BMC Palliative Care最新文献

{"title":"Understanding rural Chinese residents' perceptions of palliative care: a grounded theory study of beliefs about a good death.","authors":"Shenglong Sun, Shengyu Zhao, Shuai Yuan, Yunling Wang","doi":"10.1186/s12904-026-02275-x","DOIUrl":"10.1186/s12904-026-02275-x","url":null,"abstract":"<p><strong>Background: </strong>Palliative care development in China remains marked by urban-rural inequality, with service expansion concentrated mainly in urban and better-resourced settings. Older residents in rural areas may therefore face limited access to professional palliative care, despite substantial care needs. This study aimed to explore rural Chinese residents' perceptions of, needs for, and underlying decision-making logic regarding palliative care, to inform the development of culturally responsive rural palliative care services.</p><p><strong>Methods: </strong>This qualitative study used purposive sampling to recruit rural residents from nine provinces and one municipality in the Chinese mainland. After quality screening, 39 interviews involving 43 participants were included and analysed using a grounded theory approach.</p><p><strong>Results: </strong>The analysis generated the \"Rural Belief about Good Death\" framework, comprising four interrelated dimensions: familism as the core principle, attachment to ancestral homeland as the affective orientation, traditional filial piety as the ethical norm, and family economic security as the threshold condition. Participants' attitudes towards palliative care were not shaped by medical considerations alone, but were embedded in family-centred, place-based, morally charged, and economically constrained understandings of a good death.</p><p><strong>Conclusions: </strong>Rural palliative care in China should be developed through locally responsive models that preserve family involvement, support home-oriented care, translate palliative care into culturally meaningful terms, and reduce financial barriers. The framework offers empirical and theoretical insights for developing palliative care in rural and resource-limited settings.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991966","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":"Willingness to participate in advance care planning among older adults with relatively high educational attainment in a continuing care retirement community of the Beijing-Tianjin-Hebei region: a qualitative study.","authors":"Tao Xue, Fengjiao Wang, Nan Ding, Yuanshuo Ma, Meina Yuan, Menglin Wang, Jinping Zhao, Jingwen Li, Huicong Lv, Yang Guo, Shuo Gu, Xuefei Cui, Jie Hu","doi":"10.1186/s12904-026-02237-3","DOIUrl":"10.1186/s12904-026-02237-3","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;China is experiencing rapid population ageing, accompanied by changes in family structure, intergenerational relationships, and expectations regarding later-life care. As older adults become frail or lose cognitive and communicative capacity, they may receive end-of-life care that is inconsistent with their values and preferences. Advance care planning (ACP) may help older adults clarify and communicate their future medical and care preferences. However, ACP remains at an early stage of development in China, and evidence regarding ACP willingness among older adults living in Continuing Care Retirement Communities (CCRCs) is limited. This study aimed to explore willingness to participate in ACP among older adults with relatively high educational attainment living in a CCRC in the Beijing-Tianjin-Hebei region and to gain a deeper understanding of the factors shaping such willingness.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A qualitative study was conducted between July and September 2025 in a CCRC in the Beijing-Tianjin-Hebei region of China. Purposive and snowball sampling were used to recruit older residents, family members, healthcare professionals, and institutional administrators. Semi-structured interviews were conducted, and data were analyzed using thematic analysis guided by the Theory of Planned Behavior (TPB).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Thirty-six participants were included, comprising 20 older adults, 4 family members, 5 doctors, 5 nurses, and 2 institutional administrators. Five themes were identified: attitudes toward ACP participation, subjective norms, perceived behavioral control, factors related to ACP participation, and willingness to participate in ACP. Most older adults expressed positive attitudes toward ACP, viewing it as a way to reduce suffering, maintain dignity and autonomy, and lessen family burden. However, family members and healthcare professionals expressed more concerns about preference stability, filial responsibility, implementation risks, and legal or procedural uncertainty. Willingness to participate in ACP was shaped not only by individual attitudes but also by family support, professional guidance, institutional processes, policy environments, and social networks within the CCRC setting.