Transfusion in hospice and palliative care remains a complex issue as it is viewed as either a futile life-prolonging treatment or a legitimate intervention for symptom relief. These differing views result in inconsistent clinical practices. Anemia is common in terminally ill patients and is associated with fatigue, dyspnea, dizziness, palpitations, cognitive decline, and an impaired quality of life. Although red blood cell transfusion may provide short-term symptomatic improvement in selected patients, its benefits are often transient; repeated transfusions may be necessary, and its effect on patient survival is limited. Additionally, access to transfusion varies considerably across care settings, with relatively greater availability in tertiary hospitals and substantial barriers in many inpatient hospice units and home hospice services due to institutional and logistical constraints. This brief communication described an 88-year-old man with myelodysplastic syndrome whose transfusion-dependent fatigue substantially influenced decisions regarding hospice care. As a nearby hospice facility did not offer transfusion, the patient and family continued long-distance hospital visits to maintain symptom control. Hospice admission was delayed until his condition rapidly worsened.This case demonstrated that transfusion in patients with terminal illness may carry clinical significance not only in relation to survival, but also in providing symptom relief and in shaping patient and family preferences. Therefore, transfusion in hospice and palliative care should be considered case-by-case within an individualized, goal-concordant framework based on symptom burden, prognosis, patient values, treatment burden, institutional feasibility, and ethical principles, supported by shared decision-making and careful reassessment.

Purpose: We aimed to compare broad-spectrum antibiotic use between hospice and nonhospice patients with cancer at the end of life using nationwide data from Korea. Methods: In this retrospective cohort study, we analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. We applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. Results: After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospiceand 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P＜0.001).The proportion of patients receiving broad-spectrum antibiotics was generally lower amonghospice users across all time intervals (P＜0.001), and the number of days of therapy wasalso lower, with the largest differences observed during the final week and last 3 days of life.Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group. Conclusion Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.

Purpose: Whether celiac plexus neurolysis (CPN) retains opioid-sparing efficacy in palliative care patients receiving modern extended-release opioids remains uncertain after a recent randomized trial that reported no benefit. We describe fluoroscopy-guided CPN in such patients. Methods: Thirteen consecutive palliative care patients with unresectable or metastatic upper abdominal cancer (seven pancreatic, five hepatobiliary, one gastric) on strong opioid therapy underwent posterior fluoroscopy-guided CPN with absolute ethanol after a diagnostic lidocaine block. Daily oral morphine equivalent (OME) and Numeric Rating Scale (NRS) pain scores were recorded at baseline and 1, 2, and 4 weeks. Pain response was defined a priori as ≥30% NRS reduction. Results: Median age was 67 years, baseline median OME 86.5 mg/day (range, 15~215), and median NRS 6. Median OME decreased to 72, 60, and 57.5 mg/day at 1, 2, and 4 weeks (median reductions 46.5%, 26.7%, 43.5%;all P≤0.002), and median NRS improved to 3, 4, and 4 (all P≤0.001). A pain responsewas achieved in 8/13 (61.5%) at 1 week, 7/13 (53.8%) at 2 weeks, and 5/12 (41.7%) at 4weeks. Opioid-related adverse events declined numerically (nausea, 7/13→3/12; constipation, 4→2; somnolence, 2→0; all McNemar P>0.10). No procedural complication occurred(0/13). Conclusion CPN was followed by reduction in opioid use and pain scores, withresolution of opioid-related symptoms and no complications. Although limited by the smallsample size, these findings suggest a potential role for CPN in palliative care patients receiving extended-release opioids and warrant prospective investigation.

