Background: When a child has a life-threatening illness, guidelines emphasise the importance of providing holistic support to the whole family. Conversations about existential issues are essential in this support, yet staff often lack formal training in communication, particularly when addressing such issues as life and death. This qualitative study explored how paediatric healthcare professionals in Sweden experience and approach conversations about existential issues with children and their families facing life-threatening illness.

Methods: Eight professionals representing different disciplines and paediatric palliative care settings took part inindividual interviews, analysed using an interpretative description approach.

Results: The results show that healthcare professionals experienced the existential conversations with families as emotionally intense, ethically complex, yet meaningful. A balance between courage, presence, sensitivity, and professional boundaries was crucial, as well as the need for collegial support. The importance of honest communication and age-appropriate ways of talking about illness and death was emphasized. They stressed that communication should be empathetic and culturally sensitive, without ready-made solutions, and based on theunique needs of the family. They also described organizational factors that influenced their ability to engage inexistential conversations with the families.

Conclusions: Maintaining an open approach to existential conversations is essential to how these dialogues are carried out. Such an approach includes creating workplaces with an organizational culture that encourages existential conversations with patients and families. The importance of both personal and professional development is also emphasized, where collegial support and structures that promote professional growth, such as supervision and debriefing, strengthen the ability to address existential issues.

Background: Palliative care (PC) is increasingly recognised as an essential component of healthcare, yet access remains unequal, particularly for older people. Nursing homes accommodate older people with complex needs and account for a large proportion of deaths, making PC a central component of care in these settings and underscoring the importance of integrating a PC approach into everyday care. However, staff often lack sufficient training and may perceive PC as limited to end-of-life care rather than as an ongoing approach. Education has been proposed to strengthen PC competence, but little is known about how staff reason about PC following such initiatives. This study aimed to explore nursing home staff's reasoning about providing PC after participating in an interprofessional educational intervention (IPEI).

Methods: A descriptive qualitative design was used. Eighteen staff members from five nursing homes in Sweden, including registered nurses, assistant nurses, a physician, first-line managers, and PC champions, participated. Data were collected through semi-structured individual interviews conducted between March and April 2024 and analysed using inductive qualitative content analysis.

Results: Three main categories were identified: (1) managing one's own emotions, thoughts, and attitudes; (2) the significance of relationships, communication, and interactions in care; and (3) navigating norms, assumptions, and organisational structures in everyday PC. These categories reflect how staff reasoned about providing PC at individual, relational, and organisational dimensions.

Conclusions: The findings suggest that staff perceived the IPEI as providing opportunities for personal and professional development. Staff's reasoning further suggested that alignment across individual, relational, and organisational dimensions is important in supporting the provision of PC. Providing PC was not solely a matter of enhancing staff knowledge; rather, staff's reasoning suggested that knowledge and conditions for care are shaped through the interplay between staff attitudes, their reasoning about care, relational dynamics, and organisational conditions. When these dimensions align and mutually reinforce one another, favourable conditions for providing PC may be supported. Such conditions may also be supported through interprofessional educational initiatives that combine theoretical knowledge with opportunities for reflection and practical application.

Vilka begrepp vi använder bidrar till att utveckla palliativ vård. Det är därför dags att lämna föråldrade uttryck för nya. Det hävdar sju omvårdnadsforskare.

Purpose: The study aimed to describe patients' experiences of physical, psychological, social, and existential symptoms and challenges during the first year after allogeneic haematopoietic cell transplantation (allo-HCT).

Methods: Quantitative and qualitative data were collected and analysed with descriptive methods as part of a large retrospective cross-sectional online survey of patients who underwent allo-HCT between 2017 and 2020.

Results: In total, 126 (59.7%) of all eligible patients participated, mean age 57 years (range 21–75), equal distribution of gender and time after allo-HCT. Most patients (58%) had experienced fewer than 5 coexisting symptoms, although 8% reported more than 10. Physical symptoms or challenges (83.0%) were most often reported, followed by social (52%), existential (50%), and psychological (43%), as described in responses to open-ended questions. Analysed descriptions resulted in 12 categories/areas of physical symptoms and challenges;  two categories each of psychological—My inner self and Me in my context; social—Social isolation and Impact on relationships; and existential symptoms and challenges—Re-evaluating life and myself and An uncertain future.

