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Knowledge is needed about end-of-life care among patients with pre-existing severe mental disorders: Schizophrenia, bipolar disorder, and depression. This study aimed to explore the experiences with end-of-life care for patients with severe mental disorders, their relatives, specialised palliative care nurses and physicians, and general practitioners. Twenty semi-structured interviews were conducted and analysed using reflexive thematic analysis, hereby six interviews with patients, three with relatives, five with general practitioners, and six with specialised palliative healthcare professionals. Patients were selected with help from healthcare professionals. Four main themes were produced: thoughts about the future, healthy relations in end-of-life, changes in psychiatric condition in end-of-life, and the role of openness. Patients with severe mental disorders had wishes and fears for the future, and all participants expressed that healthy relations were crucial for patients at the end-of-life. However, sometimes this was challenged by prior complex relationships. It differed whether patients experienced a change in their psychiatric condition after having a terminal disease. Openness about severe mental disorders and end-of-life were regarded as important. Having the opportunity to openly discuss both wishes, fears, and mental disorders with healthcare professionals and having healthy relations are important for patients with severe mental disorders at the end-of-life. Insecurity about severe mental disorders among specialised palliative care professionals may lead to less openness about severe mental disorders. To optimise end-of-life care, patients need professionals to be present and available to discuss problems related to social, physical, existential, and psychiatric conditions., (© 2025 John Wiley & Sons Australia, Ltd.)

Objective: For patients with non-small cell lung cancer, microscopic residual disease (R1) is sometimes inevitable after sleeve lobectomy. However, the necessity for extensive pneumonectomy after sleeve lobectomy with R1 status remains unclear, especially when the patient cannot tolerate surgery., Methods: We retrospectively collected the clinical data of 366 patients who underwent sleeve lobectomy for microscopic residual disease (SLobR1) or pneumonectomy between 2015 and 2019 at Shanghai Chest Hospital, China. We used propensity score matching to balance the baseline characteristics between the SLobR1 and pneumonectomy groups and then analyzed the survival outcomes (overall survival and progression-free survival., Results: Propensity score matching balanced the baseline characteristics, resulting in 93 patients per group. Overall survival and progression-free survival did not differ between the SLobR1 and pneumonectomy groups. However, the subgroup analysis indicated that residual disease negatively affected early stage I disease in the SLobR1 group compared with the pneumonectomy group. In addition, the causes of death did not differ between the groups. Moreover, radiotherapy improved overall survival (P = .021) and considerably decreased the incidence of distant recurrence, similar to other studies. However, it increased the risk of extrathoracic lymph node metastasis., Conclusion: Palliative SLobR1 is acceptable, especially for patients who cannot tolerate extensive pneumonectomy. Furthermore, radiotherapy is necessary to reduce the recurrence risk., Competing Interests: Conflict of Interest/Disclosure The authors have no related conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The provision of palliative care has been seen to have a significant impact on the interprofessional health care team. Being emotionally present to support patients and families at their most stressful points in life can result in compassion satisfaction or compassion fatigue. Providing palliative care through the COVID-19 pandemic added another layer of complexity to this professional caregiving experience. Although efforts have been made by employers to support health care providers in the practices of self-care and mindfulness, the true experience of care providers was not known. This study was conducted from June 2020 to October 2020 to better understand the experiences of physicians, nurses, social workers, and spiritual care providers who were providing palliative care during the first wave of the pandemic. Twenty-five participants completed the Professional Quality of Life (The Concise ProQOL Manual: The Concise Manual for the Professional Quality of Life Scale) measure and open-ended questions to evaluate their experiences as health care providers. The findings resulted in an overarching theme of "Weathering the Storm" with 6 themes describing the experiences of the interprofessional team., Competing Interests: The author has no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Context: Many general pediatrics residents lack sufficient opportunities to conduct difficult conversations with families, particularly about end-of-life care. Simulation learning is an effective means of practicing professional skills. A pediatric palliative care (PPC) physician is uniquely suited to mentor residents and fellows learning to lead difficult conversations through simulation. Co-facilitation of the simulated difficult conversation by a bereaved parent or family member enhances the learning experience., Objectives: To report 11-years' experience simulating difficult conversations with bereaved parent-actors., Methods: PPC physicians developed two simulations to teach difficult conversations to clinical learners at a midwestern quaternary pediatric medical center. Bereaved parents and hospital chaplains co-facilitated the simulation. The first portrayed the death of an infant following emergency resuscitation, and the second, a goals-of-care conversation with the parent of a child with a degenerative condition. A de-novo evaluation rubric was prepared using the six Accreditation Council for Graduate Medical Education (ACGME) Core Competencies to evaluate the participant's performance in the simulation., Results: For the first simulated scenario (N = 194 residents; N = 16 fellows), residents improved significantly on 16/21 ACGME-based criteria between encounters; for the second (N = 118 residents; N = 14 fellows), residents improved significantly on 10/21 criteria. Fellows' performance did not improve significantly in either scenario, but they presented with high baseline scores., Conclusions: Simulations with bereaved parent actors improved general pediatrics residents' performance and comfort during difficult conversations and are transportable to diverse settings., Competing Interests: Disclosures and Acknowledgments The authors declare no conflicts of interest. We gratefully acknowledge the invaluable contribution of parent-actors and co-facilitators: Bob Griffiths, Beverly and Jeff Norris, Kelly Shackelford, Shelley White, Lori Wunderle, Monica Coon-Anda, MA, BCC, Kim Emery, MDiv, Mitchell Holley, MDiv, John Morgan, MDiv, MA, BCC, Annie Elliott, MD, and Catherine Kelly-Langen, MD. We also gratefully acknowledge collaborators: Zachary Fryda, DO, JoEllen Weilnau, PharmD, Brooke Johnston, MD, Josh Dower, MD, Michael Holder, MD, and Starla Martinez, MD. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Of note, 15% to 20% of patients with duodenal or periampullary malignancies develop gastric outlet obstruction (GOO). Although small randomized trials have reported more rapid recovery and shorter hospital stay with endoscopic stenting (ES), limited studies have evaluated outcomes at a national level. The current study characterized short-term clinical and financial outcomes associated with gastrojejunostomy (GJ) vs ES in malignant GOO., Methods: Adults with malignant GOO treated with ES or GJ were identified in the 2016-2020 Nationwide Readmissions Database. Entropy balancing was used to balance covariates between groups, and multivariate regression was used to evaluate the association between GJ or ES and in-hospital mortality, total parenteral nutrition (TPN) use, complications, length of stay (LOS), costs, and 90-day readmission., Results: Of 8186 patients with GOO, 5603 (68.4%) underwent ES, and 2583 (31.6%) underwent GJ. The cohorts were similar in age, female/male sex, and comorbidities. However, patients who underwent GJ were more commonly frail. After risk adjustment, mortality, composite complications, and 90-day readmission were comparable between patients who underwent GJ and those who underwent ES. GJ was associated with greater odds of blood transfusion (adjusted odds ratio [AOR], 1.74; 95% CI, 1.37-2.21) and postoperative TPN use (AOR, 3.76; 95% CI, 2.64-5.35). Furthermore, patients who underwent GJ experienced a significant increment of >$15,800 in costs and >6.9 days in LOS. In subgroup analysis of patients with metastatic disease, mortality, complications, and readmission remained comparable among palliation strategies., Conclusion: ES seems to yield comparable short-term morbidity and mortality relative to GJ with significant cost reduction. Increasing access to endoscopic technology and regionalizing care to high-volume centers may help improve outcomes for patients with malignant GOO., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Palliative care has become a standard of care for patients with serious illnesses. However, many rural hospitals do not have access to specialized palliative care consultation. This article describes the journey taken by a palliative care team to improve access to palliative care and overall patient outcomes at rural hospitals throughout the state of South Carolina by using the telehealth modality. The impact, challenges, and benefits of the program are discussed., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Disenfranchised grief is a form of grief that remains unacknowledged and unsupported. Building on Doka's foundational concept of disenfranchised grief, the guiding framework for this pilot project was the Knowledge to Action framework. This study is a quantitative cross-sectional web-based survey, which included a validated questionnaire: the Witnessing Disenfranchised Grief Scale. The Witnessing Disenfranchised Grief Scale measures how participants feel their grief is recognized and validated by friends and family versus administrators or supervisors. A χ2 analysis (P < .05) was completed with findings suggesting that palliative care advanced practice registered nurses broadly experienced higher levels of support from witness C types (colleagues, coworkers, family, or friends) when compared with witness A types (supervisors, bosses, or persons with administrative responsibility). A 2-sample t test also demonstrated significance when comparing both witness groups. Overall mean scores were significantly higher (P < .001) in the witness C group (mean, 68.7) versus the witness A group (mean, 51.2). Higher mean scores indicate a higher level of support reported by the participant. The findings affirm that advanced practice registered nurses working in palliative care continue to grieve both death and non-death-related losses and report a higher degree of witnessed grief by their friends, family members, and colleagues. Participants' supervisors, bosses, or administrators provide less grief acknowledgment., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Background: Rural communities, like other places in the United States, face a growing need for palliative care. Community health workers (CHWs) are one potential way to expand the ability to provide palliative care. This scoping review explores what is known about CHWs involved in palliative care teams in the United States., Objective: This scoping review is intended to outline current evidence related to best practices and factors that lead to the integration of CHWs into palliative care teams., Methods: A scoping review was conducted between June 2022 and April 2023 using 3 databases (CIHAHL, ScienceDirect, and PubMed) to identify included studies. Studies included were published between 2000 and 2022; discussed CHWs, lay health navigators, or associated terms, and palliative care in the United States; and addressed CHWs' integration with health care teams., Results: The 24 studies included in this review encompassed qualitative and quantitative reports of CHW interventions that successfully increased advanced care planning documentation, improved patient symptoms, and increased hospice use. Home visits and telephone visits allowed CHWs to provide education, advocate, make referrals, and serve as social support. Stakeholders generally support the role of CHWs in palliative care teams and understand the way they can support "cultural translation.", Conclusions: CHWs have the potential to be integrated into palliative care teams, but there is variability in the approach toward roles within palliative care teams, training for CHWs, and strategies for integration within clinical teams., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

