Access to palliative care remains uneven for people described, often variably and controversially, as culturally and linguistically diverse. Terminology and definitions differ across jurisdictions, shaping how models are designed, implemented, and reported. Evidence on model design and impact for people of culturally and linguistically diverse backgrounds is limited and heterogeneous. To map what is known about palliative care models for adults of culturally and linguistically diverse backgrounds in high-income nations, describing model components, reported outcomes, implementation influences, and gaps. A scoping review was conducted, guided by the JBI manual and the PRISMA-ScR checklist. In May 2024, MEDLINE, CINAHL, and Scopus were searched. Eligible publications described a palliative care model for adults of culturally and linguistically diverse backgrounds in high-income nations and reported evidence of utility. Letters, commentaries, editorials, protocols, reviews, and anonymously-authored publications were excluded. No limits on date, design, numbers, outcomes, or language were applied. Five publications met the inclusion criteria. Four shared components were identified - culturally sensitive care, family and community engagement, interdisciplinary and community-based approaches, as well as education and empowerment - with reported benefits for patients and family members. However, the evidence-base was geographically narrow, with no explicit engagement with an intersectional analytic lens. This review indicates areas of apparent consensus about core components, while underscoring conceptual and evidentiary limitations. Future research should employ theoretically-informed, structurally-oriented, and co-produced approaches that clarify definitions and examine how models address intersecting disadvantages and organisational constraints to achieve equitable, scalable palliative care.

Reiki and Therapeutic Touch are complementary therapies sometimes used in palliative and end-of-life care. To examine the available evidence regarding the effects of Reiki and Therapeutic Touch, compared to usual care, in palliative and end-of-life care. Systematic review registered in PROSPERO (CRD420251059364; May 23, 2025). MEDLINE, Web of Science, and Scopus were searched for English-language studies published between 2013 and 2024. Eligible studies included patients receiving palliative care who underwent Reiki and/or Therapeutic Touch compared with usual care. Any primary study design was eligible. Risk of bias was assessed and findings synthesized narratively. Nine studies involving 415 participants were included: five mixed-methods studies, three randomized controlled trials, and one qualitative cross-sectional study conducted in North America (n = 6) and Europe (n = 3). Cancer was the predominant diagnosis. Risk of bias raised some concerns in randomized trials and was moderate to high in qualitative and non-randomized designs. Some studies reported improvements in symptoms (pain, anxiety, depression, fatigue, and stress), and in quality-of-life domains (sleep, relaxation, energy, hope, and emotional well-being). Qualitative findings described perceived relaxation, comfort, and emotional support. Reporting of harms was limited; only one study monitored adverse events and reported one serious event considered potentially related to the intervention. Evidence regarding Reiki and Therapeutic Touch in palliative and end-of-life care remains limited and heterogeneous. The very low certainty of evidence precludes firm conclusions regarding their effectiveness. Further well-designed studies are needed to clarify their potential role in palliative care.

Previous studies show ambiguous results concerning quality of palliative care among patients with severe mental disorders, defined as schizophrenia, moderate to severe depression, and bipolar disorders. To investigate quality in specialist palliative care among Danish patients with pre-existing severe mental disorders using data from the Danish Palliative Database. Danish cohort study linking data from the Danish Palliative Database and hospital medical files. All adult decedents in 2023 from Central Denmark Region affiliated with specialist palliative care. Hospital records were screened for severe mental disorders. Quality indicators included: Place-of-death, days from referral to death, specialist palliative care waiting time, discussion at multidisciplinary conferences and completion of symptom assessment. Of 1869 patients, 80 (4.3%) had pre-existing severe mental disorders. Compared to patients without mental disorders, these patients died younger and more often from non-cancer conditions. They were less likely to complete symptom assessment (Risk Ratio (RR): 1.49 (95% CI: 1.15;1.95)). Those who also received active psychiatric treatment experienced longer waiting times for specialist palliative care (Mean ratios (MR): 3.48 (95% CI: 1.06;11.39)) and shorter palliative care pathways (MR: 0.44 (95% CI: 0.20;0.96)) than patients without active psychiatric treatment. Danish patients with active severe mental disorders were less likely to complete symptom assessment, had longer waiting times and shorter specialist palliative care pathways. Future efforts should focus on timely access to specialist palliative care and health professionals supporting completion of symptom assessments in this population.

