Palliative Care Practice Research Articles

The Construction of British Columbia's Palliative Care Benefits Policy and Implications for Nursing Practice.

Nurses have a critical role to play in creating, implementing, critiquing, and advancing health policy within diverse contexts to ensure people living with life-limiting illness receive equitable and ethical access to palliative care services and programs. This article describes a critical analysis of the British Columbia's Palliative Care Benefits (BCPCB). The BCPCB is a provincial government program in British Columbia (B.C.), Canada, that provides eligible residents with palliative care services at home. Utilizing Fairclough's Dialectical-Relational Critical Discourse Analysis, the study investigates the process by which BCPCB determines B.C. residents' eligibility and access to resources proportionate to their need, function, illness burden, and urgency. This article reviews the construction of palliative care in Canada and how current biomedical perspectives construct palliative care policy and services in B.C. The findings indicate that the BCPCB program produces vague, discriminatory, and ableist prognostication practices through the implementation of its eligibility policy. This article also suggests that palliative care nurses are optimally positioned for policy influence: to critique, disrupt, and transform the BCPCB Program and palliative care practices.

How Chinese Doctors Do Things With Discursive Strategies in Palliative Care Family Meetings: A Genre Theory Analysis

ABSTRACT Palliative care family meetings (PCFMs) can be conceivably endorsed as helpful means for bettering end of life (EOL) communication with terminally ill patients and their families. Relevant scholarship in China remains emerging and youthful, with many avenues left to explore. Few studies have delineated the structure and specified the strategies for conducting PCFMs in the Chinese context. To address this gap, this study gathered data from audio-recorded family meetings held in palliative care wards in China. Within the theoretical framework of genre theory in functional linguistics (FL) that defined genres as staged, goal-oriented social processes, utilizing thematic analysis and discourse analysis, the twofold generic structure of PCFMs was delineated, consisting of four genre stagings in the upper stratum and fourteen elemental genres in the lower stratum, with the identified attributes of elemental genres, their sequence and possibility of iteration. Doctors’ discursive strategies in terms of semantics and lexicogrammar were specified as they serve to achieve communicative goals regarding knowledge, identity, and emotion. It is hoped that the results will improve the context for growing palliative care practices and positive clinical outcomes in China and provide insights into the structurization and discursiveness of practices in EOL settings.

Current Status of and Barriers to Primary Palliative Care Recognized by Critical Care Specialist Nurses: A Nationwide Cross-Sectional Questionnaire Survey in Japan.

Objectives: To investigate the current state of primary palliative care practice in Japanese critical care settings, identify care perceived as equivalent to primary palliative care, and explore the barriers. Methods: We employed a quantitative descriptive questionnaire survey with a nationwide cross-sectional design involving 740 critical care specialist nurses. Results: Questionnaires were received from 384 nurses, yielding a response rate of 51.9%. Nurses recognized typical palliative care provided to cancer patients, such as "relieving suffering at end-of-life" (95.3%), "pain management" (88.8%), and "caring for patients' psychological suffering" (88.3%), as primary palliative care in the critical care setting. They also recognized "monitoring and management of delirium" (68.5%), "caring for patients' social suffering" (63.5%), and "preventing post-intensive care syndromes" (61.7%) less frequently as aspects of primary palliative care in critical care settings. Additionally, the recognition was lower among emergency department nurses than intensive care unit nurses. The nurses recognized inadequate overall palliative care practices, especially regarding patients' social (72.1%) and spiritual (76.8%) suffering. They recognized "insufficient knowledge and skills among critical care medical staff" (70.6%) and "unable to confirm the patients' preferences to treatment goals" (54.4%) as barriers to providing primary palliative care. The barriers that nurses recognized less often were "uncertainty about palliative care in critical care settings" (6.8%) and "disagreements among nursing teams regarding providing palliative care" (8.3%). Conclusion: Specialist nurses understood palliative care but felt unprepared in primary palliative care due to limited knowledge. Improved education in primary palliative care and patient-family communication is needed in Japan's critical care settings.

