Journal of hospice and palliative care最新文献

Purpose: This study investigated the role of spiritual well-being (SWB) in mediating or moderating the association between psychological resilience and quality of life (QoL) among family caregivers (FCs) of patients with terminal cancer.

Methods: This cross-sectional study included FCs from nine hospice care units in South Korea between September 2021 and May 2023. Psychological resilience was assessed using the Connor-Davidson Resilience Scale (SWB) and the FACIT-Sp-12, and QoL was assessed using the Caregiver QoL Index-Cancer (CQOLC-K). A multivariate regression analysis was also performed.

Results: The study included 164 FCs with a mean age of 53.6 years; Most were female (76.2%) and spouses (40.2%). Resilience showed a significant positive association with QoL and was related to lower burdensomeness and higher positive adaptation. Subgroup analyses based on the SWB levels revealed that the association between resilience and burdensomeness was significant only among FCs with low SWB, whereas the association with positive adaptation was significant among those with high SWB.

Conclusion: Among the FCs of patients with terminal cancer, resilience reflects QoL, in which SWB may play an important role.

Purpose: Palliative care is an essential aspect of healthcare, particularly for patients with life-limiting illnesses. Nurses play a crucial role in the provision of palliative care. In regions such as Jharkhand, India, where palliative care services are still developing, it is important to assess the level of preparedness among healthcare professionals, particularly nurses. This study aimed to assess nurses' knowledge of and attitudes nurses in Jharkhand toward palliative care.

Methods: A cross-sectional descriptive study was conducted among 200 registered nurses working in government and private healthcare facilities in Jharkhand were included in this study. A structured questionnaire comprising demographic questions, 20 knowledge-based multiple-choice questions, and a 30-item attitude scale was used for data collection.

Results: Most nurses (57%) demonstrated moderate knowledge of palliative care, and 79% of the participants showed a positive attitude toward palliative care. Nurses with palliative care training and more than five years of experience were significantly more likely to have adequate knowledge (odds ratio [OR]=4.52, P=0.001; OR=3.85, P=0.002). Nurses of Jharkhand had more positive attitudes toward palliative care when they had more education (OR=4.82, P=0.040) and worked in government healthcare facilities (OR=2.63, P=0.007).

Conclusion: This study emphasizes the need for structured education and training programs, especially in government facilities, to improve nurses' knowledge and prepare them to provide comprehensive palliative care. Enhancing nursing education and offering regular professional development opportunities are essential to improve the overall quality of palliative care delivery in the region.

Purpose: This study aimed to explore home-based hospice nurses' end-of-life care experiences and elucidate the nature and meaning of end-of-life care. This study aimed to enhance the understanding of nurses' role identity and provide basic data to improve the quality of home-based hospice care.

Methods: The collected data were analyzed using Giorgi's phenomenological. The participants were 11 nurses working at a home-based hospice facility in Seoul and the surrounding metropolitan area selected through purposive sampling. Data were collected from August to November 2024 through semi-structured, in-depth individual interviews, each lasting an average of 64 minutes. Interviews were recorded and transcribed with the participants' consent, resulting in 267 pages of data. The collected data were analyzed using Giorgi's phenomenological method.

Results: The analysis revealed four thematic categories, "Practicing emotional care," "Burden and burnout of professional life," "Rediscovering the meaning of existence" and "Awareness of sustainable care systems." Home-based hospice nurses supported patients and their families in accepting death and forming emotional bonds. They also experienced both burnout and fulfillment during the repetitive process of providing end-of-life care. Furthermore, they achieved personal and professional growth through reflection on life and death but recognized structural limitations such as a lack of staff and inadequate institutional support.

Conclusion: This study demonstrates that end-of-life care provided by home-based hospice nurses extends beyond simple physical care to include emotional and spiritual support, demonstrating the need for institutionalization, strengthening the educational foundation, and establishing a practical support system.

Palliative care (PC) is increasingly recognized as an essential component of high-quality cancer care, with evidence from randomized trials and meta-analyses demonstrating that it improves quality of life, mood, and goal-concordant end-of-life care. Despite these benefits, PC integration has been inconsistent, with many patients still receiving PC later in their disease course. Current models of integration include outpatient co-located PC clinics, inpatient consultation services, community- and home-based programs, and more recent innovations, such as telehealth and stepped approaches. These models have shown clear benefits; however, they are frequently organized by care settings rather than patient-specific needs, resulting in both underuse and inefficiency. Emerging evidence has begun to clarify the mechanisms through which PC provides patient benefits. Symptom control, coping support, longitudinal communication, and existential or spiritual interventions are among the active ingredients that are most consistently associated with improvements in patient outcomes. Recognition of these mechanistic drivers highlights the potential for precision PC, in which care is tailored to the unique drivers of each patient's needs. Implementation of precision PC requires embedding validated patient-reported outcomes and structured referral algorithms into oncology workflows, enabling real-time triage of targeted interventions. Interoperable technology, workforce expansion through the training of non-specialists, and policy reforms that support scalable delivery models, such as telehealth and nurse-led programs, will be essential for closing gaps in terms of access and equity. Precision PC offers a pragmatic framework for aligning limited resources with the diverse and evolving needs of patients with cancer, ensuring timely, individualized, and sustainable integration into modern oncology.