Conclusion: Patients experienced a variety of symptoms and challenges as a multidimensional experience during the first year after allo-HCT. A holistic approach to symptoms and challenges is needed to address individual patients' situations. This knowledge emphasises the importance of patients receiving supportive care to navigate life after transplantation and into survivorship.

This study used data from the Swedish Register of Palliative Care, supplemented with questions, to investigate presence at the time of death and explore factors associated with dying alone. The sample consisted of 10,574 patients who had died an expected death, of whom 77% had someone present at the time of death. Only 19% had expressed a wish regarding the presence of others; among those who had not, the odds of dying alone were higher. In 93%, family members had been informed that death was imminent; when they had not been informed, the odds of the patient dying alone was higher. When patients died alone, the time since someone was last present ranged from between one minute to more than 60 minutes. Furthermore, the absence of a documented medical decision regarding transition to end-of-life palliative care and higher age were associated with higher odds of dying alone.

Background: Nursing students often feel unprepared for end-of-life care, and education, and clinical experience can enhance their confidence. Clinical supervisors are crucial in this process, yet knowledge of their experiences is limited.

Aim: To explore supervisors' experiences of tutoring undergraduate nursing students in the care of dying patients.

Methods: A qualitative study with individual semi-structured interviews with eight registered nurses. Datawere analyzed using qualitative content analysis.

Results: Themes: adapting supervision to student preparedness; equipping students; and nurturing wings for secure exploration were identified. The findings underscore the multifaceted nature of palliative care supervision and highlight the need to tailor support to students' levels, experiences, and expectations through reflection, preparation, end-of-life care knowledge, and emotional coping skills. It shows how supervisors foster student growth while maintaining safety for students, patients, families, and themselves.

Conclusion: Supervisors support both students' learning and well-being while balancing patient and family safety. They play a key role in preparing future healthcare professionals to deliver high-quality end-of-life care.

Bakgrund: En stor andel av dödsfall i Sverige sker på äldreboenden, där personalen ofta saknar utbildning i palliativ vård. Tidigare forskning visar att faktorer som utbildning och erfarenhet påverkar attityder till vård i livets slutskede, men kunskap om äldreomsorgspersonalens attityder och möjligheter till etiska samtal är begränsad.

Frågeställning: Hur påverkar en ettårig utbildningsintervention med palliativa ronder och workshops personalens attityder till vård av äldre personer med palliativa behov på särskilt boende samt personalens möjligheter till etiska samtal?

Metod: En kvantitativ studie genomfördes vid fem särskilda boenden för äldre personer i Stockholms län, där personalen deltagit i en riktad ettårig utbildningsintervention. Data inhämtades med Frommelt Attitudes Toward Care of the Dying Short Form (FATCOD-SF) och studiespecifika frågor för att identifiera möjligheter till samtal, inklusive etiska samtal. Data samlades in vid två tidpunkter: under interventionen (2023) och åtta veckor efter avslutad intervention (2024). Deskriptiv statistik användes för analys.

Resultat: Ingen statistisk signifikant förändring i attityder till att vårda äldre personer i livets slut och deras närstående observerades, men interventionen visade positiva effekter för samtal om livet, döden och framtiden, samt för möjligheter till etiska samtal inom deltagarnas arbetsplatser. Efter interventionen rapporterade deltagarna att samtal om livets slut oftare initierades av såväl personal som de äldre personerna. En statistiskt signifikant förbättring noterades i samtal om etiskt svåra situationer bland personalen.

Konklusion: Interventionen hade positiva effekter på möjligheterna till etiska samtal i personalgruppen och en tendens till fler samtal om livet och döden med de äldre personerna. Den övergripande effekten på attityder gentemot vård av personer i livets slut och deras närstående var dock oförändrad.

Purpose: The aim of this study was to explore patients' experiences of being prepared for allogenic haematopoietic celltransplantation and to explore their perceived self-efficacy and preparedness for self-care after allogenic haematopoieticcell transplantation.

