palliative care

Spiritual distress is a prevalent and distressing phenomenon among patients with rare and incurable diseases, with evidence showing it affects up to 44% of individuals with advanced cancer. Manifestations include despair, helplessness, and spiritual pain—non-physical suffering that significantly impacts physical and emotional well-being. Despite its high prevalence and serious consequences, spiritual care remains under-addressed in clinical practice. To map the existing literature on the spiritual care needs of patients with incurable diseases, identify key domains of spiritual distress, and explore associated influencing factors and outcomes.

This scoping review synthesized empirical findings from a range of peer-reviewed studies exploring spiritual needs in populations with life-limiting illnesses. Articles were selected based on relevance to spiritual distress, care needs, and palliative settings, with particular attention to cross-cultural and disease-specific variations.

Spiritual needs in this population are diverse, encompassing four primary dimensions: connection, peace, meaning/purpose, and transcendence. Specific needs frequently identified include preparation for death, existential meaning-making, emotional support, maintaining autonomy, and achieving inner peace. Factors such as cultural background, religious coping, family dynamics, and disease trajectory shape the expression and intensity of these needs. Failure to address them correlates with reduced quality of life, higher healthcare utilization, and requests for physician-assisted death. Conversely, spiritual well-being offers protective benefits including enhanced quality of life, hope, dignity, and reduced end-of-life despair. Despite this, only 6% to 28% of patients report receiving spiritual care from healthcare professionals.

Spiritual care needs are integral to the lived experience of patients with rare and incurable diseases. These needs are complex, deeply personal, and shaped by cultural and existential contexts. Their neglect contributes to suffering and poor healthcare outcomes. Holistic care models must prioritize spiritual assessment and integrate targeted interventions to support well-being, dignity, and peace at the end of life.

Palliative care seeks to enhance the quality of life for patients with life-limiting illnesses and their families, transcending geographical, cultural, and socioeconomic boundaries

 The aging population and the rising prevalence of chronic diseases have made palliative care a necessity for improving individuals’ quality of life. Many healthcare professionals do not possess sufficient training and knowledge in this regard. The objective of this study was to assess the attitudes and knowledge of internal medicine residents regarding palliative care.

A cross-sectional study was performed to assess the knowledge and attitudes of internal medicine residents (N=91) at Tabriz University of Medical Sciences. A validated, structured online questionnaire was used to assess demographic characteristics, palliative care knowledge (30 items), and attitudes (37 items) across four domains. The data analysis was conducted using SPSS version 24, employing both descriptive and inferential statistical methods, including t-tests, ANOVA, and multiple linear regression.

The mean knowledge score was 19.66 ± 2.93, and the mean attitude score was 139.47 ± 11.44). Prior training (p = 0.041) and male gender (p = 0.009) showed a significant correlation with higher attitude scores. Knowledge scores had a positive correlation with year of residency (p = 0.033) and a negative correlation with age (p = 0.004). Despite limited knowledge, 67% of participants stated that they needed training on palliative care.

Despite favorable attitudes toward palliative care, the lack of knowledge, particularly in conceptual and psychological domains, should be addressed. The findings highlight the necessity of palliative care training in internal medicine residency programs.

This systematic review aimed to evaluate nursing students’ palliative care knowledge and to explore factors that may influence it. A comprehensive literature search was conducted from database inception to March 1, 2023, using Medical Subject Headings and related terms (e.g., “knowledge”, “palliative care”, and “nursing students”) across major international databases (Scopus, PubMed, and Web of Science) as well as Iranian sources, including IranMedex and the Scientific Information Database. The methodological quality of eligible cross-sectional studies was appraised with the Assessment Instrument for Cross-Sectional Studies (AXIS). Overall, eleven cross-sectional studies were included, comprising a total sample of 4,320 nursing students. The average nursing student's knowledge of palliative care was 8.94 (standard deviation [SD]=3.57) out of 20; these results indicate an insufficient level of knowledge. Factors such as age, female gender, encounters with terminally ill patients, participation in non-university educational sessions, maturity, and participation in university educational sessions may be positively associated with nursing students’ palliative care knowledge. Furthermore, the investigation revealed that the following variables had a statistically significant association with nursing students' level of knowledge in palliative care: academic year, perception of death as the cessation of life, receipt of university educational sessions, teaching content related to palliative care, type of university, academic grade, gender, place of birth, monthly family income, religious beliefs, and experience of providing care to a dying family member. Thus, future studies should focus on implementing effective interventions to enhance nursing students’ palliative care knowledge.

