BMC Palliative Care最新文献

{"title":"Exploring routine palliative care delivery to inform tailored digitalization approaches - a qualitative interview study.","authors":"Alina Weisser, Natalie Öhl, Ann-Kathrin Mahlein, Christoph Ostgathe, Tobias Steigleder, Maria Heckel","doi":"10.1186/s12904-026-02345-0","DOIUrl":"10.1186/s12904-026-02345-0","url":null,"abstract":"<p><strong>Background: </strong>Digital technologies are increasingly being introduced into palliative care. However, little is known about the implementation of new technologies from the perspectives of healthcare professionals and informal caregivers. This study explores current specialist palliative home care, particularly the circumstances of the actors as well as information exchange and care processes, to inform the implementation of new technologies.</p><p><strong>Methods: </strong>A qualitative study involving problem-centred interviews was conducted with healthcare professionals and informal caregivers involved in specialist palliative home care in Germany. The Interviews were analysed by structuring qualitative content analysis guided by the CARE-HOUSE Framework, with inductively developed subcategories.</p><p><strong>Results: </strong>Eleven interviews were conducted with eight healthcare professionals and three informal caregivers. Participants described specialist palliative home care as holistic and well-functioning but characterized by complex and fragmented communication pathways. A wide range of actors, characteristics and means and content of current data transfer could be collected. Informal caregivers frequently act as intermediaries in information exchange, resulting in a considerable organizational burden. The participants identified challenges in current care practice related to communication, data management and institutional barriers. Both groups identified centralized digital information exchange as a major opportunity to address these challenges.</p><p><strong>Conclusions: </strong>The findings suggest that digital technologies have the potential to improve communication, coordination, and information exchange in specialist palliative home care while reducing administrative burden. Successful implementation requires adaptation to palliative care, providing a user-centred design that preserves the central role of personal interaction in palliative care and accounts for the diverse needs, competencies, and roles of healthcare professionals, informal caregivers, and patients.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208036","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":"Experiences of health care in family members of persons with incurable oesophageal or gastric cancer - a hermeneutical phenomenological study.","authors":"Sofia Kårmark, Marlene Malmström, Jimmie Kristensson","doi":"10.1186/s12904-026-02380-x","DOIUrl":"10.1186/s12904-026-02380-x","url":null,"abstract":"<p><strong>Background: </strong>Cancer affects patient's family members, who often become informal caregivers. For those with an incurable illness a palliative care approach is important. The approach includes need and support for patients and family members. Early integrated PC has been proven beneficial for patients with oesophageal or gastric cancer. However, the knowledge about family members' burden is general and lacks in specificity. It is argued that early PC needs to be diagnosis specific to be successful. Previous research has shown that family members of cancer patients in general experience cancer care as unsatisfying and somewhat problematic. The specific needs, in terms of health care of family members of persons with incurable oesophageal or gastric cancer are unclear. This study therefore aims to capture their lived experiences of health care.</p><p><strong>Method: </strong>This study was conducted as a qualitative interview study during 2021-2023 and analysed with hermeneutic phenomenology according to the method described by Max van Manen. The analysis was inspired by Van Manen's analytical steps to find the essence of the phenomenon of health care experiences. Furthermore, in order to identify these, the analysis was guided by Van Manen's description of lived experiences through the five existentials of the human being: Corporality, Temporality, Spatiality, Relationality and Materiality.</p><p><strong>Results: </strong>The findings were captured in the main theme \"To strive and struggle\", which described the lived hardship of health care experiences by family members. The strives and struggles were identified in different areas and five sub-themes described these: \"The body as a tool\", \"Time is out of order\", \"Navigating in health care spaces\", \"To be in the hands of the right persons\" and \"To learn and develop new skills\".</p><p><strong>Conclusion: </strong>This study adds to the knowledge on health care experiences of family members of those with incurable oesophageal or gastric cancer. It suggests that supporting and guiding family members through the fragmented health care system by introducing integrated early PC may decrease anxiety, increase the likelihood to form trusting relationships and lead to fewer emergency department visits.