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among older adults with relatively high educational attainment living in Chinese CCRCs, willingness to participate in ACP appears to be shaped through the interaction of individual, familial, institutional, and broader social factors rather than by individual awareness alone. These findings contribute to a context-specific understanding of ACP willingness in Chinese CCRCs and suggest that future ACP implementation should combine public education with family communication, professional support, institutional preparedness, and supportive policy environments. Further research involving more diverse populations and care settings is needed to examine the transferabili","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148889123","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":"Medical information and decision-making in palliative cancer: a qualitative study of patients' perceptions, needs, and preferences regarding physician communication.","authors":"Julia Roick, Christian Heise, Nina Lambrecht, Patrick Michl, Johannes Porzelle, Sophie Rauschenberg, Anke Reinacher-Schick, Henning Rosenau, Jan Schildmann, Theresa Schneider, Karsten Schulmann, Sabine Sommerlatte, Matthias Richter","doi":"10.1186/s12904-026-02250-6","DOIUrl":"10.1186/s12904-026-02250-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with advanced cancer are frequently confronted with complex treatment decisions in the context of high emotional burden and potential limited prognostic benefit. Physician communication and the provision of medical information are therefore central to informed decision-making in the palliative treatment setting. However, little is known about how patients themselves perceive physician communication during oncological informed consent consultations and which needs and preferences they articulate regarding provision of information and decision-making. The aim of this study was to explore patients' perceptions of physician communication and to identify their needs and preferences in the context of palliative cancer treatment.</p><p><strong>Methods: </strong>This qualitative study was embedded within a multicenter interventional project in Germany. Semi-structured interviews were conducted with patients diagnosed with stage IV esophageal cancer, stage IV (non-) small cell lung cancer, or Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma who were undergoing systemic therapy. Interviews were conducted either in the outpatient clinic or by telephone, audio-recorded with participants' consent, and transcribed verbatim. Data were analyzed using qualitative content analysis according to Kuckartz, combining deductive and inductive category development. Coding was performed using MAXQDA.</p><p><strong>Results: </strong>Analysis identified three central themes. First, communication quality shaped patients' understanding and coping: patients valued direct, empathic, and transparent communication, but comprehension was often limited by emotional burden, medical terminology, and cognitive overload. Second, treatment decisions were often perceived as predetermined: shared decision-making was limited, and many patients relied on trust-based delegation rather than active decisional control. Third, communication needs were individualized and dynamic: patients differed in their desired information depth and emphasized the need for repeated conversations, plain language, involvement of relatives, and psychosocial support.</p><p><strong>Conclusions: </strong>Communication in palliative oncology should be conceptualized as an adaptive and ongoing process rather than a single informational event. Patients' informational needs and preferences for participation vary considerably and are shaped by emotional readiness, prior knowledge, and coping strategies. They should therefore be proactively explored prior to diagnosis and treatment discussions.</p><p><strong>Trial registration: </strong>The study was registered at the German Clinical Trial Register (DRKS00029632).</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674496","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":"Nursing students' attitudes toward caring for dying patients: a quantitative study.","authors":"Khulud Almutairi, Reem Saeed Alghamdi, Monirah Albloushi","doi":"10.1186/s12904-026-02273-z","DOIUrl":"10.1186/s12904-026-02273-z","url":null,"abstract":"<p><strong>Background: </strong>End-of-life care is a fundamental component of nursing practice; however, many nursing students report insufficient preparation, emotional discomfort, and a lack of confidence when caring for dying patients. Cultural and religious factors may further influence students' attitudes toward death and dying, particularly in Saudi Arabia. Understanding these attitudes and their associated factors is essential to improving nursing education and preparing students for compassionate end-of-life care. This study examined attitudes toward caring for dying patients among final-year nursing students at King Saud University and explored the influence of gender, previous death-related experiences, and religious commitment on these attitudes, including religiosity's potential moderating role.</p><p><strong>Methods: </strong>This study used a quantitative cross-sectional design. A convenience sample of 318 final-year \"Level 8\" nursing students completed a self-administered questionnaire, including demographic variables, death-related experiences, a single-item scale measuring religiosity (religious commitment), and the Frommelt Attitudes Toward Care of the Dying Scale (FATCOD-B). Data were analyzed using descriptive statistics, independent t-tests, Pearson's correlation, and hierarchical multiple regression.