While Comfort Feeding Only is appropriate for patients with advanced dementia, its emphasis on assiduous hand-feeding that may prolong life for years fails to accommodate the preferences of those who do not want to continue living with this illness. Some have proposed advance directives to completely halt the provision of oral nutrition and hydration once a person has reached an advanced stage of dementia. However, these directives may fail to address patients' discomfort, caregivers' obligations, or current care and regulatory standards when patients reside in facilities. In response to these dilemmas, we introduce Minimal Comfort Feeding (MCF). Rather than offering food and liquids proactively as with Comfort Feeding Only, caregivers provide nutrition and hydration only in response to signs of hunger and thirst. While further study is required to define and negotiate challenges in operationalizing this approach, MCF provides a framework that resolves competing ethical and clinical considerations in caring for those with advanced dementia., Competing Interests: Disclosure and Acknowledgments The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors and declare no conflicts of interest. Special thanks to Christine Clement, MSW; Ellen Kauffman, MD; Cathy Scarcello, RN; Nancy Simmers, RN; Shobha Stack, MD, PhD; and Eric Walsh, MD., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Electronic patient-reported outcome measures (e-PROMs) offer advantages in palliative cancer care, including rapid completion, improved data quality and direct storage, improving clinical decision-making. The electronic Integrated Palliative Care Outcome Scale (e-IPOS) in this context enables thorough self-assessment by patients, enhancing symptom management and self-reflection of their current situation., Aim: To evaluate the feasibility of implementing the e-IPOS in home palliative cancer care., Outcomes: The primary outcomes included the enrollment consent rate, study retention rate, e-IPOS completion rate and response completeness, and the number of clinical assessments and interventions performed during home visits. The secondary outcomes were the number of unscheduled visits and patients' perceived quality of life., Design: A two-group quasiexperimental clinical pilot study. The control group received standard palliative care, the intervention group received standard care along with weekly e-IPOS completion during home visits. Both groups were enrolled for 4 weeks., Setting/participants: Adults with advanced cancer from the home palliative care unit of the Istituto Nazionale dei Tumori of Milan., Results: Twenty-three patients were enrolled (74.19%), and 20 completed the study (drop-out: 13.04%). 82.5% of the expected e-IPOS responses were received, of which 96.9% were fully complete. In the intervention group, the Wilcoxon test showed an increase in identified needs and documented interventions ( P < .05) and a decrease in unscheduled visits ( P < .05)., Conclusion: It is feasible to recruit people via home palliative care for an e-IPOS implementation study. Future fully powered studies should investigate the feasibility and assess patients' perceptions of its use to better understand its clinical benefits., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Historically, in-person contact between patients and nurses in home-based care has been pivotal in palliative care and hospice care. The provision of home-based palliative care services could be challenged by the projected increase in patients who need palliative care and by the expected shortage of nurses. Digital health services could constitute one measure for delivering high-quality palliative care, enabling patients to stay home. Nurses often follow up these patients remotely. Because digital health services are increasingly implemented in home-based palliative care, it is imperative that nurses consider the ethical concerns regarding such service delivery. Neglecting ethical concerns could result in unintended consequences for patients and nurses and inhibit care delivery. The aim of this article was to explore ethical concerns of digital health services in home-based palliative care through the lens of the 4 biomedical principles: autonomy, beneficence, nonmaleficence, and justice. This study utilized a bottom-up methodology conducting a subanalysis of the results of 2 previous reviews., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Left ventricular assist devices can improve survival rates and quality of life for individuals with advanced heart failure. However, complications and repeated hospitalizations are common. Palliative care involvement is required before and after left ventricular assist device placement. However, limited guidance on the objectives and structure of palliative care consultation in the left ventricular assist device context has led to variation in how these consultations are conducted and confusion around the consultations' objectives and structure. We piloted and modified an evidence-based, semistructured script to guide pre-left ventricular assist device palliative care consultations. Palliative care clinicians were trained on use of the script. Presurvey and postsurvey were used to examine changes in clinician confidence and assess script acceptability. Script use did not result in changes to clinicians' confidence. Clinicians felt the script provided valuable structure and guidance but suggested improvements to script structure and flow, emphasizing the need for a standardized workflow and closer collaboration between palliative care and heart failure teams., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Shared decision making is a concept essential to establishing meaningful goals of care that reflect one's preferences, values, beliefs, culture, and quality of life. This rapid review considered shared decision making from the perspective of seriously ill or medically complex children receiving inpatient palliative or end-of-life care, where shared decision making is made on behalf of and in the child's best interest. A total of 118 articles were screened, resulting in the selection of 12 articles using a systematic process. Emergent themes noted and discussed include the roles of family and clinicians, explorative communication, transparency, cultural implications, and ethical challenges., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

We present a case of insatiable appetite and harmful overeating in a hospice patient that showcases the burden of hypothalamic hyperphagia, a rare complication of brain cancer. While confounders exist such as progression of disease and prior tapering of dexamethasone, in this case the initiation of metformin was associated with substantial appetite reduction and resolution of our patient's debilitating food-seeking behaviors. We will explore metformin as a potential cost-effective option for palliation in a hospice setting and explore some of the physiologic mechanisms involved., Competing Interests: Disclosures and Acknowledgments The authors declare no conflicts of interest., (Copyright © 2024 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Neonatal palliative care is an essential component of comprehensive neonatal care; however, its implementation remains challenging worldwide, particularly in low- and middle-income countries due to limited resources, cultural barriers, and lack of training., Objectives: The aim of this study was to investigate the structural characteristics of neonatal nurses' attitudes towards neonatal palliative care and their intention to provide such care using network analysis to identify key influencing factors and interrelationships., Design: A multi-center cross-sectional study., Setting: The setting was 92 hospitals across 28 provinces in mainland China., Participants: A convenience sampling method was employed to recruit 893 neonatal nurses from October 2023 to February 2024., Methods: The web-based survey included a sociodemographic questionnaire, the simplified Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS), and a single question gauging participants' intention to provide neonatal palliative care. Network analysis techniques were used to examine the structural characteristics of the attitude network., Results: A total of 767 valid questionnaires were received. The estimated network comprised 26 nodes representing individual NiPCAS items, with 150 non-zero edges out of a possible 325 connections. In-service education experience emerged as the most central and influential node, demonstrating the highest centrality (strength = 2.511; bridge strength = 3.144) and predictability (R 2  = 0.475). This was followed by the ideal palliative care environment and staff support for palliative care. On average, 29.3 % of each item's variance could be accounted for by surrounding items. The strongest associations with the intention to provide neonatal palliative care were observed with beliefs about the necessity of palliative care in neonatal nurse education (edge weight = 0.29)., Conclusions: The findings highlight the pivotal role of in-service education experience in shaping nurses' attitudes towards neonatal palliative care, suggesting that educational interventions may significantly influence overall attitudinal structures. The strong associations between the intention to provide neonatal palliative care, and beliefs about the necessity of palliative care in neonatal nurse education, further reinforce the critical role of education in fostering positive attitudes and intentions. The significance of organizational and resource-related factors suggests that efforts to improve neonatal palliative care should focus on enhancing staff support and creating supportive work environments., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Inadequate sleep is a common problem among those receiving palliative care services, yet there is limited knowledge regarding nonpharmacological sleep interventions among staff. An educational online program was developed to address this deficit. This study assessed the extent of knowledge acquired following the online educational sleep program and determined the feasibility of using this intervention with palliative care professionals. Thirty-one participants (54.8% licensed nurses) completed the educational program. Most worked in either inpatient residential (38.7%) or home-based (35.5%) settings and had considerable experience working in palliative care. The total average pretest score was 67.5% (SD, 6.5%; range, 56.3%-79.2%) compared with the total average posttest score of 93.1% (SD, 6.0; range, 78.7%-100%). There was a significant mean difference in the scores as documented by a paired-sample t test ( t30 = -21.9, P < .0001). The results did not differ between the disciplines and those working in each setting or by years of experience. The study had a 51.6% recruitment rate and an 88.6% retention rate. The significant increase in the palliative care professionals' knowledge following the educational program suggests it is a useful tool for nurses, aides, social workers, and managers to improve direct care., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 by The Hospice and Palliative Nurses Association. All rights reserved.)

