BMC Palliative Care最新文献

{"title":"The role of an educational robot in advance decision learning among community-dwelling older adults.","authors":"Chiu-Mieh Huang, Jia-Yi Yang, Su-Fei Huang, Hsiao-Pei Hsu, Yi-Chun Shieh, Li-Ting Lu, Jong-Long Guo","doi":"10.1186/s12904-026-02217-7","DOIUrl":"10.1186/s12904-026-02217-7","url":null,"abstract":"<p><strong>Background: </strong>Advance decisions are a key component of advance care planning (ACP) and support individuals in communicating their preferences for future medical care. Despite policy efforts to promote ACP, public awareness and engagement in completing advance decisions remain limited in many settings. Educational robots, which provide interactive and engaging learning experiences, may represent a novel strategy for delivering ACP education in community settings.</p><p><strong>Aim: </strong>This study aimed to examine older adults' acceptance of an educational robot designed to facilitate learning about advance decisions. Specifically, we investigated factors associated with their intention to continue using the robot to learn about advance decisions and their intention to recommend the robot to others for advance decisions education.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among older adults recruited from community centers in northern Taiwan. After providing informed consent, participants attended a 90-minute robot-assisted educational session introducing key concepts of advance decisions and ACP. Following the session, participants completed a self-administered questionnaire assessing human-computer trust, decisional balance (perceived pros and cons of advance decisions), personal involvement, satisfaction with the robot-assisted learning experience, intention to continue using the educational robot, and intention to recommend the robot to others. Partial least squares structural equation modeling (PLS-SEM) was used to test the proposed relationships among study variables.</p><p><strong>Results: </strong>Human-computer trust significantly increased older adults' intention to continue using the educational robot, both directly and indirectly through satisfaction with the learning experience. Trust also influenced participants' intention to recommend the robot to others indirectly via satisfaction. Perceived benefits of advance decisions were positively associated with recommendation intention, whereas perceived barriers showed no significant effects. Neither the perceived benefits nor barriers of advance decisions significantly influenced the intention to continue using the robot. Overall, satisfaction emerged as a key mediator linking trust to behavioral intentions related to robot-assisted ACP education.</p><p><strong>Conclusions: </strong>Trust in the technology and satisfaction with the learning experience play critical roles in shaping continued engagement and willingness to recommend such interventions. Integrating interactive technologies into ACP education may help expand public awareness and promote broader engagement in advance care planning.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438577","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":"\"Straddling two worlds\": complexities of spousal caregiving in amyotrophic lateral sclerosis during younger middle age.","authors":"Andrea S E Parks, Lesley Gotlib Conn, Agessandro Abrahao, Lorne Zinman, Joanna E M Sale","doi":"10.1186/s12904-026-02230-w","DOIUrl":"10.1186/s12904-026-02230-w","url":null,"abstract":"<p><strong>Background: </strong>Family support is central to amyotrophic lateral sclerosis (ALS) care. Spouses often assume the role of primary caregiver, facing daily challenges as their partner's needs progressively increase. Younger ALS caregivers appear to have distinct experiences and needs, yet age- or life-stage variations and processes of caregiving are seldom considered in studies of ALS family caregiver experience.</p><p><strong>Methods: </strong>We undertook a qualitative study, guided by constructivist grounded theory methodology, to explore the dynamics of family caregiving following an ALS diagnosis in a younger middle-aged family member (≤55 years). Data were coded to identify psychosocial processes, including how family caregivers engage in caregiving.</p><p><strong>Results: </strong>In-depth interviews were conducted with ten spousal caregivers between August 2023 and August 2025. Overall, our theoretical understanding of spousal caregiving for younger middle-aged adults with ALS (YMAs) was captured by the core category 'straddling two worlds,' reflecting how caregivers navigated multiple interconnected dichotomies: present and future, familiar and new norms, current and anticipated losses, and the worlds of the living and the dying. To contend with an uncertain future, caregivers anchored themselves in the present as they navigated a shifting sense of normalcy. Middle age expectations and social norms shaped how caregivers engaged in caregiving and experienced losses that were often unending and ambiguous.