People living with advanced heart failure in rural areas have poorer quality of care as their disease progresses, which may be due to lack of access to specialty palliative care. A collaborative care model, connecting specialty palliative care clinicians to embedded complex care teams in primary care practices, may increase access to palliative care in this population. Research objectives To explore perspectives on a proposed collaborative palliative care intervention and whether this intervention would be appropriate for people living with heart failure in rural areas. We conducted a qualitative study (n=26), including patients with heart failure (n=7), caregivers (n=2), complex care team members working in primary care practices (n=5), primary care providers (n=5), interdisciplinary specialty palliative care clinicians (n=4), and cardiologists (n=3) all living and/or practicing in a rural community in Maine. Interviews were audio recorded and professionally transcribed. We used Max-QDA, line-by-line coding, and grounded theory analysis. We found people living and working in rural areas wanted palliative care integrated into primary care. Participants voiced suspicion about care "from outsiders" and that introduction of a specialty palliative care team into their medical care might not be well received. As one primary care provider noted "rural [people] are less influenced by … seeing the latest specialist," so describing palliative care as a specialty may not be appealing. However, participants felt that patients would be open to receiving palliative care delivered by their primary care teams. Palliative care specialists and primary care clinical staff were enthusiastic about a collaborative care model to navigate patients' desire to avoid a new team while increasing access to specialty palliative care expertise. A collaborative palliative care model may be welcomed by patients, caregivers, and clinicians in rural areas.

Paediatric palliative care and paediatric euthanasia: clarifying a moral continuum.

Namaste Care, a non-pharmaceutical daily multicomponent palliative care intervention, offers care for people with dementia, aiming to improve quality of life of those living with dementia as well as their family and caregivers. This systematic review explores the Namaste Care intervention and its clinical and economic effects in multiple care settings. The aim of this review is to consolidate existing evidence on Namaste Care's clinical and economic outcomes and examine the tools used for data collection. A systematic literature search was conducted (PubMed, Scopus and Web of Science) to identify peer-reviewed studies on Namaste Care's impact on quality of life, costs, health, economic outcomes and benefits up to 22 February 2026. Methodological quality was assessed using the Mixed Methods Appraisal Tool, while the completeness of reporting of economic evaluation studies was evaluated according to the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS). 31 studies reported the clinical and/or economic outcomes of Namaste Care. The results for quality of life and quality of dying were mixed, while 5 of 11 studies evaluating quality of life reported significant improvements. The various quality-of-life instruments used include the Quality of Life in Late-Stage Dementia (QUALID), EQ-5D-3L and EQ-5D-5L instruments, ICEpop CAPability Measure for Older People (ICECAP-O), ICECAP Supportive Care Measure (ICECAP-SCM), Quality of Life for People with Dementia (QUALIDEM) and Carers-DEMentia Quality of Life (C-DEMQOL). The clinical outcomes considered included pain, behavioural symptoms and quality of end-of-life care. The Medication Quantification Scale and Minimum Data Set indicated reductions in antidepressant and antianxiety medication use. Seven studies reported significant improvements in well-being, and two studies reported reduced stress among family members following Namaste Care sessions. A subset of five studies reported a range of economic outcomes. The findings suggest that Namaste Care improves well-being, reduces caregiver stress and lowers the use of antidepressant and antianxiety medications at a moderate cost. The current literature is characterised by small, non-random, heterogeneous studies. Randomised controlled trials, which include economic evaluations, help to improve evidence-based research to support funding and implementation decisions on Namaste Care. CRD42024560056.

As Alzheimer's disease and related dementias (ADRD) progress, family caregivers may experience grief before the death of the person living with ADRD. This type of grief is commonly referred to as anticipatory grief, which can contribute to increased psychological distress (i.e., depressive and anxiety symptoms) and potentially affect caregivers' long-term mental health. This scoping review aimed to synthesize evidence on risk and resilience factors associated with anticipatory grief, its relationship with caregiver mental health, and psychosocial interventions targeting anticipatory grief among caregivers of people living with ADRD. Guided by the Stress Process Model and the Grief-Stress Model, a literature search was conducted in PubMed, CINAHL, Embase, Scopus, Web of Science, and PsycINFO in May 2025. Thirty articles met the inclusion criteria. Caregiver characteristics, such as being a spousal caregiver and greater caregiving involvement, were associated with higher levels of anticipatory grief. Caregiving-related stressors and relationship changes across the ADRD trajectory were consistently linked to anticipatory grief across studies, while psychosocial resources, such as adaptive coping and social support, were generally associated with lower levels of anticipatory grief. Anticipatory grief was consistently associated with depressive symptoms. Intervention studies were limited, but those focused on acceptance and preparedness showed potential for reducing anticipatory grief. Anticipatory grief represents an important dimension of caregiver mental health that reflects ongoing loss. Conceptualizing anticipatory grief within caregiving stress frameworks highlights how vulnerability to distress may emerge from the interplay between caregiving stressors, relationship changes, and psychosocial resources. This conceptual framing may inform future research and palliative care interventions to support the well-being of family caregivers across the dementia trajectory.

