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End of life care is a holistic approach to the provision of treatment and support for dying patients and families. It focuses on four dimensions: the physical, social, psychological and spiritual. In relation to the latter dimension, healthcare professionals are joined by spiritual care specialists, namely, chaplains. Even though great strides have been made towards holistic provision, chaplains remain marginalized. This article focuses on one essential yet often overlooked tool utilized by chaplains in spiritual care, and it showcases the fundamental importance of the practice in holistic end of life delivery, using Hong Kong chaplaincy as a case study: conversation as a bridging tool. Specifically, I focus on three distinctive aspects: conversation to overcome the challenges created by the chaplain's role ambiguity, conversation to bridge cultural and linguistic limitations, and conversation to address death anxieties through narrational encounters, including conversations about dreams. Despite the value of conversation in end of life care, this article illustrates that the wider hospital care team has a strong negative perception of chaplains' use of conversation, contributing to the marginalized status of chaplains.

End-of-life care is moving out of hospitals and families are replacing professionals in the delivery of care as death approaches. Guided by concepts from the social care model (Cantor & Brennan, 2000), this qualitative study aimed to explore and describe the interrelationship between informal and formal care in a terminal illness. In-depth interviews with 64 families were audiotaped, transcribed, and coded. Genograms and ecomaps were created to visually represent caregivers' sources of support and used to analyze caregiving networks. Results indicate that quasi-formal and informal social support become an important link between informal and formal caregiving. As a relative is dying, families value kindness and compassion, clear and straightforward communication, information, anticipatory guidance, and respect for self-determination from formal caregivers.

BackgroundIncreasing life expectancy for people with intellectual disability is resulting in greater need for end‐of‐life care services. However, limited knowledge is available regarding what barriers to accessing end‐of‐life care support are evident, particularly comparatively across rural and metropolitan locations.MethodsFocus group interviews were undertaken with 35 direct‐care staff from four rural and two metropolitan locations. A semistructured interview guide was used, with a focus on health service access. All focus group data were independently transcribed, with thematic analysis then performed.ResultsFrequency analysis identified 262 statements relating to health services access. Thematic analysis identified four key areas of "isolation," "support from doctors," "general health support access" and "internal staffing issues."ConclusionsImproved access to end‐of‐life services is urgently required across both rural and metropolitan areas. Development of specialist training and support models for both disability and general healthcare staff may assist to reduce some identified barriers.

Persons facing death due to terminal illness experience diverse physical, emotional, and relationship challenges. Dying persons have more than just physical needs, and spiritual issues may feature prominently as sources of intense struggle and comfort as people prepare to die. The spiritual health of the dying may be as important as their biological condition when facing death. Nevertheless, the present health care environment, with its emphasis on diagnostics and curative treatment, may allocate minimal attention and resources to the spiritual needs of the dying and their families. The neglect of spiritual issues may contribute to emotional, cognitive, and physical difficulties experienced at the end of life. Therefore, recognizing spirituality within the biomedical context of dying is essential. This requires an appreciation for the multifaceted nature of spirituality, coupled with an openness to individual theology, and an ability to integrate the spiritual dimension within a "bio-psychosocial" framework of assessment.

AbstractAimsOral candidosis is common in patients with end‐of‐life cancer; however, its prognosis is unclear. We aimed to assess oral candidosis and Candida species as prognostic indicators in palliative care for these patients.MethodsWe consecutively included palliative care patients, assessed for candidosis via microbiological techniques, and classified into three groups by the extent of oral lesions. The association between oral candidosis and overall survival was assessed using a Cox proportional hazards model adjusted by performance status (PS).ResultsWe studied 142 patients (median age 77; 52.8% women) with a 76.1% oral candidosis prevalence. Candida albicans (80.6%) was the most common species. Oral lesions were classified as none, grade 1 (28.7%), or ≥ grade 2 (14.8%). During follow‐up, Cox models identified ≥grade 2 lesions (aHR = 2.04; 95% CI: 1.18–3.54; p = .011) and Candida tropicalis (aHR = 2.38; 95% CI: 1.03–5.55; p = .044) as predictors.ConclusionThe extent of oral candidosis lesions or the presence of C. tropicalis may serve as prognostic indicator in patients with end‐of‐life cancer. Therefore, solely concentrating on the prevalence and frequency of fungal species may be insufficient for predicting life prognosis; it is advisable to assess these parameters through both visual examination and culture.