Faithful Caregiving: Christian, Hindu, Buddhist and Muslim Spiritual Practices in Palliative Care

Faithful Caregiving: Christian, Hindu, Buddhist and Muslim Spiritual Practices in Palliative Care

Contactless radar-based heart rate estimation in palliative care – a feasibility study and possible use in symptom management

BackgroundHeart rate (HR) monitoring is a medical standard to provide information about a patient’s health status. In palliative care, relationship and social engagement are crucial therapeutic concepts. For fear of disrupting communication, social contact, and care, continuous HR monitoring is underutilised despite its potential to inform on symptom burden and therapeutic effects. This study investigates radar-based HR monitoring as an innovative and burden-free approach for palliative care patients, compares its accuracy with conventional ECG methods, and shows potential for therapeutic guidance.MethodsA single-centre, comparative clinical trial was conducted with palliative care patients at the ward of the Department of Palliative Medicine of the University Hospital of Erlangen. The HR measurements obtained with radar were compared with Holter ECG (study arm I, overnight) and Task Force® Monitor (TFM)-based ECG validation recordings (study arm II, one hour). In addition, long-term radar measurements without validation were analysed in comparison with clinical health records (study arm III).ResultsBoth validation methods showed correlation by scatter plot, modified Bland-Altman plot, and equivalence testing. N = 34 patients participated in study arm I. HR of 4,079 five-minute intervals was analysed. Radar measurements and ECG showed high agreement: difference of HRs was within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}5 bpm in 3780 of 4079 (92.67%) and within ±13.4 bpm (\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}1.96 times the SD of the mean) in 3979 (97.55%) intervals, respectively. In study arm II, n = 19 patients participated. 57,048 heart beats were analysed. The HR difference was within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}5 bpm for 53,583 out of 57,048 beats (93.93%) and within \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\\pm\\:$$\\end{document}8.2 bpm ( ± 1.96 times the SD of the mean) in 55,439 beats (97.25%), respectively. Arm III showed HR changes extracted from radar data in correlation with symptoms and treatment.ConclusionRadar-based HR monitoring shows a high agreement in comparison with ECG-based HR monitoring and thus offers an option for continuous and above all burden-free HR assessment, with the potential for use in symptom management in palliative care, among others. Further research and technological advancements are still necessary to fully realize this innovative approach in enhancing palliative care practices.

Facing Illness Together: Understanding the Role of the Couple in Palliative Care.

Serious illness is rarely experienced by patients in isolation. Many patients present to palliative care (PC) accompanied by their intimate partner. The intimate partnership is a critical axis around which many patients' experiences of serious illness revolve. However, there is a lack of literature and training on how PC clinicians can effectively support couples as a unit. Many existing PC communication strategies can be expanded to the dyadic unit, offering more holistic support for patients, partners, and the entity of their relationship. This paper integrates concepts from couples therapy, psychology, and PC communication to provide insights into the emotional, psychological, interpersonal, and practical challenges couples face during serious illness, as well as opportunities for growth and resilience. Key strategies for PC clinicians include helping couples navigate shifts in relational identity, share the "emotional housework," and transform conflict into connection. Concrete techniques are illustrated throughout this manuscript, employing clinical micro-vignettes to demonstrate their practical application in PC practice. Recognizing the couple as a unified entity empowers clinicians to foster open communication, helping couples maintain connection and evolve intimacy throughout the illness journey. By applying relational concepts and acknowledging the couple's shared experience, PC clinicians can enhance the quality of life for both patients and their partners. Conceptualizing the couple as a distinct entity within PC practice can deepen clinician-patient communication and improve therapeutic effectiveness.

The ethical dimensions of utilizing Artificial Intelligence in palliative care

Palliative care aims to improve the quality of life for seriously ill individuals and their caregivers by addressing their holistic care needs through a person- and family-centered approach. While there have been growing efforts to integrate Artificial Intelligence (AI) into palliative care practice and research, it remains unclear whether the use of AI can facilitate the goals of palliative care. In this paper, we present three hypothetical case examples of using AI in the palliative care context, covering machine learning algorithms that predict patient mortality, natural language processing models that detect psychological symptoms, and AI chatbots addressing caregivers’ unmet needs. Using these cases, we examine the ethical dimensions of utilizing AI in palliative care by applying five widely accepted moral principles that guide ethical deliberations in AI: beneficence, nonmaleficence, autonomy, justice, and explicability. We address key ethical questions arising from these five core moral principles and analyze the potential impact the use of AI can have on palliative care stakeholders. Applying a critical lens, we assess whether AI can facilitate the primary aim of palliative care to support seriously ill individuals and their families. We conclude by discussing the gaps that need to be further addressed in order to promote ethical and responsible AI usage in palliative care.

Per-Patient Illness Trajectory Analyses.