International studies show intentional sedation to relieve suffering to be a common and relevant treatment in specialist palliative care. The EAPC framework for using sedative drugs has currently been updated and national recommendations have been disseminated. However, there was a lack of hands-on materials targeted for healthcare professionals and of information materials for patients and informal caregivers to ensure patient-centred care. The iSedPall study group developed a complex intervention to further support the use of sedative drugs in specialist palliative care. The following pilot study aimed at examining the feasibility of the intervention being applied in different settings and by different professions. A sequential explanatory mixed-methods design was applied between 02/23 and 01/24. An online survey (pre-post-test) assessed quantitative data on the feasibility of the outcome indicator `confidence in professional skills`, primary feasibility outcomes, and the implementation process. Focus groups added to the quantitative results. Four specialist palliative care services (inpatient and home care) piloted the intervention for nine months. Global mean scores of primary feasibility outcomes proved the intervention as acceptable, appropriate, and feasible for inpatient and home care settings. The outcome indicator seems to be adequate for measuring changes in healthcare professionals` confidence, especially for physicians. The relevance of the intervention, its impact on practice, and the implementation process have been judged heterogeneously. Promoting (e.g., personal exchange, educational materials) and inhibiting factors (e.g., lack of time and technical resources) for implementation have been stated. An implementation study would benefit from adaptations regarding the intervention, study design, and implementation strategy. Especially the nursing perspective has to be considered to a greater extent for strengthening the palliative care approach. Context-specific factors seem to play a key role in implementation. Therefore, training of in-group champions, considering local technical and personal resources, and actively engaging the team could mitigate potential barriers and foster the success. Our findings will inform a full-scale implementation study to further explore the use of the intervention by healthcare professionals in clinical practice. The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00027241; Date of registration: 10/12/2021; https://www.drks.de/drks_web/setLocale_EN.do ).

Bridging the gap: Evaluating a community-based palliative care intervention for underserved patients with Parkinson's disease.

Nursing and interdisciplinary interventions to support people with advanced cancer at the end of life in emergency departments: A systematic review.

: To evaluate the quality of life (QOL) of patients with chronic intestinal pseudo-obstruction (CIPO) before and after treatment. : This study enrolled 50 adult patients diagnosed with CIPO at 4 institutions, of whom 42 underwent therapy. Patient background, body mass index, treatment, palliative care intervention, numerical rating scale for abdominal pain or bloating, the medical outcomes study 36-item short-form health survey (SF-36) and summary scores (physical component summary, mental component summary, and role/social component summary), Japanese version of the Patient Assessment of Constipation Quality of Life (JPAC-QOL) and subscales (physical discomfort, psychosocial discomfort, worries and concerns, and satisfaction), and Patient Assessment of Constipation Symptoms (PAC-SYM) and subscales (stool, rectal, and abdominal symptoms) were prospectively sampled and collected. : The patients (n = 50; 35 females and 15 males) had an average age of onset of 44.7 years and, body mass index of 17.3 kg/m², and 38 (76%) required palliative care intervention. Effective therapeutic interventions included intestinal sterilization (19/42), decompression therapy with percutaneous endoscopic gastrojejunostomy (PEG-J) (6/42), and dietary restriction (6/42). The numerical rating scale for abdominal distension and pain decreased significantly after treatment. All SF-36 summary scores showed improvements. The JPAC-QOL and PAC-SYM both showed improvement overall and in all subscales. : Patients with CIPO have a lower physical, psychological and social QOL, which is equivalent to or lower than that of adult patients with inflammatory bowel disease or psychiatric disorders. Sterilization of the intestinal tract and PEG-J decompression effectively improve the QOL of patients.

