BMC Palliative Care最新文献

{"title":"Dynamic interactions of facilitators and barriers in palliative care in China: a qualitative study.","authors":"Haixia Lu, Yanming Wu, Lingling Gu, Yuanyuan Jin, Huiling Li","doi":"10.1186/s12904-026-02245-3","DOIUrl":"10.1186/s12904-026-02245-3","url":null,"abstract":"<p><strong>Background: </strong>China is experiencing rapid population ageing and increasing demand for palliative care. However, development remains uneven because of fragmented policies, workforce shortages, limited public understanding, and sociocultural barriers. Existing studies have typically described these factors separately, offering limited insight into how they interact within complex health systems. This study aimed to examine the dynamic interactions among facilitators and barriers shaping palliative care development in China, informed by Wu-Xing theory.</p><p><strong>Methods: </strong>We conducted a multi-method qualitative study across hospitals, palliative care institutions, and community settings in multiple regions of China between January 2024 and November 2025. Purposive sampling was used to recruit 49 stakeholders. Focus group discussions involved 38 stakeholders, including healthcare professionals, policymakers, researchers, volunteers, and service-sector representatives, while field observations captured the experiences of 6 patients and 5 family members in palliative care settings. Data were analysed using reflexive thematic analysis, with Wu-Xing theory used as an interpretive framework to examine relationships among themes.</p><p><strong>Results: </strong>Five interdependent factors shaped palliative care development in China: policy standards, professional development, promotion and outreach, public awareness, and ethical culture. Analysis suggested two linked cycles. The Generating Cycle described how policy standards supported professional development, professional development enabled promotion and outreach, promotion and outreach improved public awareness, public awareness nurtured ethical culture, and ethical culture in turn updated policy standards. The Controlling Cycle described how policy standards regulated promotion and outreach, promotion and outreach reshaped ethical culture, ethical culture rectified professional development, professional development recalibrated public awareness, and public awareness in turn updated policy standards, contributing to mutual adjustment across the system.</p><p><strong>Conclusions: </strong>Palliative care development in China may be better understood as a dynamic health-system process rather than as a linear effort to address isolated barriers. The Wu-Xing framework provides a culturally grounded lens for examining how policy, workforce capacity, communication, public attitudes, and ethical norms interact. These findings highlight the need for more integrated and context-sensitive strategies to strengthen palliative care in China.</p><p><strong>Trial registration: </strong>Not applicable.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551199","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":"Communication and educational gaps in end-of-life care in Italian internal medicine wards: a cross-sectional study.","authors":"Mario Stabile, Maria Ghinatti, Elena Migliore, Fabrizio Elia, Francesca Riccardi, Lorenzo Ferrando, Nicolò Gilardi, Francesco Ravera, Benedetta Cigolini, Martina Penso, Daniele Dotta, Elena Barbagelata, Gabriella Biffa, Franco Aprà, Luigi Fenoglio, Nicola Girtler, Roberto Pontremoli, Christian Bracco, Alberto Ballestrero, Gabriele Zoppoli","doi":"10.1186/s12904-026-02241-7","DOIUrl":"10.1186/s12904-026-02241-7","url":null,"abstract":"<p><strong>Background: </strong>End-of-life (EOL) care is a frequent and complex aspect of internal medicine, yet data on physicians' training, clinical practices, and perceived challenges are limited. This study aimed to explore current practices, knowledge gaps, and unmet needs in EOL care among Italian internal medicine physicians and residents.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted under the auspices of the Piedmont-Liguria-Aosta Valley Section of the Italian Society of Internal Medicine (SIMI). The survey included 25 closed-ended questions addressing five domains: epidemiological, pharmacological, practical, psychological, and educational aspects of EOL care. Physicians actively involved in clinical care from multiple internal medicine wards participated voluntarily. Responses were collected anonymously via paper and online formats. Descriptive statistics were used to summarize data. Differences between groups (specialists vs. residents, oncology/hematology vs. non-oncology wards, low vs. medium vs. high clinical intensity wards) were assessed using the Mann-Whitney U and Kruskal-Wallis tests. Associations between ordinal variables were evaluated using Spearman's rank correlation coefficient. P-values were adjusted using the Benjamini-Hochberg procedure.