Background: Children with end-stage solid tumors would benefit from established nonsurgical options for palliative site-directed local control with the intent of improving quality of life (QOL) and extending survival. We investigated the practice and tolerability of palliative ablation strategies in patients with pediatric solid tumors., Methods: Children and young adults with solid tumors ineligible for surgical site-directed control were treated with palliative ablative strategies between 2010 and 2020 at five institutions participating in the Pediatric Surgical Oncology Research Collaborative. Demographic, histologic, and clinical data were retrospectively evaluated, and assessment of patient reasons for choosing ablative strategies was qualitatively assessed., Results: A total of 69 patients underwent 89 ablative procedures for 132 lesions. More than 10 histologies were represented, the most common of which were Ewing sarcoma (n = 15 patients), osteosarcoma (n = 13 patients), and rhabdomyosarcoma (n = 9 patients). Ablation techniques included cryoablation (n = 9 procedures/16 lesions), radiofrequency ablation (RFA) (n = 4 procedures/5 lesions), microwave ablation (MWA) (n = 5 procedures/12 lesions), and stereotactic body radiotherapy (SBRT) (n = 68 procedures/99 lesions). Grade 3 or higher adverse events (AEs) included pain requiring IV medication in cryoablation (three out of 12 procedures), RFA (one out of four procedures), and MWA (two out of five procedures), bleeding in MWA (two out of five procedures), and skin burns requiring surgical intervention in SBRT (one out of 68 procedures). Patients were generally hospitalized after percutaneous ablation (19 out of 21 cryoablation, RFA, and MWA procedures) but the hospital stay was short (mean/SD 1 ± 4 days). Only four patients who were already hospitalized experienced hospitalization extension due to undergoing an ablative procedure. The primary reason for pursuing ablative measures could be broadly categorized into four groups: treatment of unresectable disease either due to surgical inaccessibility or metastasis (n = 31), symptom relief, either pain or mass effect (n = 25), specific patient QOL concerns unrelated to pain or life prolongation (n = 5), and physiologic instability for otherwise resectable disease (n = 4). All patients undergoing treatment for symptom relief received SBRT., Conclusion: In this cohort of patients undergoing palliative treatment of incurable or unresectable pediatric solid tumors, ablation strategies were well tolerated. Further research is needed to determine patient reported outcomes after ablation strategies are pursued and patient and family satisfaction with the choice for ablative strategies. An understanding of institutional availability and ability to employ these strategies would also be informative., (© 2024 Wiley Periodicals LLC.)

A man in his late 50s was referred by a speech and language therapist for consideration of a palatal lift prosthesis (PLP) to improve his speech intelligibility. He presented with hypokinetic dysarthria characterised by reduced loudness, breathy voice and hypernasality. The patient had a diagnosis of progressive muscular dystrophy and mobilised in a motorised wheelchair. He was dependent for dressing and bathing, but independent for grooming. He had no cognitive impairment and provided his own consent. He was partially dentate and presented with generalised periodontal loss. This case report details the provision of a PLP in an individual with a terminal diagnosis to improve speech quality despite a poor periodontal state and worsening physical disability., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Objectives: Palliative care, which was formally established in the Global North, is now recognized globally as part of health care. As part of a larger study, we were interested in how decision-makers at a leading hospice in South Africa understood the changing local context and its influence on the delivery of services. We were interested in how the concept of "total pain," as outlined by Saunders, applies in a very unequal and under-resourced society in the shadow of a long, oppressive colonial, and apartheid past., Methods: We conducted face-to-face semi-structured interviews with 12 staff at St Luke's Combined Hospices in Cape Town, South Africa, and analyzed the data following Braun and Clarke's thematic analysis approach., Results: Four major themes emerged from the data. First, St Luke's has faced the challenge of serving a larger and far more diverse population than it had under apartheid. Second, the organization has undergone a process of rethinking holism and holistic services offered to palliative care patients in this context. Third, diversity and cultural sensitivity are key to how services are offered, and finally, the concept of "total pain" in this context is linked to questions of power and empowerment., Significance of Results: This study is small and situated within a particular context, and it is clear that more data are needed. Nevertheless, the study shows that considering the Global South and postcolonial context is important for thinking about total pain and a global system of palliative care which is sensitive to the majority world context.

Purpose: Improvements in the treatment of advanced cancer have increased life expectancy but have also increased the costs to healthcare systems, patients and their families. A systematic review is needed to summarize research work on the cost of cancer. The primary objective was to describe the characteristics and methodology of studies investigating the cost of cancer during the palliative phase. Secondary objectives were to assess whether palliative care interventions influence the costs of advanced cancer and to describe the costs explored and models used in cost-effectiveness studies., Method: According to the PRISMA guideline (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), Pubmed, Web of Science, NHS, EconLit and Google Scholar databases were screened from 11/01/2020 to 03/01/2024. All types of methods about the costs of the palliative phase of solid cancer were accepted. Study characteristics, economic perspective, time horizon and the type of costs explored were collected., Results: Of the 498 studies identified, 66 were included in the final analysis. Most (60%) used a retrospective methodology. Almost all (65, 98%) studied direct costs, and only 12 (18%) studied indirect costs. No article assessed intangible costs or the total cost of the palliative phase of cancer. The payer's perspective was most commonly adopted (39, 59%). The time horizon was less than 6 months in most cases (41, 63%). Eighteen studies (86%) highlighted that PC interventions were cost-effective., Conclusion: Existing evidence suggests that palliative care is cost-effective from the hospital and payer's perspective. More research is needed to evaluate the cost of informal caregiving and out-of-pocket expenses borne by patients., Competing Interests: Declarations. Ethics approval: This is a systematic review, no ethical approval is needed. Consent to participate: This is a systematic review, no consent to participate is needed. Consent for publication: This is a systematic review, no consent to publish is needed. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: More than 50% of patients with dementia visit the emergency department (ED) each year. Patients with dementia experience frequently unrelieved symptoms that can benefit from palliative care . Response to palliative care needs in the ED can be quite challenging and access to palliative care is generally scarce. The aim of this scoping review is to assess ED use and responsiveness to palliative care needs of patients with dementia in their last year of life., Methods: A scoping literature review following the Joanna Briggs Institute methodology. Electronic search of the literature was undertaken in Medline (PubMed), Web of Science, Scopus, Scielo, and APA PsycInfo, last updated on 19 February 2024., Results: Twenty-four studies were identified and confirmed that patients with dementia frequently resort to the ED near the end of life, frequently more than once in their last year of life. Eight studies directly addressed palliative care needs, suggesting significant rates of palliative care needs among patients with dementia and in comparison, to other oncological or non-oncological conditions. Infections and neuropsychiatric symptoms were the main reasons of admission to the ED. Access to palliative care was confirmed to be low., Significance of Results: This scoping review indicates that patients with dementia frequently resource to the ED in their last year of life with unmet palliative care needs. Although scarce access to palliative care and the existence of important barriers in the ED, palliative care intervention in this setting can be seen as an opportunity to attend palliative care needs and referral to palliative care services.

Objectives: To explore the potential of incorporating personally meaningful rituals as a spiritual resource for Western secular palliative care settings. Spiritual care is recognized as critical to palliative care; however, comprehensive interventions are lacking. In postmodern societies, the decline of organized religion has left many people identifying as "no religion" or "spiritual but not religious." To assess if ritual could provide appropriate and ethical spiritual care for this growing demographic requires comprehensive understanding of the spiritual state and needs of the secular individual in postmodern society, as well as a theoretical understanding of the elements and mechanisms of ritual. The aim of this paper is to provide a comprehensive and theoretically informed exploration of these elements through a critical engagement with heterogeneous literatures., Methods: A hermeneutic narrative review, inspired by complexity theory, underpinned by a view of understanding of spiritual needs as a complex mind-body phenomenon embedded in sociohistorical context., Results: This narrative review highlights a fundamental spiritual need in postmodern post-Christian secularism as need for embodied spiritual experience. The historical attrition of ritual in Western culture parallels loss of embodied spiritual experience. Ritual as a mind-body practice can provide an embodied spiritual resource. The origin of ritual is identified as evolutionary adaptive ritualized behaviors universally observed in animals and humans which develop emotional regulation and conceptual cognition. Innate human behaviors of creativity, play, and communication develop ritual. Mechanisms of ritual allow for connection to others as well as to the sacred and transcendent., Significance of Results: Natural and innate behaviors of humans can be used to create rituals for personally meaningful spiritual resources. Understanding the physical properties and mechanisms of ritual making allows anyone to build their own spiritual resources without need of relying on experts or institutionalized programs. This can provide a self-empowering, client-centered intervention for spiritual care.