</p><p><strong>Conclusions: </strong>Caregiving for a spouse with ALS in younger middle age involves temporal, practical, emotional, and existential processes. Caregivers of YMAs may benefit from interventions that help them tolerate uncertainty, stay grounded in the present, maintain normalcy, and grieve losses throughout the caregiving trajectory.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425709","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":"Better palliative care for residents of inpatient nursing homes through qualification of nursing staff - a cluster randomised study.","authors":"Franziska Radicke, Laura Rehner-Stegen, Heiko Krause, Britta Buchhold, Dennis Nonnenberg, Janina Sarah Dombrowski, Wolfgang Hoffmann, Neeltje van den Berg","doi":"10.1186/s12904-026-02224-8","DOIUrl":"10.1186/s12904-026-02224-8","url":null,"abstract":"<p><strong>Background: </strong>In Germany, 80-90% of people require palliative care in the final stages of life. Inpatient care facilities are increasingly becoming the final place of residence for many people, and therefore also often their place of death. Inadequate identification of palliative care needs can result in substandard palliative care in nursing homes, where residents are often admitted to the hospital towards the end of their lives. This study investigated whether a special palliative care qualifications for nursing staff could improve the care for residents in inpatient care facilities.</p><p><strong>Methods: </strong>A cluster-randomised intervention study was conducted. Nursing staff from the participating care facilities in the intervention group took part in the 40-hour 'Palliative Care - Multiprofessional' basic qualification course. The outcomes were the use of specialised outpatient palliative care, and the documentation of palliative-relevant symptoms and measures for residents in the three months prior to their death. Data from the patient records were assessed and statistically analysed.</p><p><strong>Results: </strong>During the observation period, 119 residents deceased in the 10 participating nursing homes (5 of which were in the intervention group), of whom 42 were in the intervention group and 77 were in the control group. Specialised outpatient palliative care was documented for 19.0% of residents in the intervention group and 9.1% of residents in the control group. Pain was documented in 57.1% of residents in the intervention group versus 49.4% in the control group. This palliative symptom was documented 225 times in total. An appropriate subsequent measure was documented in 150 cases (73.6% in the intervention group versus 61.9% in the control group). Logistic multilevel analysis showed that residents in the intervention group were more likely to receive a measure for a documented pain event (OR 1.804).</p><p><strong>Conclusions: </strong>The results show that having a qualification in palliative care leads to palliative symptoms being identified more accurately and appropriate measures being implemented more effectively. Using data from real healthcare settings is challenging because there are no overall standards. Nevertheless, the results reflect real healthcare practice. Advanced training in palliative care helps improves the care provided to palliative residents in nursing homes. Trained staff can help to identify the need for care more accurately and ensure that appropriate palliative care is provided.</p><p><strong>Trial registration: </strong>German Clinical Trials Register, DRKS00020749 ( https://drks.de/search/en/trial/DRKS00020749/entails ), 7 May 2020.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13379974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425769","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":"Promoting palliative care for people with heart failure: the P3HF study protocol.","authors":"Yutong Men, Nathan Wright, Giselle O'Connor, Ling Han, Hargun Kaur, Ella Suh, Jenny Chen, Bashar Kadhim, Tariq Ahmad, Michael Beasley, Nora Segar, Nancy Kim, Jonathan Quang, Mona Sharifi, Shelli Feder","doi":"10.1186/s12904-026-02206-w","DOIUrl":"10.1186/s12904-026-02206-w","url":null,"abstract":"<p><strong>Background: </strong>Heart failure is often a chronic, life-limiting illness associated with high symptom burden, frequent hospitalizations, and substantial suffering near the end of life. Although palliative care improves quality of life and is strongly recommended by clinical practice guidelines, fewer than 20% of people with heart failure receive it. We developed the Promoting Palliative Care for People with Heart Failure (P3HF) Clinical Decision Support (CDS) tool-an evidence-based, end-user informed tool integrating a validated prognostic-risk model, tiered functionality, and behavioral nudges in the electronic health record (EHR). This manuscript describes the development of the P3HF CDS and protocol for a clinical trial evaluating its effects.