Improvement in quality of life and palliation of symptoms forms the primary end point in patients unfit for definitive treatment modalities. Quad-shot like radiotherapy aims to achieve these objectives with addition of chemotherapy in advanced head and neck malignancy. In this study, patients >18 years of age, with advanced head and neck malignancy (stage IVA&B) in non-nasopharyngeal sub-site, not fit for radical treatment were included in this mono-centric, prospective, interventional study. Quad-shot like regimen of 14.4Gray in 4fractions delivered with concurrent carboplatin (AUC2) on day-1 of radiation cycle and reviewed after 3-weeks. Based on palliative response, total two repetition are done. Quality of life analysis was done with European Organization for Research and Treatment– Head & Neck-35 questionnaire Treatment induced toxicity evaluated with common terminology criteria for adverse event version 5.0 and radiation therapy oncology group toxicity grading. Treatment outcome was assessed with response evaluation criteria in solid tumors1.1. Microsoft-excel, SPSS version-22 used to analyze data. Kaplan-Meier survival curves were used for overall survival, P-value<0.05 with Pearson chi-square test and ANOVA was considered as statistically significant. The palliation of symptoms and improvement in quality of life were recorded in 80% and sustained up to 3 months, with median overall survival of 8±0.411 months, maximum benefit appreciable with larynx compared to other sub-sites. However, grade-4 toxicity reported with one patient in post phase-1 and two patients in post phase-2 and managed with best supportive care. Quad-shot like radiotherapy with concurrent chemotherapy for advanced head and cancer found to be beneficial in patients unfit for radical treatment resulting in desirable palliative outcome.

The growing elderly population and prevalence of chronic diseases have elevated palliative care as a global public health concern. The knowledge and attitudes of undergraduate nursing students regarding palliative care will impact the quality of care in the future.

This study was conducted with aim to evaluate the knowledge and attitudes of nursing students towards palliative care among at Tehran University of Medical Sciences .

This cross-sectional descriptive study was conducted in 204 on nursing  students in their 5th to 8th academic semesters at Tehran University of Medical Sciences in 2022. Data was collected using the Palliative Care Quiz for Nursing (PCQN) and a researcher-developed attitude questionnaire through an online survey. Statistical analysis was conducted using SPSS software (version 16.0). p<0.05 was considered statistically significant.

The analysis of the attitude questionnaire showed that 87.3% of participants had a positive attitude towards palliative care. Gender was a significant factor in attitude, with women scoring higher (p=0.0001). The mean PCQN score was 10.26 ± 2.33, indicating limited knowledge. There was no significant correlation between knowledge and attitude scores.

 Most undergraduate nursing students had inadequate knowledge about palliative care, but they generally held positive attitudes towards it. Therefore, it is crucial to develop an effective palliative care program for nursing students by implementing a unified curriculum.

Caring for palliative care (PC) patients can impose a high level of burden on family caregivers (FCs). However, little is known about predictors of burden among this population. This study aims to determine the prevalence and factors predicting a high level of FCs burden in those who care for PC patients.

This cross-sectional study recruited FCs of individuals with advanced or terminal illness from the PC settings of two health service networks in the south of Thailand. The data were collected using self-administered questionnaires. The prevalence of burden was estimated. Binary logistic regression was employed to identify factors predicting FC burden, and the area under the ROC curve was used to assess model discrimination.

Of 305 FCs met the eligibility criteria, and 42.3% (95% CI: 36.4-47.7) of them reported experiencing a high level of burden. Factors significantly predicting high burden were severe anxiety (OR=2.19; 95% CI: 1.19-4.01), severe depression (OR=2.17; 95% CI 1.10-4.27), FCs with illness (OR=2.13; 95% CI: 1.23-3.70), decreased quality of life (QOL) by 1 point (OR=1.04; 95% CI: 1.02-1.06), respectively. Likewise, the final model was statistically significant (area under ROC curve=0.79; 95% CI: 0.63-0.74, P<0.001), indicating that this model could differentiate between FCs who reported a high burden and those who did not.

