The study, led by Rasha A. Mohamed of Mansoura University and the University of Bisha together with an international team of nursing researchers, used a qualitative descriptive design to capture the lived experiences of nurses who deliver palliative care to patients with advanced cancer. Participants were recruited purposively, meaning the researchers deliberately selected nurses with direct, relevant experience rather than sampling at random. Data were gathered through four focus group discussions, each audio-recorded and transcribed verbatim, and then analyzed using an inductive thematic approach. In this method, researchers code the transcripts line by line, group the codes into categories, and iteratively refine overarching themes through team consensus, allowing the structure of the findings to emerge from the data itself rather than from a predetermined framework.

The setting matters. Saudi Arabia presents a distinctive context for end-of-life care, one in which cultural and religious values shape how death, dying, and family involvement are understood and navigated. The authors note that qualitative evidence on nurses’ experiences in this setting has been limited, despite the fact that palliative care is a crucial component of comprehensive cancer care. Understanding what nurses actually encounter, the researchers argue, is essential for building tailored strategies that strengthen palliative practice and support the workforce that sustains it. This is not an abstract concern: as cancer incidence rises globally and survival trajectories lengthen, the number of patients living with, and dying from, advanced disease continues to grow, and the nurses caring for them carry an increasingly complex professional and emotional load.

The first theme identified in the analysis, preserving dignity through holistic palliative care, speaks to the ethical core of the work. Nurses described their role as safeguarding the personhood of patients whose bodies and independence were being eroded by disease. Dignity preservation, in this framing, is not a courtesy but a clinical intervention in its own right, woven into everything from symptom management to the way nurses speak with patients about their condition. The finding echoes a long tradition in palliative care philosophy, which holds that a good death is defined not only by the absence of pain but by the presence of respect, autonomy, and comfort in the fullest sense.

The second theme, navigating multidimensional professional responsibilities throughout the illness trajectory, captures how the nurse’s job changes shape as a patient moves from diagnosis toward the end of life. Nurses in the study described acting as advocates for their patients, coordinating care across specialties and settings, and communicating in ways that are culturally and religiously sensitive. This is technically demanding work. It requires clinical judgment about symptom control, organizational skill to align families, physicians, and support services, and the communication finesse to discuss prognosis and goals of care in a manner consistent with patients’ values. The illness trajectory, the study suggests, is not a single care scenario but a shifting set of demands that nurses must continually renegotiate.

Central to the nurses’ accounts was the third theme: delivering holistic nursing care that integrates physical, emotional, and spiritual support. This multidimensional model treats the patient not as a set of failing organs but as a whole person facing existential as well as physical distress. Pain and other symptoms must be managed pharmacologically, but nurses also described attending to fear, grief, and spiritual needs, dimensions of care that are harder to measure and often under-resourced. In the Saudi context, spiritual support carries particular weight, since religious frameworks strongly inform how patients and families approach dying. Nurses who can work within these frameworks, rather than around them, are better positioned to provide care that patients and families actually experience as compassionate.

The fourth theme is where the study’s findings turn sobering: balancing compassionate care with emotional and organizational challenges. The nurses acknowledged significant emotional burdens inherent in repeated exposure to death and dying, a well-documented occupational hazard that can accumulate into burnout, moral distress, and attrition from the specialty. At the same time, they identified organizational obstacles, insufficient support structures, resource limitations, and the absence of policies that integrate palliative care smoothly across the illness trajectory. The interplay between these two categories of challenge is important from a health systems perspective. Emotional exhaustion is often treated as an individual problem to be managed with resilience training, but the study’s findings point toward a structural reading: when organizations fail to support nurses, the emotional costs of compassionate care compound rather than resolve.

The fifth theme looks forward. Nurses in the study envisioned a stronger palliative care system built on three pillars: education, collaboration, and public awareness. Targeted education would strengthen the clinical and communication skills that end-of-life care demands, from complex symptom management to difficult conversations about prognosis. Collaboration would knit together the multidisciplinary actors, physicians, nurses, social workers, chaplains, and family caregivers, whose coordination determines whether palliative care is seamless or fragmented. Public awareness initiatives, meanwhile, aligned with cultural and religious values, would help communities understand what palliative care is and is not, reducing stigma and encouraging earlier engagement with supportive services. The authors conclude that overcoming current barriers requires precisely this kind of coordinated intervention rather than piecemeal fixes.