</p><p><strong>Methods: </strong>We will conduct a pragmatic randomized clinical trial at two large urban hospitals, within a single health system, using an embedded, convergent mixed-methods design to evaluate the P3HF CDS. Eligible patients are adults (≥ 18 years) hospitalized with heart failure, N-terminal pro-B-type natriuretic peptide (NT-proBNP) ≥ 500 pg/mL, and receipt of intravenous diuretics within 24 h of admission. We will analyze data from the EHR and surveys and interviews with end-users (attending physicians, residents, fellows, advanced practice providers) of the CDS tool and palliative care clinicians to assess CDS usability, acceptability, appropriateness, feasibility (implementation outcomes), and efficacy in increasing inpatient palliative care (Primary clinical outcome) consultations. Secondary exploratory outcomes include increasing palliative care outpatient referrals, improved advance care planning documentation, higher hospice enrollment, and reductions in hospital length of stay and 30-day readmissions compared to usual care.</p><p><strong>Discussion: </strong>The P3HF CDS is an evidence-based, theory and end-user informed tool designed to promote timely palliative care for people with heart failure. The P3HF trial will examine the acceptability and effects of the CDS in real-world clinical settings.</p><p><strong>Trial registration: </strong>NCT06933875 ( https://clinicaltrials.gov/study/NCT06933875 , Registration date: 2025-04-18).</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424975","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":"Nurses' grief after patient loss: a cross-sectional study of coping strategies and emotional impact in a Nigerian tertiary hospital.","authors":"Muhammad Awwal Ladan, Yakubu Salifu, Muna Alshammari, Bilkisu Kankia Lawal, Abdullahi Haruna Ibrahim, Muhammad Abdullahi Adam, Halima Abdul Musa","doi":"10.1186/s12904-026-02229-3","DOIUrl":"10.1186/s12904-026-02229-3","url":null,"abstract":"<p><strong>Background: </strong>Nurses frequently develop close therapeutic relationships with patients and experience significant emotional distress when patients die. Despite extensive literature on caregiver burden in palliative care, there is limited data on how nurses in resource-constrained settings cope with grief and the downstream effects on their well-being and practice. This study aimed to examine grief coping strategies, emotional responses, and perceived mental health impacts among nurses following patient loss in a tertiary specialist hospital in Northern Nigeria.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey between January and March 2025 at a high-volume (a high patient sort) Specialist hospital in Kano State, Nigeria. Using Yamane's formula for finite population, 194registered nurses with at least one year of clinical experience (N = 194) were invited; all 194 (100%) completed a structured self‑administered questionnaire. Three domains were assessed using 4‑point Likert scales (1 = Strongly Disagree to 4 = Strongly Agree): (1) grief coping strategies (10 items), (2) attitudes and emotional responses after patient death (10 items), and (3) perceived impacts on mental health (10 items). We calculated descriptive statistics and mean domain scores; higher scores indicate stronger endorsement of the item or domain. Inferential statistics also explore gender differences and the years of clinical experiences across the three domains. Ethical approval was granted by the Kano State Ministry of Health Research Ethics Committee (NHREC/17/03/2018), and written informed consent was obtained from all participants.</p><p><strong>Results: </strong>A total of 194 nurses participated in the study. Emotional exhaustion, anxiety, sleep disturbances, and burnout concerns were commonly reported following patient loss. Peer support, spiritual practices, and relaxation techniques were the most frequently used coping strategies. Female nurses reported significantly higher coping strategy scores (p = 0.013), stronger emotional responses (p = 0.008), and greater mental health impacts (p = 0.003) than male nurses. No significant differences were observed across years of professional experience.</p><p><strong>Conclusions: </strong>Patient loss remains a significant source of emotional and psychological distress among nurses. While peer support and spirituality are important coping mechanisms, healthcare institutions should implement structured grief-support systems to strengthen resilience, promote psychological well-being, and sustain the delivery of compassionate, high-quality care.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148424620","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":"Lonely boats swaying in the storm: experiences and supportive needs of adult only-children confronting parental end-of-life care: a qualitative study.","authors":"Ziyue Chen, Zhaoyu Li, Peng Yue, Ying An, Qi Shen, Yinshi Kan","doi":"10.1186/s12904-026-02226-6","DOIUrl":"10.1186/s12904-026-02226-6","url":null,"abstract":"<p><strong>Background: </strong>After nearly four decades of Chinese one-child policy, only-children have reached a point where they need to face the challenge of parental end-of-life care. However, current studies are limited to the whole process of parental aging and lacks attention to the difficulties and challenges that arise in end-of-life care.