Despite the high frequency and severity of fatigue among patients with advanced cancer receiving immunotherapy, there are limited treatment options available. The aim of the study was to explore the effects of the methylphenidate (MP) with standardized physical activity (PA) on cancer related fatigue (CRF).

In this pilot study, patients with advanced cancer with clinically significant CRF (<34 on Functional Assessment of Cancer Illness Therapy – fatigue scale, FACIT-F), on anti-PD1 immunotherapy were eligible. Patients were randomized to standardized PA with either patient-controlled MP 5 mg (MP + PA arm) or matching Placebo (Pl + PA arm) twice daily for 14 days. The primary outcome was the change in the FACIT-F score. Secondary outcomes included changes in fatigue dimensions (Multidimensional Fatigue Symptom Inventory-Short Form (MSFI-SF), Functional Assessment of Cancer Therapy – General (FACT-G), Patient-Reported Outcome Measurement Information System-Fatigue (PROMIS-F), and hospital anxiety and Depression Scale (HADS).

Of the 40 randomized patients, 34 were evaluable. The FACIT-F scores significantly improved in both the arms with mean (SD) change, effect size (ES) of 11(14), 0.87(P < .001); and 9(12), 0.74(P = .04) in MP + PA, and Pl + PA arms respectively. We also found significant improvements in PROMIS-F, ES − 1.05(P = .003), MFSI-SF(global), ES − 1.32(P < .001), and HADS-depression, ES − 0.92(P = .004) in the MP + PA arm; There were no significant differences in adverse events between groups.

Our preliminary study found MP + PA was associated with significant improvement in CRF scores. The fatigue dimensions and depression scores significantly improved in the MP + PA arm. Further comparative studies using MP + PA for CRF are justified.

Most people at the end of life wish to die at home. Lay carers are crucial to supporting a home death and key to a good death is management of symptoms; this may prevent unwanted hospital admissions. If a dying person is too weak to swallow, regular medicines are administered continuously via subcutaneous (SC) cannula. When symptoms “break through,” additional (or as-needed) doses can be given, usually by a visiting healthcare professional. Delayed symptom control can occur due to time taken for healthcare professionals to arrive at the home.

Lay carers can be trained to administer as-needed SC medicines; the practice is safe and legal in the UK, although not widely used. The “CARer-Administration of as-needed SC medication for breakthrough symptoms in people dying at home” (CARiAD) feasibility trial of lay carer administration in the UK was the first to conduct in-depth interviews with carers trained in the practice.

The objective of this paper is to give voice to carers and show how experiences reflect benefits and challenges of lay administration at the end of life.

Qualitative interviews with carers trained in the practice. Interviews were analyzed using Interpretive Phenomenological Analysis.

Caring for a loved one at home during the last days of life is complex. Accounts reveal a desire to fulfill a loved one’s wishes by keeping them at home and having the death they wanted. Carers were afraid of uncontrolled symptoms, especially pain, empowered by the ability to help and grateful to avoid long delays. Potential for carer burden and fears of hastening death require careful reassurance from health care professionals.

We learned that carers endorsed and embraced the opportunity to do more to keep their loved ones comfortable and at home. This is significant in making the case for wider access to the practice in the UK.

Patients with advanced cancer, their caregivers, and healthcare professionals can differ in their preferences for patient treatment and care. The objectives of this study were to (1) identify what healthcare professionals in specialist palliative care feel aids or challenges patients with advanced cancer and their caregivers to manage their discordance, and (2) decipher what is helpful or challenging for healthcare professionals themselves to manage discordance between patients with advanced cancer and their caregivers.

A qualitative study was conducted comprising online focus groups with 19 healthcare professionals from different professions in specialist palliative care. Participants were purposively and snowball sampled, and recruited from specialist palliative care settings, including hospital, hospice, and community-based care. The data were member checked and analyzed using thematic analysis.

Trust and consistent communication between the patient, caregiver, and healthcare professional, were considered by participants as helpful for patients and caregivers to manage discordance. Emotional and psychological burden for both the patient and caregiver together with preexisting conflict between the patient and caregiver, were perceived as barriers for patients and caregivers to manage their discordance. Knowledge and expertise gained from practice combined with professional resilience and peer support enabled participants to help patients and caregivers navigate discordance. Relational conflict between the patient and caregiver combined with participants’ own uncertainty about ethical and legal connotations of helping the patient and caregiver resolve their differences, were barriers to helping the patient and caregiver manage their discordance.

Interventions focused on assisting patients with advanced cancer in palliative care and their caregivers manage their differences in decision-making could serve to alleviate emotional burden for both the patient and caregiver. Healthcare professionals in specialist palliative care value the perspective of both patients with advanced cancer and their caregivers when helping them manage their discordance in decision-making.

Cancer patients may suffer negative consequences; however, they also report positive aspects of psychological adjustment, such as posttraumatic growth. One of the most widely used instruments for measuring this is the Posttraumatic Growth Inventory (PTGI).

Cross-cultural adaptation and Mexican validation of the PTGI-X in the palliative oncology population.

A prospective cross-sectional study was conducted in 2 phases: the first involved translation and cross-cultural adaptation (expert judgment/piloting), and the second involved validation of the scale. In the latter, the sample comprised 236 advanced-stage oncology patients, and the following analyses were performed: 1) items under the classical test theory, 2) discrimination and internal consistency indices, 3) confirmatory factor analysis, and 4) convergent and divergent validity.