Background: Telehealth-facilitated models of palliative care are a patient-focused way to deliver specialist care in or closer to home for people with a life-limiting illness. Telehealth can increase access to palliative care and support people experiencing symptoms of advanced disease in their own home, reducing the discomfort of travel. This retrospective cohort study examines the activity and outcomes of a regional telehealth-facilitated palliative care service to (i) describe which patients are most likely to use telehealth; and (ii) explore possible impacts of telehealth on patient outcomes including place of death, timely access to care, responsiveness to urgent needs and pain management., Methods: Analysis of service activity data (patient demographics, care modality, consultation frequency) and Palliative Care Outcomes Collaborative data registry (place of death, timely access to palliative care, responsiveness to urgent needs as measured by time in unstable phase, pain management) were undertaken. Outcomes were compared between patients who had no videoconsultations (n = 683) and those who had one or more videoconsultations (n = 524)., Results: Compared to people who had no videoconsultations, those who had at least one appointment via video were: more than twice as likely to die at home and spent a shorter amount of time in the unstable phase of palliation. Mixed results were found regarding timely access to palliative care. There was no significant difference in pain management between consultation modes., Conclusion: Telehealth-facilitated palliative care has multiple benefits, including the increased likelihood of fulfilling someone's wish to die at home, often their preferred place of death., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval to use this service activity and patient data was provided by the Gold Coast Hospital and Health Service Human Research Ethics Committee (HREC/2019/QGC/51879) and additionally ratified by The University of Queensland Human Research Ethics Committee (Clearance Number: 2019002355). The Gold Coast Hospital and Health Service Human Research Ethics Committee waived the need for informed consent to be obtained as the data was de-identified and an application for data release under the Public Health Act 2005 (PHA) was approved by data custodians and the office of the Director General of Queensland Health. Consent for publication: Not applicable. Competing interests: Although the evaluation that led to this manuscript was carried out independently through The University of Queensland research team members, authors AB and JB are employees of the palliative care service., (© 2024. The Author(s).)

Objectives: Explore humanitarian healthcare professionals' (HCPs) perceptions about implementing children's palliative care and to identify their educational needs and challenges, including learning topics, training methods, and barriers to education., Methods: Humanitarian HCPs were interviewed about perspectives on children's palliative care and preferences and needs for training. Interviews were transcribed, coded, and arranged into overarching themes. Thematic analysis was performed using qualitative description., Results: Ten healthcare workers, including doctors, nurses, psychologists, and health-project coordinators, were interviewed. Participants identified key patient and family-related barriers to palliative care in humanitarian settings, including misconceptions that palliative care was synonymous with end-of-life care or failure. Health system barriers included time constraints, insufficient provider knowledge, and a lack of standardized palliative care protocols. Important learning topics included learning strategies to address the stigma of serious illness and palliative care, culturally sensitive communication skills, and pain and symptom management. Preferred learning modalities included interactive lectures, role-play/simulation, and team-based case discussions. Participants preferred online training for theoretical knowledge and in-person learning to improve their ability to conduct serious illness conversations and learn other key palliative care skills., Significance of Results: Palliative care prevents and relieves serious illness-related suffering for children with life-threatening and life-limiting conditions; however, most children in humanitarian settings are not able to access essential palliative care, leading to preventable pain and suffering. Limited palliative care knowledge and skills among HCPs in these settings are significant barriers to improving access to palliative care. Humanitarian HCPs are highly motivated to learn and improve their skills in children's palliative care, but they require adequate health system resources and training. These findings can guide educators in developing palliative care education packages for humanitarian HCPs.

Objectives: To incorporate a longitudinal palliative care curriculum into obstetrics and gynecology (Ob-Gyn) residency that could become standardized to ensure competencies in providing end of life (EOL) care., Methods: This was a prospective cohort study conducted among 23 Ob-Gyn residents at a tertiary training hospital from 2021 to 2022. A curriculum intervention was provided via lecture and simulation. An inpatient palliative care rotation was also created for the intern class. Scores for knowledge and confidence were compared pre- and post-curriculum. Performance on patient simulations was compared for interns who had the inpatient palliative rotation versus those that had not in a crossover fashion. Number of palliative care consults was also compared before and during the curriculum. A pooled, weighted rank-based test was used for analysis of the data with a p -value < 0.05 considered significant., Results: One hundred percent of the 23 eligible participants participated in this study. A statistically significant increase in scores on all quizzes ( p -values 0.047, <0.001, and <0.001) and confidence surveys (composite score p -value < 0.001) was seen after curriculum completion. No statistically significant difference was able to be identified in standardized patient simulation performance. Palliative care consultation increased by 55%., Significance of Results: EOL care is a critical component of any physician's practice including obstetrician gynecologists. However, prior studies demonstrate a lack of standardized training. Our study demonstrates that a multimodal palliative care curriculum is an effective method to train Ob-Gyn residents and improve palliative care involvement in patient care.

Teaching death, spirituality, and palliative care equips students with critical skills and perspectives for holistic patient care. This interdisciplinary approach fosters empathy, resilience, and personal growth while enhancing competence in end-of-life care. Using experiential methods like simulations and real patient interactions, educators bridge theory and practice. Integrating theological insights and inclusive-pluralism encourages meaningful dialogue, preparing students to address patients' physical, emotional, and spiritual needs. This holistic pedagogy not only improves patient outcomes but also promotes collaboration and compassion in healthcare.

Background: Specialist palliative care teams (SPCTs) have significant benefits for patients with advanced disease or frailty, including improved quality of life, greater satisfaction with care, and less potentially inappropriate care at the end of life. Experienced SPCTs are recognised to have higher referral rates compared to novice teams. The aim of this study was to assess the development of hospital-wide integration of specialist palliative care (PC) and of SPCTs in Dutch hospitals between 2014 and 2020., Methods: Three cross-sectional surveys of SPCTs in Dutch hospitals were conducted in 2015, 2018 and 2021. Key members of the hospital SPCTs completed questionnaires about the preceding year that included items on hospital and PC program characteristics, hospital-wide integration of specialist PC, and SPCT characteristics (92 hospitals in 2015, 79 in 2018 and 74 in 2021). The analysis included hospitals with an operational SPCT, as determined by providing inpatient PC consultation services. Univariate analyses compared hospitals and SPCTs by year. Significance was determined by p-values < 0.05., Results: In 2014, 65% of participating hospitals provided inpatient PC consultations (n = 48). This increased to 92% in 2017 (n = 58) and 98% in 2020 (n = 48). Over the years, participating hospitals showed an increasing level of hospital-wide integration of specialist PC, such as an increased number of dedicated PC outpatient clinics (56% in 2020, compared with 47% in 2017 and 27% in 2014). The annual number of inpatient referrals to SPCTs has increased significantly over the years. The SPCTs have developed significantly in various aspects, including collaboration between primary and hospital care, the availability of services to patients at home and non-clinical activities., Conclusion: Over the years, Dutch hospitals have shown growth in hospital-wide integration of specialist PC. Specialist palliative care teams have made significant progress in increasing inpatient consultations, and in improving collaboration between primary and hospital care., Competing Interests: Declarations. Ethics approval and consent to participate: This study involved organizations (hospitals) and no human subjects. Therefore, within the scope of the Dutch Medical Research Involving Human Subjects Act (WMO) and according to the Central Committee on Research involving Human Subjects (CCMO) this type of study is exempt from approval of an ethics committee. As the respondents were no research subjects themselves and solely provided organisational data, respondent participation in the survey was regarded as implicit consent. All respondents (i.e. key members of specialist palliative care teams or hospital palliative care program leaders) were informed that participation was anonymous and voluntary and withdrawal of the survey was possible at any time. All participants gave their informed consent by participating in the survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Providing quality palliative care during a pandemic was challenging. Both specialist and community healthcare services cared for patients that faced life-threatening illness and who were influenced by the restrictions of the COVID-19 pandemic. Little knowledge has yet been provided on how registered nurses (RNs) experienced the palliative care quality during the COVID-19 pandemic. The aim of this study was to explore RN's experiences of providing palliative care quality during the COVID-19 pandemic., Methods: This qualitative study had a descriptive design. Semi-structured individual interviews were conducted between November 2021 and January 2022 with 18 RNs who worked in intensive care units in hospitals, dementia care or palliative care units in nursing homes in Norway during the pandemic. Data were analysed by using qualitative content analysis. The study was conducted and reported according to the COREQ's checklist., Results: Analysis of the data resulted in an overall theme: 'Striving to achieve control'. This theme comprised six categories: (1) when the toolbox does not fit; (2) protective equipment-social distance and opportunities for closeness; (3) unpredictable workday; (4) the right person to the right assignment at the right time; (5) presence and absence of relatives and friends; and (6) situations that required creativity. RNs had various experiences regarding how the quality of care was perceived; being worse, preserved, or in some cases even better than before the pandemic., Conclusions: The provision of quality palliative care was experienced by RNs as challenging during the pandemic. The pandemic forced them to be creative and to strive for control to provide the best palliative care possible given the situation. The results of this study may contribute to important knowledge for leaders, policy makers and RNs to learn from the COVID-19 pandemic and planning for future pandemics or crises. Especially to optimise factors perceived by RNs to be important for the palliative care quality, related to the specific situation and care context, to include the perspectives of those involved and take into consideration the time perspective of the pandemic., Competing Interests: Declarations. Ethical approval considerations and consent to participate: Approval was obtained from the Norwegian Centre for Research Data (NSD) (Reference numbers: 838156 and 634351), local data protection officer for the specialist healthcare services and the head of the departments of the included care context. This study is a part of a larger multi-centre study, Palliative Quality Care COVID-19 (PaQC-C19), conducted in Sweden and Norway. Approval was therefore also obtained by The Swedish Ethical Review Authority (dnr. 356 2021/01623). However, this present study reports solely on the Norwegian population. The study was conducted according to the principles of ethical research in the Helsinki declaration [40] and Ethical guidelines for nursing research in the Nordic countries [41]. Participants were given written and verbal information about the aim of the study, the voluntary nature of participation and the right to withdraw at any time before data were analysed with no need for explanation and that the study results were to be published. Written informed consent was obtained from all the participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

