussions and to address considerations for ICD management prior to the EOL. The search resulted in the retainment of 12 studies. Three themes emerged from the data: barriers and facilitators, ethical considerations in clinical practice, and nurse's role. Lack of knowledge, which has been associated with cultural differences, has been found among the barriers, and interdisciplinary education and open communication appeared as facilitators. As clinicians' ethical considerations and fears emerged from the literature, nurses' special role has not been sufficiently supported. Complex care requires facilitation by multidisciplinary teams and education around the device's function regarding EOL issues. Establishing expert consensus statements on advance care planning might help define the distinct roles of each healthcare practitioner involved. Further research is needed in addressing the identified gaps.

Challenges and Perspectives for Direct Recycling of Electrode Scraps and End‐of‐Life Lithium‐ion Batteries

AbstractThe growing demand and production of lithium‐ion batteries (LIBs) have led to a critical concern regarding their resources and end‐of‐life management. Consequently, LIB recycling has emerged as a prominent topic in academia and in industries, driven by new worldwide governmental regulations and the increasing gap between the supply and demand of critical and strategic raw materials. Widely considered as a more sustainable and cheaper recycling method compared to pyrometallurgy and hydrometallurgy, direct recycling currently grabs the spotlight. This perspective provides insights and outlooks on the chemical and technological challenges of the innovative direct recycling approach for LIBs, addressing both the production scraps and batteries at their end‐of‐life (EOL). Technological advancements, changes in battery chemistry, along with the LIB market dynamics and collaborations between battery makers and recyclers, are key drivers of LIB waste recycling. While production scraps lend themselves well to direct recycling, EOL batteries encounter challenges in adopting this novel recycling technology. Besides, the need to assess novel direct recycling processes using Life Cycle Assessment (LCA) is also important for identifying eco‐design strategies and optimizing the processes, leading to a more sustainable energy storage system.

Life cycle assessment of electric kick scooters: consolidating environmental impact quantification and concluding climate-friendly use options

BackgroundThe environmental impact of electric scooters has been the subject of critical debate in the scientific community for the past 5 years. The data published so far are very inhomogeneous and partly methodologically incomplete. Most of the data available in the literature suffer from an average bias of 34%, because end-of-life (EOL) impacts have not been modelled, reported or specified. In addition, the average lifetime mileage of shared fleets of e-scooters, as they are operated in cities around the world, has recently turned out to be much lower than expected. This casts the scooters in an unfavourable light for the necessary mobility transition. Data on impact categories other than the global warming potential (GWP) are scarce. This paper aims to quantify the strengths and weaknesses of e-scooters in terms of their contribution to sustainable transport by more specifically defining and extending the life cycle assessment (LCA) modelling conditions: the modelling is based on two genuine material inventories obtained by dismantling two different e-scooters, one based on a traditional aluminium frame and another, for the first time, based on plastic material.ResultsThis study provides complete inventory data to facilitate further LCA modelling of electric kick scooters. The plastic scooter had a 26% lower lifetime GWP than the aluminium vehicle. A favourable choice of electric motor promises a further reduction in GWP. In addition to GWP, the scooter's life cycles were assessed across seven other impact categories and showed no critical environmental or health impacts compared to a passenger car. On the other hand, only the resource extraction impact revealed clear advantages for electric scooters compared to passenger cars.ConclusionsUnder certain conditions, scooters can still be an important element of the desired mobility transition. To assure a lifetime long enough is the crucial factor to make the electric scooter a favourable or even competitive vehicle in a future sustainable mobility system. A scooter mileage of more than 5400 km is required to achieve lower CO2eq/pkm emissions compared to passenger cars, which seems unlikely in today's standard use case of shared scooter fleets. In contrast, a widespread use of e-scooters as a commuting tool is modelled to be able to save 4% of greenhouse gas (GHG) emissions across the German mobility sector.

Racial and Ethnic Disparities in Intensity of Care at the End of Life for Patients With Lung Cancer: A 13-Year Population-Based Study.

Lung cancer is the leading cause of cancer death in the United States. Disparities in lung cancer mortality among racial and ethnic minorities are well documented. Less is known as to whether racial and ethnic minority patients with lung cancer experience higher rates of intensity of care at the end of life (EOL) compared with non-Hispanic White (NHW) patients. We conducted a population-based analysis of patients 18 years and older with a lung cancer diagnosis who died between 2005 and 2018 using the California Cancer Registry linked to patient discharge data abstracts. Our primary outcome was intensity of care in the last 14 days before death (defined as any hospital admission or emergency department [ED] visit, intensive care unit [ICU] admission, intubation, cardiopulmonary resuscitation [CPR], hemodialysis, and death in an acute care setting). We used multivariable logistic regression models to evaluate associations between race and ethnicity and intensity of EOL care. Among 207,429 patients with lung cancer who died from 2005 to 2018, the median age was 74 years (range, 18-107) and 106,821 (51%) were male, 146,872 (70.8%) were NHW, 1,045 (0.5%) were American Indian, 21,697 (10.5%) were Asian Pacific Islander (API), 15,490 (7.5%) were Black, and 22,325 (10.8%) were Hispanic. Compared with NHW patients, in the last 14 days before death, API, Black, and Hispanic patients had greater odds of a hospital admission, an ICU admission, intubation, CPR, and hemodialysis and greater odds of a hospital or ED death. Compared with NHW patients, API, Black, and Hispanic patients who died with lung cancer experienced higher intensity of EOL care. Future studies should develop approaches to eliminate such racial and ethnic disparities in care delivery at the EOL.