Discrimination coefficients (pBis) ranging from 0.32 to 0.72 were obtained from the translated and adapted version. Cronbach’s alpha was 0.94. The 5-factor theoretical model was assumed; the confirmatory factor analysis yielded a scaled χ2 of 749.01 (df = 265; χ2/df = 2.83), CFI = 0.93, TLI = 0.93, RMSEA = 0.088, and SRMR = 0.065. Bivariate correlations were employed, showing moderate positive associations between the scale factors (r = 0.60 and 0.79) and low-magnitude positive correlations between the factors of posttraumatic growth and perception of quality of life (r = 0.14 and 0.18).

The PTGI-X-Mx showed satisfactory psychometric properties in patients with advanced oncological disease receiving palliative care.

End-of-life dreams and visions (ELDVs) and delirium frequently occur near death but differ in core features. Clinical differentiation becomes challenging when they co-occur. This case report illustrates the interplay between ELDVs and delirium, examines the limits of current diagnostic criteria in mixed cases, and outlines a nuanced approach to distinction.

We report the case of an elderly Brazilian woman with metastatic cancer who exhibited both ELDVs and delirium. Mental status was serially assessed using the Confusion Assessment Method (CAM). ELDV accounts were prospectively triangulated across patient, family, and clinician reports to enhance reliability and contextual understanding.

The patient’s experiences showed ELDV hallmarks – vivid, realistic encounters with deceased relatives, biographical relevance, and preparatory themes – yet many were affectively distressing and occurred alongside fluctuating attention and consciousness consistent with delirium. CAM effectively identified delirium but could not, on its own, distinguish ELDVs within delirious states. When co-occurring, ELDVs often emerged during “windows of lucidity” marked by preserved autobiographical context, intact recall with subsequent coherent narration, and insight, despite intense emotional valence. Distress alone was not discriminatory, probably being shaped by psychosocial and cultural factors. These observations indicate the need to supplement CAM with qualitative and phenomenological criteria, including content, vividness, biographical meaning, insight, cultural fit, and acuity/recall.

To our knowledge, this is the first case to map evolving end-of-life mental status using serial CAM while prospectively documenting ELDVs via triangulated reports. The findings highlight the complexity of differentiating co-occurring ELDVs and delirium and challenge the sufficiency of CAM alone. An integrated approach – combining CAM screening with structured ELDV assessment – may prevent misclassification and support holistic, dignified palliative care. As a single case in an underexplored domain, these insights require confirmation in larger, prospective studies to assess generalizability.

This study aims to examine the awareness, attitudes, and acceptability of medical aid in dying (MAiD) among healthcare professionals in Pakistan, a predominantly Muslim country where cultural and religious values heavily influence medical ethics and end-of-life decisions.

A cross-sectional survey was conducted online among 70 healthcare professionals, including physicians, nurses, and allied health workers in Pakistan. Data were collected via a structured, self-administered online questionnaire assessing knowledge, attitudes, and willingness to participate in MAiD-related actions. Descriptive and correlational analyses were conducted to identify patterns and associations.

Participants demonstrated moderate knowledge about MAiD (M = 17.13, SD = 3.42) and moderate support for its legalization (M = 18.89, SD = 4.99). However, levels of negative attitudes (M = 32.21, SD = 6.11) and legal and ethical concerns (M = 24.73, SD = 3.66) were high. Behavioral willingness to engage in MAiD-related actions remained low (M = 2.42, SD = 3.38), with limited intent to assist (M = 0.39), refer (M = 0.64), or approve physician-assisted MAID (M = 0.81). A significant negative correlation emerged between knowledge and support for legalization (r = − .25, p = .037), while no significant associations were observed between knowledge and willingness to participate in MAiD. Gender and profession did not significantly influence attitudes or willingness.

While Pakistani healthcare professionals display a conceptual understanding of MAiD, their readiness to participate remains low, primarily due to ethical, legal, and religious concerns. These findings highlight the need for creating awareness regarding MAiD and for providing culturally sensitive education, structured training in palliative care, and the development of clear legal frameworks to guide end-of-life decision-making in Muslim-majority contexts.

Although prior research has identified common attributes of a Good Death across cultures, few studies have simultaneously incorporated the views of patients, family caregivers, and physicians – particularly in Latin America, where structural barriers to palliative care persist. This study examines how these stakeholders in Mexico perceive and designate what constitutes a Good Death, aiming to identify its core components and cultural particularities.

Qualitative interviews were conducted with 14 advanced-stage oncologic and nononcologic patients receiving home-based palliative care, 12 family caregivers, and 21 physicians. Data were analyzed using principles of generic purposive sampling and thematic analysis.

The most frequent designation for a Good Death was “Dignified and Peaceful Death,” perceived as a multidimensional and multitemporal process. Five core domains emerged: physical, psychological, interpersonal, spiritual, and structural. These dimensions manifested across distinct phases – before death (as preparation), during death, and after death.

A Dignified and Peaceful Death begins when individuals become aware of their mortality and encompasses cultural, emotional, and structural elements that transcend physical death. This perspective suggests that end-of-life care should respond not only to biomedical needs but also to broader existential and relational dimensions that shape patient and family experiences in resource-limited settings.