Palliative Medicine最新文献

{"title":"Comfort and symptoms at the end of life with dementia in the Namaste Care Family cluster-randomised trial.","authors":"Yara J Schepen, Maartje S Klapwijk, Jos W R Twisk, Wilco P Achterberg, Jenny T van der Steen, Hanneke J A Smaling","doi":"10.1177/02692163261486997","DOIUrl":"https://doi.org/10.1177/02692163261486997","url":null,"abstract":"<p><strong>Background: </strong>Symptom burden at the end of life in dementia remains high. While Namaste Care may enhance comfort, its effect on symptoms during the last week of life has not been established.</p><p><strong>Aim: </strong>To assess the frequency of symptoms experienced by nursing home residents with dementia during the last week of life, and to evaluate the delivery of Namaste Care Family during the last week of life and its effect on comfort and symptom burden.</p><p><strong>Design: </strong>This mixed-methods study combined quantitative data from a cluster-randomised controlled trial with semi-structured interviews. Symptoms were assessed using the End-of-Life in Dementia (EOLD) Scales - Symptom Management (SM; family perspective) and Comfort Assessment in Dying (CAD; staff perspective). Multilevel analyses examined the effect of the Namaste Care Family programme on symptom burden. Interview data was analysed using a content analysis.</p><p><strong>Setting/participants: </strong>Ten nursing homes implemented the Namaste Care Family programme, while nine provided usual care. During the study, 103 of 231 residents with moderate to advanced dementia died (47 intervention group, 56 control group). Interviews (<i>N</i> = 32) were conducted with family caregivers, staff and volunteers.</p><p><strong>Results: </strong>Serenity (80%), discomfort (72%), and pain (70%) were most frequently observed. The programme had no significant effect on symptom burden (EOLD-SM -0.14 points, 95% CI -5.25, 4.96, <i>p</i> = 0.96; EOLD-CAD 0.35 points, 95% CI -1.98, 2.68, <i>p</i> = 0.77). Interviews showed difficulties in implementing the programme during the last week of life.</p><p><strong>Conclusions: </strong>Comfort and distressing symptoms were both present at the end-of-life phase with dementia. The Namaste Care Family programme did not influence this.</p><p><strong>Clinical trial registration: </strong>This trial was registered with the CCMO Research with human participants (ID 5692/5570).</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261486997"},"PeriodicalIF":6.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of virtual reality in hospices: A survey of clinical practice and staff perspectives.","authors":"Katie Flanagan, Victoria Vickerstaff, Briony Hudson, Libby Sallnow, Olivia Morris, Nicola White","doi":"10.1177/02692163261491882","DOIUrl":"https://doi.org/10.1177/02692163261491882","url":null,"abstract":"<p><strong>Background: </strong>Virtual reality creates immersive, computer-generated environments that can make you feel like you are there. Evidence suggests that virtual reality may help people with incurable illnesses by alleviating symptoms such as pain. Although the use of virtual reality hospices is increasing, there is limited understanding of how it is being implemented in practice or how hospice staff perceive virtual reality.</p><p><strong>Aim: </strong>To estimate how many hospices in the UK are using virtual reality and explore how staff perceive this technology.</p><p><strong>Design: </strong>Online survey.</p><p><strong>Setting and participants: </strong>183 independent adult hospices in the UK. One response per hospice was permitted.</p><p><strong>Results: </strong>88 hospices responded (48% response rate) between October 2024 and June 2025. Fifty-seven per cent of responding hospices in the UK do not own a virtual reality headset. Attitudes towards virtual reality, irrespective of owning a virtual reality headset, were generally positive. Hospices used virtual reality to address anxiety, boredom and pain. Responding hospices that did not own virtual reality cited not having enough funds to purchase virtual reality, the expense of virtual reality and inadequate resources for implementation as reasons for not owning virtual reality.</p><p><strong>Conclusions: </strong>These findings provide a national baseline for virtual reality use in UK hospices. Findings highlight that although some hospices are using virtual reality and that staff are generally positive about the technology, there are concerns about its expense and its use over the long-term.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"2692163261491882"},"PeriodicalIF":6.