One of the most crucial stages of palliative care is the last days and hours of life, which require special attention and knowledgeable identification of clinical signs described as signs of impending death (SID). Our case series of 11 patients receiving home palliative care describes bilateral hypoactive, stereotyped upper arm movements (scratching of the head, forehead, and nose) that were previously unknown or described, often accompanied by SID.

Patients with serious illnesses wish to maintain their autonomy and decide the course of their end of life. The role of healthcare professionals is to assess the patient's understanding of their illness, help them become aware of the progression of their condition, and adapt these conversations according to the patient's emotional state, while providing regular spaces for discussion. Some patients continue to have expectations that may seem unrealistic despite a limited prognosis. The goal is to align treatments with the patient's ' objectives and values, while guiding them toward existential maturation, which represents the necessary process of accepting one's own mortality as a non-traumatic event. This process is built through repeated interactions with the patient, which is why it is crucial to begin these discussions early., Competing Interests: Les auteur-e-s n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objectives: Communication is essential to medical care and is key in improving patient outcomes. We aimed to understand clinicians' emotions when communicating with patients in palliative care (PC) and the evolution of their communication skills., Methods: Between October and November 2021, 231 Swiss PC clinicians participated in an online cross-sectional survey (65% nurses, 35% physicians). Three questions invited participants to reflect on the development of their communication skills and on their emotions when communicating with patients in PC. Answers to these questions were analyzed thematically., Results: Constantly adapting to complex emotions in communication was the overarching theme. Three main themes further allowed for an understanding of different communication challenges: emotions as a dynamic compass, not always under control , and evolving comfort and competence through personal and professional growth . In evolving comfort and competence , 6 strategies helped clinicians overcome fears and improve their confidence in communication: learning by doing and formal training, integrating life experiences and gaining insight from private life, taking time, collaborating and connecting with peers, acknowledging individuality, and connecting with one's own and patients' emotions., Significance of Results: Participants described powerful emotional experiences when communicating with patients in PC, underscoring the emotional labor involved in PC communication. Our study highlights the need to re-conceptualize emotions as a valuable resource rather than a hindrance in clinical practice. The interplay between personal and professional identities in shaping communication skills, emphasizes the importance of emotional competence as a core professional skill. As clinicians often develop these skills individually, our findings suggest a need for earlier integration of emotional competence training in medical education, along with ongoing support through collaboration, and improved allocation of time resources, to enhance clinician well-being and patient care.

Objectives: Chronic kidney disease (CKD) is a global health challenge that affects patients' symptom burden and quality of life. Palliative care interventions show promise in addressing the multiple needs of CKD patients, focusing on symptom management, psychosocial support, and advance care planning. This study aimed to evaluate the effectiveness of palliative care interventions in improving symptom management in patients with CKD., Methods: The study used a quasi-experimental research design with a sample size of 128 participants diagnosed with CKD. Participants were selected based on strict criteria to ensure consistency of palliative care interventions. Non-probability purposive sampling was used to select participants. Data were collected using validated instruments such as the Edmonton Symptom Assessment System, Kidney Disease Quality of Life-Short Form, Palliative Performance Scale, Dialysis Symptom Index and Functional Assessment of Chronic Illness Therapy-Fatigue. These instruments provided robust measures of symptom severity, quality of life, performance status, symptom burden, and fatigue. The intervention consisted of 4 sessions designed to address symptom management, psychosocial support, and advance care planning strategies., Results: Post-intervention, CKD patients showed significant improvements across multiple measures. Pain decreased from 6.2 to 4.8 ( p = 0.002, 23% improvement), and fatigue decreased from 7.5 to 6.1 ( p = 0.001, 19% reduction). Depression improved from 5.6 to 4.2 ( p = 0.001, 25% reduction) and anxiety decreased from 4.9 to 3.8 ( p = 0.004, 22% reduction). Physical functioning increased from 65.3 to 72.1 ( p = 0.002, 10% improvement), cognitive function from 72.8 to 78.5 ( p = 0.003, 8% increase), and emotional well-being from 60.2 to 65.7 ( p = 0.004, 9% improvement). Ambulation improved from 75.2 to 81.5 ( p = 0.001, 8% increase), activity from 68.7 to 74.3 ( p = 0.004, 8% increase), and self-care from 82.4 to 88.1 ( p = 0.003, 7% improvement). Nutritional status improved from 79.6 to 85.2 ( p = 0.002, 7% increase) and level of consciousness from 70.3 to 75.8 ( p = 0.005, 8% increase). Fatigue scores decreased significantly from 53.2 to 48.6 ( p = 0.001, 9% decrease), activities of daily living from 50.1 to 45.8 ( p = 0.001, 9% decrease), and well-being from 55.6 to 50.2 ( p = 0.001, 10% improvement)., Significance of the Results: The results highlight the potential of palliative care interventions to improve outcomes and well-being for people with CKD. By addressing their complex needs, these interventions offer valuable lessons for nephrology and palliative care practice, emphasizing holistic approaches to patient care. The findings add to the evidence supporting the integration of palliative care into CKD management, highlighting its value in improving patient outcomes and quality of life.

Objectives: The objective of this study is to conduct an in-depth exploration of the psychological well-being, hope, and expectations of cancer patients receiving care in a palliative care unit, utilizing a qualitative research approach., Methods: We employed the methodology of interpretative phenomenological analysis (IPA). Our data collection involved conducting 1-hour semi-structured interviews with the patients. In the subsequent data analysis, we applied investigator triangulation to ensure rigor and reliability., Results: Understanding patients' hope and expectations from palliative care is crucial as it can serve as an indicator of the quality of care and motivate care providers to fulfill these expectations as much as possible. Throughout the IPA, 3 superordinate themes emerged from the qualitative data: cancer diagnosis and the spectrum of emotions, hope and cancer patient, and oncology patient expectations of palliative care., Significance of Results: From the patient's perspective, making sense of their cancer experience involves managing symptoms, redefining their understanding of illness, adapting to functional changes, and fostering open communication among themselves, their families, physicians, and the palliative care team. This underscores the crucial necessity for an interdisciplinary approach and emphasizes the importance of reinforcing positive support systems. In essence, our study delves into the multifaceted psychological aspects of cancer patients in the context of palliative care, shedding light on their hope and expectations as they navigate the challenging terrain of cancer treatment and palliative support.

Introduction: CDK4/6 inhibitors in combination with aromatase inhibitors (AIs) are the standard first-line treatment for hormone receptor-positive (HR+), HER2-negative (HER2-) metastatic breast cancer. Landmark trials have demonstrated a comparable progression-free survival (PFS) across CDK4/6 inhibitors, but the overall survival (OS) outcomes have varied. This study aimed to evaluate the real-world PFS and OS for palbociclib and ribociclib when combined with AIs in patients with HR+/HER2- advanced breast cancer., Materials and Methods: This was a retrospective chart review of adult patients with HR+/HER2- metastatic breast cancer treated at a single academic center between 1 January 2015 and 1 December 2022. The baseline demographics, clinical characteristics, and treatment details were extracted. A Kaplan-Meier analysis was used to estimate the PFS and OS, and differences between the treatment groups were assessed using the log-rank test. Cox proportional hazards models were constructed to adjust for confounding factors., Results: Seventy-five patients were included in the final analysis. The cohort was predominantly female (98.7%) and postmenopausal (77.3%), with 52.0% having de novo stage IV disease. Palbociclib was prescribed to 74.7% of the patients, and ribociclib to 25.3%. The patients receiving ribociclib were significantly younger (57.6 vs. 67.5 years, p = 0.013) and more likely to be premenopausal (42.1% vs. 5.4%, p < 0.001). The real-world median PFS and OS for palbociclib were 20.3 months (95% CI: 14.8-46) and 37.2 months (95% CI: 20.3-not reached [NR]), respectively. For ribociclib, the median PFS and OS were not reached. The Cox proportional hazards models adjusting for age and menopausal status found no significant differences between ribociclib and palbociclib for the PFS (HR = 0.92, p = 0.86) or OS (HR = 0.95, p = 0.92)., Conclusion: In this real-world analysis, palbociclib demonstrated a median PFS consistent with the results from landmark trials, although the observed OS was shorter. The ribociclib-treated patients had a numerically longer PFS and OS compared with those treated with palbociclib, but the differences were not statistically significant. The discontinuation rates were similar between the two groups.