</p><p><strong>Results: </strong>The students demonstrated neutral to moderately negative attitudes toward caring for dying patients (M = 25.45, SD = 5.95). Male students reported significantly more positive attitudes than female students (p < 0.001); gender accounted for 3.4% of the variance in attitudes (R² = 0.034). No significant associations were found between these attitudes and previous death-related experiences or palliative care education. Religious commitment was not a significant predictor of attitudes when added to the model (ΔR² = 0.003, p = 0.312), and its moderating effect on the relationship between gender and attitudes was not statistically significant (ΔR² = 0.011, p = 0.055); the full model explained 4.8% of the variance (R² = 0.048). However, the descriptive pattern suggested that gender differences decreased at higher levels of religious commitment.</p><p><strong>Conclusions: </strong>Final-year nursing students exhibited suboptimal attitudes toward end-of-life care, emphasizing the need for enhanced educational strategies. Nursing curricula should incorporate structured and culturally sensitive approaches to address emotional preparedness, communication skills, and reflective learning. Considering gender differences and the potential influence of religiosity may further support the development of effective interventions to improve students' readiness for end-of-life care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13525659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857587","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":"Predictive effect of symptom burden and spiritual well-being on patient empowerment in palliative care patients: a cross-sectional study.","authors":"Züleyha Gürdap, Uğur Öner","doi":"10.1186/s12904-026-02272-0","DOIUrl":"10.1186/s12904-026-02272-0","url":null,"abstract":"<p><strong>Background: </strong>Patient empowerment is central to high-quality palliative care, yet the factors influencing a patient's sense of control remain poorly understood. While clinical practice often focuses on physical symptoms, the impact of spiritual well-being and prior illness experience on empowerment requires further exploration. This study examined how symptom burden and spiritual well-being relate to patient empowerment in individuals receiving palliative care.</p><p><strong>Methods: </strong>A descriptive, cross-sectional, and correlational design was employed. The study included 140 patients followed in a palliative care unit of a public hospital in Turkiye. Data were collected using the Edmonton Symptom Assessment Scale-Revised, the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale, and the Patient Empowerment Scale. Data analysis included descriptive statistics, Pearson correlation, and multiple linear regression analysis.</p><p><strong>Results: </strong>The mean total symptom burden score was 50.95 ± 11.41, with pain, fatigue, anxiety, and depression being the most severe symptoms. Despite high symptom intensity, patients maintained moderate levels of spiritual well-being (24.25 ± 4.93) and empowerment (3.05 ± 0.48). Correlation analysis revealed a significant positive relationship between spiritual well-being and empowerment (r = 0.520, p < 0.01). Regression analysis showed that the model explained 42.8% of the total variance in patient empowerment. Spiritual well-being (β = 0.484, p < 0.001) and the presence of other chronic diseases (β = 0.372, p < 0.001) were identified as the strongest significant predictors of empowerment, whereas symptom burden did not have a significant predictive effect (p > 0.05).</p><p><strong>Conclusion: </strong>Spiritual resources are significantly associated with patient empowerment, even in the presence of a high symptom load. Nursing care can be enhanced by complementing physical symptom management with a holistic approach that incorporates spiritual support and acknowledges the experiential expertise of patients.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041445","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":"Barriers and facilitators to advance care planning implementation: a qualitative interprofessional study in the Spanish public health and social care system.","authors":"Beatriz Braña-Marcos, Tatiana Arboleya-Faedo, Cristina Fernández-García, Lucía Fernández-Arce, Estefanía Vegas-Pardavila, María Isabel Orts-Cortés","doi":"10.1186/s12904-026-02268-w","DOIUrl":"10.1186/s12904-026-02268-w","url":null,"abstract":"<p><strong>Background: </strong>Advance Care Planning (ACP) is essential for improving the quality of end-of-life care. Despite having a well-established legal framework, the implementation of ACP in Spain is limited and largely bureaucratic. The existing literature has primarily focused on knowledge deficits among professionals, overlooking the emotional, cultural, and organisational dynamics shaping clinical practice. This study aimed to explore the experiences of healthcare and non-healthcare professionals regarding ACP implementation and to identify the multilevel factors that influence its integration into routine practice within the public health and social care system.