Background: Patients with cancer and their caregivers experience significant psychological, physical, and emotional burdens throughout the disease trajectory which reduces their quality of life (QoL). Early palliative care (EPC) has been proposed as a strategy to alleviate physical, psychological and emotional burdens and improve health outcomes. While evidence generally supports the benefits of EPC, variations in reported outcomes highlight the need for a deeper understanding of its impact across different patient populations and healthcare settings. Objective: The primary aim of this study was to evaluate the pooled effects of EPC on psychological, functional status, and QoL outcomes in both cancer patients and their caregivers. The secondary aim was to evaluate the satisfaction of the patients and their family caregivers. Methods: A systematic review and meta-analysis were conducted following the preferred reporting item for systematic review and meta-analysis (PRISMA) guidelines. Four databases, PubMed, Scopus, EBSCOhost, and Cochrane, were searched up to January 2024. This study included randomized controlled trial (RCT) and pilot-RCT studies reporting psychological outcomes (anxiety, depression), functional status, QoL, and satisfaction in cancer patients and their caregivers. Subgroup analysis was performed to explore the short-term (< 24 weeks) versus long-term (≥ 24 weeks) effects of EPC. Mean differences (MD) and standard mean differences (SMD) were calculated using a fixed-effects model according to the Mantel–Haenszel model and a random-effects model according to the DerSimonian and Laird method. Results: A total of 24 studies met our inclusion criteria. For cancer patients, EPC significantly reduced anxiety (MD = -0.62, 95% CI: -1.02; -0.23, p = 0.002) and improved QoL (SMD 0.13, 95%CI: 0.06; 0.19, p = 0.0004). However, there was no significant reduction in depression (SMD -0.15, 95% CI: -0.36; 0.05, p = 0.14) and improvement in functional status (MD = 2.14, 95% CI: -0.78; 5.06, p = 0.15). Subgroup analysis revealed that long-term EPC significantly reduced anxiety and depression while improving QoL, but had no significant effects on functional status. For caregivers, EPC did not significantly impact either physical or mental QoL (Short form/SF-36 physical: MD = 0.81, 95% CI: -0.46; 2.09, p = 0.21; SF-36 Mental: MD = 0.53, 95% CI: -1.03; 2.08, p = 0.51). Moreover, satisfaction was more likely to be higher in patients and their caregivers who received EPC than in those who received usual care (MD 2.45, 95% CI: 0.90; 4.01, p = 0.002, MD 4.09, 95% CI: 0.60; 7.58, p = 0.02, respectively). Conclusion: EPC reduces long term psychological burden and improve QoL and care satisfaction experience among patients with cancer. Therefore, EPC should be more broadly introduced into cancer care earlier to address patient’s psychological burdens.

Introduction: This study aims to assess the palliative care nursing (PCN) knowledge and attitude of nursing students toward end-of-life care (EoLC) after completing the multi-methods PCN courses. Methods: A quasi-experimental study with a pre-and post-palliative survey was conducted. One hundred and sixty five nursing students from a faculty of nursing in Indonesia were enrolled, and knowledge and attitude were assessed using the palliative care quiz for nurses (PCQN) and the Frommelt Attitude Toward Care of the Dying and Death (FATCOD). Paired t-test and ANOVA were applied in this study. Results: After being involved in the PCN course, the mean score of PCN knowledge of the students increased significantly (p < 0.001). According to sub-domain analysis, the knowledge increased significantly in pain and symptom management (p < 0.001) and not significantly in the domains of theory and principle of the palliative, psychosocial, and spiritual care (p = 0.053; p = 0.080). Moreover, students’ attitude toward EoLC also increased significantly (p < 0.001), and positive attitudes increased from 75.6% to 91.5%. According to the ANOVA test, knowledge in two different groups (witnessed dying people and GPA) is not statistically meaningful (FWDP (1158) = 0.817, p = 0.367; FGPA (2.158) = 1.143, p = 0.322). Similarly, attitudes toward EoLC in two different groups are not statistically meaningful (FWD (1158) = 0.971. p = 0.326, FGPA (1157) = 1.278, p = 0.281). Conclusion: PCN courses with multi-method learning and teaching are effective to increase PCN knowledge, particularly in pain and symptom management knowledge, and also effective in increasing the positive attitudes toward EoLC.