The burden is high among FCs of palliative care patients. Mental illness affected both functional capacity and QOL and raised FC burden. Preventing and treating such disorders are crucial. Therefore, further studies should investigate strategies for alleviating FC burden in this population.

Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible respiratory condition that imposes a significant physical and psychological burden, often leading to a poor quality of life. Although palliative care can help address these challenges, in Iran it is typically limited to cancer patients and is not commonly provided to those with COPD. Globally, the early integration of palliative care for chronic illnesses is expanding. The present study aims to investigate the feasibility and acceptability of an early tele-palliative care intervention for patients with COPD in Iran and to explore its potential effects on quality of life, anxiety, depression, and emergency department readmissions.

This randomized controlled feasibility trial protocol involves a 3-month early tele-palliative care program delivered by two nurse coaches, targeting patients with COPD. Participantswere randomly assigned to either the intervention group (n = 26) or the control group (n = 26) using permuted block randomization. Both groups received traditional COPD care; however, the intervention group also received six weekly telephone sessions and six weeks of follow-up support via phone call and WhatsApp Messenger. The primary objective was to assess the feasibility and acceptability of early tele-palliative care, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction, attitudes toward the intervention, and adherence to the intervention. The secondary outcome included changes in quality of life, anxiety, depression, and hospital readmissions. These were measured using validated instruments at two time points: Baseline (pre-intervention) and three months post-intervention. Statistical analyses were performed using SPSS version 22, including the independent samples t-test, paired samples t-test, chi-square test, and Fisher’s exact test. Analysis of covariance (ANCOVA) was used to compare the mean outcomes between the two groups while statistically controlling for the effect of baseline values. Statistical significance was set at p < 0.05.

This study protocol aimed to determine the feasibility and acceptability of an early tele-palliative care intervention for patients with COPD in Iran. The findings provided essential data to inform the design of a future large-scale clinical trial and support the potential integration of early telehealth palliative care into standard COPD management in the country.

Obstructive jaundice commonly complicates pancreatic cancer and often requires biliary decompression. Percutaneous transhepatic biliary drainage (PTBD) followed by stent placement is used for palliation, but long-term stent patency and the relationship between patency and overall survival (OS) remain incompletely characterized.

We conducted a retrospective cohort study of 60 consecutive patients who underwent sequential PTBD and biliary stent placement at the Affiliated Hospital of Jiangnan University (Wuxi, China) between January 2020 and December 2024. Primary endpoint was stent patency (time from stent insertion to radiologically confirmed occlusion or repeat intervention). Secondary endpoint was OS measured from stent insertion. Patient characteristics, stent type (covered vs uncovered), tumor location, stage, and receipt of systemic chemotherapy were extracted from electronic medical records. Kaplan–Meier analysis and Cox proportional hazards models (adjusted for age, sex, cancer stage, tumor location, baseline bilirubin and chemotherapy) were used. Proportional hazards assumption was tested using Schoenfeld residuals.

Median stent patency was 12.0 months (IQR 8.0–15.0) and median OS was 9.5 months (IQR 6.0–13.0). Covered stents were associated with longer patency (median 13.0 vs 11.0 months; log-rank P=0.018). In multivariable Cox regression, Stage IV disease (adjusted HR 2.50; 95% CI 1.68–3.86; P<0.001) and age (per year, adjusted HR 1.05; 95% CI 1.02–1.09; P=0.002) were independent predictors of mortality; covered stent use was associated with lower mortality (adjusted HR 0.78; 95% CI 0.61–0.99; P=0.043). Schoenfeld tests showed no violation of the proportional hazards assumption (global P=0.18). Stent-related complications occurred in 16.7% of patients (migration 5.0%, infection 3.3%, biliary leak 1.7%, recurrent jaundice 6.7%).