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149196036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International differences in the technical qualities of place of death classifications and data: A survey of researchers' perspectives.","authors":"Mayra Delalibera, Sílvia Lopes, Inês Dias da Silva, Barbara Gomes","doi":"10.1177/02692163261468152","DOIUrl":"10.1177/02692163261468152","url":null,"abstract":"<p><strong>Background: </strong>Place of death is a key population-level indicator for palliative care and health services planning. However, substantial international variation in how it is recorded limits cross-country comparisons and health system evaluations.</p><p><strong>Aim: </strong>Analyse the technical qualities of national place of death classifications and data, and identify strengths and weaknesses from the perspective of researchers using death certificate data.</p><p><strong>Design: </strong>Cross-sectional online survey. The questionnaire design was informed by the United Nations (UN) and World Health Organization (WHO) recommendations for international statistical and health classifications, and included closed- and open-ended questions.</p><p><strong>Setting/participants: </strong>Sixteen researchers identified through published place of death studies participated. Collectively, they had analysed data from 67 countries until 2022, most for over 10 years.</p><p><strong>Results: </strong>Most researchers reported that national classifications were stable, had mutually exclusive categories, and included a category for \"home\". However, shortcomings were identified: lack of detailed categories for relevant settings (e.g. hospice, nursing home), ambiguous or inconsistent terminology, and limited use of hierarchical or multi-axial structures. Participants emphasised the need for greater standardisation of categories, clearer definitions, and improved data quality through training on completing death certificates.</p><p><strong>Conclusions: </strong>This is the first study to assess place of death classifications and data from researchers' perspectives. Findings highlight critical limitations in current classification systems and provide guidance for developing an international classification aligned with UN and WHO recommendations. This will enable more meaningful cross-country comparisons and strengthen evidence to inform palliative care and health services planning worldwide.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1420-1426"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Receipt of cancer care among stage IV non-small-cell lung cancer patients with and without intellectual or developmental disabilities: A population-based retrospective cohort study.","authors":"Rebecca L W Hansford, Laura E Davis, Rebecca Griffiths, Tara Horrill, Paul Nguyen, Catherine L Goldie, Timothy P Hanna, Alyson L Mahar","doi":"10.1177/02692163261464345","DOIUrl":"10.1177/02692163261464345","url":null,"abstract":"<p><strong>Background: </strong>Little is known about non-curative lung cancer care, including palliative care, for adults with intellectual, or developmental disabilities. Clinical management may vary due to health status, ability to communicate, access to inclusive healthcare, and healthcare bias.</p><p><strong>Aim: </strong>We examined the receipt of cancer-directed consultations, treatments and palliative care among stage IV non-small-cell lung cancer (NSCLC) patients with and without intellectual or developmental disabilities.</p><p><strong>Design: </strong>This was a population-based retrospective cohort study using provincial routinely collected health data. Receipt of consultations with surgeons, medical oncologists, and radiation oncologists, receipt of systemic therapy, radiation, and surgery as well as receipt of palliative care in the year following diagnosis were compared between people with and without intellectual or developmental disabilities. Cause-specific Cox proportional hazards regression, accounting for death as a competing event, was used.</p><p><strong>Setting/participants: </strong>Adults diagnosed with stage IV NSCLC between 2010 and 2022 in Ontario, Canada.</p><p><strong>Results: </strong>The study included 33,184 individuals diagnosed with stage IV NSCLC (n intellectual or developmental disabilities = 106). Adults with intellectual or developmental disabilities were significantly less likely to receive any cancer-directed consultation (hazard ratio [HR] = 0.62; 95% confidence interval [CI] 0.49-0.78), any cancer-directed cancer treatment (HR = 0.52; 95% CI 0.39-0.70), and radiation or systemic therapy (HR = 0.49; 95% CI 0.36-0.66) than non-disabled adults. There was no statistical difference in receipt of palliative care (HR = 1.15; 95% CI 0.93-1.41).