</p><p><strong>Results: </strong>Of approximately 7,400 invited physicians, 619 completed the survey (response rate ≈ 8.4%; median age 38 years; 60.5% female; 70.8% board-certified internists). More than 88% reported facing terminal patients at least weekly, yet only 2.5% were aware of Advance Directives for > 25% of inpatients. Use of sedatives and analgesics during terminal sedation varied, while discontinuation of active therapies, total parenteral nutrition (TPN), and transfusions was widely accepted. Internal protocols and dedicated multidisciplinary discussions were infrequently used. Most respondents reported difficulties communicating with patients and families at EOL. Formal training in EOL care was perceived as largely inadequate during undergraduate, residency, and postgraduate education. Compared with residents, board-certified internists more frequently reported postgraduate/Master training, whereas residents more frequently reported undergraduate and residency training in EOL. Exploratory correlation analyses generated hypotheses linking communication difficulties with patients to those with family members and training experiences across educational stages.</p><p><strong>Conclusions: </strong>The study highlights substantial gaps in training, communication, and organizational support, independent of clinical setting. Structured education and integration of psychological support are urgently needed. These findings can inform curriculum development, hospital policies, and future research to improve physician preparedness and patient-centered EOL care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148551266","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 advance care planning education in nursing home placements: a qualitative descriptive study of nursing students' experiences.","authors":"Stephanie Craig, Julie Doherty, Kevin Brazil, Gary Mitchell","doi":"10.1186/s12904-026-02248-0","DOIUrl":"10.1186/s12904-026-02248-0","url":null,"abstract":"<p><strong>Background: </strong>Advance care planning (ACP) is a core component of high-quality palliative and end-of-life care, particularly in nursing homes where residents commonly experience frailty, multimorbidity and cognitive impairment. Although digital ACP education has shown promise for qualified staff, limited qualitative evidence has examined how undergraduate nursing students experience such learning during clinical placement. This study explored first-year nursing students' experiences of using an online e-resource during nursing home placements exploring its acceptability, perceived influence on knowledge and confidence, and application to practice.</p><p><strong>Methods: </strong>A qualitative descriptive study was undertaken within a UK School of Nursing and Midwifery. All eligible first-year undergraduate nursing students undertaking nursing home placements between January and March 2024 received access to a care-home-specific ACP e-resource. Sixteen students participated in semi-structured online interviews. Data were analysed using reflexive thematic analysis, informed by Social Cognitive Theory, particularly self-efficacy.</p><p><strong>Results: </strong>Three interrelated themes were identified: Building Confidence, Putting Learning into Practice, and Spreading the Learning. Students described the resource as accessible, relevant to the nursing home context, and appropriately pitched to their stage of learning. It appeared to support greater perceived readiness to recognise and engage with ACP-related issues in practice, including discussion of deterioration, future care and end-of-life planning. Students also valued acknowledgement of the emotional impact of care, particularly the inclusion of self-care content. Although participants identified limitations of asynchronous learning and expressed a preference for greater rehearsal and interactivity, many also described sharing the resource with staff, peers and others in practice settings.</p><p><strong>Conclusions: </strong>A digital, care-home-specific e-resource may support undergraduate nursing students' preparedness for palliative and end-of-life communication during nursing home placements. Embedding context-specific digital ACP education within preregistration curricula may strengthen early preparedness, particularly when supplemented by opportunities for reflection, rehearsal and discussion.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13679160/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220625","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":"Service motivation and its associated factors among palliative care volunteers with self-reported personality traits: a cross-sectional study in China.","authors":"Xuancheng Chen, Fengjuan Zhang, Lu Lin, Huiling Li","doi":"10.1186/s12904-026-02246-2","DOIUrl":"10.1186/s12904-026-02246-2","url":null,"abstract":"<p><strong>Background: </strong>Personality plays a crucial role in shaping the motivation of palliative care volunteers, a key factor in sustaining high-quality end-of-life care. However, previous studies have paid limited attention to whether factors associated with service motivation vary across different personality profiles. This study aimed to examine the associations between personality traits and service motivation and to identify factors associated with service motivation among palliative care volunteers in China.