Sequential PTBD and biliary stenting provides effective biliary decompression with a median stent patency of 12 months but only limited impact on OS, which is dominated by disease stage. Covered stents improved patency and were associated with a modest survival advantage after adjustment. Prospective, multicenter studies are required to confirm these findings and to explore integration with systemic therapies.

Palliative care is a holistic approach aimed at enhancing the quality of life for patients with cancer. Given the rising number of cancer patients in Iran, its significance has become increasingly apparent. This study investigates the effect of palliative care on the quality of life and satisfaction of patients with cancer.

This before-and-after quasi-experimental study was conducted in 2024 on 320 patients with breast, tongue, stomach, thyroid, osteosarcoma, and colon cancer at a teaching hospital in Tehran, Iran. Participants were selected through convenience sampling based on eligibility criteria, including being over 18 years of age, having literacy, being able to speak Persian, and being psychologically stable. The quality of life and life satisfaction of patients were assessed before and after participation in a structured palliative care program. The intervention consisted of six two-hour palliative care sessions, delivered over two months. Data were collected using the Satisfaction with Life Scale (SWLS) and the EORTC QLQ-C30 Quality of Life Questionnaire. Data analysis was conducted using SPSS software, version 26, and a paired t-test was employed for statistical evaluation.

The results indicated that the participants had a mean age of 50.67 years, with a standard deviation of 13.23 years. After receiving palliative care, the overall quality of life score, along with its dimensions (except for emotional functioning, sore throat, and diarrhea), showed a significant improvement (P < 0.001, Cohen’s d = 2.36). Moreover, the intervention led to a significant improvement in patients' life satisfaction, with a p-value of less than 0.001 and a Cohen’s d of 1.01.

The study findings demonstrated that palliative care services, typically provided to individuals nearing the end of life, enhanced the quality of life for cancer patients. Policymakers should prioritize support for patients, and healthcare managers must collaborate to improve and provide palliative care services with qualified personnel, especially nurses.

Childhood malignancies give parents and children substantial psychological anguish and life disruption. One of the best strategies to enhance cancer patients’ lives is palliative care. The present study aims to define the palliative care needs of families with children with cancer, identify strategies to address these needs, educate nursing staff to react as much as possible, and improve health care services.

The current research was a qualitative investigation undertaken with the involvement of families of children diagnosed with cancer who were sent to educational hospitals in Ilam City in 2024. The data were collected via purposive sampling. Subsequently, data were gathered using semistructured interviews, and a guided content analysis was conducted for data analysis. The first stage of coding started by identifying the analysis unit, which encompasses words, phrases, topics, and sentences that possess distinct meanings. The primary ideas inside each analysis unit will be organized under the heading of the semantic unit.

This study included 10 individual interviews with diverse subjects. The interviews revealed four main categories and 12 subcategories of palliative care needs for families with children with cancer: psychological care (mental distress, homesickness, cancer taboo, and collapse of mental image), social care (lack of coherent support network, financial challenges, displacement, and out‑of‑hospital/telephone care), and physical care. Rethinking Spirituality was removed.

Palliative care for children addresses medical, psychological, social, and spiritual issues to improve quality of life for the child and family. Correct and ethical treatment based on clinical recommendations is crucial.

 Palliative care is an approach designed to enhance the quality of life and alleviate suffering associated with life-threatening illnesses. It should also be included in Home Care Services. This study aimed to identify the needs of patients in palliative care and their caregivers from the perspective of Home Care Service providers.

 This qualitative research study was conducted with a multidisciplinary team of providers under the Home Care Service program in the interior of São Paulo state, Brazil. Data were collected through semi-structured interviews and analyzed using the Content Analysis method.

Three categories emerged from the provider's narratives: insufficient knowledge about palliative care, the needs of patients in palliative care, and the needs of caregivers of patients in palliative care. Additionally, nine subcategories were identified: palliative care as end-of-life care, palliative care as an opportunity to provide comfort measures, lack of palliative care training for the multidisciplinary team, pain management, nutrition, emotional support, and psychological care, presence of family members, psychological support, and assistance in care management.

This study identified the needs of patients in palliative care and their caregivers from the perspective of Home Care staff. The primary needs of patients, as identified by the staff, encompassed both physical and psychosocial support, including the presence of family members. For these patients’ caregivers, staff emphasized the importance of psychological support and assistance in managing care. The study highlights the importance of continuous education in the home palliative care setting that recognizes the needs of both patients and caregivers.