What gives the study its force is the consistency of the underlying message across all five themes. Nurses see palliative care as a fundamentally holistic, person-centered practice, and they are committed to delivering it, yet they report that emotional, communication, educational, and organizational barriers repeatedly impede consistent, high-quality end-of-life care. That gap between ideal and reality is not unique to Saudi Arabia; studies across many health systems have documented similar strains. But the Saudi findings carry particular significance for a region where palliative care as a distinct specialty is still maturing and where cultural and religious considerations shape clinical practice in ways that imported models do not always anticipate. Locally grounded qualitative research of this kind provides the evidence base for adaptations that fit.

Methodologically, the study’s strengths lie in its transparency and rigor. The use of verbatim transcription, iterative coding, and team consensus in theme development guards against individual researcher bias, and the researchers report that findings were shared with participants for feedback on the relevance of the themes, a validation step that strengthens qualitative credibility. The protocol was approved by the University of Bisha’s Institutional Review Board, conducted under the ethical guidelines of the Declaration of Helsinki, and all participants gave informed written consent. The study received no external funding, and the authors declare no competing interests. Published open access as an early, citable version with a permanent DOI, the research invites both scrutiny and uptake.

For health policymakers and hospital administrators, the implications are concrete. The study argues for organizational reforms that give palliative nurses the support structures their work requires, and for policies that embed palliative care across the entire cancer trajectory rather than reserving it for the final days. For nursing educators, it makes the case for curricula that build not only technical competence but also the communication skills and cultural literacy that end-of-life care demands. And for the public, it is a reminder that behind every well-managed death stands a nurse who has absorbed the physical, emotional, and spiritual weight of that process. Meeting the growing demand for palliative care will depend, above all, on whether health systems choose to support the people who provide it.

Subject of Research: Nurses' experiences delivering palliative care to patients with advanced cancer

Article Title: Exploring nurses experiences in delivering palliative care to patients with advanced cancer

Article References: Mohamed, R. A., Alkalash, S. H., Gab Allah, A. R., Alanazi, M. O., ElShora, S. N. A. E., Mohammed, S. F., Anbar, R., Dakhilallah, H., Alshahrani, M., Elfaki, E., & Almowafy, A. A. (2026). Exploring nurses experiences in delivering palliative care to patients with advanced cancer. BMC Nursing, 25(1), Article 879. https://doi.org/10.1186/s12912-026-05401-5

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05401-5

Keywords: palliative care, advanced cancer, oncology nursing, nurses' experiences, qualitative research, end-of-life care, Saudi Arabia, holistic care, nursing education, burnout, patient dignity, health policy

The review, led by Alan Roger Santos-Silva of the Piracicaba Dental School at the University of Campinas in Brazil, together with colleagues from the University of Toronto, the Federal University of Juiz de Fora, City of Hope Comprehensive Cancer Center, and Cedars-Sinai, synthesizes evidence on structured spiritual history-taking and its relevance to oral oncology. The authors ground their argument in a definition that the World Health Organization has formally endorsed: spirituality is a dimension of health. In clinical terms, researchers describe it as the way individuals seek and express meaning and purpose, and the way they experience connectedness to the moment, to themselves, to others, to nature, and to the significant or sacred. Crucially, this framing does not require any religious belief. A patient who finds meaning in family, in art, or in nature has a spiritual life that can shape how they endure treatment.

Why does this matter so much in oral cancer specifically? The review catalogs the cascade of complications that follow diagnosis and therapy. Tumor biology, surgical resections, radiation-induced toxicities, and the side effects of chemotherapy, targeted therapy, and immunotherapy can produce facial disfigurement, speech impairment, dysphagia, chronic pain, taste loss, and salivary dysfunction. These physical outcomes ripple directly into body image, autonomy, and quality of life. Patients frequently respond with emotional distress, social withdrawal, fear of recurrence, financial strain, and existential uncertainty, which clinicians may observe as tears, silence, expressions of hopelessness, or outright resistance to treatment. Prior studies cited in the review have documented demoralization, loneliness, and even suicidal ideation among oral cancer inpatients, with spiritual needs emerging as a significant correlate of these outcomes.

The core practical proposal of the review is the spiritual history: a structured conversation designed to identify a patient’s beliefs, values, and coping resources. Several validated frameworks exist, including FICA, HOPE, SPIRIT, FAITH, a tool endorsed by the Royal College of Psychiatrists, and the Patient-Centered Clinical Method. Among these, FICA and HOPE stand out as the most widely used, validated, and adaptable across healthcare environments. FICA, which prompts clinicians to explore Faith or belief, the Importance of that belief, the individual’s spiritual Community, and how they wish those beliefs Addressed in care, takes only about two minutes to administer. HOPE, developed by Anandarajah and Hight, similarly guides clinicians through questions about sources of hope, organized religion, personal spirituality and practices, and how these should be integrated into medical decision-making. The tools provide structured pathways for clinicians to explore spirituality respectfully and efficiently within professional boundaries.