Abstract: Creutzfeldt–Jakob disease (CJD) is an uncommon, lethal neurodegenerative prion condition marked by fast deterioration and absence of a curative therapy. Families of individuals with CJD frequently experience significant psychological distress and anticipatory grief. Psychoeducation and palliative care are crucial for assisting families in comprehending the illness trajectory, planning for end-of-life, and navigating bereavement. This case study investigates the role of structured psychoeducational and palliative care interventions in improving coping mechanisms, caregiving readiness, and acceptance among the family members of a woman diagnosed with CJD. After obtaining informed consent, five structured sessions were held with five family members of the patient. Interventions were informed by recognized psychoeducational frameworks and focused on psychoeducation, symptom management, caregiving techniques, anticipatory mourning, and psychosocial spiritual readiness. Sessions were conducted during both postmortem and postmortem phases, facilitating longitudinal observation of familial reactions. Initially, family members exhibited shock, helplessness, and denial of the prognosis. The notion of “end-of-life care” surfaced as a significant motif, facilitating family involvement in the patient’s concluding phases while concurrently allowing for emotional preparation for bereavement. Psychoeducational interventions enhanced decision-making confidence and promoted collective coping within the family. The amalgamation of psychoeducation with palliative and end-of-life care enhanced the caregiving experience, eased the acceptance of death, and diminished the severity of mourning. The findings highlight the necessity of culturally attuned, organized psychological assistance to empower families, bolster resilience, and increase caregiving outcomes in terminal conditions like CJD.

Palliative care interventions and outcomes in patients with heart failure: an umbrella review.

The aim of this retrospective study was to describe the course of patients with opioid use disorders (OUD) admitted to an acute palliative care unit (APCU) for managing pain and nonmedical use of prescribed transmucosal fentanyl products. Briefly, 11 patients underwent opioid switching and initiation of medications for OUD, primarily using methadone and buprenorphine. In total, 11 patients were included in this series. The clinical protocol, which integrated opioid rotation with the use of adjunctive medications such as olanzapine and ketamine, resulted in a significant reduction in pain and withdrawal symptoms. Methadone and buprenorphine, used to manage pain while avoiding access to fentanyl products and monitoring withdrawal symptoms with subsequent dose tapering, were effective in an APCU providing comprehensive palliative care treatment. The proper and flexible use of methadone and buprenorphine in an APCU can help patients who were prescribed fentanyl products improperly.

Palliative care improves quality of life (QoL) in advanced illnesses, but data in end-stage liver disease (ESLD) are limited. It is unknown whether palliative care delivered by hepatologists is effective when compared with palliative care specialists. To compare the effectiveness of palliative care delivered by trained hepatologists with the care delivered by conventional palliative care specialists in improving QoL at 3 months. This comparative effectiveness cluster randomized trial for US patients treated for ESLD in 19 US medical centers compared a palliative care intervention delivered by palliative care-trained hepatologists (hepatologist group; 11 centers) with palliative care specialists (consultative group; 8 centers). Eligible patients were US adults with either decompensated cirrhosis or hepatocellular cancer who had a life expectancy of at least 6 months, had not received or scheduled liver transplantation, or had not received palliative care in the prior 3 months. Hepatologists in hepatologist group alone received primary palliative care training. Data collection occurred from January 2019 through June 2025; analysis was conducted from July to September 2025. Participants received 4 palliative care visits over 3 months delivered by either palliative care-trained hepatologists or palliative care specialists, using a structured palliative care checklist. Superiority or a priori noninferiority of the effect of palliative care delivered by hepatologists vs palliative care specialists on change in QoL at 3 months, measured by the Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) total score (higher scores indicating better QoL). Secondary outcomes included change in symptom burden, distress, depression, satisfaction from baseline to 3 months, and mortality. A total of 935 patients were enrolled (mean [SD] age, 63.0 [10.3] years; 275 female [29%]; 130 Hispanic ethnicity [14%]; 144 Black [15%], 736 White [79%]). From baseline to 3 months, QoL improved in both groups (adjusted mean: hepatologist, 8.01 [95% CI, 5.38 to 10.65]; consultative, 7.02 [95% CI, 4.34 to 9.71]; both P < .001). Although superiority was not found in change in QoL, prespecified noninferiority analysis showed that the improvement in the hepatologist group was noninferior to the consultative group (adjusted mean difference, 0.98 [95% CI, -2.86 to 4.83]; P = .01). Symptom burden (adjusted mean difference, -7.52 [95% CI, -9.89 to -5.15] vs -5.31 [95% CI, -7.60 to -3.03]) and depression (adjusted mean difference, -1.18 [95% CI, -1.78 to -0.57] vs -0.90 [95% CI, -1.49 to -0.31]) improved in both groups, without significant between-group differences. Patient satisfaction improved more in the hepatologist group compared with the palliative care group (adjusted mean difference, 3.37 [95% CI, 2.24 to 4.49] vs 0.91 [95% CI, -0.15 to 1.96]; P = .002). Mortality at 3 months was similar in both groups. This cluster trial found that palliative care delivered by trained hepatologists was comparable with palliative care delivered by palliative care specialists in improving QoL in patients with ESLD and was associated with greater improvement in patient satisfaction, demonstrating the effectiveness among enrolled patients. ClinicalTrials.Gov Identifier: NCT03540771.

