Nurse managers' role in providing high-quality palliative care is crucial for addressing the increasing demand in municipal care. This study aims to compile existing evidence on nurse managers' awareness of and competence in palliative care in municipal care settings. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and was registered in PROSPERO (CRD42024559183). In total, 6289 articles were initially retrieved, and 489 additional articles were identified in the updated searches. A narrative synthesis was conducted. Eight studies met the inclusion criteria and three themes emerged from the narrative synthesis: (1) Conceptual grasp of palliative care, (2) Recognition of gaps and needs, and (3) Competence in fulfilling complex responsibilities. Nurse managers' understanding of palliative care along with identified gaps and priorities shaped their competence in managing complex responsibilities related to palliative care, where confidence influenced how they performed the responsibilities. The results pointed to a knowledge gap in the explored area. Future research is needed to explore nurse managers' perspectives on how they understand and perform their leadership role in relation to palliative care.

BACKGROUND: In Sweden, approximately half of all individuals who die receive municipal care prior to death. Access to high-quality palliative care remains unequal, with known disparities between both care settings and diagnostic groups. Individuals receiving municipal home care are at higher risk of acute hospital admissions and in hospital death than those in long-term care facilities. However, the impact of municipal care setting on the quality of end-of-life care is largely unknown. The aim of this study was to describe the impact of care setting on the quality of end-of-life care among patients receiving municipal healthcare services.

METHOD: This population-based cohort study included all individuals reported during 2023-2024 in the Swedish Register for Palliative Care as recipients municipal palliative care during the last week of life (n = 50,219). Associations between care setting (ordinary housing, and long- and short-term care facilities) and end-of-life quality indicators were analyzed using modified Poisson regression to estimate risk ratios (RR) with 95% confidence intervals. Analyses were adjusted for age, sex, and cause of death.

RESULTS: Compared to individuals receiving care in ordinary housing, those in long- and short-term care were more likely to receive symptom assessments ([RR; 95% CI] 1.14; 1.09-1.19 vs. 1.08; 1.03-1.13). However, they were less likely to receive end-of-life information ([RR; 95% CI] 0.92; 0.91-0.94 vs. 0.98; 0.97-0.99), bereavement support for relatives ([RR; 95% CI] 0.98; 0.97-0.99 vs. 0.95; 0.94-0.96), and external pain consultations ([RR; 95% CI] 0.52; 0.49-0.57 vs. 0.81; 0.76-0.88).

CONCLUSIONS: Care setting influences the quality of municipal end-of-life care. Strengths and weaknesses vary across settings, highlighting the need for targeted quality improvement efforts.

Background: As the global population ages, the demand for palliative care is expected to increase. However, studies show that older patients often receive inadequate palliative care, partly due to healthcare professionals lacking sufficient training and tools to identify and address palliative care needs effectively. This study aims to explore healthcare professionals’ experiences regarding facilitators and barriers to integrating a palliative care approach in a geriatric setting by implementing the Swedish Palliative Care Guide.

Methods: This qualitative study employed a design consisting of four small-group interviews (with three participants each) and one individual interview, involving a total of 13 healthcare professionals working in a geriatric setting. The aim was to explore their experiences with integrating the Swedish Palliative Care Guide. Data were analyzed using the rapid identification of themes method and inductive content analysis.

Results: The analysis revealed four interrelated themes—organizational prerequisites, knowledge of palliative care, teamwork, and communication—that acted as both facilitators and barriers to integrating the Swedish Palliative Care Guide in a geriatric setting. While structured tools and shared goals supported implementation, challenges such as unclear responsibilities, knowledge gaps, and discomfort discussing end-of-life issues hindered consistent application. Participants emphasized that continuity in care and a shared understanding among team members enhanced the use of the guide. In contrast, short-term admissions and a lack of systemic integration of the Swedish Palliative Care Guide into routine practice pose significant challenges to its long-term sustainability.

Conclusions: Successful implementation of the Swedish Palliative Care Guide in geriatric settings requires clear professional responsibilities, integration into existing digital documentation systems, and targeted training to support staff in initiating end-of-life conversations. Tailoring implementation strategies for local conditions, such as short-term admissions and high staff turnover, can enhance sustainability. These findings provide practical guidance for improving the integration of palliative care approaches into everyday geriatric practice.

Background: Patients with oesophageal and gastric cancer face a poor prognosis and multiple symptoms and problems that negatively affect their quality of life. In view of the prognosis and extensive illness burden, an early palliative care approach is of importance.

Aim: The overall aim of this thesis was to describe and compare symptoms, problems and care needs in relation to the initial treatment strategy among patients newly diagnosed with oesophageal and gastric cancer and to explore how those with incurable illness manage everyday life.

Method: The project comprised three studies with a quantitative (Studies I–III) and one study with a qualitative design (Study IV). Study I and II were based on a Swedish cohort of patients who died from oesophageal and gastric cancer in 2014–2016. Data were collected from the National Register for Oesophageal and Gastric Cancer (Studies I and II), the National Cause of Death Register (Studies I and II), the Swedish Register of Palliative Care (Study I) and the National Patient Register (Study II). The impact of the initial treatment strategy and survival time on the quality of end-of-life care (Study I) and the impact of initial treatment strategy and assignment of a contact nurse on health care use (Study II) were investigated. Study III was a cross-sectional study on patients newly diagnosed with oesophageal and gastric cancer. Data on quality of life, symptoms and problems were collected using the European Organization for Research and Treatment of Cancer (EORTC) instruments QLQ-C30 and QLQ-OG25 and the Integrated Patient Outcome Scale. Study IV was a semi-structured interview study on how persons newly diagnosed with incurable oesophageal and gastric cancer manage everyday life.