</p><p><strong>Objectives: </strong>This study aims to explore experiences and supportive needs of adult only-children confronting their parental end-of-life care.</p><p><strong>Methods: </strong>This study was conducted in four medical institutions in Beijing, China. Sixteen participants were recruited through purposive and snowball sampling. Data were collected through semi-structured interviews. Interviews recordings were transcribed verbatim and analyzed following conventional content analysis approach.</p><p><strong>Results: </strong>Three themes and nine subthemes were identified. Theme 1: Lonely boats: the characteristics of only-children confronting parental end-of-life care which includes: (a) there is no one to share burden, (b) there is no one to discuss, (c) there is no one to accompany. Theme 2: \"Swaying in the storm\": experiences of adult only-children confronting parental end-of-life care, including: (a) intensive physical caregiving burden, (b) solitary decision-making, (c) emotional turbulence and psychological pressure. Theme 3: Supportive needs in confronting parental end-of-life care, including (a) need for additional caregiving assistance, (b) need for medical decision and information support, and (c) need for empathy and emotional support.</p><p><strong>Conclusions: </strong>For adult only-children, parental end-of-life care is shaped by a structurally singular filial position in which there is no sibling to share caregiving responsibilities, no sibling to discuss difficult decisions with, and no sibling to accompany them emotionally through parental decline. This position may intensify their physical caregiving burden, solitary decision-making role, emotional turbulence and psychological strain. Targeted support should include flexible and trustworthy respite or caregiving services to relieve care burden. It should also include accessible medical information, decision-making support, advance care planning, and end-of-life education to reduce decisional isolation. Compassionate communication from healthcare professionals, together with peer and bereavement support, is needed to address emotional distress and grief. Coordinated healthcare, community, and social support systems are required to meet the distinctive needs of this growing caregiver population in China.</p><p><strong>Trial registration: </strong>Not registered.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637137/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425735","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":"Financial hardship in cancer family caregivers: a scoping review.","authors":"Emmanuel Nkrumah, Chisom O Odii, Avery C Bechthold, Courtney P Williams, J Nicholas Odom, Rachel D Wells","doi":"10.1186/s12904-026-02174-1","DOIUrl":"10.1186/s12904-026-02174-1","url":null,"abstract":"<p><strong>Background: </strong>Family caregivers of adults diagnosed with cancer usually face significant financial hardship due to employment disruptions and the cost of cancer-related expenses. This leads to physical, emotional, and psychological burden on them. However, despite this important contribution, family caregivers are rarely recognized as major stakeholders in palliative and supportive care during the caregiving trajectory.</p><p><strong>Purpose: </strong>To address these gaps and inform palliative care practice, policy, and future research, we conducted a scoping review to synthesize and critically evaluate the current state of the science on how financial hardship influences decision-making regarding coping strategies and sources of support among family caregivers.</p><p><strong>Methods: </strong>Guided by the Arksey and O'Malley scoping review framework, EMBASE, CINAHL, and PubMed were searched for English language articles published between January 2015 and May 2025 using the keywords: \"financial distress,\" AND \"family caregiver,\" AND \"cancer.\"</p><p><strong>Results: </strong>Of 816 articles screened, 28 met the eligibility criteria. Caregivers reported financial hardships due to cancer-related income loss, employment disruptions, and out-of-pocket costs, which contributed to psychosocial and emotional burden. Across the studies, most financial, psychosocial, and emotional outcomes were self-reported. Contributions from family and friends, community organizations, and insurance systems were the sources of support for family caregivers. Caregivers employed a range of coping strategies (e.g., borrowing from family/friends, forgoing leisure and medical treatments, and sale of possessions) to manage financial hardships. Most U.S. participants (>50%) were White/Caucasian, with minimal representation of caregivers identifying with racial/ethnic minority groups.