Purpose: This study examined the levels of end-of-life care preparedness, importance, performance, and educational needs among community-based home care workers and identified factors influencing end-of-life care performance to inform hospice/end-of-life care education programs. Methods: This study used a descriptive, correlational design. The participants were 152 community-based home care workers with at least 6 months of work experience. Data were collected using structured questionnaires that assessed end-of-life care preparedness, importance, performance, and educational needs. Data were analyzed using descriptive statistics, correlation analysis, importance-performance analysis (IPA), and hierarchical multiple regression analysis using SPSS version 29.0. Results: Overall, end-oflife care performance was significantly lower than its perceived importance (t=14.41, P＜ 0.001), with the largest gaps observed in the caregiving support and emotional support domains. In the IPA, multiple items related to death preparation for patients/families, spiritual/ emotional support, and care around the time of death fell into the low-importance/lowperformance quadrant. Educational needs positively correlated with importance, intention,confidence, preparedness, and performance. In hierarchical regression, preparedness (β =0.21, P=0.03) and importance (β=0.26, P＜0.001) significantly predicted performance, explaining 15% of variance. Conclusion End-of-life care performance among home care workers was influenced by psychological factors, including preparedness, importance, and confidence in end-of-life care, as well as institutional and environmental factors. Standardized educational programs and organizational support are required to improve the quality of community-based end-of-life care.

Purpose: This study aimed to evaluate changes in the proportion of patients receiving palliative sedation (PS) before and after the mass resignation of junior physicians in South Korea. Methods: This single-center retrospective chart review included patients who died between February 19, 2023 and August 18, 2024. We retrospectively identified patients who were prescribed sedatives such as midazolam outside the intensive care unit on the day of death and classified them as having received PS. Data were extracted from electronic medical records. Categorical variables were compared using the chi-square test, while continuous variables were compared using the Student’s t-test. Results: In the year before resignation, 78 of the 745 deceased patients (10.5%) received PS; whereas in the subsequent six months, 24 of the 237 patients (10.1%) received PS. No statistically significant difference was observed in the proportion of patients receiving PS between the two periods. Conclusion The proportion of patients receiving PS did not show a significant difference, despite the disruption caused by the mass resignation of junior physicians.

Purpose: This study explored the experiences of physicians and nurses providing end-oflife care in Korean acute care hospitals. It aimed to identify the challenges faced in caring for dying patients and to suggest strategies for improving hospital-based end-of-life care. Methods: A qualitative exploratory design was employed using focus group interviews.Eleven healthcare professionals (five physicians and six nurses) working in tertiary or general hospitals participated in the study between July and August 2018. The interviews were conducted using a semi-structured guide covering seven thematic areas. All sessions were audio-recorded, transcribed verbatim, and analyzed thematically following Braun and Clarke’s framework. Results: Six major themes emerged: (1) communication with patients and families, (2) physical care for dying patients, (3) psychological and spiritual support, (4) hospital environment and system constraints, (5) moral distress and emotional burden on healthcare providers, and (6) suggestions for improvement. The participants described difficulties in open communication, limited resources for comfort care, emotional strain from invasive treatment at the end of life, and the absence of standardized institutional protocols.They emphasized the need for structured communication training, multidisciplinary collaboration, and integration of palliative care principles into acute care practice. Conclusion Physicians and nurses play a pivotal yet emotionally demanding role in providing end-oflife care in acute hospitals. Institutional reforms, including education, protocol development, and supportive environments, are essential to ensuring dignified, patient-centered care and sustain healthcare providers in their professional roles.

Purpose: This study aimed to identify the factors influencing end-of-life care performance among community-based care workers prior to the implementation of the Integrated Care Support Act in South Korea. Methods: A cross-sectional survey was conducted among 153 community care workers who provided home-based services. Data were collected using structured questionnaires that assessed perceptions of a good death, attitudes toward end-of-life care, end-of-life care stress, and end-of-life care performance. Data analysis included descriptive statistics, independent t tests, Pearson correlation coefficients, and hierarchical multiple regression using SPSS version 29.0. Results: End-of-life care performance demonstrated a significant positive correlation with end-of-life care stress (r=0.43,P＜0.001). Hierarchical regression analysis identified end-of-life care stress (β=0.32, P＜ 0.001), gender (female; β=–0.20, P=0.01), and intention to participate in end-of-life care education (β=–0.20, P=0.01) as significant predictors. The final model explained 25%of the variance in end-of-life care performance. Conclusion End-of-life care stress was the strongest predictor of performance among community-based care workers, along with gender and intention to participate in end-of-life care education. These findings suggest that, when appropriately managed and supported, end-of-life care stress may function as a motivating factor rather than solely a burden. Therefore, structured education and emotional support interventions—such as debriefing and peer-based supervision—are recommended. Additionally, the implementation of the Integrated Care Support Act should be accompanied by institutional systems that facilitate effective end-of-life care practices.