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted within the Public Health System of Asturias (Spain). A multidisciplinary focus group was carried out with 10 professionals (medicine, nursing, social work, psychology, and auxiliary nursing care technicians [TCAE; equivalent to healthcare assistants]) selected through purposive sampling. Data were analysed using inductive qualitative content analysis. To support credibility, nine participants took part in an immediate participatory review at the end of the focus group, in which they reviewed a preliminary synthesis based on the observers' field notes and collaboratively reorganised it into a SWOT (Strengths, Weaknesses, Opportunities, Threats) matrix. The study adhered to COREQ guidelines.</p><p><strong>Results: </strong>Two main themes emerged: barriers and facilitators to ACP implementation. Barriers were identified at professional (emotional avoidance, limited communication training), sociocultural (family conspiracy of silence, paternalism), and organisational levels (bureaucratisation, fragmented care, rigidity of the Advance Directive document). Key facilitators included longitudinal care in primary care settings, the strategic role of nursing in initiating and sustaining ACP conversations, and increasing patient empowerment. Participants highlighted the need to move beyond advance directives as isolated documents towards integrating ACP as a dynamic, ongoing process within the electronic health record.</p><p><strong>Conclusions: </strong>ACP implementation is hindered by a perceived dissonance between autonomy-oriented theoretical models and a clinical reality constrained by cultural inertia, emotional avoidance, and organisational fragmentation. Overcoming these barriers may require moving beyond technical training to incorporate emotional and communicative competencies and shifting from a document-centred approach to a relational and dynamic model of care, with primary care and nursing as key drivers. These findings contribute to qualitative ACP research by conceptualising ACP as a \"living\" process integrated into the electronic health record and by using participatory SWOT analysis to translate findings into implementation-relevant insights.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148931635","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":"Practice patterns of strong opioid recommendations by palliative care consultation services in German hospitals (online survey).","authors":"Evelyn Mueller, Susanne Gahr, Annette Schnell, Christoph Aulmann, Carmen Roch","doi":"10.1186/s12904-026-02266-y","DOIUrl":"10.1186/s12904-026-02266-y","url":null,"abstract":"<p><strong>Background: </strong>Strong opioids are central to effective symptom control in palliative care. In cases of complex symptom burden, primary care teams frequently rely on palliative care consultation services (PCCSs) for expert guidance. This survey explored the recommendations issued by hospital-based PCCS teams regarding the use of strong opioids in patients with advanced disease (e.g. clinical indications, opioid agent).</p><p><strong>Methods: </strong>A closed online survey was conducted via the SoSci Survey platform. All PCCS teams registered with the German Association for Palliative Medicine were invited to participate in November 2024, with a reminder sent three weeks later.</p><p><strong>Results: </strong>Thirty-nine PCCS teams participated (21 university hospitals, 18 general hospitals). All respondents agreed on the indication for strong opioids in cancer-related pain and dyspnea. Differences emerged regarding the use of opioids in patients with non-malignant conditions: although most PCCS considered opioids appropriate for dyspnea associated with pulmonary (n = 37) or cardiac disease (n = 33), non-cancer pain was less consistently endorsed (n = 20). Hydromorphone and morphine were the most commonly used opioids (> 30 services reporting frequent use), whereas the use of fentanyl, oxycodone, and buprenorphine varied widely across services.</p><p><strong>Conclusions: </strong>There is consensus regarding the use of opioids in patients with cancer-related pain and dyspnea. The differing approaches to their use for symptoms caused by non-malignant conditions suggest varying clinical interpretations and underscore the need for further research and clearer guidelines.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13428421/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148649729","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":"Breaking the script in healthcare to improve care for LGBTQ+ people with serious illness.","authors":"Carey Candrian, Jennifer Tjia, Kristin G Cloyes","doi":"10.1186/s12904-026-02254-2","DOIUrl":"10.1186/s12904-026-02254-2","url":null,"abstract":"<p><p>LGBTQ+ people experience bias, stigma, and discrimination during interactions with healthcare providers. Highly-scripted systems limit how people share critical information about themselves, their values, and their goals of care. Practicing person-centered communication and narrative-eliciting skills, instead of imposing scripts, opens safer spaces for patients and caregivers to assert their truths.