Integrating palliative care (PC) into oncology is essential for improving the quality of life (QoL) of patients with cancer. This review aims to provide a comprehensive and critical analysis of the current nursing perspective on cancer-related symptom management in PC, while identifying gaps and opportunities for improving PC services in Iran. 

This study was designed as a state-of-the-art (SotA) review methodology to provide a comprehensive and analytical up-to-date synthesis of the current state of knowledge on PC in oncology nursing. A literature search was conducted across international and national databases, including Scopus, PubMed, Google Scholar, Web of Science, SID, Magiran, and Islamic World Science and Technology Monitoring and Citation Institute (ISC), covering studies published from 2014 to 2025. The focus was on articles addressing nurses’ roles, care strategies, and challenges in symptom management within PC settings.

Oncology nurses in Iran play a key role in managing cancer-related symptoms across physical, psychological, social, and spiritual domains. However, their ability to deliver comprehensive care is hindered by limited specialized training, unclear national policies, nursing shortage, and cultural barriers. Most Iranian studies focus on single symptoms rather than symptom clusters, and the use of digital tools such as telemedicine remains minimal.

Oncology nurses in Iran play a critical role in symptom management, but face barriers such as limited training in PC, workforce shortages, cultural sensitivities, and policy gaps. Increasing training, developing national frameworks, and utilizing telemedicine can improve the quality and access to PC.

Palliative care plays an important and vital role in reducing pain and suffering among patients receiving treatment in critical care settings. This narrative review was conducted in 2025 with the aim of reviewing the existing evidence on models, interventions, and challenges associated with implementing palliative care in the intensive care unit (ICU). 

This study was a narrative review of the existing evidence regarding interventions, models, and outcomes of palliative care in adult ICU patients. Between January 2010 and July 2025, an extensive literature search was performed across databases including PubMed, Scopus, Embase, Web of Science, Google Scholar, Magiran, Irandoc, and SID. Eligible studies included peer-reviewed publications focusing on palliative care in the ICU for populations aged ≥ 18 years, published in English or Persian. Following screening and quality assessment, 19 articles were included in the final analysis.

Among the 19 selected studies (7 narrative reviews with expert consensus, 2 narrative reviews, 2 systematic reviews with meta-analysis, 3 systematic reviews, 3 interventional studies, and 1 mixed-methods study), two primary models of ICU palliative care integration were identified: The consultative model and the integrative model. The success of these approaches depended on specialized training for nurses and physicians, standardized protocols, and interprofessional collaboration, although a lack of training and resources remained a significant challenge. The use of appropriate screening criteria and triggers can enhance access to and the quality of palliative care in the ICU.

Palliative care in the ICU, whether through an integrative or consultative model, improves care quality, alleviates physical and psychological symptoms in critically ill patients, increases family satisfaction, and optimizes resource utilization. Nurses play a central role in delivering these interventions, and specialized training, standardized protocols, and interprofessional collaboration are prerequisites for their successful implementation. Palliative care should be an integral part of the management of all critically ill patients, not solely end-of-life care, and evidence-based policymaking along with the development of a supportive organizational culture facilitates its implementation.

Palliative care constitutes an integral component of the healthcare emergency response system. This study investigated palliative care services in Iran during the COVID-19 pandemic, with the objectives of documenting adaptations and developing a roadmap for future health crises. The findings aim to promote inter-institutional collaboration, inform policy, enhance care quality, and emphasize the importance of maintaining patient dignity in emergency situations.

A qualitative research methodology was employed in two primary phases in 2022. In the initial phase, semi-structured interviews were conducted and analyzed utilizing an inductive approach. The study implemented a purposive sampling method, followed by snowball sampling, to achieve data saturation. Data saturation was attained after 17 interviews. The participants comprised medical personnel engaged in the care of patients infected with the virus. Concepts and categories were derived using MAXQDA 2018.1. In the second phase, expert panels were convened, and key informants in the field of palliative care were invited to provide recommendations regarding the reorganization of the initially developed categories. 