Background: Summary statistics often hide individual patients' suffering, thereby impeding quality improvement efforts. Objectives: We aimed to show the experience of a population with health care toward the end of life while preserving the experience of the individual. Design: We developed a data display method called per-patient illness trajectory analysis. We tested it using a demonstration cohort of 192 patients with cancer referred to a regional Swedish specialized home-based palliative care practice. Chart review provided detailed information about illness trajectory events with a focus on unplanned hospitalization. Results: We created per-patient timelines spanning from cancer diagnosis until death and using a logarithmic scale: Compared with a conventional, linear timescale, this scale expands the time resolution toward the end of life. The method fosters the assessment of unmet palliative care need and care quality for individuals, small high-need groups, and populations. Conclusion: In populations of up to 200 people, per-patient illness trajectory analysis is feasible and promising. Using random sampling, it could be extended to larger populations.

EOLP-02. END-OF-LIFE CHALLENGES IN NEURO-ONCOLOGICAL PATIENT CARE: A YOUNGNOA SURVEY

Abstract BACKGROUND Malignant brain tumors inevitably relapse, almost always causing significant functional and neurological impairments. Thus, palliative care is crucial in managing individuals with malignant brain tumors. It is essential for neuro-oncologists to be well-prepared to openly communicate about and meet the palliative needs of these patients. With this survey, we sought to evaluate palliative care practices in Germany and their impact on the treatment of neuro-oncological patients. METHODS We conducted an anonymous, interdisciplinary survey targeting palliative care practices among neuro-oncologists in Germany, all members of the Neuro-oncology Working Group of the German Cancer Society. The questionnaire, designed in close coordination with board-certified palliative care specialists, was distributed to 450 physicians. It collected personal information and assessed respondents’ knowledge of and access to palliative care structures. The survey was conducted online from March 31 to April 30, 2023. RESULTS Ninety-two physicians completed the survey. Of these, 81 (88%) reported feeling comfortable with end-of-life conversations, while 11 (12%) did not. No significant differences were observed between the two subgroups regarding their level of medical education (p=0.7140), workplace (p=0.4966), sex (p=0.9999), medical specialty (p=0.5478), or region of practice (p=0.9999). However, those comfortable with end-of-life discussions had significantly more palliative care training either during specialty training (p=0.0475) or through active participation in palliative care courses (p=0.0254). Further detailed analysis is in progress. CONCLUSIONS The survey indicates that while the majority of participants are comfortable with end-of-life discussions, a clear correlation exists between their comfort level and the extent of palliative care training received. This highlights the critical need for enhanced and targeted palliative care education within neuro-oncology training programs to prepare physicians for the complex communication and care challenges in neuro-oncological palliation. Further analysis will continue to explore additional educational and systemic factors that could increase the quality of palliative care in neuro-oncology.

Formulation in Palliative Care: Elevating Our Potential for Therapeutic Communication.

A fundamental principle of clinical reasoning is that assessment precedes plan; clinicians are taught to base interventions on the presumed etiology of a presentation. A notable exception is in the domain of communication education, where training is focused heavily on tools and interventions, with minimal focus on the assessment that informs which tools or strategies to select with a given patient. The concept of formulation (foundational in psychotherapy education) provides a framework with which to address this gap, enhancing a clinician's ability to be more therapeutically effective with the communication tools at their disposal. Our formulation serves as the compass that guides our decisions around communication, allowing us to conceptualize communication as a therapeutic intervention and align our approach to communication with the broader philosophy of clinical reasoning. This manuscript explores the concept of formulation, the direct relevance and applicability to palliative care, sample cases to underscore the impact of this framework, and high-yield tips for use of formulation in general palliative care practice. Palliative care clinicians and IDTs can readily apply formulation in synergy with the communication tools they already possess, elevating their ability to address patients' psychological needs.