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149185278","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":"Structures and objectives of day hospices - Design of a logic model.","authors":"Ulrich Kaiser, Ursula Vehling-Kaiser, Felix Kaiser, Moritz Fiedler, Michael Rechenmacher, Elèene Kaiser, Florian Kaiser","doi":"10.1186/s12904-026-02356-x","DOIUrl":"10.1186/s12904-026-02356-x","url":null,"abstract":"<p><strong>Background: </strong>Day hospices represent a new component of outpatient palliative care in Germany. They focus on improving the quality of life and symptom control for patients with advanced, incurable diseases and aim to relieve the burden on family caregivers. However, a uniform theoretical framework for day hospices has not yet been established.</p><p><strong>Methods: </strong>To develop a logic model for day hospices, data were obtained from a retrospective literature review and qualitative, semi-structured telephone interviews with 11 patients and 5 relatives. The logic model was developed by the author team using a nominal group process and subsequently cross-checked by five patients and two staff members of a day hospice.</p><p><strong>Results: </strong>The final logic model comprised 18 categories and 105 program elements, organized into five pillars: resources, activities, output, outcome, and impact. It describes the functioning of a day hospice and its expected short- and long-term effects logically and coherently, based on key organizational, structural, and personnel requirements, as well as the services and interventions based on these requirements.</p><p><strong>Conclusions: </strong>The developed logic model provides an initial program theory for day hospices. It offers a clear and structured framework for understanding their functions and expected outcomes. The model can serve as a practical foundation for establishing new day hospices and for guiding future research and quality development in this emerging area of palliative care.</p><p><strong>Trial registration: </strong>The study was registered as part of the IMPULS-Study in the German Register of Clinical Studies (DRKS-ID: DRKS00031613; Date of registration: 04 April 2023) and the Display portal of the Center for Clinical Studies of the University Hospital Regensburg (Z-2022-1734-6; Date of registration: 01 October 2022).</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149498","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":"Developing a death education program based on the needs of family caregivers for advcaned cancer patients: a Delphi study.","authors":"Ruoyue Zhou, Yanzhe Wang, Shaojuan Feng, Cheng Xu, Binyang Hu, Yonghong Li, Sisi He","doi":"10.1186/s12904-026-02260-4","DOIUrl":"https://doi.org/10.1186/s12904-026-02260-4","url":null,"abstract":"<p><strong>Objective: </strong>To develop a scientifically sound and feasible death education program tailored to the needs of family caregivers of patients with advanced cancer, aimed at guiding clinical practice and enhancing the effectiveness of death education.</p><p><strong>Background: </strong>Family caregivers serve as crucial social support for patients with advanced cancer. Beyond bearing heavy caregiving responsibilities, they must also manage negative emotions arising from the patients' advanced illness or death. Family caregivers' levels of death anxiety may even exceed those of the advanced cancer patients themselves. Death education can transform individuals' attitudes toward death, alleviate death anxiety, reduce fear of death, and promote awareness and understanding of life. Currently, death education for family caregivers of patients advanced cancer receives limited attention, and comprehensive death education programs tailored to this group are lacking.</p><p><strong>Methods: </strong>An initial draft of a death education program, specifically tailored to address the needs of family caregivers providing care for patients with advanced cancer, was systematically developed through a quantitative survey, semi-structured interviews and literature review. The program was then refined through two rounds of Delphi expert consultation and pilot testing.</p><p><strong>Results: </strong>The two rounds of Delphi expert surveys distributed 18 and 15 questionnaires, respectively. The valid response rates were 83% and 100%, with expert authority coefficients of 0.858 and 0.870, and Kendall's coefficient of concordance of 0.234 and 0.272 (P < 0.001). After Delphi expert consultation and pilot testing, the final program comprised 5 primary items, 17 secondary items, and 54 tertiary items. In the pilot test, the recruitment rate was 83% and the completion rate was 70%, providing preliminary evidence of the program's acceptability and feasibility.</p><p><strong>Conclusion: </strong>By systematically integrating quantitative survey findings, qualitative interview findings, literature review evidence, Delphi expert consultation, and pilot testing, this study developed a death education program specifically designed to meet the needs of family caregivers of patients with advanced cancer. The program development process was scientifically sound and reliable, and the program content was comprehensive and targeted. The pilot test provided preliminary evidence of acceptability and feasibility; however, further validation in larger samples and real-world clinical settings is needed.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116787","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":"Clinical decision support for potentially sedating drugs in palliative care: a mixed-methods pilot study.","authors":"Sabine H Krauss, Beatrice Odierna, Stefanie Kolmhuber-Seibold, Constanze Rémi, Claudia Bausewein, Carsten Klein, Christoph Ostgathe, Alexander Kremling, Jan Schildmann, Eva Schildmann","doi":"10.1186/s12904-026-02346-z","DOIUrl":"https://doi.org/10.1186/s12904-026-02346-z","url":null,"abstract":"<p><strong>Background: </strong>Within the framework of the project iSedPall, a Clinical Decision Support Tool (CDST) was developed and piloted to address uncertainties in the use of potentially sedating drugs commonly administered in palliative care. The so-called 'warning list' contains evidence- and expert consensus-based data. This study aimed to test its feasibility of implementation, appropriateness, and acceptability.