The results demonstrated the implementation of novel approaches in palliative care across seven principal domains, including effective and compassionate communication and care coordination, management of pain and other symptoms, psychosocial care, spiritual care, complementary and traditional medicine, end-of-life, grief, and bereavement care, and support for care providers. The study revealed that, in the context of the ongoing pandemic in Iran, the establishment of palliative care services has reached unprecedented levels compared to other similar crises.

This study examined the adaptations in palliative care implemented during the ongoing pandemic, emphasizing the necessity of evaluating these emerging practices and integrating palliative care into future epidemic guidelines to ensure comprehensive patient support during crises. It underscores the need for continuous research and the formulation of new policies in this field.

Progressive neurological disorders (PNDs) are a real public health challenge with significant impact on patients’ quality of life. Limited research exists on PNDs social impact in low- and middle-income countries. The present study was conducted with aim to explore the impact of PNDs on patients’ daily lives in the physical, social, professional, and financial levels. This cross-sectional study was conducted in 2024 on patients diagnosed with PND within the last 12 months. A survey developed by the authors focused on social and professional activities and financial stability, distributed through social networks communities. Data collection gathered 89 responses. The findings showed low regular health monitoring (59.5%), insufficient pain medication prescriptions (33.7%), significant decrease in social activities (t=4.920; p<0.005), and occupational activities (t=3.689; p<0.005) accompanied by a need of financial support for a large number of patientsImplications for Practice: The findings advocate for the implementation of specific health programs to manage PNDs from diagnosis to palliative care, build national database and develop research. Recognition of PNDs as disabilities and development of intersectoral collaborations will improve prevention and also living conditions of patients through the facilitation of work-retention and extension of social coverage. Awareness of professionals, community and policy makers must also be strengthened to ensure this category of disease visibility.

Palliative care improves the quality of life (QoL) and extends the survival of cancer patients. It is associated with reduced depression, improved physical and psychological symptoms, and increased patient satisfaction.

This study aimed to assess the current status of palliative care provision for cancer patients in Iran.

This qualitative study was conducted in 2023 using 19 semi-structured interviews with health professionals, cancer patients at the Tajrish Hospital Cancer Clinic, and their family caregivers. Participants were selected through purposive sampling. Data were analyzed using conventional content analysis based on the approach of Graneheim and Lundman (2004). Themes from each main category were incorporated into a strengths, weaknesses, opportunities, and threats (SWOT) analysis. The trustworthiness of the data was evaluated using Lincoln and Guba’s criteria.

Analysis resulted in 462 codes, 14 subcategories, and 5 main categories: (1) Comprehensive support, (2) effective communication, (3) uncertainty, (4) information seeking, and (5) infrastructure. These categories were mapped onto the SWOT matrix to identify strengths, weaknesses, opportunities, and threats.

The palliative care system in Iran remains in its developmental stages. To improve service delivery, it is essential to conduct a comprehensive assessment of its current state — including strengths, weaknesses, opportunities, and threats — and implement targeted interventions accordingly.

Palliative care is a fundamental component of cancer care for children. However, access to pediatric palliative care (PPC) remains limited in low- and middle-income countries. One of the major challenges in developing and implementing PPC is the lack of evidence-based models. Sharing practical experiences in establishing PPC services in various countries, including Iran, can provide valuable insights for similar healthcare settings.

This article aims to present the experiences and measures taken to establish and provide PPC at a major referral children's hospital in Iran, from inception to the present.

This study reports on the experience of establishing an outpatient pediatric palliative care clinic based on the World Health Organization (WHO) framework between 2021 and 2024 at Mofid Children's Hospital in Tehran, Iran.

Following WHO guidelines, this project was implemented in 11 steps. Key challenges encountered during the process included stakeholder engagement, human resource shortages, training gaps, and service monitoring. The most effective solutions involved increasing knowledge and awareness about PPC, promoting formal and informal education, and leveraging support from charities and research institutions.

The establishment of a PPC clinic at a national referral children's hospital and the documentation of its outcomes can serve as a model for expanding these services across Iran. Additionally, this model may be adapted for implementation in other countries facing similar challenges.