This study sought to assess actions which Indonesia, Sudan, and Tanzania took to implement the health workforce commitments they made at the Third Global Forum on Human Resources for Health (HRH) in November 2013. The study was conducted through a survey of published and gray literature in English and field research consisting of direct contacts with relevant ministries and agencies. Results show that the three countries implemented interventions to translate their commitments into actions. The three countries focused their commitments on improving the availability, geographical accessibility, quality of education, and performance of health workers. The implementation of the Recife commitments primarily entailed initiatives at the central level, such as the adoption of new legislation or the development of accreditation mechanisms. This study shows that action is more likely to take place when policy documents explicitly recognize and document HRH problems, when stakeholders are involved in the formulation and the implementation of policy changes, and when external support is available. The Recife Forum appears to have created an opportunity to advance the HRH policy agenda, and advocates of health workforce development in these three countries took advantage of it.

Introduction: This study aims to explore nursing students’ perception and experience of end-of-life care (EoLC) in Indonesia, particularly in the family environment. Methods: This study used a qualitative research design to explore the experiences and perceptions of nursing students who have witnessed the dying of their family members. The study recruited 15 nursing students using a purposive sampling method, who were then invited to reflect and write their experiences in witnessing death of their families, and perceptions towards EoLC. The written reflections were analyzed using thematic analysis. Results: Thematic analysis showed that the experience of witnessing dying of a family member shaped nursing students’ perceptions and attitudes towards EoLC. Some themes that emerged in this study included the importance of effective communication with patients and their families, symptom management, spiritual, emotional, and social support, as well as the need to improve nursing education and training. Conclusion: This present study shows that the experience of witnessing the death of a family member shapes nursing students’ perceptions of EoLC in Indonesia. This present study provides recommendations that the students must be prepared emotionally and psychologically in caring EoL or dying patients. How attitude and readiness to care EoL patients are shaped by the experience in witnessing the dying family or loved one. As such, palliative and EoL curriculum should be included methods that allow desensitization and naturalization of dying for the students in order to make them ready to provide better EoLC for patients and their families. The results of this study can contribute to improving the quality of EoLC in Indonesia.

The increasing incidence of chronic conditions on a global scale requires a comprehensive approach to palliative care, which is recognized as an essential element of the continuum of care for people with life-threatening conditions. It has been argued that the integration of early palliative care for people with chronic conditions is beneficial. Nevertheless, barriers to integrating early palliative care have been extensively not reviewed. This review aimed to explore the barriers and facilitators of integrating early palliative care for people living with chronic conditions, employing a socio-ecological framework to provide a critical understanding of the influencing factors at multiple levels. The method was a mini review. This review emphasizes the complex and diverse factors that either hinder or facilitate progress in four areas: individual (such as gaps in knowledge and emotional reactions), interpersonal (such as support from family caregiver), healthcare professionals and policy (such as barriers in education, guidelines, and collaboration among professionals), and community (such as societal knowledge and attitudes). Each level presents unique challenges and opportunities for enhancing early palliative care integration, from addressing misconceptions and fears at the individual level, to fostering supportive policies and community awareness. In conclusion, the effective management of early palliative care requires a comprehensive strategy that spans various dimensions, including educational initiatives, policy adjustments, and active involvements of the community. Healthcare systems are supposed to enhance the integration of early palliative care into the trajectory of chronic conditions and enhance the quality of life of affected persons and their families by recognizing and addressing the socio-ecological elements involved.

Background: Caregivers of patients with palliative and chronic conditions often experience complex physical, emotional, and social burdens. These burdens impact not only their well-being but also the continuity and quality of care provided. Purpose: This study aimed to identify the level of caregiver burden and factors associated with it in families caring for members with palliative conditions and chronic illnesses. Patients and Methods: A cross-sectional study of 71 caregivers was conducted using convenience sampling. Data were collected using the FATCOD-B, knowledge toward palliative care, and Zarit Burden Interview (ZBI). Data were analyzed using the Rasch model and bivariate tests. Results: A high burden was reported by 50.7% of caregivers, while 39.4% and 9.9% experienced moderate and low burden, respectively. The variables of marital status, length of care, the availability of health insurance, and caregiver attitude showed a significant relationship to caregiver burden (p< 0.05). Rasch’s analysis revealed that perceived loss of privacy was the statement with the lowest level of agreement. At the same time, feelings of not being optimal enough in providing care were the statement most frequently acknowledged by caregivers. Conclusion: Psychosocial and structural factors influence caregiver burden. These findings highlight the need for integrated interventions, including psychosocial support, financial security, and caregiver education, to mitigate burden in this population.