</p><p><strong>Conclusion: </strong>These findings contribute to an emerging evidence base documenting differences in cancer treatment and outcomes among adults with intellectual or developmental disabilities. Person-center research is needed that examines end-of-life lung cancer care treatment decision-making to identify and mitigate barriers to optimal management.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1400-1407"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148579957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review of the current prognostic tools used to predict the survival length of people living with advanced dementia.","authors":"Abigail Maughan, Andrea Bruun, Nuriye Kupeli, Juan Carlos Bazo-Alvarez, Nicola White","doi":"10.1177/02692163261468148","DOIUrl":"10.1177/02692163261468148","url":null,"abstract":"<p><strong>Background: </strong>Dementia is a progressive neurodegenerative condition, yet it is frequently under-recognised as terminal, contributing to delayed or inadequate end-of-life care. Accurate prognostication in advanced dementia is essential to support timely palliative interventions. However, prognostic uncertainty remains high, and existing tools are inconsistently validated.</p><p><strong>Aim: </strong>To identify and review current prognostic models designed for survival estimation of people with advanced dementia.</p><p><strong>Design: </strong>Systematic review prospectively registered on PROSPERO, supported by a narrative synthesis of key findings.</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, and PsycINFO were searched from inception to April 2025, alongside grey literature sources. Eligible studies reported development or validation of prognostic models estimating survival in advanced dementia. Risk of bias was appraised using PROBAST, and certainty of evidence using GRADE guidelines.</p><p><strong>Results: </strong>Six prognostic tools were identified across seven studies, including 225,553 individuals with advanced dementia across community, hospital, and nursing home settings. Key prognostic indicators included demographic factors, comorbidities, and functional dependency. Reported AUC values ranged from 0.55 to 0.76. The PRO-MADE model demonstrated the highest discrimination (AUC 0.76) and was the only tool to report detailed calibration metrics, though external validation showed reduced performance. Five studies demonstrated high risk of bias due to methodological limitations and lack of external validation.</p><p><strong>Conclusions: </strong>Current prognostic tools for advanced dementia show limited and inconsistent accuracy and should not be used in isolation. Further research should focus on robust external validation across various countries and healthcare settings before one model can be recommended for widespread application.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1289-1301"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating early palliative care: Qualitative results from a multi-site implementation trial.","authors":"Jennifer Philip, Anna Collins, Kylee Bellingham, Brian Le, Anna K Nowak, Nicole M Rankin, Sue-Anne McLachlan, Vijaya Sundararajan, Gregory B Crawford, Robyn Hudson, Geoffrey Mitchell, Maarten Ijzerman, Meinir Krishnasamy","doi":"10.1177/02692163261465765","DOIUrl":"10.1177/02692163261465765","url":null,"abstract":"<p><strong>Background: </strong>While evidence demonstrates benefits of early palliative care, translation into practice remains inconsistent. Effective implementation strategies are required to advance the field.</p><p><strong>Aim: </strong>To understand implementation strategies perceived as effective in delivering early palliative care for people with cancer.</p><p><strong>Design: </strong>Multi-site stepped-wedge implementation trial of an early palliative care model for people with cancer, 'Care Plus', with qualitative outcome data focused upon perceptions of implementation strategies. Designed to target barriers to palliative care, Care Plus intervention involved: introduction of palliative care at designated cancer specific illness points; outpatient delivery of minimum three palliative care consultations alongside usual cancer care; and primary care case conferences. Interviews to understand perceptions of implementation strategies were audio-recorded, transcribed and analysed using a combined thematic inductive and theoretical deductive approach. This enabled identification of emerging ideas as well as categorisation based upon the RE-AIM implementation framework domains (Reach, Effectiveness, Adoption, Implementation and Maintenance).