</p><p><strong>Methods: </strong>Mixed-methods pilot study including data from four pilot centres (two inpatient palliative care units, two palliative home care teams): a retrospective cohort study by chart review, an online survey, and focus groups (one focus group per pilot centre and two setting-specific focus groups). Quantitative data was analysed via descriptive statistics and content analysis was used for the focus groups.</p><p><strong>Results: </strong>Retrospective cohort study (n = 1,189 patients): The frequency of the use of the warning list depended on the patient group. The list was used most frequently for patients in whom sedation occurred as an adverse drug reaction. Online survey: 13/33 respondents used the list. Eight planned to continue using the warning list after the end of the project. Focus groups (six focus groups with overall n = 22 professionals): Generally, the aim of the warning list was well understood. The benefits were seen primarily in terms of education and background information. Participants also suggested the availability in electronic form. A potential risk is that the warning list could be misinterpreted as dose recommendations for sedation.</p><p><strong>Conclusions: </strong>The warning list seems to be appropriate, acceptable, and feasible to be implemented for professionals, according to pilot evidence from four centres. The mixed-methods approach proved valuable in carefully exploring the risks alongside the benefits. Future research should be conducted in more generalisable settings, take a closer look at different professional groups as well as settings, and further explore the various types of potential use of the CDST. Implementation in electronic form should be explored carefully, reflecting positive and negative consequences on daily routines.</p><p><strong>Trial registration: </strong>The study was registered in the German Clinical Trials Register (DRKS-ID: DRKS00027241; Date of registration: 10/12/2021; https://drks.de/search/en/trial/DRKS00027241 ).</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117125","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":"Satisfaction with treatment decision-making and long-term experiences of life-prolonging treatments for metastatic castration-resistant prostate cancer.","authors":"Paula Routier Cañigueral, Agneta Wennman-Larsen, Sandra Doveson, Ulrika Rönningås, Maja Holm","doi":"10.1186/s12904-026-02336-1","DOIUrl":"10.1186/s12904-026-02336-1","url":null,"abstract":"<p><strong>Background: </strong>Treatments in the phase of metastatic castration-resistant prostate cancer (mCRPC) aim to prolong survival and reduce the symptom burden. The fast development of life-prolonging therapies makes treatment decision-making (TDM) complex, weighting survival against possible side-effects and quality of life, especially in a real-world context. This study aimed to describe satisfaction with TDM at start of the first, second and third line of life-prolonging treatment and to describe and compare long-term treatment experiences when receiving one or several lines of treatment in patients with mCRPC.</p><p><strong>Methods: </strong>A longitudinal observational study. Participants completed a study-specific questionnaire every three months for up to two years from the start of any first line of life-prolonging treatment after mCRPC. Satisfaction with TDM was measured at the start of each new treatment line while treatment experiences were measured using the first and last completed questionnaire of each participant. Medical data was obtained from medical records. Descriptive statistics were used to present data while inferential statistics were used for analysis of group comparisons and over time changes.</p><p><strong>Results: </strong>A total of 122 participants (mean age 75.3 years) with an average follow-up time of 18.3 months were included. Satisfaction with TDM was generally high at the start of the first, second and third line of treatment, but lower regarding discussions on how treatment could affect their life situation. Treatment experiences were positive, yet there was a significant decrease from the first to the last follow-up in whether they would choose (p = 0.04) and recommend (p = 0.01) the same treatment to others. For participants who received one line of treatment, a significant decrease was found between the first and the last follow-up (p = 0.02), while no differences were found for those who received two or more lines.</p><p><strong>Conclusions: </strong>Despite high satisfaction with aspects of TDM and the treatment given it is important to discuss how the treatment can impact the patient's life situation. The slightly decreased satisfaction over time on the treatment received could reflect a possible need to strengthen communication between patients and healthcare professionals, shifting from a disease-centered perspective towards a more person-centered and palliative care approach.