Fresh Perspectives on Familiar Challenges

Spanish researchers conducted a systematic review of 35 international studies published between 2000 and 2025 to assess the effectiveness of tools for the early identification of palliative care needs. The authors compared traditional clinical scales and questionnaires with emerging artificial intelligence models. The analysis found that most tools primarily assess mortality risk and hospitalisation rates, leaving patients’ psychological, social, and spiritual needs overlooked. Furthermore, AI algorithms have not yet undergone independent validation. The authors conclude that the predictive ability of current scales remains moderate and urge a shift in clinical screening from predicting mortality towards assessing real-time changes in patient condition and quality of life.

A paediatric palliative care team at Boston Children’s Hospital and the Dana-Farber Cancer Institute faced a growth crisis: the existing system could not cope with the workload, and staff burnout was escalating. To address this, leadership sent 16 team specialists on short observational placements to seven leading North American palliative care centres. An external perspective highlighted key vulnerabilities in their practice — from ill-defined boundaries of responsibility to breakdowns in handover between shifts. Based on these insights, the team overhauled the service structure: they established a dedicated outpatient arm, introduced regular reviews of complex cases, and set clear operational standards. A staff survey conducted a year later showed that the reform reduced workplace stress and streamlined service operations.

A systematic review of 26 studies (8,831 patients) demonstrated that a preventive approach is central to managing delirium in ICUs and palliative care units. Non-pharmacological prevention yields the most reliable outcomes, including comprehensive care, sleep hygiene, light therapy, and family involvement. Pharmacological prevention is generally ineffective, although atypical antipsychotics and dexmedetomidine show some potential. For established delirium in palliative care patients, evidence for medication is limited: prescribing antipsychotics, benzodiazepines, or opioids is justified mainly to control severe pain and manage acute psychomotor agitation at the end of life. Pharmacotherapy should strictly serve as an adjunct to nursing care and non-pharmacological measures.

A multicentre study of palliative care specialists in Bangladesh found that the primary barriers to adequate pain management in hospitals and at home remain a limited range of available opioids (oral morphine syrup is the main analgesic) and low staff awareness. The study highlighted a systemic knowledge gap: the vast majority of doctors and nurses are unaware of national clinical guidelines on opioids. The situation is further complicated by strict prescribing regulations, fear of addiction and severe adverse effects, misconceptions about palliative care, and reluctance among other medical departments to refer patients to palliative specialists. The authors emphasise that overcoming ‘opioid hunger’ in resource-limited settings requires circulating unified guidelines, revising prescribing regulations, and providing interdisciplinary medical education.

A literature review and 10 years’ experience delivering Last Aid Courses across 23 countries demonstrate that educating the public in basic end-of-life care skills is not only achievable but essential. A standardised four-module curriculum helps individuals learn practical care, understand symptom management and legal issues, and support loved ones through bereavement, thereby helping to break the taboo surrounding death. Research confirms high demand for these courses across diverse audiences — including adults, children, and teenagers. Completing the course increases willingness to discuss end-of-life matters openly and to assist seriously ill relatives. The authors conclude that Last Aid Courses should become an established public health norm alongside first aid training, though further research is required to evaluate their long-term societal impact.