Introduction: Spiritual care is a fundamental aspect of palliative care, addressing the emotional, existential, and spiritual needs of patients facing life-threatening illnesses. However, in Thailand, the integration of spiritual care into the healthcare system remains underdeveloped due to the absence of professional spiritual care providers. This study aims to explore potential models and future directions for spiritual care within the palliative care context, focusing on how such care can be provided in the absence of professional spiritual care providers., Method: This study is a part of the mixed-method project Shoulders to Cry on: Care for spirituality when spiritual care providers do not exist, aimed at exploring spiritual care in settings without professional providers in Thailand. Qualitative in-depth interviews were conducted with 20 experts from palliative care, religious studies, and social work fields. The participants were recruited through purposeful sampling, and the data were analysed using inductive thematic analysis. Transcribed interviews were managed using NVivo software to identify key patterns and insights for future spiritual care models., Result: The analysis resulted in the development of the S.P.I.R.I.T. model, which outlines six essential themes for the future of spiritual care: (1) Spirituality Training Programs, (2) Providers for Spiritual Care, (3) Integrating Spiritual Care into Healthcare, (4) Research and Evidence-based Practices, (5) Interdisciplinary Collaboration, and (6) Transforming Care Systems. The findings suggest establishing structured training programs and interdisciplinary collaboration are crucial for effective spiritual care delivery., Conclusion: The study emphasises the need for integrating spiritual care into Thailand's healthcare system, focusing on education, research, and collaboration between healthcare providers and religious or community figures. The S.P.I.R.I.T. model offers a framework for addressing current gaps, which could facilitate Thailand's palliative care system in better meeting the spiritual needs of patients. Future studies should focus on establishing spiritual care education in palliative care, especially in resource-limited countries, and addressing local contextual obstacles., Competing Interests: Declarations. Ethics approval and consent to participate: This study received ethical approval from the Institutional Review Board of Mahidol University, Thailand, on August 23rd, 2024. The reference number is COA. MURA 2024/591. All participants provided informed consent prior to their involvement in the study, and steps were taken to ensure the privacy and confidentiality of their data. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Objectives: Palliative care (PC) is an interdisciplinary approach aimed at improving the physical, psychological, and spiritual well-being of patients and families affected by life-threatening diseases. This study aimed to investigate the need for PC among critically ill patients and their quality of life (QOL) in low-income groups in Bangladesh., Methods: This cross-sectional study was conducted at four healthcare facilities from March to April 2023, involving 553 registered patients with advanced chronic conditions. After applying inclusion and exclusion criteria, 183 patients in the advanced stage of illness were included. We collected data on sociodemographic, comorbidities, disabilities, and the 10-item African Palliative Outcome Scale (APOS). The Supportive and Palliative Care Indicators Tool (SPICT) was used to identify individuals requiring PC. The study investigated patients with an Eastern Cooperative Oncology Group (ECOG) performance status of 3-4, indicating significant functional impairment, and explored QOL across four domains: physical health, psychological health, social relationships, and environmental factors., Results: The mean age of the 183 patients was 53.8 (± 14.53) years, with 69.5% being female. We found that 10.3% of patients with chronic illness required PC, particularly cancer patients (87%) and those with chronic kidney disease (CKD) (53.3%). The APOS scores indicated that family anxiety (48.6%) was the most burdensome issue, followed by severe pain (15.5%), severe worry about illness (22.4%), and feelings of life being unworthy (9.4%). Patients with severe functional limitations (ECOG 3-4) were significantly more likely to need PC (58%) compared to those with moderate or no limitations (ECOG 0-2) (24%). Among those requiring PC, 70.1% rated their QOL as poor or very-poor, while only 23.8% of patients not needing PC reported similar ratings. Female patients had poorer QOL than males across all domains, and those facing financial hardships also experienced significantly lower QOL., Conclusion: In Bangladesh's low-income communities, a significant proportion of patients with chronic illnesses require palliative care (PC) due to advanced conditions. The findings emphasize the importance of integrating PC early in the treatment process for cancer and CKD patients, as it can greatly improve their QOL and provide essential support for both patients and families. The results advocate for a holistic approach to PC that addresses physical, psychological, social, and environmental factors affecting patients' QOL., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Bangladesh Medical Research Council (BMRC) under the reference number BMRC/HPNSP-Research Grant/2121–2022/08(1 -10) on January 6, 2022. The respondents and/or their legal representatives provided written informed consent, acknowledging the study’s objectives, procedures, associated risks and benefits, voluntary participation rights, the option to withdraw, and the assurance of data anonymity and confidentiality. The study was carried out in accordance with the Institutional Research Ethics and the Declaration of Helsinki, and its latest amendment was in October 2013, which is comparable to its ethical standards. The researchers adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines when conducting and reporting the findings of this observational study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background and Objectives: In the context of palliative care, the aim is to alleviate suffering and improve quality of life, with particular attention to PUs, which have a significant impact on quality of life and survival. This study examines the relationship between perilesional skin condition and survival in terminally ill patients with pressure ulcers (PUs). Materials and Methods: A descriptive and observational study was conducted in two hospitals in Valencia with a sample of 100 terminally ill patients. Sociodemographic, clinical and PPU-specific variables were assessed using validated scales such as FEDPALLA-II and the Barthel Index. Results: Although it is a study of an observational nature, which may preclude establishing causality, the results showed that functional capacity, perilesional tissue epithelialization, and albumin levels were significant predictors of survival, while the number and location of PUs had no direct impact. Perilesional tissue epithelialization was highlighted as a critical indicator reflecting the systemic stability of the patient. Conclusions: The study highlights the importance of a comprehensive approach to palliative care that addresses both the local aspects of the lesions and the patient's systemic and functional status. These findings support the implementation of therapeutic interventions based on a structured perilesional tissue assessment to improve quality of life and prolong survival in terminally ill patients. In addition, a positive correlation was found between Barthel Score and survival, suggesting that patients with greater functional independence have a longer life expectancy. On the other hand, the negative correlation between total lymphocyte count and survival suggests that lymphocytopenia may be a marker of adaptive immunosuppression. Perilesional tissue epithelialization, overall functionality and serum albumin levels are key factors in predicting survival, highlighting the need for a comprehensive palliative care approach to optimize quality of life and prolong survival in terminally ill patients with PUs.