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002881","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":"Are patients receiving specialist palliative care thirsty? A qualitative interview study.","authors":"Caroline Lythell, Anne Söderlund Schaller, Tiny Jaarsma, Maria Friedrichsen","doi":"10.1186/s12904-026-02331-6","DOIUrl":"10.1186/s12904-026-02331-6","url":null,"abstract":"<p><strong>Background: </strong>Thirst is a potentially distressing yet under-researched symptom experienced by patients receiving specialist palliative care. Despite its clinical relevance, little is known about how patients experience thirst, or how it is assessed and managed in practice. This may affect patient comfort. This study aimed to describe how patients in specialist palliative home care experience thirst and investigate its impact on their daily lives.</p><p><strong>Design: </strong>A qualitative inductive design.</p><p><strong>Methods: </strong>Data were collected through semi-structured interviews with 24 patients. The interviews were analysed following the approach of Braun and Clarke's reflexive thematic analysis. This study adheres to the EQUATOR guidelines by using Standards for Reporting Qualitative Research (SRQR).</p><p><strong>Results: </strong>Four main themes were identified describing patients' experiences of thirst in palliative care: (1) the challenge of distinguishing thirst from dry mouth, where patients frequently conflated the two; (2) a persistent symptom in the shadow of others, where thirst was perceived as less significant compared to more distressing symptoms; (3) when thirst is not a priority, reflecting patients' experiences of limited acknowledgement and understanding from healthcare professionals; and (4) always a bottle close, illustrating how patients continuously adapted their daily lives to manage thirst, often without reflecting on its impact.</p><p><strong>Conclusion: </strong>Recognising thirst is crucial for both patients and health care professionals, as it can impact the patient's comfort and quality of life, even if its severity is often downplayed compared to other symptoms. Effective recognition and management of thirst, combined with clear communication from health care professionals, can improve patient care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002885","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":"Acceptability of My Ten: a physical activity intervention for family caregivers of people with advanced cancer.","authors":"Jamie L Penner, Sylvie Lambert, S Robin Cohen","doi":"10.1186/s12904-026-02309-4","DOIUrl":"https://doi.org/10.1186/s12904-026-02309-4","url":null,"abstract":"<p><strong>Background: </strong>The caregiving experience can have a significant impact on family caregivers' (caregivers) health and well-being, particularly those of patients with advanced cancer. Interventions to support caregivers through health-promoting strategies are needed. The physical and psychological benefits of physical activity (PA) are well documented, yet the value of PA for caregivers of people with advanced cancer is not well understood. To address this gap, a home-based individually tailored PA intervention was designed with the aim of increasing caregivers' positive affect and health and decreasing their negative affect and fatigue. The objective of this study was to explore the acceptability of the intervention for caregivers.</p><p><strong>Methods: </strong>A descriptive exploratory qualitative research design was used. Caregivers (N = 10) were recruited to participate in the intervention for 6 weeks and provided weekly qualitative feedback on its structure and process. A follow-up individual interview was conducted with caregivers to solicit their overall experience with the intervention. Data were analyzed using content analysis.</p><p><strong>Results: </strong>Eight of 10 caregivers completed the intervention. Caregivers deemed the PA intervention to be acceptable. No modifications were necessary other than slight changes in formatting to the PA log. Caregivers were appreciative of attention to and support of their own self-care. A home-based PA program allowed them to take breaks from caregiving responsibilities while staying near the patient. Individually tailored PA, goal setting and self-monitoring were helpful for caregivers to engage in and adhere to their PA plans. In addition, weekly telephone calls for feedback and support helped to problem solve any barriers and provided motivation. Given that caregivers often chose to engage in smaller, more frequent bouts of PA, the intervention was named My Ten.</p><p><strong>Conclusions: </strong>The My Ten PA intervention is acceptable to caregivers of those with advanced cancer, helping them to engage in and adhere to PA as a health-promoting strategy.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117137","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":"Death anxiety and its associated factors among palliative care nurses in China: a multicenter cross-sectional study.","authors":"Jinyun Zhang, Qian Wu, Sen Wang, Liangkun Xu, Heng Xiao, Bingxin Liu","doi":"10.1186/s12904-026-02324-5","DOIUrl":"10.1186/s12904-026-02324-5","url":null,"abstract":"<p><strong>Background: </strong>To investigate the current status of death anxiety among palliative care nurses, explore its associated factors based on the Conservation of Resources theory, and provide an empirical reference to inform future targeted clinical interventions.