</p><p><strong>Conclusion: </strong>Financial hardships were common among family caregivers, which were linked to worse psychosocial and physical health outcomes. Findings highlight the prevalence of financial hardships among cancer caregivers. In clinical practice, clinicians may consider comprehensive screening for financial hardships and the timely introduction of cost conversations for patients. However, few articles focused on the experiences of caregivers from racial and ethnic minority groups, highlighting a critical gap and need for more inclusive research.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148425794","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":"Translation, cross-cultural adaptation and preliminary psychometric evaluation of the Victoria Respiratory Congestion Scale into Spanish.","authors":"Jaume Canal-Sotelo, Antonio Martin-Marco, David Bottaro-Parra, Rosa Blasi-Martínez, Lina Nitola-Mendoza, Adrià Oller-Bonache, Carla Camí, Eva Barallat-Gimeno","doi":"10.1186/s12904-026-02209-7","DOIUrl":"10.1186/s12904-026-02209-7","url":null,"abstract":"<p><strong>Background: </strong>Death rattles are a frequent clinical sign in patients in an end-of-life situation, despite the lack of consensus on how to address them. The Victoria Respiratory Congestion Scale (VRCS) is an internationally utilized scale, but it has yet to be translated to Spanish. The aim of the present study was to translate and cross-culturally adapt the VRCS into Spanish and to assess selected psychometric properties, namely criterion validity and inter-rater reliability, in patients at the end-of-life.</p><p><strong>Methods: </strong>A systematic translation and cross‑cultural adaptation methodology was applied to ensure semantic, conceptual, and cultural equivalence of the instrument for Spanish‑speaking patients at the end-of-life. A cross-sectional study was conducted between May and September 2024 in home-care patients and patients in the palliative care unit at Hestia Balaguer Hospital and Hospital de la Ribera, to assess the criterion validity and inter-rater reliability of the Spanish version of the VRCS. Criterion validity was evaluated by calculating the correlation between the sound level measurements obtained using a smartphone sound level meter app and the VRCS scores using Spearman's correlation coefficient. Inter-rater reliability was calculated using weighted Cohen's kappa by comparing the VRCS scores independently assigned by two observers.</p><p><strong>Results: </strong>The first outcome of the study was the translation and cross-cultural adaptation of the Spanish VRCS (Sp-VRCS). The validity and reliability were assessed in a sample of 47 patients aged between 54 and 98 years old, with 82.98% being men. In addition, 76.60% of them had a primary diagnosis of cancer. Spearman's correlation coefficients were ρ = 0.758 (maximum dB), ρ = 0.649 (mean dB), and ρ = 0.569 (minimum dB), indicating moderate to acceptable correlations. All correlations were statistically significant (p < 0.01, two-tailed). The inter-rater reliability analysis revealed that the weighted Cohen's kappa coefficient was 1.00, indicating a perfect inter-rater agreement in this sample.</p><p><strong>Conclusions: </strong>The Sp‑VRCS demonstrated good criterion validity and high inter-rater reliability agreement. The present study provides preliminary psychometric evidence for the Spanish version of the VRCS. The results support its use as a feasible and clinically useful scale for assessing respiratory congestion in palliative care patients at the end-of-life. Further multicentre validation studies addressing additional psychometric properties are recommended before broader implementation.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13471475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Walker and Avant concept analysis of slow code practice in end-of-life resuscitation.","authors":"Hamed Gholizad Gougjehyaran, Hadi Hassankhani, Elnaz Asghari, Hamidreza Haririan","doi":"10.1186/s12904-026-02222-w","DOIUrl":"10.1186/s12904-026-02222-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The slow code is a complex and ethically sensitive phenomenon in cardiopulmonary resuscitation (CPR), referring to a deliberately partial or delayed resuscitation attempt in patients with poor prognosis or terminal conditions. Although it is recognized in clinical practice, the concept remains ambiguous and ethically controversial. Clarifying its defining attributes, antecedents, and consequences is essential for ensuring ethical and responsible end-of-life decision-making in healthcare.