De-escalating treatments and transitioning care in a cardiac intensive care units network

Abstract Funding Acknowledgements None. Background Recent data (1) have shown that end-of-life (EOL) management of patients with acute decompensated heart failure (ADHF) in Cardiac Intensive Care Units (CICU) is aggressive, with late or no involvement of palliative care (PC) teams. Purpose To evaluate current PC and EOL practices in a contemporary multicenter registry of patients with ADHF who deteriorated to cardiogenic shock (CS). Methods A survey-based approach was used to collect data on PC and EOL management practices. We enrolled CS patients from 12 participating centers. A subset of 153 patients with ADHF-CS, enrolled between March 2020 and March 2023, was analyzed. We asked participating centers to report their practice regarding de-escalating treatments and transitioning care in the context of EOL, focusing on 1) discussion of implantable cardioverter defibrillator (ICD) deactivation with patients, 2) documentation of do-not-resuscitate (DNR) orders in the patient's medical record, and 3) documentation of advance directives in the patient's medical record. We also examined early PC team involvement and ICD deactivation as indicators of de-escalating treatments and transitional care in ADHF-CS. Results are presented as numbers and percentages (%) for categorical variables and medians (interquartile range, IQR) for continuous variables. Results Baseline characteristics of the population are shown in Table 1. Figure 1 describes the practices of the participating centers. DNR was routinely documented in the medical records in only 5 of 12 centers (41.7%). PC teams were involved in 21 of 153 enrolled ADHF-CS patients (13.7%). Of the 51 patients with an ICD, 17 died: 13 patients (76%) died in the hospital and 4 (24%) died within 6 months of discharge. ICD deactivation occurred in 6 of 17 deceased patients (35.3%). One patient had ICD deactivation supported by home PC services. Conclusions This study shows that the practice of de-escalating therapy, including ICD deactivation, is not routine in the participating centers. Our findings highlight the importance of integrating PC as a concurrent process with intensive care to effectively address the unmet needs of these patients and their families.

Association between physician age and patterns of end-of-life care among older Americans.

End-of-life (EOL) care patterns may differ by physician age given differences in how physicians are trained or changes associated with aging. We sought to compare patterns of EOL care delivered to older Americans according to physician age. We conducted a cross-sectional study of a 20% sample of Medicare fee-for-service beneficiaries aged ≥66 years who died in 2016-2019 (n = 487,293). We attributed beneficiaries to the physician who had >50% of primary care visits during the last 6 months of life. We compared beneficiary-level outcomes by physician age (<40, 40-49, 50-59, or ≥60) in two areas: (1) advance care planning (ACP) and palliative care; and (2) high-intensity care at the EOL. Beneficiaries attributed to younger physicians had slightly higher proportions of billed ACP (adjusted proportions, 17.1%, 16.1%, 15.5%, and 14.0% for physicians aged <40, 40-49, 50-59, and ≥60, respectively; p-for-trend adjusted for multiple comparisons <0.001) and palliative care counseling or hospice use in the last 180 days of life (64.5%, 63.6%, 61.9%, and 60.8%; p-for-trend <0.001). Similarly, physicians' younger age was associated with slightly lower proportions of emergency department visits (57.4%, 57.0%, 57.4%, and 58.1%; p-for-trend <0.001), hospital admissions (51.2%, 51.1%, 51.4%, and 52.1%; p-for-trend <0.001), intensive care unit admissions (27.8%, 27.9%, 28.2%, and 28.3%; p-for-trend = 0.03), or mechanical ventilation or cardiopulmonary resuscitation (14.2, 14.9%, 15.2%, and 15.3%; p-for-trend <0.001) in the last 30 days of life, and in-hospital death (20.2%, 20.6%, 21.3%, and 21.5%; p-for-trend <0.001). We found that differences in patterns of EOL care between beneficiaries cared for by younger and older physicians were small, and thus, not clinically meaningful. Future research is warranted to understand the factors that can influence patterns of EOL care provided by physicians, including initial and continuing medical education.