Methods: Nine participants, who recently underwent allo-HCT, were interviewed regarding their views on preparedness,self-efficacy and self-care. The interviews were analysed using inductive qualitative content analysis.

Results: An overarching theme, Life is taken apart, then you have to know how to put the pieces together, and four sub-themes: Convert information into something understandable; Taking responsibility, maintaining and preparing for an uncertaintime in life; Balancing vigilance with independence; and Reorientating in an altered body places new demands on self-careillustrate the dismantlement of life during treatment and how actions and approaches can build a new life.

Conclusions: Both participants and healthcare professionals prioritised preparing for allo-HCT in the period before admission. However, during admission, preparation decreased and the time was not used for preparatory learning. This meant that participants were well prepared for the acute phase but unprepared for life after completion of treatment. Among the participants, self-efficacy was good. They sought information about taking care of their health before and in the aftermath of allo-HCT.

Implications for Cancer Survivors: This study provides insight into, and knowledge about, how patients prepare before, during and after treatment. This knowledge should primarily be directed towards healthcare professionals to be used for future patients who may need advice and support, as well as continued preparation for a life after transplantation.

Background/Objectives: Undergoing intensive cancer treatment, such as allogeneic haematopoietic stem cell transplantation, challenges the entire life situation of patients and their family caregivers. A prerequisite for effective care is that interventions are tailored to the unique circumstances of each individual. The aim of this study was to examine the feasibility of a developed person-centred nursing model in this context.

Methods: The nursing model involves systematic use of conversation tools with subsequent conversations to assess and address the needs of patients (two tools) and their family caregivers (one tool). Patients, family caregivers and registered nurses from two Swedish stem cell transplantation centres testing the model were included. Data to measure practicality were gathered from the tools and documented conversations, while acceptability was assessed from the interviews.

Results: 36 patients, 32 family caregivers and 16 registered nurses participated. 67–94% of the patients and 94% of the family caregivers completed the tools. 78–97% of the subsequent conversations were conducted as planned. 78% of the patients and registered nurses were positive about one of the patient tools, while 41% were positive about the other patient tool. 95% of the family caregivers and registered nurses were positive about the family caregiver tool. Most participants considered that the systematic use of tools helped to structure a holistic needs assessment.

Conclusions: This feasibility study indicates that most components of our nursing model are practical, acceptable and support registered nurses when conducting person-centred nursing. With further development, the model has the potential to enhance the quality of care and support within the cancer context.

Introduction: Allogeneic stem cell transplantation (allo-HCT) involves a long trajectory with high risk of complications. In person-centred care (PCC), patients’ needs, resources and the care relationship are central to the care process. Healthcare professionals’ (HCPs) ratings of PCC have not previously been investigated in this context.

Objectives: The aim of this study was to investigate healthcare professionals’ ratings and views of person-centred care in allo-HCT care, and associations with individual characteristics and targeted PCC education.

Design: Cross-sectional study, employing quantitative and qualitative methods.

Methods: 85 HCPs at two Swedish allo-HCT centres participated (80% women; mean age: 44 years, range: 23-72 years). A survey was conducted using the PCC Assessment Tool (P-CAT), containing 13 items, a total scale (min 13-max 65) and two subscales (I: min 8-max 40; II: min 5-max 25). Additionally, HCPs’ written responses to four study-specific questions about PCC were collected.

Results: The mean for P-CAT total scale was 45.31, (subscale I: 28.41; subscale II: 16.90). Higher ratings of PCC were reported for assessment of patients’ needs, discussion about how to provide PCC and patients’ care, while time to provide PCC, the care environment and how the organization prevents providing PCC were rated lower. Higher age and targeted PCC education were associated with higher PCC ratings. HCPs described PCC as the patient being seen as a capable individual with their own resources, with PCC increasing patient and family involvement—giving higher satisfaction and tailored care for patients. However, HCPs reported time as a barrier for PCC.

Conclusion: HCPs’ ratings of PCC in this context are high regarding discussing and assessing patients’ needs, but there is room for improvement regarding organizational and environmental aspects. Targeted PCC education increases the level of PCC. HCPs’ views of PCC partly reflect the foundations of PCC—patient’s narrative, capability and involvement.