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148632077","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":"Advance care planning preferences and associated factors in patients with multiple chronic conditions: a systematic review and exploratory network meta-analysis.","authors":"Juan Wu, Longbao Zhao, Lijun Ran, Guangchun Zou, Rongchun Jiang, Mengjie Liu","doi":"10.1186/s12904-026-02255-1","DOIUrl":"https://doi.org/10.1186/s12904-026-02255-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients with multiple chronic conditions (MCC) often experience complex illness trajectories, functional decline, repeated healthcare encounters, and increasing need for future decision-making support. Advance care planning (ACP) may help align future care with patients' values and preferences, but evidence on ACP preferences and associated factors in this population remains fragmented. This review aimed to synthesize evidence on ACP preferences and associated factors among patients with MCC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review with exploratory network meta-analysis of ACP preference-related domains was conducted in accordance with PRISMA guidance and registered in PROSPERO (CRD420251165443). PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and China Biomedical Literature Service System were searched from inception to December 2025. Studies published in English or Chinese that reported ACP-related outcomes among adults with MCC or multimorbidity were included. For mixed-population studies, MCC-specific or multimorbidity subgroup data were extracted whenever available. Separate exploratory Bayesian network meta-analyses were conducted for conceptually distinct preference domains where extractable data were available. Associated factors were synthesized narratively. Study quality was assessed using the Newcastle-Ottawa Scale and Joanna Briggs Institute checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-five studies were included. The included studies varied substantially in population definition, illness trajectory, care setting, ACP outcome measurement, and availability of MCC-specific data. In exploratory ranking analyses, durable power of attorney for health care (DPAH) showed a relatively high ranking probability among ACP format categories (SUCRA = 83.76%). For end-of-life treatment preferences, do-not-resuscitate orders (SUCRA = 80.06%) and forgoing life-sustaining treatment (SUCRA = 72.15%) showed relatively high ranking probabilities. For place-of-care or place-of-death preferences, absence of a documented or expressed preference showed a high ranking probability (SUCRA = 89.12%), which should be interpreted as lack of recorded or reported preference rather than as an active preference not to express a preference. Associated factors were grouped into individual, clinical and functional, family and social, healthcare provider and care-setting, and cultural, legal, and health-system domains. Because of heterogeneity in populations and outcome definitions, ranking results should be interpreted as exploratory and not as evidence of clinical superiority or universal preference.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;ACP among patients with MCC is heterogeneous and shaped by interacting clinical, functional, family, cultural, legal, and health-system factors. Exploratory network findings may help describe reported ACP preference patterns, but they should not be interpreted as compa","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276145","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":"Healthcare professionals' perceptions of managing psychological needs in palliative and end-of-life care: an All-Ireland mixed-methods survey.","authors":"Niall Galligan, Barry Quinn, Rory Cousins, Deirdre Murphy, Brid McCarthy, Nipuna Thamanam, John Wonnacott, Mary Rabbitte, Fiona Somers, Lisa Graham-Wisener","doi":"10.1186/s12904-026-02262-2","DOIUrl":"https://doi.org/10.1186/s12904-026-02262-2","url":null,"abstract":"<p><strong>Background: </strong>Despite recognition in clinical guidelines and quality standards, integration of psychological care into palliative and end-of-life care settings remains inconsistent across and within health systems. Structural, workforce and training challenges persist as key barriers. This study provides the first investigation of healthcare professionals' perspectives on the assessment and support of psychological needs within adult palliative and end-of-life care across the island of Ireland.</p><p><strong>Methods: </strong>A convergent mixed-methods design, with online survey data from 152 healthcare professionals working in palliative and end-of-life care settings across the island of Ireland. Quantitative data were analysed descriptively and qualitative data using reflexive thematic analysis.</p><p><strong>Results: </strong>The findings indicate that although psychological support is perceived as foundational to palliative and end-of-life care, this does not appear to be prioritised in relation to workforce development and service delivery. Healthcare professionals report a lack of training opportunities, issues with accessing specialist psychology resource, and time constraints that hinder their ability to assess and address psychological needs effectively.</p><p><strong>Conclusions: </strong>There is an urgent need for investment in psychological care across adult palliative and end-of-life care settings on the island of Ireland. Integration of specialist psychology resource and enhancing training pathways for the broader workforce are essential to implementing effective stepped care models that ensure psychological needs are met.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149276125","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}