High-quality evidence suggests that specialist palliative care reduces the odds of dying in hospital. The economic implications have not been established. To evaluate the cost-effectiveness of home- and hospital-based specialist palliative care for adults with poor prognosis in England. Health-economic decision-modelling using five-state Markov cohort models with a 24-h cycle and lifetime horizon. We evaluated home- and hospital-based care separately. We modelled counterfactuals using Cochrane review evidence of treatment effects on place of death and quality of life. We estimated place of death distributions, utilisation, quality-adjusted life years, and unit and intervention costs from the literature. Home-based care was associated with reduced costs of £7908 per person (95% confidence interval: -18,044 to 395) and increased quality-adjusted life years by 0.035 per person (0.033 to 0.037). Hospital-based care reduced costs by £6480 per person (-11,482 to -1671) and increased quality-adjusted life years by 0.033 per person (0.031 to 0.035). We estimated that for England in 2022, specialist palliative care supported over 20,000 people to die outside of hospital, saved approximately 1.5 million hospital bed days and reduced system expenditures by £817 million. Specialist palliative care reduces hospital bed days, deaths in hospital and healthcare costs, as well as improving quality of life, among adults in England. A minority who might benefit currently receive specialist palliative care and needs are growing rapidly. Expanding access may yield further gains, but bridging current gaps in access also requires new approaches to reaching and meeting the needs of underserved groups.

People with advanced cancer often experience a range of symptoms and reduced well-being. Experience sampling methods, which involve completing multiple smartphone-based questionnaires per day over several days, may offer detailed insights into how these experiences unfold in daily life. To evaluate feasibility and acceptability of experience sampling methods in advanced cancer, and its potential to uncover moment-to-moment symptom and well-being fluctuations. Observational study including baseline measurement, a 7-day experience sampling period with up to 10 assessments per day of symptoms and well-being, and follow-up measurement. We evaluated feasibility through response data and acceptability through a follow-up questionnaire measuring burden, ease-of-use, instruction clarity, and measurement reactivity. We analyzed fluctuations using within-person standard deviations. We invited 79 people with advanced breast or lung cancer via two Belgian hospitals; 40 (51%) enrolled. Thirty-seven participants provided 1703 valid (71% of 2400 scheduled) experience sampling assessments. On 7-point scales, participants reported low burden (M = 2.1, SD = 0.8), high ease-of-use (M = 5.6, SD = 1.2) and instruction clarity (M = 6.5, SD = 0.5), and minimal measurement reactivity (M = 1.3, SD = 0.3). On 0-100 scales, we observed the greatest means of within-person fluctuations across days for tiredness (MiSD = 16.7, SD = 7.7), feeling relaxed (MiSD = 13.0, SD = 7.3), and activity limitations (MiSD = 12.4, SD = 9.9). Higher mean symptom intensity generally corresponded with greater within-person fluctuations. Experience sampling methods proved feasible and acceptable for people with advanced cancer, effectively capturing individuals' unique symptom and well-being fluctuations in daily life. The methods are a promising avenue to enhance personalized care and improve quality of life by revealing the mechanisms behind individuals' fluctuations.

Muslims constitute the largest religious minority in Euro-American countries. Interactions between Muslim patients and healthcare providers in end-of-life care may give rise to religio-cultural ethical dilemmas, resulting in tensions. Understanding these tensions may support care providers in navigating the critical transition from life to death within non-Muslim majority contexts. To thematically map ethical tensions arising from religio-cultural dilemmas in end-of-life care for Muslim patients, and to equip healthcare professionals in Euro-American contexts with the insights needed to address them. A scoping review was conducted in accordance with the Johanna Briggs Institute (JBI) methodology. A comprehensive literature search was performed in Scopus, Medline, CINAHL, and APA PsycInfo, from inception to 7 November 2024, in collaboration with a medical information specialist. Empirical studies addressing religio-cultural ethical dilemmas and tensions in end-of-life care for Muslims were included. Ethical tensions were examined using a structured framework integrating theological perspectives with empirical findings. Of 9237 records screened, 12 studies met the inclusion criteria. Three overarching themes emerged: (1) end-of-life communication, (2) spiritualizing pain, and (3) treatment withholding/withdrawal. Tensions were most pronounced when divergent moral frameworks prioritized conflicting principles. Ethical tensions in end-of-life care for Muslim patients in Euro-American healthcare settings reflect diverse, context-dependent interpretations of Islamic principles. Addressing these tensions requires early, culturally sensitive engagement and the development of a shared ethical framework in close collaboration with healthcare providers, Muslim chaplains, mosques, imams, and umbrella organizations.