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted between April and November 2025 among 326 palliative care volunteers providing companionship, emotional support, and other non-clinical supportive services for patients with life-limiting illnesses and their families in Zhejiang Province, Jiangsu Province, and Shanghai, China. Volunteers were selected using convenience sampling. Service motivation was measured with the Chinese version of the Volunteer Functions Inventory (VFI), while social support was assessed using the Social Support Rating Scale (SSRS). Group comparisons were conducted using nonparametric tests, and stratified multiple linear regression analyses were performed in SPSS version 24.0 to identify factors associated with service motivation within each personality group.</p><p><strong>Results: </strong>The median VFI score was 150.00 (interquartile range: 132.00-173.00). Volunteers who identified as extraverted had significantly higher motivation levels than those who were introverted. Age ≥ 60 years and urban residence were consistently associated with higher service motivation in both personality groups (P < 0.05). For extraverted volunteers, having an average monthly income > RMB 8,000 was associated with lower motivation (P < 0.05). Conversely, among volunteers with self-reported introverted personality traits, having an educational level of associate degree/bachelor's degree or above and having > 3 years of volunteering experience were associated with lower levels of service motivation, whereas greater social support was significantly associated with higher motivation (P < 0.05).</p><p><strong>Conclusion: </strong>Service motivation among Chinese palliative care volunteers varied with self-reported personality traits, and several factors were associated with motivation within each personality group. These findings highlight the importance of considering individual differences, including demographic and social variables, in volunteer recruitment and management. Tailored volunteer management strategies that account for individual differences could help enhance engagement and sustained participation among Chinese palliative care volunteers.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149197248","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":"Correction: The digital legacy in end-of-life care: unspectacular and meaningless, or not enough recognized? An online survey on the attitudes and personal experiences of professionals and volunteers.","authors":"Anne Meißner, Dafina Mahaj","doi":"10.1186/s12904-026-02228-4","DOIUrl":"10.1186/s12904-026-02228-4","url":null,"abstract":"","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":"25 1","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13386608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148550734","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":"Home-based palliative care provisions in Kerala, India: do government-run and community-owned centers differ in their operations and efficacy?","authors":"S Gowri, E P Abdul Azeez, Manoj Mathew, K P Farsana, K Sarath","doi":"10.1186/s12904-026-02232-8","DOIUrl":"10.1186/s12904-026-02232-8","url":null,"abstract":"<p><strong>Background: </strong>Palliative care provisions have been operative in Kerala, India, predominantly through a home-based model for the last three decades. Over time, the community- and home-based model has evolved into a widely recognized and sustainable model, providing almost universal palliative care access to people in need in Kerala through community-owned and government-run centers. However, a significant gap exists in explaining how these models' efficacy and operations vary. In this context, this study aims to compare the nature of operations and the effectiveness of interventions at government-run palliative care centers (GPCs) and community-owned palliative care centers (CPCs) in Kerala, India.</p><p><strong>Methods: </strong>We employed a qualitative research approach, guided by a comparative case study design. We have chosen ten palliative care centers, five each from government-run and community-owned centers, for the comparison. We have conducted in-depth interviews with key service providers and beneficiaries of the palliative care services.</p><p><strong>Results: </strong>We have identified 8 dimensions for comparison. The medical services offered by both categories of palliative care were similar. However, the results revealed significant differences in community participation, socioeconomic and psychosocial support provided, and sustainability measures adopted across the centers. CPCs demonstrate a broader, more holistic approach by integrating services, resulting in better operations and greater effectiveness than GPC initiatives.