Palliative Care

Seven-year cancer-center cohort demonstrates much earlier outpatient palliative referrals

In a 700-patient cohort, median survival after first outpatient palliative visit increased from 9.3 months in 2017 to 31.7 months in 2021. Seventy-two percent of patients were referred ≥6 months before death or last follow-up, showing timely referral is achievable in practice. The median number of palliative visits per patient rose from 3 to 7 over the seven-year period, indicating deeper longitudinal engagement. Earlier referral correlated with better performance status, certain cancer types, lower pain and anorexia, and later calendar year of consultation. These data support operationalizing “timely” oncology referral as at least six months before expected death with potential multi-year follow-up. 1

Metasynthesis details how caregivers balance avoidance, meaning, and support at end of life

A metasynthesis of 44 qualitative studies involving 691 caregivers identified five main coping themes in non-dementia terminal illness. Caregivers moved between avoiding acknowledgment of decline, mobilizing professional and social support, and cognitively reframing through positive reappraisal and acceptance. They derived meaning from fulfilling relational obligations, spiritual beliefs, and preserving normal routines and shared activities with the patient. Coping was portrayed as fluid navigation of caregiving demands and pre-death grief, including identity loss and anticipated death. Authors recommend routine, longitudinal assessment of caregiver grief with early interventions targeting both caregiving stress and anticipatory grief. 2

ACP-CAT validated against patient and family ratings in real-world ACP encounters

This cross-sectional study used 137 recorded advance care planning conversations from oncology and renal services in Hong Kong. ACP-CAT showed high interrater reliability, with mean Gwet’s AC1 of 0.81 and 88.6% rater agreement. Higher ACP-CAT scores correlated with better patient and family Quality of Communication end-of-life planning subscale ratings, supporting convergent validity. Scores were unrelated to patients’ self-rated health or information and decision-making preferences, supporting discriminant validity. Clinicians frequently explored fears and health goals but rarely addressed nonmedical priorities, valued activities, or surrogate decision makers. 3

Scoping review maps religio-cultural tensions in caring for Muslim patients at end of life

A scoping review of 12 empirical studies identified key ethical tensions in end-of-life care for Muslims in Euro-American systems. Three main domains emerged: end-of-life communication, spiritualizing pain, and decisions about treatment withholding or withdrawal. Tensions intensified when clinicians and families applied divergent moral frameworks, such as pain relief versus perceived spiritual benefits of suffering. Interpretations of Islamic principles varied across contexts, cautioning against monolithic assumptions about Muslim patients’ views. Authors propose early, culturally sensitive engagement and shared ethical frameworks co-developed with Muslim chaplains, imams, and related organizations. 4