Spiritual needs of family caregivers in palliative care

ObjectiveThe primary aim of this study is to elucidate the spiritual needs encountered by family members who intricately engage in the progression of illness within the palliative care framework, thus assuming the paramount responsibility of caregiving.MethodsThis study was approved by the Institutional Review Board and Ethics Committee of the University of Health Sciences İzmir Tepecik Training and Research Hospital (17/01/2022–2022/01–16). The research was designed as a prospective study. It was conducted through face-to-face, interactive interviews with family caregivers of patients admitted to the palliative care unit at Tepecik Training and Research Hospital between April 2022 and December 2022. The interviews were performed using a phenomenological approach and structured in a question-and-answer format. Data from twenty family caregivers were analyzed using thematic analysis. The questions were specifically designed to explore the psychological processes, spirituality, conceptions of God, meaning-making, and coping strategies of the family caregivers.ResultsCaregivers experienced various psychological and emotional states progressing through stages of denial, anger, and acceptance. Spirituality emerged as a critical coping mechanism providing strength and meaning amidst caregiving challenges. Caregivers’ perceptions of God varied from loving to punitive, influencing their interpretations of suffering and caregiving roles.ConclusionThis study underscores the importance of integrating spiritual support into palliative care practices. Recognizing and addressing caregivers’ spiritual needs is crucial for enhancing their well-being and improving the quality of palliative care delivery. Training healthcare professionals in spiritual care and implementing targeted interventions can effectively support family caregivers in their caregiving journey.

Self-reported pain assessment, core competence and practice ability for palliative care among Chinese oncology nurses: a multicenter cross-sectional study

ObjectiveThe study was to survey the current situation and explore the relationship between pain assessment ability, palliative care core competence and palliative care practice ability among oncology nurses in mainland China.MethodsA multicenter cross-sectional study design was employed. Study data were collected in 26 tertiary hospitals among 1198 registered oncology nurses in the oncology department in Hubei province, China. A web-based survey was conducted using a stratified random integral sampling method to obtain data. All variables were measured using standardized instruments. Data was analyzed using SPSS 26.0 and AMOS 26.0 statistical software. All statistical tests were two-sided, with the significance level set at P < 0.05. The structural equation model was utilized to test the mediation effect of pain assessment ability on the pathway from palliative care core competence to palliative care practice ability.ResultsThe mean scores for pain assessment, core competence and practice ability were 125.68 (SD = 31.16), 76.67 (SD = 19.59) and 67.17(SD = 12.57), respectively. Pearson correlation analysis revealed significant positive correlations among the PCPS, EPCS, and Self-PAC scores of the oncology nurses (P < 0.01). The association between core competence and palliative care practice ability was mediated by pain assessment ability (ES = 0.125, 95%CI: 0.090–0.168).ConclusionsTo enhance the effectiveness of palliative care practice, managers need to strengthen the core competencies of palliative care nurses and their ability to assess patients’ pain, as these two factors will promote the practical abilities of oncology nurses.

The experiences of rural generalist occupational therapists in provision of palliative care in rural, regional, and remote Australia: A phenomenological inquiry.

Access to specialist palliative care in rural and remote Australia is limited, resulting in a reliance on generalist health professionals to provide these services. Although literature exists concerning the experiences of some health professions in providing rural generalist palliative care, little is known about the experiences of occupational therapists who fill these roles. This paper aims to address this gap in knowledge by exploring the experiences of rural generalist occupational therapists in the provision of palliative care in rural, regional, and remote Australia. An interpretive phenomenological approach guided this research. Data were collected from eight rural generalist occupational therapists across Australia, using semi-structured, in-depth interviews. Data were thematically analysed to develop a nuanced understanding of lived experience in provision of palliative care. Due to the focus of this research on the practice experiences of occupational therapists, consumer and/or community involvement was not undertaken in its design or implementation. Three key themes were identified: 'community connections - a double-edged sword'; 'frustrations with structural and contextual factors limiting quality palliative care service provision'; and 'education and support as enablers of professional preparedness for palliative care service provision.' Taken collectively, these findings shed light on a variety of challenges and opportunities associated with rural generalist palliative care occupational therapy practice, as well as clues to their effective management. Knowledge of rural generalist occupational therapists' experiences can inform workforce development, promote retention of rural occupational therapists, and improve outcomes for dying persons, their families and caregivers. This study offers new insights into challenges and opportunities for rural generalist occupational therapy practice in palliative care and highlights the way in which both, new and existing support structures may be of value in promoting practice capacity and therapist wellbeing. It can be hard to get expert support for dying people in areas outside of cities in Australia. Health workers in these areas should be helped to provide good care. In this study, we spoke with some health workers in rural and remote areas who occasionally work with people who are dying. They told us that people in these areas were often helpful in supporting people who are dying because they felt close to them. But they also said that this made caring sadder for health workers because, sometimes, they were close to the people who were dying too. Having too much work, not enough experience and long distances made providing good care extra difficult. The health workers said that getting expert advice or using online teaching could help them improve their practice, but finding the time to do this is hard.

Implementing palliative and end of life care for people with dementia.