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study applied Walker and Avant's (2019) concept analysis method to clarify the concept of slow code in CPR. A comprehensive literature review was performed using PubMed, Scopus, Web of Science, CINAHL, ProQuest, and SID databases. The search covered studies published up to 2025 in both English and Persian. The following keywords and their combinations were used with Boolean operators AND and OR: slow code, symbolic resuscitation, code status, do not resuscitate, end-of-life decision-making, nursing ethics, and CPR ethics. Relevant literature was screened and analyzed to identify defining attributes, antecedents, and consequences of the concept.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis revealed that the slow code represents a symbolic and ethically complex clinical act, performed when resuscitation is deemed clinically futile but ethical, cultural, or familial expectations pressure healthcare teams to act. Defining attributes include partial or intentionally delayed resuscitation, symbolic compliance with clinical or institutional norms, and an underlying intent to reconcile professional ethics with contextual constraints. Antecedents include patient-related factors (terminal illness, poor prognosis, low probability of return of spontaneous circulation), team-related factors (moral distress, perception of futility, prior ethical conflict), and organizational factors (absence of DNR policies, ambiguous end-of-life care guidelines, hierarchical team culture, and time pressure). Consequences include prolonged patient suffering, family misunderstanding or loss of trust, moral distress and emotional burden among healthcare providers, and organizational ethical dilemmas. However, transparent management guided by ethical frameworks can facilitate constructive discussions about end-of-life care, improve communication with families, and inform institutional policy development.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;This concept analysis clarifies slow code as a distinct yet ethically controversial phenomenon characterized by intentionally limited or symbolic resuscitation despite perceived medical futility. Clarifying this concept does not endorse its clinical use; rather, it provides a clearer conceptual framework for distinguishing slow code from related end-of-life practices, supporting ethical education, informing institutional policies, and guiding future empirical research. The findings further hig","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13629000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148413392","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":"The impact of death attitudes on death anxiety among nursing interns: a multicenter cross-sectional study.","authors":"Han Zhou, Yue Shen, Bo Zheng, Yonghui Wan, Xuezeng Tan","doi":"10.1186/s12904-026-02223-9","DOIUrl":"10.1186/s12904-026-02223-9","url":null,"abstract":"<p><strong>Background: </strong>This multi-center, cross-sectional study investigated death attitudes and death anxiety among nursing interns in China, explored their internal correlations, and identified independent predictors of high death anxiety to provide an empirical basis for enhancing death education and end-of-life care quality.</p><p><strong>Methods: </strong>A survey was conducted among 400 nursing interns from four medical institutions using an online platform. Validated instruments included the Death Attitude Profile-Revised (DAP-R) and the Chinese Version of the Templer Death Anxiety Scale (CT-DAS). High death anxiety was defined as a CT-DAS score > 35. Multivariate logistic regression was employed to identify factors significantly associated with death anxiety.</p><p><strong>Results: </strong>Of the participants, 27.5% were classified as having high death anxiety. Correlation analysis revealed that natural acceptance was negatively associated with death anxiety (r = -0.252, P < 0.001), while fear of death (r = 0.508), death avoidance (r = 0.274), approach acceptance (r = 0.200), and escape acceptance (r = 0.225) showed significant positive correlations (all P < 0.001). Multivariate analysis identified female gender as a significant risk factor (OR = 4.17, 95% CI: 1.45-12.02, P = 0.008). Fear of death (OR = 1.39, 95% CI: 1.26-1.54, P < 0.001), approach acceptance (OR = 0.90, 95% CI: 0.84-0.96, P = 0.002)and escape acceptance (OR = 1.16, 95% CI: 1.05-1.28, P = 0.003) were associated with death anxiety.</p><p><strong>Conclusions: </strong>Nursing interns in China exhibit a relatively high prevalence of death anxiety, which is closely linked to gender, clinical knowledge, and cognitive orientations toward death. Higher levels of fear of death and escape acceptance are associated with increased death anxiety, whereas approach acceptance appears to be protective. It is imperative to integrate structured, experiential death education into nursing curricula to enhance interns' psychological resilience and improve the delivery of end-of-life care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":48945,"journal":{"name":"BMC Palliative Care","volume":" ","pages":""},"PeriodicalIF":3.7,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406500","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}