South Korea received international acclaim for its rapid response to the initial coronavirus disease 2019 (COVID-19) pandemic crisis through the "K-Quarantine" model, successfully managing it without closing its borders; however, terminally ill patients awaiting death in 19 public hospice facilities (83.4%/297 beds) had to vacate their beds to accommodate patients with COVID-19. This study examines and analyzed South Korea's hospice response policies during the pandemic. It draws on empirical data from domestic and international literature reviews and relevant websites. This study aimed to provide foundational data and policy recommendations for future pandemic preparedness. The findings revealed that, owing to the national response policy focused on infectious disease control and hospital bed allocation, 21 of the 88 inpatient hospice units in South Korea were closed, with their beds repurposed Therefore, hospice palliative care services became a "negotiable service" largely excluded from pandemic response policies. Strict visitation policies lowered hospice service utilization and disrupted service continuity. Emergency care support helped to mitigate care gaps; however, hospice care was limited in addressing patients' specialized needs, demonstrating structural fragmentation within the health and welfare systems. In conclusion, South Korea's hospice and palliative care response policy to the COVID-19 pandemic has failed to meet the essential goal of hospice palliative care: enhancing patient dignity and quality of life. To strengthen preparedness for future pandemics, designating specialized hospice institutions as essential health facilities, establishing infrastructure stabilization funds, developing a crisis-responsive payment systems, are essential.

Purpose: This study aimed to analyze research trends in those left behind after sudden bereavement in 2000, using text network analysis.

Methods: This study structured and examined keywords in the abstracts of articles extracted from a web-based database. Five major databases (PubMed, Embase, Cochrane, CINAHL, and PsycInfo) were searched for key terms associated with bereavement and grief. After the data extraction, three dictionaries (thesaurus, exclusion, and definition) were created to refine the terms. A co-occurrence matrix was constructed, and text network analysis was performed to identify and visualize the core research topics.

Results: In total, 108 studies on those left behind after bereavement were published, with <9 papers released annually. The top five words extracted from the studies on individuals left behind after bereavement were family, relationship, child, parent, and support. Cohesion analysis confirmed that the community could be divided into five categories (support by need, diseases and symptoms, changes due to bereavement, causes and processes of bereavement, and damage to the family) based on studies of individuals left behind after bereavement.

Conclusion: Research addressing those left behind after sudden death is scarce, and only 108 studies were identified. These five clusters suggest that the research topics related to sudden bereavement represent distinct grief experiences characterized by unique psychological, social, and contextual features.

Shared decision-making (SDM) represents a central framework for achieving person-centered, value-concordant care in palliative and end-of-life settings. This review synthesizes current SDM concepts, practical models, and future directions relevant to palliative care specialists. Foundational models, such as the three-talk framework and the National Institute for Health and Care Excellence guidelines, emphasize iterative dialogue, informed preferences, and relational trust. In clinical practice, SDM is integrated with adaptive interdisciplinary approaches that align immediate treatment choices with long-term goals, particularly when combined with advance care planning. Examples such as SDM involving oncologists and palliative care specialists, as well as telehealth-based family conferences, illustrate measurable benefits in documentation, communication, and palliative engagement. Future priorities include addressing emotional distress, improving health literacy, and embracing relational autonomy in diverse cultural contexts. Emerging technologies such as artificial intelligence, large language models, and immersive virtual reality may offer promising tools for visualizing prognostic trajectories, supporting reflection, and enhancing empathy. Ultimately, SDM in palliative care transforms decision-making from a technical act into a moral and relational process, uniting evidence, compassion, and shared meaning to ensure that every medical choice honors the patient's dignity and values.

Conjunctival squamous cell carcinoma (SCC) is a rare ocular malignancy that can occasionally present. We describe the case of an older patient who presented with a massive orbital lesion that caused severe functional and cosmetic impairments. Palliative radiotherapy of the orbital mass resulted in remarkable tumor regression and symptomatic relief. After 18 months of follow-up, the patient remained clinically stable without regrowth of the primary lesion. This case highlights the potential of palliative radiotherapy to achieve durable local control and meaningful improvement in the quality of life, even in advanced conjunctival SCC.

Purpose: This study aimed to explore the job experiences of early-career social workers with <2 years of experience in hospice and palliative care, examine the expectations of related stakeholders, and propose policy recommendations for the advancement of this field.

Methods: Two focus group interviews were conducted with 10 early-career social workers working in hospice and palliative care settings, and the findings were analyzed using a constant comparative method.

Results: The analysis revealed that while early-career social workers experienced personal growth and a sense of fulfillment in their roles, they also faced various challenges as they adapted to the unique environment and intervention approaches of hospice and palliative care teams. Hospice social workers are expected to serve as communication bridges between patients, caregivers, and medical staff while fulfilling their core responsibilities. However, a considerable gap was observed between these expectations and the realities of their work. For the advancement of hospice and palliative care, self-reflection and identity formation by social workers are necessary for personal transformation, while policy-level measures such as human resource management, job systematization, and organizational and systemic reform are also required.

Conclusion: This study provides valuable foundational data and clinical preparation guidelines for early-career social workers entering the hospice and palliative care field. Furthermore, it offers evidence supporting the policy and institutional changes essential for the continued development of hospice and palliative care.

Purpose: This study investigated the association between spiritual well-being and care burden among family caregivers of patients with terminal cancer.

Methods: Data from 172 family caregivers from nine hospice care units in South Korea were analyzed using multivariate regression models. Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-being questionnaire, and the subjective care burden on family caregivers was assessed using the Caregiver Reaction Assessment tool.

Results: The current study demonstrated a positive association between spiritual well-being and family caregivers' care burden, which is consistent with a previous study that evaluated anxiety. On the subscales, disrupted schedules were positively associated with the meaning/peace domain. Further analysis revealed that adjusting for emotional distress changed the direction of the association or mitigated the magnitude of the association.

Conclusion: Among family caregivers of patients with cancer, spiritual well-being reflects their care burden, in which emotional distress may play an important role.