</p><p><strong>Conclusion: </strong>The findings of the study emphasizes that community-based healthcare models grounded in organic civic networks offer a unique advantage in delivering services more effectively, while government-run frameworks operate with minimal community participation. Replicating Kerala's community- and home-based palliative care model in resource-constrained and low- and middle-income contexts requires considering the state's unique socio-political, cultural, and policy context for successful translation.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148521309","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":"Empathy and attitudes toward palliative care among Chinese medical students: a cross-sectional study.","authors":"Cengceng Lu, Jing Li, Huan Chen, Yue Zhao, Min Ding, Yan Wang","doi":"10.1186/s12904-026-02231-9","DOIUrl":"10.1186/s12904-026-02231-9","url":null,"abstract":"<p><strong>Background: </strong>Palliative care is increasingly recognized worldwide for improving the quality of life of patients with life-threatening illnesses and their families. However, in China, palliative care education is often marginalized, and limited research has examined how medical students' empathy levels and personal characteristics influence their attitudes toward palliative care.</p><p><strong>Methods: </strong>A cross-sectional study surveyed 546 undergraduate students from clinical medicine, nursing, and related majors at a Chinese medical university, with 463 valid responses analyzed (response rate: 84.8%). Data were collected using an online questionnaire incorporating demographic measures, the Chinese version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD-B), and the Interpersonal Reactivity Index-Chinese version (IRI-C). Statistical analyses included descriptive statistics, Pearson correlation, and multiple linear regression.</p><p><strong>Result: </strong>The mean attitude score toward palliative care was 96.16 ± 10.82, and the mean empathy score was 52.93 ± 11.25, indicating moderate levels. Empathy was significantly positively correlated with attitudes toward palliative care (r = 0.378, p-value < 0.01), with the Fantasy subdimension showing the strongest association. Regression analysis identified better family atmosphere, bereavement experience, and volunteer or part-time work as significant predictors of both empathy and attitudes.</p><p><strong>Conclusion: </strong>Integrating empathy training and experiential learning into medical curricula may enhance Chinese medical students' preparedness to deliver compassionate end-of-life care, highlighting the need for targeted palliative care education reforms.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647585/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450047","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":"Between fate and fault: a qualitative study on the presence, absence and ambivalence of guilt in subjective theories of illness among patients with advanced cancer in palliative care.","authors":"Anna Kitta, Nestor D Kapusta, Franziska Ecker, Joachim Bär, Feroniki Adamidis, Lea Kum, Eva K Masel","doi":"10.1186/s12904-026-02227-5","DOIUrl":"10.1186/s12904-026-02227-5","url":null,"abstract":"<p><strong>Objective: </strong>Patients' personal beliefs about illness shape how they experience the disease. This study explores how individuals with a terminal cancer diagnosis understand the nature and causes of their illness and whether their explanations include feelings of guilt or personal responsibility.</p><p><strong>Methods: </strong>This study employs a qualitative methodology. It comprises 23 semi-structured interviews with patients living with cancer admitted to the palliative care unit of a tertiary hospital in Austria. The interviews were recorded digitally and transcribed verbatim. The data were analyzed using thematic analysis and MAXQDA 2022 software.</p><p><strong>Results: </strong>Three main themes could be identified within the interviews: Patients shared their (1) understanding of the disease and its origin and their (2) self-evaluation in the context of guilt-being non-guilty or guilty or avoiding judgment when applying the possible causes to their individual situation. Finally, the interviews showed the participant's (3) agency and adaptation in response to causal attributions.</p><p><strong>Conclusion: </strong>Some patients with advanced cancer at the end-of-life experience guilt and blame themselves. In palliative care settings, understanding beliefs on illness causation is essential for meaningful clinician-patient communication. Additionally, more emphasis needs to be placed on providing patients with information on the origins of oncological diseases early in the disease trajectory. Addressing patients' subjective theories of illness sensitively and being aware of them will enable clinicians to improve end-of-life care by adopting patient-centered strategies of care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450111","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 to interventional pain management in patients with cancer: a systematic review.","authors":"Elham S Alzahrani, Asrar O Abduldaiem, Abdulrahman I Alardan, Njood A Alshowigi","doi":"10.1186/s12904-026-02235-5","DOIUrl":"10.1186/s12904-026-02235-5","url":null,"abstract":"<p><strong>Background: </strong>Systemic opioids fail to provide adequate relief in 10-30% of advanced cancer patients due to poor response or debilitating adverse effects. While intrathecal drug delivery and neurolytic blocks offer effective alternatives, these interventions are severely underutilized due to systemic barriers, inadequate provider education, and late referrals, leaving pain undertreated in up to 40% of patients. This review aims to compile barriers to pain management interventions among patients with terminal cancer.