Purpose: The Chinese community constitutes the largest demographic and faces the highest rates of cancer incidence in Singapore. Given this, palliative care plays a crucial role in supporting individuals, particularly those nearing the end of life, with family serving as their primary source of support. Many Chinese family caregivers in Singapore reported significant unmet needs in cancer care provision, with studies indicating that they often bear the brunt of caregiving responsibilities. Despite this, there has been a lack of research exploring the needs and perspectives of Chinese Singaporean family caregivers caring for terminally ill cancer patients at home. Thus, this study seeks to address this gap by investigating the lived experiences of Chinese Singaporean family caregivers providing end-of-life cancer care in a home setting., Methods: This study employed a hermeneutic phenomenological approach, guided by the framework developed by van Manen (1990), to uncover the essential meaning of each participant's lived experience. In-depth, semi-structured virtual interviews were conducted face-to-face with ten Chinese Singaporean family caregivers. These caregivers shared their personal journeys of caring for a loved one with advanced cancer during their final stage of life at home. The interviews were audio recorded, and open-ended questions were used to facilitate discussion. Each interview lasted between 30 and 60 min. The principal investigator manually transcribed all audio recordings. Additionally, an external transcriber translated the interviews into written form to ensure accuracy and authenticity. The interview texts were then analyzed and interpreted using the philosophical underpinnings rooted in phenomenology., Results: The attempts to identify meanings and make sense of the Chinese Singaporean's lived experience led to the development of two main themes and eight sub-themes. Under the primary theme of "experiences from caregiving" comprises the sub-themes "being a caregiver," "suffering," and "well-being," and the major theme of "expectations in caregiving" encompasses the sub-themes "caregiving support," "decision-making," "communication," "spirituality," and "being a Chinese Singaporean"., Conclusion: In conclusion, addressing family caregivers' needs requires culturally sensitive nursing education, peer support initiatives, public awareness campaigns, and enhanced training for domestic helpers. These measures, coupled with further research into diverse cultural caregiving needs and male caregivers' experiences, will improve support systems and empower caregivers in their essential roles., Competing Interests: Declarations. Ethics approval: Ethical approval was obtained from both the University of Southern Queensland Research Ethics Committee (H20REA101) and the Agency for Integrated Care Institutional Review Board (2020–002). The procedures used in this study adhere to the tenets of the Declaration of Helsinki. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Palliative care is becoming more widely acknowledged as a crucial part of intensive care for all patients with life-threatening illnesses. Intensive care unit (ICU) nurses regard as a lead role to facilitate this integration, which require nurses to possess professional and comprehensive core competencies. However, there is little knowledge about the palliative care core competencies among ICU nurses., Aims: To explore the association of moral distress, attitude toward death, and palliative care core competencies of ICU nurses, and explore the mediating role of attitude toward death., Methods: This is a quantitative, cross-sectional study. Random cluster sampling method was used. 342 ICU nurses were selected from 5 hospitals across 4 provinces in China. Participants were evaluated using the Moral Distress Scale-revised (MDS-R), the Attitude toward Death Profile-Revised (DAP-R), and the Palliative Care Nurses' Core Competencies Scale (PCNCC). This study followed the STROBE statement., Results: The level of palliative care core competencies among ICU nurses is moderate. Moral distress and negative attitude toward death are negatively associated while positive attitude toward death is positively associated with core competencies in palliative care among ICU nurses. Attitude toward death partially mediates the relationship between moral distress and core competencies., Conclusion: Link between moral distress, attitude toward death, and palliative care core competencies among ICU nurses was found in this study., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval was obtained from The First Affiliated Hospital of Dali University (with the codes DFY20240403001). Consent was embedded at the beginning of the online questionnaire and participants were prompted to withdraw at any time. Participants completed and submitted the electronic questionnaire indicating that their informed consent had been obtained. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The overuse of antimicrobials is prevalent in palliative oncology care, with up to 86.9% of terminal cancer patients receiving these agents during end-of-life care. This overutilization stems from recurrent infections due to immunosuppression, malnutrition, and frequent hospitalizations, as well as difficulty differentiating infection-related symptoms from cancer-related complications., Discussion: Antimicrobial use in palliative cancer care offers limited symptomatic relief while posing significant risks, including Clostridioides difficile infections, multidrug resistance, and patient dissatisfaction. The lack of clear survival benefit highlights the need for judicious antimicrobial use, particularly in terminally ill patients. Effective antimicrobial stewardship strategies, such as integrating infection management into goals-of-care discussions, early referrals to specialized palliative care teams, and implementing early intravenous-to-oral antimicrobial switches, are critical for balancing patient comfort and minimizing unnecessary antibiotic exposure., Conclusion: Optimizing antimicrobial use in palliative oncology care requires a multidisciplinary approach that prioritizes patient-centered goals, minimizes harm, and addresses misconceptions about antibiotic efficacy in end-of-life care. Antimicrobial stewardship programs, when tailored to palliative settings, play a vital role in reducing overuse and improving care quality in this vulnerable patient population., Competing Interests: Declarations. Ethics approval and consent to participate: Not required. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

This review critically examines neuro-palliative care disparities in historically minoritized groups in the U.S., particularly in Asian, Black, and Latino communities. Addressing a gap in the 2022 American Academy of Neurology guidelines, this review synthesizes current literature and our clinical experiences as neurologists who identify as members of these communities in diverse care settings. We identify common barriers to palliative care access and acceptance, influenced by cultural heterogeneity, mistrust, and systemic disparities. The review offers targeted, actionable recommendations at the provider, healthcare system, and policy level to improve care and reduce disparities., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: This study aims to validate the Palliative and Complex Chronic Pediatric Patients QoL Inventory (PACOPED QL), a new quality-of-life (QoL) assessment tool for pediatric palliative patients with complex chronic conditions. The goal is to create a comprehensive and inclusive instrument tailored to this unique population, addressing the gap in existing tools that do not meet these specific needs., Methods: The validation process included a literature review and consultations with experts. A pilot study refined the items, followed by a cross-sectional study involving pediatric palliative patients and their caregivers. Statistical analyses, such as Cronbach's alpha for internal consistency and exploratory factor analysis for structural validity, were utilized., Results: The PACOPED QL, comprising 50 items across 8 domains and 6 subdomains, demonstrated strong reliability with Cronbach's alpha and Guttman split-half reliability both exceeding .9. Validity assessments confirmed its suitability for children with complex illnesses. The tool was refined through expert consultations and pilot testing, reducing items from an initial 85 to a final 50, ensuring relevance and clarity., Significance of Results: The PACOPED QL shows strong reliability and validity in assessing QoL in pediatric palliative patients. Its comprehensive structure makes it a promising tool for clinical practice and research, addressing a critical need for a tailored assessment in this population. The instrument's robust psychometric properties indicate its potential utility in improving the QoL assessment and care for children with life-threatening illnesses. Further studies are encouraged to confirm its effectiveness across various settings.

Objectives: Historically, patients with cancer were referred to palliative care near the end of life. In recent years, the increased integration of palliative care throughout the entire trajectory of illness has helped patients with cancer better manage their symptoms and improve QOL. However, it is unknown how patients think about the presence and role of earlier, integrated palliative care. This study explored how patients and caregivers experience cancer care in the context of palliative care co-management with oncology., Methods: We conducted interviews with 18 patients and 13 caregivers to investigate perspectives, attitudes, and experiences surrounding cancer care, specifically with their experiences of co-management with a palliative care outpatient clinic and oncology. Using grounded theory, we identified a typology of patient and caregiver approaches when discussing the care they received and/or desired., Results: Our data revealed 3 approaches to thinking about palliative care in cancer care. While some participants embraced the "Cure Centrality" approach, caring only about fighting the disease, others adopted a "Quality-of-Life (QOL) Centrality" approach, desiring their health-care team to prioritize a broader range of concerns. A third approach, The "Dual Centrality" approach, espoused values from both approaches., Significance of Results: While co-management of palliative care and oncology is complementary by design, our data suggest that patients and caregivers take a variety of approaches to their copresence. For some patients, palliative care served as an important legitimizing resource for patients desiring expanded priorities in their care (e.g. higher value on QOL and symptom management) and enabling patient-centered care.

Background: Palliative care is recognized for its holistic approach in improving the quality of life for patients and their families, focusing on pain relief, symptom management, and addressing emotional, social, and spiritual needs. However, the field is evolving due to increasing demand for these specialized services, emphasizing the need for the ongoing research into palliative care practices. Research Purpose: Is to investigate the multidomain impact of palliative care on end-of-life patients and evaluate their effectiveness on these domains. Method: A quantitative descriptive design was adopted for conducting the current study. Approval obtained from a designated hospital in Amman, Jordan, and official permission to carry out the study. The study's participants consisted primarily of physicians and nurses who were involved in providing care to terminally ill patients. The research tool employed in this study is a standardized palliative care assessment that was used in Australia, with modifications based on the literature review. The validity and reliability of the adapted tool have been ensured through rigorous testing procedures. Results: Findings indicated that the implementation of standardized practical palliative care exhibited an average level across all domains, specifically, the spiritual domain received the highest mean score (1.80), while the structural domain had the lowest (1.69). There were significant differences in palliative care provision across specialized work sites, with radiotherapy and blood disease sites scoring higher ( M  = 2.04 and M  = 1.87, respectively). Educational levels significantly influenced care perceptions, favoring BSc holders. Age did not significantly affect palliative care provision, probably because of standardized care protocols and sample size. In addition, nurses rated palliative care higher than physicians, likely due to their more direct patient involvement. Conclusion: In light of the results, it is evident that there is a pressing need to consistently evaluate the healthcare services offered to meet the needs of the increasing population of terminally ill patients., Competing Interests: The author declares no conflicts of interest., (Copyright © 2025 Mohammad O. Abu Hasheesh. The Scientific World Journal published by John Wiley & Sons Ltd.)