</p><p><strong>Methods: </strong>A multicenter cross-sectional study was conducted among certified palliative care nurses affiliated with 44 hospitals across Shanxi Province, China. The survey link was broadly distributed to all certified palliative care specialist nurses who had completed the standardized training program organized by the Shanxi Nursing Association. Ultimately, 318 valid questionnaires were obtained from nurses affiliated with 44 hospitals (valid questionnaire rate = 95.21%). Data were collected using a general information questionnaire, the Chinese version of Templer-Death Anxiety Scale (CT-DAS), the Positive Psychological Capital Questionnaire (PPQ), and the Perceived Organizational Support Scale (POS). Theory-driven hierarchical linear regression analysis was performed to examine factors associated with death anxiety.</p><p><strong>Results: </strong>The median total score for death anxiety among the palliative care nurses was 45.00 (IQR: 44.00-47.00), with 95.0% (n = 302) scoring above the screening cutoff (≥ 35) for high death anxiety. Hierarchical linear regression analysis (R² = 0.660, P < 0.001) revealed that age, female gender, having no children, higher monthly income (≥ 8,000 RMB), and a nursing tenure of ≥ 5 years were positively associated with death anxiety, whereas positive psychological capital and perceived organizational support were negatively associated with death anxiety (all P < 0.05).</p><p><strong>Conclusion: </strong>A substantial proportion of palliative care nurses experienced high death anxiety, which was statistically associated with a combination of sociodemographic, occupational exposure, and psychological and organizational resource factors. Given the cross-sectional design, these findings are hypothesis-generating. Future longitudinal and interventional studies are warranted to verify these associations and evaluate whether strengthening psychological and organizational resources can effectively mitigate death anxiety and support nurse well-being.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116807","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":"Multi-level determinants of comprehensive palliative care delivery for breast and cervical cancer patients in Ethiopia: using the socio-ecological model as an analytical framework.","authors":"Kalkidan Solomon Deribe, Sarona Shewaye, Nahom Solomon Habtamu, Abigiya Wondimagegnehu, Yoseph Mamo Azmera, Adamu Addissie, Eva J Kantelhardt, Mirgissa Kaba","doi":"10.1186/s12904-026-02300-z","DOIUrl":"10.1186/s12904-026-02300-z","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Comprehensive palliative care is essential for improving the quality of life of women with breast and cervical cancer in Ethiopia, yet services remain poorly organized, largely inaccessible, and concentrated in the capital. While existing studies have quantified service gaps, the multi-level determinants enabling or hindering comprehensive care remain under-explored, particularly how these factors differ between urban and rural settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To explore the multi-level determinants of implementing comprehensive palliative care for women with breast and cervical cancer in Ethiopia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An exploratory qualitative study was conducted from January to March 2025 in urban Addis Ababa and Sidama. Using purposive sampling with maximum variation, ninety-three participants including 37 women with breast or cervical cancer, 20 caregivers, and 36 key informants were recruited. Data were collected through open ended interview guides, transcribed verbatim, and analyzed using framework analysis guided by the Socio-Ecological Model. The analysis focused on identifying determinants at individual, interpersonal, community, organizational, and policy levels. ATLAS. ti V.09 was used to analyze the data.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Determinants of comprehensive palliative care access and quality emerged across five socio-ecological levels, with urban-rural variations. At the individual level, determinants included personal health literacy, assets, and financial resources. Patient resilience and health literacy enabled care, but outweighed by catastrophic out-of-pocket costs and misconceptions of cancer as a curse more pronounced in Sidama. At the interpersonal level, social support and family dynamics were critical. Supportive families enabled care, while family stigma and partner abandonment were major barriers with stigma more intense in Sidama. At the community level, social capital, community networks, and traditional structures served as determinants. Survivor-led groups, edirs, and religious leaders enabled support, yet their impact was constrained by resource deficits. Sidama relied on informal support. Cervical cancer patients experienced stigma rooted in sexually transmitted infection leading to social exclusion, whereas breast cancer patients' stigma was linked to fears of contagion and visible disfigurement. At the organizational level, access to healthcare services, resource allocation, and organizational culture were dominant determinants. Specialized cancer centers and community based health insurance enabled access, but systemic undervaluation of comprehensive palliative care, opioid shortages, lack of trained staff, and broken referral systems were barriers, worse in Sidama. At the policy level, governance, regulations, and health system financing were the overarching determinants. A national guideline exists but lacks rural implementation guidance, and is ","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819957","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}