</p><p><strong>Methods: </strong>We searched for relevant articles up to February 2026 from PubMed, Scopus, and Web of Science. Two independent reviewers extracted data from the selected studies, including baseline information, outcomes, interventional pain management methods, patient data, physician and facility data, and barriers to different pain management interventions.</p><p><strong>Results: </strong>We collected 7,614 records after excluding 3,529 duplicates. Thorough screening resulted in the retrieval of 14 entries eligible for inclusion in our review. Our synthesis from 14 studies identified multi-level barriers to interventional pain management, including Intrathecal Drug Delivery Systems (IDDS) and Celiac Plexus Neurolysis (CPN). Patient-related barriers centered on lack of understanding, as well as fear of adverse effects and infection. Clinician-related obstacles were significant; 51% of pain fellows reported unmet training needs, while only 28% of hospice providers felt confident managing IDDS, leading over 80% to prefer systemic analgesics. Systemic issues included fragmented care coordination, a median two-year delay from diagnosis to IDDS implant, and a lack of standardized guidelines. Furthermore, socioeconomic disparities were evident, as racial minorities and residents of lower-income neighborhoods faced significantly lower access to these interventions.</p><p><strong>Conclusion: </strong>The underutilization of interventional pain management techniques is driven by a complex interplay of patient misconceptions, clinician training gaps, and systemic fragmentation.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438533","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":"Identifying individuals who could benefit from a palliative approach to their care using a multi-phase, consultative, iterative approach.","authors":"Nicole Williams, Lynn Martin, John P Hirdes, Aynharan Sinnarajah, Christina Vadeboncoeur, Margaret Saari, Veronique M Boscart, Dawn M Guthrie","doi":"10.1186/s12904-026-02233-7","DOIUrl":"10.1186/s12904-026-02233-7","url":null,"abstract":"<p><strong>Background: </strong>Access to a palliative approach to care improves the quality of life of individuals with a serious illness and their families. This paper describes the development of a decision-support tool that identifies individuals receiving home care and long-term care services who could potentially benefit from a palliative approach to their care based on information available in interRAI assessments used in those sectors as part of regular practice.</p><p><strong>Methods: </strong>A consultative and iterative multi-phase approach was employed to develop the \"Serious Illness Collaborative Action Plan\" (or Serious Illness CAP), over an 18-month period. Criteria for triggering this CAP were established with 49 individuals across seven advisory groups; criteria were operationalized using items and measures available in interRAI instruments and tested using anonymized population-level data from home care (N = 568,586) and LTC (N = 35,713) sectors in three Canadian provinces were analyzed.</p><p><strong>Results: </strong>The CAP is based on the presence of health instability and potentially modifiable exacerbating issues (i.e., severe/excruciating daily pain, moderate/severe mood problems, severe fatigue, self-reported loneliness or social isolation, and condition/disease that create instability in thinking, self-care, mood, or behaviour patterns). The CAP identifies three distinct groups: those at high priority for a palliative approach, those at moderate priority, and those who don't trigger the CAP. Among home care clients in Ontario, 42% triggered the CAP; 10% (n = 57,025) at a high priority, and 32% (n = 181,531) at a moderate priority. Within LTC homes in Nova Scotia and Saskatchewan, these equaled 12% (overall), 5.2% (n = 1,858 as high priority) and 6.8% (n = 2,411 as moderate priority).</p><p><strong>Conclusions: </strong>The development of this new CAP will help support clinicians in home care and LTC settings to engage in conversations and promote awareness of the benefits of a palliative approach to care for individuals with serious or life-limiting illness and their families.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148450145","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}