</p><p><strong>Setting/participants: </strong>Four Australian hospitals, involving patients, carers and healthcare providers purposively sampled across representative tumour streams.</p><p><strong>Results: </strong>Fifty-one interviews: patients (<i>n</i> = 11), caregivers (<i>n</i> = 2) and healthcare providers (physicians <i>n</i> = 19, nurse consultants/practitioners <i>n</i> = 16, other <i>n</i> = 3), with, in total, 232 patients receiving Care Plus. Participants highlighted effective implementation strategies as: clinician-endorsed 'transition' points to prompt referral; systematic identification of patients; patient referral embedded into workflows; branding 'Care Plus', key phrases and mentored training to support referring clinicians; regular feedback to clinicians; and co-locating palliative care and cancer clinics.</p><p><strong>Conclusion: </strong>These effective strategies are available for the field to replicate supporting broader palliative care implementation.</p><p><strong>Trial registration: </strong>ACTRN12619001703190, [https://www.anzctr.org.au/].</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1363-1374"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain management without excess: An essential palliative care imperative.","authors":"Stephen R Connor, Ghauri Aggarwal, Joanne Brennan, Julia Downing, João Batista S Garcia, Eve Namisango, Lukas Radbruch, Rikard K Wicksell, William E Rosa","doi":"10.1177/02692163261481974","DOIUrl":"10.1177/02692163261481974","url":null,"abstract":"","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1226-1228"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision making aids in palliative care: A systematic review & meta-analysis of randomized controlled trials.","authors":"Joe El Khoury, Rachel Garofalo, Molly M Kilpatrick, Arya B Mohabbat, Maisha T Robinson, Carolyn Mead-Harvey, Zaheera Lukman, Larry J Prokop, Abd Moain Abu Dabrh","doi":"10.1177/02692163261464375","DOIUrl":"10.1177/02692163261464375","url":null,"abstract":"<p><strong>Background: </strong>Shared Decision Making in palliative care encompassing patient-clinician collaboration has shown potential for improved patient outcomes. However, the impact of decision aids intended to support palliative care decision making discussions across clinical care settings remains uncertain.</p><p><strong>Aim: </strong>To assess the impact of shared of decision aids on decision making, clinical outcomes, and quality of life for patients with palliative care needs and their caregivers.</p><p><strong>Design: </strong>Systematic review and meta-analysis of randomized controlled trials, reported according to PRISMA, with overall evidence quality assessed using GRADE.</p><p><strong>Data sources: </strong>Ovid MEDLINE (all segments), EMBASE, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, and Scopus, from inception through September 20, 2024, without restrictions on publication date, sample size, or language. Eligible studies were randomized controlled trials that included adult patients with palliative care needs or their caregivers, using any form of decision aids. Outcomes encompassed decision-related, clinical, and quality of life measures.</p><p><strong>Results: </strong>Sixteen randomized controlled trials were included. Participant ages ranged from 44 to 85 years. Predominant decision aids were videos or printed materials addressing goals of care and treatment options, with aims that included improving understanding of prognosis and supporting values clarification. Decision aids significantly improved decision-related knowledge (SMD: 0.40, 95% CI: 0.14-0.67, <i>p</i> = 0.003) and lowered preference for cardiopulmonary resuscitation (OR: 0.28, 95% CI: 0.20-0.40, <i>p</i> < 0.001). They showed no significant impact on decisional conflict, satisfaction, or regret.</p><p><strong>Conclusion: </strong>Evidence regarding the effectiveness of decision aids in palliative care decision making is limited and of low overall quality, with observed improvements primarily in patient knowledge and changes in stated treatment preferences rather than established improvements in decision quality or values-concordant care. Future research should prioritize integration into comprehensive shared decision making frameworks, cultural adaptations, and larger-scale studies to enhance patient-centered outcomes.