Palliative Care

Province-wide snapshot of continuous palliative sedation under a legal mandate

This Quebec cohort analyzed 1005 adults who received continuous palliative sedation (CPS) until death under a mandatory-reporting end-of-life law. Most CPS occurred in academic hospitals or hospices, with no reported use at home or in chronic-care institutions. Cancer dominated as the underlying diagnosis, and psychological or existential distress was the most frequent indication, often alongside other refractory symptoms. Median CPS duration was 2 days, longer when driven by psychological or existential distress. 1

Microdose psilocybin for psychological distress in advanced incurable illness

This open-label, single-arm trial tested a 3-week escalating microdose psilocybin regimen for severe psychological distress in adults with advanced incurable illness. Of 20 enrolled, 17 started and 13 completed treatment; most participants had cancer and prognoses between 1 and 12 months. No serious adverse events occurred, and only mild or moderate adverse events were reported, though four withdrew for progression or poor response. Among completers, most reported meaningful global improvement and large reductions in depressive, anxiety, and demoralization scores. 2

Mechanism-based, precision approaches for cancer pain

This scoping review of 278 recent studies links cancer pain to tumor–neuron–immune crosstalk and tumor-derived neurotrophic factor–driven nociceptor sensitization. Genetic and epigenetic variation partly explains inter-individual differences in pain phenotypes and analgesic responses. Management is moving from opioid-centric ladders toward multimodal precision strategies combining NSAIDs, opioids, adjuvants, nerve blocks, intrathecal delivery, and neuromodulation. Stereotactic body radiotherapy appears to provide more durable analgesia than conventional radiotherapy in selected metastatic pain settings. 3

Why contextualized serious-illness care stalls in real-world systems

Focus groups with 20 multidisciplinary Dutch clinicians caring for serious illness explored barriers and facilitators to contextualized care using COM-B and related frameworks. Participants described adequate motivation and basic skills to elicit relevant life context but difficulty translating this into consistent behaviour. Barriers clustered in the Opportunity domain, including environmental constraints, fragmented information systems, misaligned incentives, and weak shared team norms. Emotional complexity of contextual conversations, particularly in the palliative phase, further impeded implementation despite clinicians’ intrinsic commitment. 4