The aim of this study was to assess the differences in the pattern of symptoms and their changes after a comprehensive palliative care treatment in older patients in comparison with adults, who were admitted to an acute palliative care unit (APCU). Patients were categorized into three age ranges: adults (< 65years, group A), old (65-74years, group O), very old (75-84years, group OO). The following parameters were collected: general characteristics, recent anticancer treatments, on/off treatment, previous care setting, Edmonton Symptom Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS), opioid doses, expressed as oral morphine equivalents (OME). Five-hundred-and-twenty patients were surveyed. Older patients had a lower Karnofsky level, were discharged on-therapy in a lower number of cases, and had a lower overall survival. The age-related differences in pain and dyspnea intensities recorded at admission, were nullified after a comprehensive palliative care treatment. Lower doses of opioids were effective. The APCU's consistency and the expertise of its team contributed to improved outcomes of the elderly.

In the outpatient (i.e., pre- and post-hospital) and inpatient care of patients with chronic progressive diseases, such as chronic obstructive pulmonary disease (COPD) or idiopathic pulmonary fibrosis (IPF), there are serious communication gaps across sectors, particularly regarding advanced care planning and palliative care treatment. Strategies to avoid over-treatment in intensive care are needed.

This article reviews palliative care concepts valuable to neurologists caring for people with multiple sclerosis (MS), describes the three stages of palliative principles in care delivery, and suggests triggers to refer for specialized palliative care interventions. Advances in disease-modifying therapies have extended life expectancy and reduced disability progression in patients with multiple sclerosis. However, palliative care remains underutilized in addressing persistent symptoms, care partner burden, and psychosocial challenges. Palliative care strategies in MS can be divided into three stages: early-stage palliative care needs and screening after diagnosis; midstage palliative care needs, including symptom management and quality-of-life optimization; and late-stage palliative care needs, including managing severe MS and end-of-life care. Additional foci of specialist palliative care may include end-of-life care, advance care planning, care partner support, and patient consideration of medically assisted death. Neurologists, neurology care teams, and primary care providers can serve as generalist palliative care providers, with referral to specialist palliative care teams when needed. Patient-reported outcome measures and screening symptom scales can aid in the periodic assessment of people with MS and their care partners.

Although telehealth is increasingly implemented in palliative oncology, the psychosocial effectiveness of nurse-led telehealth interventions remains unclear. Existing reviews are largely descriptive and do not isolate nurse-delivered interventions or synthesize psychosocial outcomes for both patients and family caregivers. To evaluate the effectiveness of nurse-led telehealth interventions on psychosocial outcomes among patients with cancer receiving palliative care and their family caregivers. Systematic review and meta-analysis. Nine electronic databases were searched from inception to April 2025 for randomized controlled trials evaluating nurse-led telehealth interventions. Nine trials (n = 3177 participants) were included. Among patients, nurse-led telehealth significantly reduced anxiety (Hedges' g = 0.46) and improved quality of life (Hedges' g = 0.33). Effects on depressive symptoms were not statistically significant. Among family caregivers, significant improvements were observed in anxiety (Hedges' g = 0.30), depression (Hedges' g = 0.42), quality of life (Hedges' g = 0.45), and stress burden (Hedges' g = 0.44). Interventions comprising more than six sessions demonstrated greater effectiveness for selected outcomes. Nurse-led telehealth interventions improve psychosocial outcomes in palliative oncology for both patients and family caregivers. Structured and adequately intensive programs may enhance intervention impact and support evidence-based digital nursing practice.