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1229-1254"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148606210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital legacy in palliative care: A concept analysis with Walker and Avant's approach.","authors":"Anne Meißner, Jennifer Pengel, Björn Steinführer","doi":"10.1177/02692163261455491","DOIUrl":"10.1177/02692163261455491","url":null,"abstract":"<p><strong>Background: </strong>The increasing digitalization of everyday life means that digital artifacts persist after death, presenting unique and complex challenges in palliative care. Lacking clear conceptualization, digital legacy raises clinical, ethical, and legal uncertainties. Conceptual clarity is crucial to support palliative care teams in addressing digital legacy issues at the end of life.</p><p><strong>Aim: </strong>To examine and clarify the concept of digital legacy in palliative care.</p><p><strong>Design: </strong>A concept analysis was conducted using Walker and Avant's eight-step method.</p><p><strong>Data sources: </strong>Seven electronic databases (CINAHL, Embase, Medline, PsycInfo, Scopus, Web of Science, CareLit) were searched in May 2025, with no time restrictions and relevant English- and German-language publications were reviewed. Given the conceptual focus, no formal study quality appraisal was conducted.</p><p><strong>Results: </strong>From 373 records, 46 articles were included. Digital legacy comprises the totality of digitally encoded artifacts that endure after an individual's death, manifesting as multidimensional, dynamically reconfigurable formations shaped by varying degrees of purposefulness, curation, meaning, media dependency, and access. Consequences include a broad range of emotional responses, ongoing support needs, transgenerational transmission, and potential risks of misuse.</p><p><strong>Conclusions: </strong>The concept of digital legacy in palliative care offers insights into its attributes, antecedents, and consequences. It clearly demonstrates that digital legacy is a complex, multidimensional phenomenon that extends far beyond technical data storage as an integral component of palliative care. Further research is needed to investigate the dynamics of digital legacy in palliative care.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1347-1362"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing deprescribing in community-dwelling patients with palliative needs in primary care: A qualitative systematic review.","authors":"Jesse F van Weelderen, Ankie C M Hazen, Alexa M M Mulder, Eric C T Geijteman, Saskia C C M Teunissen, Dorien L M Zwart, Matthew P Grant","doi":"10.1177/02692163261465769","DOIUrl":"10.1177/02692163261465769","url":null,"abstract":"<p><strong>Background: </strong>Patients with palliative needs often use potentially inappropriate medications, leading to adverse health outcomes. Deprescribing remains poorly enacted in primary care. Understanding the factors influencing deprescribing is essential for successful implementation into clinical practice.</p><p><strong>Aim: </strong>To explore factors influencing deprescribing in community-dwelling patients with palliative needs in primary care from the perspectives of patients, their caregivers and primary healthcare practitioners.</p><p><strong>Design: </strong>Qualitative systematic review using thematic synthesis, registered in PROSPERO (CRD42024620219).</p><p><strong>Data sources: </strong>MEDLINE, Embase, CINAHL, and PsycINFO were searched from 2000 to January 2025, directed by the Palliative cAre Literature rEview iTeraTive mEthod (PALETTE) framework. Studies were included if they reported on independently living adults with palliative care needs.</p><p><strong>Results: </strong>23 studies were included. Four themes were established: (i) initial stance towards deprescribing: shaped by values, general perceptions of (de)prescribing, and competencies. This served as the premise for (ii) the deprescribing conversation: characterised by an individualised deliberation, shared decision-making, and tailored communication and practical strategies. During this conversation, (de)prescribing was reconsidered in the context of the individual patient, informing final decisions. Whether and how these conversations occurred was dependent on (iii) organisational factors, including systematic work processes and interprofessional collaboration. All factors operated within and interacted with (iv) the context of care, containing system-level prerequisites.</p><p><strong>Conclusions: </strong>Deprescribing in community-dwelling patients with palliative needs in primary care can be optimised by employing a multidimensional strategy that includes patient-centredness, shared decision-making, education, collaboration within the multidisciplinary care team, and systematic work processes, ultimately aiming to improve quality of life.</p>","PeriodicalId":19849,"journal":{"name":"Palliative Medicine","volume":" ","pages":"1270-1288"},"PeriodicalIF":6.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}