Effective advance care planning depends on clinician-patient communication quality. However, ACP-CAT, the only validated observer-rated instrument, remains untested in real-world clinical encounters and non-Western contexts. Validating ACP-CAT in assessing clinician-patient communication quality with advanced cancer and chronic kidney disease in Hong Kong, comparing against patient and family ratings of clinician communication. Cross-sectional study of adult patients with advanced cancer or chronic kidney disease from five hospitals and one hospice service. Two independent raters evaluated audiotaped advance care planning conversations using ACP-CAT, while patients and family members assessed communication quality using the Chinese Quality of Communication Questionnaire (C-QOC). We assessed the psychometric properties, including interrater reliability, convergent and discriminant validity. One hundred and thirty-seven advance care planning conversations involving 84 cancer patients, 53 renal patients, 107 family members, and 20 clinicians. ACP-CAT demonstrated high interrater reliability (mean Gwet's AC1 = 0.81; 88.6% agreement). Convergent validity was demonstrated through significant correlations between ACP-CAT total score and patient-rated C-QOC End-of-life planning subscale (r = 0.29, p < 0.01), family-rated C-QOC summary score (r = 0.27, p < 0.05), and family-rated C-QOC End-of-life planning subscale (r = 0.34, p < 0.01). Discriminant validity was supported by absence of correlations with patients' self-rated health status and information or decision-making preferences (all p > 0.05). Clinicians frequently explored patients' fears and health goals, but rarely discussed nonmedical priorities, valued activities, or surrogate decision makers. ACP-CAT demonstrates strong concurrent validity with patient- and family-rated measures and ecological validity in real clinical settings. These findings support its reliability for assessing advance care planning communication quality across diverse cultural contexts.

Background:Healthcare assistants play a critical role in providing palliative and end-of-life care in the community across many healthcare systems internationally. Despite working alone in emotionally demanding and unpredictable settings, no research has examined their psychological wellbeing or factors influencing turnover.Aim:To investigate the correlations between mental wellbeing, intention to leave their role and workplace support in lone working healthcare assistants providing palliative and end-of-life care in the community.Design:Explanatory sequential mixed methods study, using cross-sectional survey (Warwick-Edinburgh Mental Well-being Scale and Turnover Intention Scale, project team-developed questions), followed by interviews. Quantitative data analysed using descriptive and inferential statistics, qualitative data analysed using framework approach.Setting/participants:Lone working healthcare assistants from a UK non-profit organisation providing palliative and end-of-life care.Results:Among 218 survey respondents (22.5% response rate), 80% (n = 174) reported average to high mental wellbeing (mean = 52.2, SD = 8.6). Intention to leave was low (mean = 14.9, SD = 5.3). Higher wellbeing correlated with lower intention to leave (r(216) = −0.25, p < 0.001). Interviews (n = 14) and survey data revealed support from known individuals, particularly line managers, was most valued and accessed by 87.2% of respondents, significantly associated with higher wellbeing and lower turnover intention. Clinical supervision and peer support were frequently accessed and valued, though impact on wellbeing and retention varied. Anonymous online support services remained largely unused despite high awareness.Conclusions:The study challenges assumptions about psychological distress experienced by this workforce while showing that targeted, personalised workplace support strategies could be key to retention, offering evidence-based pathways for strengthening workforce sustainability.

Uncertainty about the future is commonly experienced by older adults with advanced multimorbidity, impacting multiple life domains and frequently causing anxiety. Communicating about future uncertainty affects patient satisfaction, quality of decision-making and opportunities for future planning. Patient, carer and healthcare professional experiences of future uncertainty communication have been little studied to date. In the context of older adults with advanced multimorbidity, to explore patient, carer and healthcare professional experiences and preferences for communication of uncertainty about their future. Multi-method qualitative research utilising in-depth interviews and focus groups with reflexive thematic analysis. Older adults with advanced multimorbidity (n = 15), their nominated informal carers (n = 3), and community and inpatient healthcare professionals working with this population (n = 17). Participants' experiences of uncertainty communication were influenced by their acceptance or avoidance of addressing future unknowns. Patients and their informal carers expressed a range of information needs: they prioritised open and honest dialogue with healthcare professionals, tailored to their unique circumstances and supported by reassurance and proactive plans, even when medical options were limited. Healthcare professionals acknowledged the importance of addressing uncertainty: they expressed a lack of experience and confidence and feared upsetting patients or losing their trust. As a result, opportunities for timely and personalised communications may be missed. To support patients and carers navigate the inherent uncertainties of advanced multimorbidity, healthcare professionals would benefit from tailored communication training designed to increase their experience of undertaking honest and open dialogue about future uncertainties, informed by patients' individual context and preferences.