The evidence that such conversations actually help is more robust than many clinicians might assume. In a systematic review cited by the authors, the majority of patient samples considered it appropriate for healthcare professionals to ask about spiritual needs in at least some circumstances, and a cross-sectional study found approval rates for specific spiritual history questions ranging from 94.0 percent to 99.8 percent. Integration of spiritual inquiry into clinical encounters has been associated with improved provider-patient relationships, increased trust, and greater satisfaction with care. In an intervention study, patients who received a spiritual intervention over three weeks showed a significantly greater reduction in depressive symptoms and greater improvement in quality of life compared with controls, and also reported a more positive perception of the interpersonal care provided by their physician.

Randomized trial data add further weight. In a cluster-randomized trial, patients who reported that spirituality played an important role in their lives showed a 6.2-point difference in mental well-being on the SF-12 mental health subscale compared with the control group, a moderate effect size, although the primary outcome of health-related self-efficacy showed no significant benefit. In another randomized controlled trial, patients who underwent spiritual assessment attended significantly more clinical appointments during a three-month follow-up period: only 8 percent of patients in the intervention group missed appointments, compared with 26 percent in the control group. For oncology teams, where missed radiation fractions and skipped follow-up visits can directly compromise survival, a two-minute conversation that triples attendance is a striking result. The review also notes that brief conversations acknowledging spiritual concerns can foster emotional support and signal clinician openness without causing distress or discomfort, addressing a common fear that raising the topic might upset patients.

So why is spiritual assessment still so rare in oral oncology? The review identifies a familiar cluster of barriers: insufficient time, lack of knowledge and training, discomfort discussing spiritual topics, and uncertainty about professional boundaries. These obstacles may appear early in the care pathway, because some professionals, particularly dentists, often lack specific training in psychosocial care, a gap the authors suggest may extend to other members of the healthcare team as well. The problem is compounded by the fact that dentists and oral medicine specialists are frequently the first clinicians to encounter oral cancer patients and continue caring for them throughout and after treatment, positioning them ideally to notice spiritual distress but rarely equipped to respond to it.

The good news, according to the review, is that these skills are teachable. Educational interventions including role-play exercises, standardized patient interactions, and curriculum modules have increased healthcare providers’ confidence, communication skills, and the feasibility of spiritual assessment. Spiritual care competencies can be embedded in undergraduate and postgraduate programs as well as continuing education, with demonstrated improvements in knowledge retention and behavioral application. A systematic review of teaching spirituality to medical students and a scoping review of educational strategies in nursing and healthcare both support the conclusion that targeted training produces measurable gains. Expanding such initiatives into health training curricula, the authors argue, would equip clinicians to address spiritual concerns confidently and ethically within their scope of care.

The multiprofessional dimension is central to the authors’ vision. Dentists and oral medicine specialists collaborate with physicians, nurses, nutritionists, and psycho-oncology teams, any of whom may encounter spiritual concerns and emotional distress during patient care. A documented spiritual history can facilitate appropriate referrals to chaplaincy or mental health services, support shared decision-making, and align treatment plans with patient values. As supportive cancer care evolves toward multidisciplinary, patient-centered models, the review contends that all team members should be prepared to identify and respectfully address spiritual needs that may affect adherence, coping, and quality of life. In this model, the spiritual history functions less as a standalone intervention and more as a connective tissue that links the dental chair to the wider supportive care network.

The review’s conclusions are measured but actionable. There is evidence supporting structured frameworks for obtaining a spiritual history in clinical practice; these strategies are well accepted by patients, improve communication and satisfaction, and enhance clinician preparedness to deliver holistic care. Incorporating spiritual assessment into multiprofessional practice, beginning with oral medicine and continuing throughout the care pathway, may strengthen supportive oncology care, promote cultural sensitivity, and address a frequently unmet dimension of patient well-being. The recommended actions are concrete: adopt spiritual history-taking tools such as FICA and HOPE in routine oral oncology practice, and expand targeted education to build clinician skills and confidence. For a disease that attacks identity as much as tissue, the review suggests that healing may sometimes begin with a question that takes two minutes to ask.