Dementia is characterised by memory loss, behavioural changes and decline of cognitive, social and physical functions and is a life-limiting condition. At the point of diagnosis it is classed as a palliative condition, yet there is limited public and healthcare professional awareness that, once diagnosed, a person will either die of dementia or die with dementia. This article discusses how the recognition and timing of the need for palliative dementia care is pivotal in providing person-centred care. The authors explore factors such as optimal prognostication, advance care planning, staff education and accessing support from palliative and end of life care teams and Admiral Nurses. The authors also use a fictional case study to demonstrate best practice in palliative dementia care.

Perinatal palliative care in low- and middle-income countries: a scoping review.

2.4 million neonatal deaths and 2.6 million stillbirths occur each year. Over 98% of perinatal loss occurs in low- and middle-income countries. Despite the global burden of perinatal loss, access to relevant perinatal palliative and psychosocial care is poor and understudied. In this review, we synthesize perinatal palliative care literature from low- and middle-income countries. We focus on the clinical practice of perinatal palliative care and educational models being used in resource-constrained settings. We used a systematic scoping review approach, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. The PubMed, Scopus, Embase, Cochrane, CINAHL, and Global Health (embsco) databases were searched. There were no date or language restrictions placed during the search. Study selection was conducted using Covidence to facilitate a staged review process. A total of 10,145 articles remained after removing duplicate studies. Following the three-staged review, 81 studies were included in our analysis. The largest portion of published perinatal palliative care literature focused on clinical care (n=44). Nine studies focused on provider training in perinatal palliative care and 28 studies addressed parent or family experience. Of the included studies, 84.9% had a first or last author from a low- or middle-income country and 91.8% included an author from the country of focus in the manuscript. The findings presented in this scoping review reveal that healthcare workers and families desire improved guidelines about perinatal palliative care that reflect the realities of local culture and resources. Additionally, providers need enhanced training in perinatal palliative care techniques and management approaches that can be applied in a range of clinical settings. Global perinatal palliative care strategies must encompass compassionate communication with families, psychosocial support after stillbirth or neonatal death, and emotional and mental health support for healthcare workers who provide perinatal palliative care.

Knowledge, attitudes, practices of cancer palliative care and their associated factors among nursing officers in Apeksha Hospital, Maharagama

Introduction: Nursing officers, having a good knowledge, favourable attitudes, and correct practices in cancer palliative care uplift patient’s quality of life. Objectives: To describe the level of knowledge, attitudes, practices of cancer palliative care and associated factors among the nursing officers in Apeksha Hospital, Maharagama. Methods: A descriptive cross-sectional study was carried out among 252 participants with more than one year of work experience at Apeksha Hospital, Maharagama. Stratified sampling technique was adopted to select the nursing officers from different wards. Data were collected using a validated self-administered questionnaire. Sum of points of each participant and the percentage was calculated. Depending on the mean score they were categorized into groups accordingly. Data were analysed initially by a descriptive analysis and then by Chi square test using SPSS software version 26. P&lt;0.05 was the significance level. Results: Response rate was 70. %. The mean age of the study participants was 32.9 (SD=6.55) years. The majority (59.5%) had good knowledge, 53.2% had favourable attitudes and 54% engaged in correct practices. Mean knowledge score was 26.4 (SD=3.44). Nurses above 30 years of age, married and having more than 10 years’ experience had significant association with knowledge (p&lt;0.05). Most of the participants who had good knowledge had correct practices (p&lt;0.001). Most of the participants those who had favourable attitude had correct practices (p&lt;0.001). Association of level of knowledge and attitude was not found to be statistically significant (p=0.109). Conclusion: The majority of the nurses had a good knowledge, favourable attitudes and were engaged in correct practices in palliative care. There is a significant association between the year of experience and the nurses’ knowledge on palliative care. Having a good knowledge and favourable attitude on palliative care were positive factors for correct practices.Keywords: Knowledge, Attitude, Practices, Cancer palliative care, Nurses

"Who You Are and Where You Live Matters": Hospice Care in New York City During COVID-19 Perspectives on Hospice and Social Determinants: A Rapid Qualitative Analysis.