South Korea received international acclaim for its rapid response to the initial coronavirus disease 2019 (COVID-19) pandemic crisis through the “K-Quarantine” model, successfully managing it without closing its borders; however, terminally ill patients awaiting death in 19 public hospice facilities (83.4%/297 beds) had to vacate their beds to accommodate patients with COVID-19. This study examines and analyzed South Korea’s hospice response policies during the pandemic. It draws on empirical data from domestic and international literature reviews and relevant websites. This study aimed to provide foundational data and policy recommendations for future pandemic preparedness. The findings revealed that, owing to the national response policy focused on infectious disease control and hospital bed allocation, 21 of the 88 inpatient hospice units in South Korea were closed, with their beds repurposed Therefore, hospice palliative care services became a “negotiable service” largely excluded from pandemic response policies. Strict visitation policies lowered hospice service utilization and disrupted service continuity. Emergency care support helped to mitigate care gaps; however, hospice care was limited in addressing patients’ specialized needs, demonstrating structural fragmentation within the health and welfare systems. In conclusion, South Korea’s hospice and palliative care response policy to the COVID-19 pandemic has failed to meet the essential goal of hospice palliative care: enhancing patient dignity and quality of life. To strengthen preparedness for future pandemics, designating specialized hospice institutions as essential health facilities, establishing infrastructure stabilization funds, developing a crisis-responsive payment systems, are essential.

Purpose: Palliative care is an essential aspect of healthcare, particularly for patients with life-limiting illnesses. Nurses play a crucial role in the provision of palliative care. In regions such as Jharkhand, India, where palliative care services are still developing, it is important to assess the level of preparedness among healthcare professionals, particularly nurses. This study aimed to assess nurses’ knowledge of and attitudes nurses in Jharkhand toward palliative care. Methods: A cross-sectional descriptive study was conducted among 200 registered nurses working in government and private healthcare facilities in Jharkhand were included in this study. A structured questionnaire comprising demographic questions, 20 knowledge-based multiple-choice questions, and a 30-item attitude scale was used for data collection. Results: Most nurses (57%) demonstrated moderate knowledge of palliative care, and 79% of the participants showed a positive attitude toward palliative care. Nurses with palliative care training and more than five years of experience were significantly more likely to have adequate knowledge (odds ratio [OR]=4.52, P=0.001; OR=3.85, P=0.002).Nurses of Jharkhand had more positive attitudes toward palliative care when they had more education (OR=4.82, P=0.040) and worked in government healthcare facilities (OR=2.63, P=0.007). Conclusion This study emphasizes the need for structured education and training programs, especially in government facilities, to improve nurses’ knowledge and prepare them to provide comprehensive palliative care. Enhancing nursing education and offering regular professional development opportunities are essential to improve the overall quality of palliative care delivery in the region.

Purpose: This study aimed to explore home-based hospice nurses’ end-of-life care experiences and elucidate the nature and meaning of end-of-life care. This study aimed to enhance the understanding of nurses’ role identity and provide basic data to improve the quality of home-based hospice care. Methods: The collected data were analyzed using Giorgi's phenomenological. The participants were 11 nurses working at a home-based hospice facility in Seoul and the surrounding metropolitan area selected through purposive sampling. Data were collected from August to November 2024 through semi-structured, in-depth individual interviews, each lasting an average of 64 minutes. Interviews were recorded and transcribed with the participants’ consent, resulting in 267 pages of data. The collected data were analyzed using Giorgi's phenomenological method. Results: The analysis revealed four thematic categories, “Practicing emotional care,” ”Burden and burnout of professional life,” “Rediscovering the meaning of existence” and “Awareness of sustainable care systems.” Home-based hospice nurses supported patients and their families in accepting death and forming emotional bonds. They also experienced both burnout and fulfillment during the repetitive process of providing end-of-life care. Furthermore, they achieved personal and professional growth through reflection on life and death but recognized structural limitations such as a lack of staff and inadequate institutional support. Conclusion This study demonstrates that end-of-life care provided by home-based hospice nurses extends beyond simple physical care to include emotional and spiritual support, demonstrating the need for institutionalization, strengthening the educational foundation, and establishing a practical support system.