Background: Clinicians are frequently asked 'how long' questions at end-of-life by patients and those important to them, yet predicting timeframes to death remains uncertain, even in the last weeks and days of life. Patients and families wish to know so they can ask questions, plan, make decisions, have time to visit and say their goodbyes, and have holistic care needs met. Consequently, this necessitates a more accurate assessment of empirical data to better inform prognostication and reduce uncertainty around time until death. The aims of this study were to determine the timeframes for palliative care patients (a) between becoming comatose and death, and (b) between being totally dependent and bedfast, and then comatose, or death, using Australia-modified Karnofsky Performance Status (AKPS) scores. The secondary aim was to determine if covariates predicted timeframes., Method: This is a large retrospective cohort study of 2,438 patients, 18 years and over, cared for as hospice inpatients or by community palliative care services, died between January 2017 and December 2021, and who collectively had 49,842 AKPS data points. An Interval-Censored Cox Proportional Hazards regression model was used., Results: Over 53% (n = 1,306) were comatose (AKPS 10) for longer than one day before death (mean = 2 days, median = 1, SD = 2.0). On average, patients were found to be totally dependent and bedfast (AKPS 20) for 24 days, before progressing to being comatose. A difference in life expectancy was observed at AKPS 20 among people with cancer (mean = 14.4, median = 2, SD = 38.8) and those who did not have cancer (mean = 53.3, median = 5, SD = 157.1)., Conclusion: Results provide clinicians with validated data to guide communication when answering 'how long' questions at end-of-life. Knowledge of projected time to death can prompt timely conversations while the patient can understand and engage in meaningful conversations. The importance of considering covariates such as location and diagnosis in determining timeframes has been highlighted. Shared decision-making and essential person-centered end-of-life care can be planned., Competing Interests: Declarations. Ethics approval and consent to participate: Calvary Healthcare Human Research Ethics Committee approved the study (10-2022) and cross institutional approval was granted from the University of Canberra and Australian National University Ethics Committees. Routinely collected clinical data was de-identified and aggregated. Individual patient consent was not required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Heart failure (HF) is a chronic condition with an unpredictable trajectory, making effective communication between patients and healthcare providers crucial for optimizing outcomes. This study aims to investigate and compare the communication needs regarding HF trajectory and palliative care between patients and healthcare providers and to identify factors associated with the communication needs of patients with HF., Methods: A cross-sectional study design was employed, involving 100 patients with HF and 35 healthcare providers. Data were collected using structured questionnaires assessing communication needs, health literacy, self-care behavior, and social support. Statistical analyses were performed, including Spearman's rank correlation, Pearson's correlation, and multiple regression analyses., Results: Patients prioritized communication related to device-related questions, whereas healthcare providers focused more on aspects of HF in daily life. Both groups ranked end-of-life communication as the lowest priority. The communication needs of patients were positively correlated with health literacy (r = 0.27, p = .007), self-care behavior (r = 0.32, p = .001), and social support (r = 0.24, p = .016). Multiple regression analyses indicated that self-care behavior was a significant factor influencing the communication needs of patients (β = 0.27, p = .011)., Conclusions: Enhanced patient-centered communication strategies are required to address the communication priority gaps between patients and healthcare providers. Improving health literacy, supporting self-care behaviors, and leveraging social support are critical in meeting patients' communication needs. Tailored communication training for healthcare providers can bridge this gap and improve overall HF management., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Head and neck squamous cell cancer (HNSCC) has a poor prognosis, with approximately 25-30% of patients transitioning into the palliative phase at some point. The length of this phase is relatively short, with a median duration of five months. Patients in this stage often have increased prognostic information needs. Unfortunately, predicting individual life expectancy in this phase is particularly challenging, as physicians and patients tend to overestimate survival. To address this issue, we developed the prognostic model OncologIQ Palliative based on user preferences. In this study, we now aim to assess the clinical impact of utilizing this model during counselling., Methods: This study will employ both quantitative and qualitative approaches. The primary outcome is decisional conflict and satisfaction with the decision-making process after counselling without (cohort 1) and with (cohort 2) OncologIQ Palliative. Therefore, a prospective sequential cohort study will be conducted. Secondary outcomes include the amount of palliative treatment, overall survival rates, and quality of life. These measurements will be collected after the intervention. Additionally, patients' perspectives on the decision-making process and proactive care planning, including end-of-life discussions, will be explored through interviews., Discussion: By offering more personalized prognostic information for HNSCC patients in the palliative phase, we anticipate a shift towards more patient-centred counselling. This approach can facilitate enhanced end-of-life discussions and better proactive care planning. Patients may experience reduced decisional conflict, feel better prepared for what's coming, and find assistance in their decision-making process. This could potentially lead to fewer palliative treatments. Overall, these aspects can contribute to a better quality of life and quality of care for HNSCC patients in the last phase of their lives., Trial Registration: This study was registered November 18, 2024, on ClinicalTrials.gov: NCT06699316., Competing Interests: Declarations. Ethics approval and consent to participate: Ethics approval to start inclusion of patients for cohort 1 was granted by the ethics committee of the Erasmus MC (MEC-number: MEC-2022-0473, version 2.0, dated 13-12-2022). Ethical approval for the initiation of cohort 2 is granted by the ethics committee of the Erasmus MC (MEC-number: MEC-2024-0621, version 1.0, dated 27-08-2024). All participants will be required to provide their informed consent in writing before inclusion in the study. Any protocol modifications will be submitted as an amendment to the ethics committee and updated in Clinical Trial registry. These changes to the research will be made after a favourable opinion by the accredited ethics committee of the Erasmus MC. The study will be conducted according to the principles of the Declaration of Helsinki, Gedragscode Gezondheidsonderzoek 2022 and in accordance with the Erasmus MC Research Code and General Data Protection Regulation. Given the very low-risk nature of this study and that it is classified as Non-WMO, we did not establish a Data Monitoring Committee, report adverse events, or conduct auditing. The METC has approved this approach. Handling of personal data will comply with the Dutch Personal Data Protection Act. All data will be processed digitally, in a protected area. Subjects, and their data will be coded by a serial number (patient identification code), which is not based on the patient initials or birthdate. We will use a subject identification code list to link the data to the subject. Data will be stored in a secured folder and additionally secured by a password. Only the executive researchers and research coordinator will have access to the key. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Palliative care aims to improve quality of life for patients with end-stage illnesses by addressing physical, psychological, social and spiritual needs. Early referral to palliative care improves patient outcomes, quality of life and overall survival in a variety type of cancers. This study aimed to assess knowledge, attitudes and perceived benefits of early integration of palliative care among oncology nursing., Methods: A descriptive cross-sectional study was conducted in public, private, and educational hospitals located in Palestine. Data were collected using paper based self-administered questionnaires from nurses working in hematology, general oncology, and bone marrow transplantation departments., Results: Among of 128 nurses, the study revealed a moderate level of knowledge (3.64 ± 0.96), Positive attitude (3.59 ± 1.02) and moderately recognized the perceived benefits of early palliative care (3.57 ± 1.02). A statistically significant difference in nurses' knowledge, attitudes and perceived benefits of early palliative care based on clinical experience. Pearson's correlation showed a significant positive relationship between the total knowledge and attitudes score (r = 0.211, p < 0.001), as well as with perceived benefits total score (r = 0.567, p < 0.001). Moreover, there was a significant positive relationship between the total attitude score and perceived benefits score (r = 0.303, p < 0.001)., Conclusions: These findings suggest that enhancing knowledge and highlighting the benefits of early palliative care integration could foster more favorable attitudes among oncology nurses. investing in education and training to have all nurses prepared to provide high-quality palliative care results in better patient outcomes and less suffering. Patients with advanced cancer should be referred to the palliative care teams at an early stage of treatment in conjunction with their treatment in order to improve patient outcomes and quality of life., Competing Interests: Declarations. Ethics approval and consent to participate: In this study, all methods were performed in accordance with the relevant guidelines and regulations. The study has been reviewed and approved by An Najah National University’s Institutional Review Board (Oct. 2021/30), and permission was obtained from the selected hospitals. And written informed consents had been obtained from all the nurses. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: For cancer patients, prognostication by physicians constitutes a fundamental basis of decision-making to manage the cancer journey, especially with advanced stages of cancer. Various tools such as the palliative prognostic index (PPI) have been established to estimate patient survival. Such reliable and widely applied tools unfortunately provide unexpected results of prognosis predictions in some cases. To support disease-related decision-making, this study explores factors associated with prognosis prediction outliers in patients with advanced cancer in palliative care units (PCUs)., Methods: For this retrospective observational study conducted at a PCU, we surveyed medical records of patients with advanced cancer admitted to our facility during August 2018-June 2022. Specifically, we collected data for the PPI, laboratory data, physical status, and psychological symptoms on admission., Results: Our survey of data of 675 patients revealed that the presence and absence of severely reduced oral intake were significantly associated, respectively, with shorter (p < 0.001) and longer (p < 0.001) than estimated survival. Moreover, symptoms other than pain and female sex were associated, respectively, with shorter-than-expected and longer-than-expected survival., Conclusion: The oral intake status of patients with advanced cancer in a PCU plays an important role in prognosis estimation. During prognosis, effects of symptoms other than pain and sex difference must also be considered. Although PPI-based prediction can provide a foundation for care management, cancer patients in more advanced stages of disease particularly require more detailed consideration., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Endoscopic retrograde cholangiopancreatography is considered the gold standard for treating benign and malignant biliary obstructions. However, its use in complex biliary obstructions is limited. Over the past decades, therapeutic endosonography (EUS) and emerging technologies such as lumen-apposing metal stents have enabled endoscopic treatment of conditions previously requiring non-endoscopic or surgical approaches. Studies show that EUS-guided choledochoduodenostomy is a reliable alternative to endoscopic retrograde cholangiopancreatography in the treatment of distal malignant biliary obstructions and can be considered a primary drainage modality in centers with adequate expertise. For malignant hilar biliary obstructions, draining at least 50% of viable liver tissue often requires combining different modalities. The treatment strategy in these patients should be individualized, depending on the Bismuth classification, patient physical status, and intended systemic therapy. Due to the lack of evidence, general recommendations cannot be made for EUS-guided hepaticoduodenostomy or combined procedures with transhepatic bridging stents. These novel techniques should be limited to selected palliative cases where conventional methods have failed and conducted within clinical trials to generate evidence before broader application., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)