Introduction: Poor oral health is a common and neglected concern in palliative care (PC), negatively impacting patients' quality of life. There is a significant gap in the knowledge and practices of primary care physicians regarding oral health due to various barriers, with few documented support strategies in this area, as well as an information gap on the nutritional aspects that complement palliative practices in oral care. Objective: It was to carry out a concise systematic review in order to present the main clinical approaches to palliative care in dentistry, as well as showing the associated nutritional importance. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from December 2025 to January 2026 across the Web of Science, Scopus, Embase, PubMed, ScienceDirect, SciELO, and Google Scholar databases. The quality of the studies was assessed using the GRADE instrument, and the risk of bias was evaluated according to the Cochrane instrument. Results and Conclusion: According to the GRADE instrument, most studies presented homogeneity in their results, with X2=77.8%&gt;50%. A total of 136 articles were found and submitted for eligibility analysis, with 12 final studies selected to compose the results of this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 33 studies with a high risk of bias and 26 studies that did not meet GRADE and AMSTAR-2 standards. It was concluded that early palliative care intervention can be effective in reducing psychological suffering and improving the quality of life of critically ill dental patients. Dentists can play a key role in linking tertiary and community care to promote patient well-being. Weight loss and impaired oral intake were associated with psychosocial distress affecting patients and caregivers. Future research is needed to explore the experiences of patients, caregivers, and healthcare professionals regarding nutrition and to evaluate the effectiveness of alternative nutritional strategies.

Palliative care interventions for children with serious illness require real-world design expertise to bring research to the bedside in ways that are engaging, effective, and feasible. To describe the collaborative process of bringing an evidence-based humanistic care intervention, photo-narratives, through practical user experience (UX) design for future implementation at a children's hospital. The collaborative design process was completed at an academic university. Researchers at the affiliated children's hospital approached two teams of UX design graduate students to (1) further refine and (2) develop a technology-integrated implementation strategy for the photo-narrative intervention. The researchers and teams met weekly to follow a project-specific seven-step UX design approach, including (1) framing project timeline and deliverables, (2) regulatory and access considerations, (3) understanding the problem and intervention, (4) data collection, (5) design constraints (information technology considerations, workflow), (6) low-fidelity prototyping, and (7) usability testing and high-fidelity prototyping. Collaboration between researchers and UX design teams can further the critical intervention design and prototyping that is essential to implementing successful real-world palliative care interventions.

Cardiovascular disease remains the leading global cause of morbidity and mortality. Although advances in prevention, diagnostics, and disease-modifying therapies have prolonged survival, many individuals now live longer with high symptom burden, functional decline, and complex decisional needs. Palliative care (PC) for adults with advanced cardiovascular disease can improve quality of life, support caregivers, and align treatments with patient values and goals. Core elements include symptom management, effective communication, shared decision-making, advance care planning, and integration of psychosocial and spiritual support across the disease trajectory and different care settings. Current evidence demonstrates that early PC intervention can improve symptom control, enhance quality of life, reduce psychological distress, and decrease high-intensity yet low-value care near the end of life. Nevertheless, outside of heart failure populations, gaps in widespread PC implementation across populations supported with cardiac devices as well as across diverse cultural and health systems remain. This state-of-the-art review (i) synthesizes conceptual foundations, referral triggers, and delivery models for PC in cardiovascular medicine; (ii) reviews disease-specific considerations across heart failure, valvular disease, pulmonary hypertension, arrhythmias, and congenital heart disease; (iii) outlines ethical and legal issues including advance directives and device deactivation; (iv) provides practical guidance for symptom management and communication frameworks; and (v) proposes a pragmatic algorithm to support clinical integration of PC into cardiovascular medicine.

Objective Palliative care (PC) can reduce symptoms and resource use in decompensated advanced chronic liver disease (dACLD), yet is often underused. This study describes current practices and factors linked to increased PC use for patients who died from dACLD in the UK. Methods We conducted a retrospective, multicentre cohort study of adults who died of dACLD between 1 January and 30 June 2022 and had a non-terminal admission in their last year of life (LYOL). Patient and service-level data were collected. The primary outcomes were use of established PC interventions, namely (1) poor prognosis discussion, (2) advance care planning (ACP) and (3) specialist palliative care (SPC) referral. A multivariable logistic regression model identified factors associated with increased utilisation of PC interventions. Results Data from 803 patients across 85 hospitals showed a median of three admissions and 30 inpatient days in the LYOL. Poor prognosis discussions and ACP occurred for 49.9% and 36.9% of patients, respectively. Inpatient SPC referrals were made for 49.6% (79.1% during a terminal admission) and outpatient SPC referrals for 17.6%. On multivariable analysis, three variables were significantly associated with increased utilisation of one or more PC interventions: (1) Use of an objective prognostic score, (2) Documentation of suitability for transplant and (3) ACLD multidisciplinary team (MDT) discussion. Conclusions Patients with dACLD infrequently receive PC interventions, despite multiple healthcare attendances. SPC was typically limited to a late stage, reflecting missed opportunities for holistic care. Routine, objective assessment of prognosis and MDT management may increase PC interventions in patients with dACLD.