Context: Social determinants of health (SDOH) impacted the quality of home hospice care provided during the COVID-19 pandemic. Perspectives from professionals who provided care identify challenges and lessons learned from their experience. Objective: To examine hospice professionals' perspectives of how SDOH affected the delivery of high-quality home hospice care in New York City (NYC) during the COVID-19 pandemic. Methods: We conducted semistructured interviews with 30 hospice professionals who delivered care to home hospice patients during the COVID-19 pandemic in NYC using a qualitative descriptive design. Purposive sampling was used to recruit professionals from a range of disciplines including physicians, advanced practice providers, nurses, social workers, chaplains, and hospice administration and management. Participants worked for one of two large NYC metro hospices and one outpatient palliative care practice serving the five boroughs of NYC and the surrounding suburbs. Rapid qualitative analysis was used to identify themes. Results: Thirty hospice professionals were interviewed, spanning a variety of clinical and administrative roles. Most (21 out of 30) reported that social determinants affected access and/or delivery of equitable hospice care. Two key themes emerged from interviews: (1) SDOH exist and affect the delivery of high-quality care and (2) disparities were exacerbated during the COVID-19 pandemic resulting in barriers to care. Subthemes outline barriers described by hospice professionals: decreased hospice enrollment, telehealth challenges, resulting in deficient patient/family education, shortages of nursing assistants in some neighborhoods, and diminished overall quality of hospice care for some patients. SDOH created barriers to hospice care through neighborhood factors, resource barriers, and system challenges. Conclusion: SDOH provide a context to understand disparity in the provision of hospice care. COVID-19 exacerbated these conditions. Addressing multidimensional barriers created by SDOH is key in creating high-quality and equitable hospice care, particularly during a crisis.

Scaffolding patient agency: Conceptualising readers' cognitive work in the comic gutter.

A life-limiting illness can erode an individual's positive sense of self. Storytelling can help counteract this, through scaffolding patients' agency and supporting them in acting to change something which matters to them. This article explains how visual stories - comics - are used within the PATCHATT intervention to support the redevelopment of a person's agential self. Through the provision of a conceptual map, this article explores the gutter as a liminal space, arguing for the importance of the deep reader engagement which takes place there. It uses Bob's comic, a story used within PATCHATT, to explore how reflexivity and imagination work together within the liminal space of the gutter to stimulate and enhance palliative care patients' agential change leadership. It concludes by considering the implications of the argument put forward for palliative care practice.

Living for the Moment - How Important Is It in the End of Life?

This essay investigates the role of present-moment living in end-of-life care, drawing on reflections from a personal patient encounter in a palliative care setting, Mrs. B, a 63-year-old patient with terminal squamous cell lung cancer, whose experience underscores the impact of living with a sense of fulfillment and joy despite a life-limiting diagnosis. Mrs. B's approach to her illness-marked by an optimistic acceptance of mortality and a focus on daily joys-challenges traditional palliative care paradigms that emphasize somberness and future-oriented care. Through detailed narrative and reflective analysis, the essay highlights how Mrs. B's resilience and spiritual beliefs contributed to her ability to maintain a positive outlook in the face of terminal illness. This case study illustrates the potential for joy and present-moment living to coexist with palliative care practices, offering a nuanced perspective on patient care. The discussion extends to the implications for healthcare professionals, advocating for a more adaptable and empathetic approach that aligns with individual patient values and preferences. This reflection calls for a shift in palliative care practices towards recognizing and supporting the diverse ways patients navigate their end-of-life experiences.

Journeys into palliative care: Social workers' narratives of mobilising and sustaining practice

INTRODUCTION: With Aotearoa, New Zealand's increasing diversity and ageing population, social work has a vital role in palliative care practice. This study advances the understanding of palliative care social work and its implications for practice, education and support from a practitioners’ point of view. METHODS: Utilising a constructivist case study approach, in-depth data was collected from social work practitioners about their pathways and practices in palliative care. Purposive and snowball sampling techniques were employed, resulting in 12 individual semi-structured interviews and a focus group with 5 participants. FINDINGS: The participants' voices illustrate current social work practice and its implications from personal, pedagogical, and professional perspectives. Participants were often drawn to palliative care social work through career embeddedness and personal experiences of loss and grief. The study revealed how past, present, and future considerations shape palliative social work practice, including journeys to palliative care, mobilising social work practice, and sustaining support. Participants used various assessment tools based on service context, with limited exposure to palliative care in tertiary curricula. Most participants continued to seek post-qualifying professional development opportunities working in this field. CONCLUSION: The study underscores the importance of team support, ongoing education, and self-care for effective social work practice in palliative care. Recommendations include enhancing educational emphasis on palliative care, developing a New Zealand-based assessment tool for palliative care social work, and improving professional encounters related to death and dying. These insights can guide efforts to enhance palliative care social work practice in Aotearoa, New Zealand.