Service Provider Perspectives on Advance Care Planning Use in Rural Dementia Patients and Caregivers: A Qualitative Study

ABSTRACT Advanced care planning (ACP) utilization remains very limited in rural communities compared to urban areas. ACP earlier in the disease trajectory is particularly important for people with dementia (PWD) due to its progressive nature affecting their decision-making ability. Considering the well-documented benefits of ACP in improving the quality of end-of-life (EOL) care, the rural vs. urban disparity may indicate poorer EOL quality for rural PWD. This study aimed to explore barriers and current resources for ACP of PWD from the perspectives of health or social service providers serving rural communities. Using a qualitative approach, semi-structured face-to-face interviews were conducted with 11 health or social service professionals serving older adults and their caregivers in rural Alabama. Thematic analysis revealed three major barriers: (1) lack of knowledge, (2) psychosocial barriers, and (3) limited access to healthcare. Participants also showed misconception that a lawyer or a notary is required for ACP. Two themes arose in the participants’ recommendations to address the barriers: (1) providing ACP-relevant information and (2) addressing psychosocial stressors about ACP. This study highlighted an urgent need for social policy in ACP education for caregivers and service providers in rural settings.

Anticancer therapy at end-of-life: A retrospective cohort study.

A significant proportion of patients with incurable cancer receive systemic anticancer therapy (SACT) within their last 30 days of life (DOL). The treatment has questionable benefit, nevertheless is considered a quality indicator of end-of-life (EOL) care. This retrospective cohort study aims to investigate the rates and potential predictors of SACT and factors associated with SACT within the last 30 DOL. The study also evaluates the scope of Eastern Cooperative Oncology Group (ECOG) performance status and the modified Glasgow prognostic score (mGPS) as decision-making tools for oncologists. This review of medical records included 383 patients with non-curable cancer who died between July 2018 and December 2019. Descriptive statistics with Chi-squared tests and regression analysis were used to identify factors associated with SACT within the last 30 DOL. Fifty-seven (15%) patients received SACT within the last 30 DOL. SACT within 30 last DOL was associated with shorter time from diagnosis until death (median 234 days vs. 482, p = 0.008) and ECOG score < 3 30 days prior to death (p = 0.001). Patients receiving SACT during the last 30 DOL were more likely to be hospitalised and die in hospital. ECOG and mGPS score were stated at start last line of treatment only in 139 (51%) and 135 (49%) respectively. Those with short time since diagnosis tended to receive SACT more frequently the last 30 DOL. The use of mGPS as a decision-making tool is modest, and there is lack in documentation of performance status.

End-of-Life Care of Persons with Alzheimer's Disease and Other Dementias.

End-of-life (EOL) care has been a common option for patients with terminal medical conditions such as cancers. However, the utilization of EOL care in Alzheimer disease and other dementing conditions have become available relatively recently. As the end-stage dementia approaches, the clinicians and caregivers become faced with numerous clinical challenges-delirium, neuropbehavioral symptoms, the patient's inability to communicate pain and associated discomfort, food refusal, and so on. In addition to providing quality clinical care to the EOL patients, clinicians should pay special attention to their families, assuring that their loved ones will receive supportive measures to improve quality of life (QOL).

Second Life of Used Lithium-Ion Batteries from Electric Vehicles in the USA

This article focuses on the reuse and recycling of end-of-life (EOL) lithium-ion batteries (LIB) in the USA in the context of the rapidly growing electric vehicle (EV) market. Due to the recent increase in the enactment of both current and pending regulations concerning EV battery recycling, this work focuses on the recycling aspect for lithium-ion batteries rather than emphasizing the reuse of EOL batteries (although these practices have value and utility). A comparative analysis of various recycling methods is presented, including hydrometallurgy, pyrometallurgy, direct recycling, and froth flotation. The efficiency and commercial viability of these individual methods are highlighted. This article also emphasizes the practices and capabilities of leading companies, noting their current superior annual processing capacities. The transportation complexities of lithium-ion batteries are also discussed, noting that they are classified as hazardous materials and that stringent safety standards are needed for their handling. The study underscores the importance of recycling in mitigating environmental risks associated with EOL of LIBs and facilitates comparisons among the diverse recycling processes and capacities among key players in the industry.

The Use of Simulated Participant and Virtual Reality Simulation to Enhance Nursing Students’ Communication Skills in “End of Life Care” - A Single-Arm Repeated Measures Study

BackgroundIncreasing demand for palliative care necessitates effective training for nursing students in end-of-life (EOL) and advanced care planning (ACP). Conventional teaching methods often fall short. MethodsA single-arm pre-post design involved 219 nursing students in VR and SP simulations. Quantitative measures and qualitative feedback were obtained. ResultsStatistical analysis revealed significant improvement post-intervention (p < 0.001). Qualitative feedback highlighted realism, interactivity, and skill development. Challenges included emotional intensity and scenario repetition. ConclusionsCombining virtual reality (VR) and simulated participant (SP) simulation significantly enhances nursing students' confidence and communication for end-of-life (EOL) conversations, offering a realistic educational experience. Further research is recommended in understanding this teaching method.