Results: Patients with a survival of ≤3 and 4–7 months had higher risk for hospital death compared with patients with a survival ≥17 months. Patients surviving ≤3 months had lower risk for bereavement support and end-of-life information, compared with those with a survival ≥17 months. The performance of an oral health assessment and pain assessment was not associated with survival time (Study I). Patients with palliative treatment and no tumour-directed treatment had a higher incidence rate ratio for unplanned care compared with those receiving curative treatment. Patients with no tumour-directed treatment also had a lower incidence rate ratio for planned care compared with those with a curative treatment. Patients with a contact nurse assigned to them had higher incidence rate ratios for unplanned care and planned outpatient care visits, compared with patients with no contact nurse assigned (Study II). Among all patients, the quality of life was markedly lower than in the general Swedish population, and impairments were found in all aspects of quality of life, particularly role and emotional functioning and symptoms such as eating-related problems, fatigue, insomnia and dyspnoea. The majority of patients reported severe anxiety among family and friends. Among patients with oesophageal cancer, those with a palliative treatment strategy, compared with a curative strategy, reported lower quality of life, and physical and role functioning, and higher intensity of several symptoms and problems. Among patients with gastric cancer, no differences between treatment groups were found (Study III). Interpretation of the interviews resulted in the overall theme “Striving towards normality in an unpredictable situation”, with three related themes, “Trying to comprehend the disease”, “Dealing with the consequences of illness” and “Re-evaluating what is important in everyday life”, and seven subthemes (Study IV).

Conclusion: Patients newly diagnosed with oesophageal and gastric cancer suffer from poor quality of life and several burdensome symptoms and problems and those with the poorest prognosis exhibit the highest risk of receiving unplanned care and low-quality end-of-life care. Patients with incurable illness manage their everyday life by striving for normalcy. The findings emphasize the need for a proactive palliative care approach to enhance patients’ quality of life and ability to manage the new life situation.

Background: Patients with oesophageal and gastric cancer have a low likelihood of being cured and suffer from a broad spectrum of symptoms and problems that negatively affect their quality-of-life (QOL). Although the majority (67–75%) of patients at the time of diagnosis suffer from an incurable disease, research has primarily focused on the pre- and postoperative phase among patients treated with curative intent, with little attention to symptoms and problems in the diagnostic phase, especially in those who cannot be offered a cure.

Methods: In this cross-sectional study 158 patients newly diagnosed with oesophageal and gastric cancer visiting the surgical outpatient department for a preplanned care visit were included consecutively during 2018–2020. The validated instruments QLQ-C30 and QLQ-OG25, developed by the European Organization for Research and Treatment of Cancer (EORTC), and selected items from the Integrated Patient Outcome Scale (IPOS) were used to assess QOL, symptoms and problems. Differences between patients with a curative and a palliative treatment strategy were analysed using t -test and Mann–Whitney U test. The QLQ-C30 and QLQ-OG25 scores were compared to published reference data on the general Swedish population.

Results: Among all, the QOL was markedly lower, compared with general Swedish population (mean ± SD, 55.9 ± 24.7 vs 76.4 ± 22.8, p  < 0.001). Compared to general population, the patients had significant impairment in all QOL aspects, particularly for role and emotional functioning and for symptoms such as eating-related problems, fatigue, insomnia and dyspnea. Majority of patients also reported severe anxiety among family and friends. Among patients with oesophageal cancer those with a palliative treatment strategy, compared with curative strategy, reported significantly lower QOL (mean ± SD, 50.8 ± 28.6 vs 62.0 ± 22.9 p  = 0.030), physical (65.5 ± 22.6 vs 83.9 ± 16.5, p  < 0.001) and role functioning (55.7 ± 36.6 vs 73.9 ± 33.3, p  = 0.012), and a higher burden of several symptoms and problems. No significant differences between treatment groups were shown among patients with gastric cancer.

Conclusions: Patients newly diagnosed with oesophageal and gastric cancer, and especially those with incurable oesophageal cancer, have a severely affected QOL and several burdensome symptoms and problems. To better address patients’ needs, it seems important to integrate a palliative approach into oesophageal and gastric cancer care.

Background: Patients diagnosed with oesophageal and gastric cancer face a poor prognosis and numerous challenges of symptom management, lifestyle adjustments and complex treatment regimens. The multifaceted care needs and rapid disease progression reinforce the need for proactive and coherent health care. According to the national cancer strategy, providing coherent health care and palliative support is an area of priority. More knowledge is needed about health care utilization and the characteristics of the health care service in order to understand the readiness, accessibility and quality of current health care. The aim of this study was to describe individuals’ health care use from the time of treatment decision until death, and investigate the impact of the initial treatment strategy and assignment of a contact nurse (CN) on health care use among patients with oesophageal and gastric cancer. Methods: This population-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014–2016. Through linking data from the National Register for Oesophageal and Gastric Cancer, the National Cause of Death Register, and the National Patient Register, 2614 individuals were identified. Associations between the initial treatment strategy and CN assignment, and health care use were investigated. Adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using Poisson regression. Results: Patients receiving palliative treatment and those receiving no tumour-directed treatment had a higher IRR for unplanned hospital stays and unplanned outpatient care visits compared with patients who received curative treatment. Patients receiving no tumour-directed treatment also had a lower IRR for planned hospital stays and planned outpatient care visits compared with patients given curative treatment. Compared with this latter group, patients with palliative treatment had a higher IRR for planned outpatient care visits. Patients assigned a CN had a higher IRR for unplanned hospital stays, unplanned outpatient care visits and planned outpatient care visits, compared with patients not assigned a CN. Conclusions: A palliative treatment strategy and no tumour-directed treatment were associated with higher rates of unplanned health care compared with a curative treatment strategy, suggesting that a proactive approach is imperative to ensure quality palliative care.