Subject of Research: Spiritual history-taking in supportive care for oral cancer patients

Article Title: Taking a spiritual history in the oral oncology setting

Article References: Santos-Silva, A. R., Magalhaes, M., Calderipe, C. B., Lopes, M. A., Ávila-Pires, E. V., & Epstein, J. B. (2026). Taking a spiritual history in the oral oncology setting. Supportive Care in Cancer, 34(10), Article 989. https://doi.org/10.1007/s00520-026-11215-7

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11215-7

Keywords: oral cancer, spirituality, spiritual history, FICA tool, HOPE questions, supportive care, palliative care, dentistry, holistic care, patient-centered care, multiprofessional teams, health professional education

The Stott and Davis model, first described decades ago, remains one of the most widely taught consultation frameworks in general practice. It organizes every encounter around four tasks: managing the presenting problem, modifying help-seeking behavior, managing continuing problems, and opportunistic health promotion. Its strength lies in efficiency and completeness—it reminds clinicians not to stop at the first complaint but to scan the consultation for missed opportunities. Its weakness, the authors argue, is that it says nothing explicit about the deeper dimensions of the patient in front of the doctor. A clinician can tick all four boxes and still fail to register the depression, the unemployment, or the spiritual distress that shapes why a patient came in at all.

The biopsychosocial–spiritual model addresses that gap on the theoretical side. Building on Engel’s classic biopsychosocial critique of reductionist biomedicine, the BPSS framework insists that illness is experienced simultaneously at biological, psychological, social, and spiritual levels. In principle, it offers a comprehensive map of patient needs. In practice, as Tshitenge and Bogatsu note, its application in routine consultations remains inconsistent, particularly where clinicians are pressed for time and have no structured method for translating a broad theoretical lens into concrete clinical actions. Holism, without a procedural backbone, tends to evaporate under the pressure of a ten-minute appointment.

The third ingredient is the Clinical Reasoning Cycle, an iterative model of expert thinking that moves through stages such as considering the patient situation, collecting cues and information, processing and interpreting those cues, identifying problems, establishing goals, taking action, and evaluating outcomes, with reflection feeding back into the next cycle. Clinical reasoning research has long shown that diagnostic errors often arise not from gaps in knowledge but from failures in the reasoning process itself—premature closure, inadequate cue gathering, and insufficient reflection. The CRC was designed to make those invisible cognitive steps explicit and teachable, which is precisely why the authors chose it as the connective tissue of their integrated framework.

The core technical move of the paper is an alignment operation. Each of the four Stott and Davis tasks is mapped onto the iterative stages of the Clinical Reasoning Cycle, so that managing the presenting problem, for example, becomes not a single act but a full reasoning loop: gathering cues about the complaint, interpreting them in light of the patient’s context, establishing goals with the patient, acting, and evaluating. At the same time, the four BPSS domains—biological, psychological, social, and spiritual—are embedded across every phase of every loop. This means that cue collection is not limited to biomedical data; it explicitly includes psychosocial and spiritual cues. Problem identification is not confined to diagnoses; it encompasses the broader patient situation. The framework thereby converts two parallel, disconnected traditions—structured consultation management and holistic care theory—into a single operational sequence.

The authors also describe how the framework functions educationally. Because the CRC stages are explicit, learners can be assessed on each one: Did the student gather social and spiritual cues, or only biomedical ones? Did the student consider health promotion opportunities within the consultation rather than deferring them indefinitely? Did the student reflect on the encounter afterward? The integrated model provides what the authors call a coherent scaffold for teaching consultation skills alongside clinical reasoning, promoting reflective practice and professional development rather than treating these as separate curricular silos. In settings where family medicine training is expanding rapidly, including across sub-Saharan Africa, such a scaffold could standardize expectations for learners while remaining flexible enough for experienced clinicians to apply intuitively.

Context matters here. The paper comes from Botswana, a health system characterized by high burdens of HIV, tuberculosis, noncommunicable diseases, and increasing multimorbidity, often delivered with limited staff and infrastructure. The authors position the framework as particularly applicable to primary care and diverse, resource-limited settings marked by complexity. In such environments, a consultation model that assumes a single uncomplicated problem and a well-resourced referral chain simply does not fit. By explicitly incorporating sociocultural and spiritual dimensions, the framework is also designed to support culturally responsive and patient-centred care—an important consideration in communities where spiritual explanatory models of illness strongly influence help-seeking behavior, adherence, and trust in the health system.

The paper is careful about its own epistemic status. It is a conceptual contribution, not an empirical trial; the authors explicitly state that no human participants, data, or animal subjects were involved, and that ethics approval was therefore not applicable. They acknowledge that further research is required to evaluate the framework’s feasibility, acceptability, and impact on clinician performance, learner outcomes, and patient care. This honesty is notable in a field where new frameworks are sometimes promoted as if conceptual elegance were equivalent to demonstrated effectiveness. The authors also report no specific funding and no competing interests, and the article is published open access under a Creative Commons licence, making the full technical alignment of the three models freely available to educators and clinicians worldwide.

What would evaluation look like in practice? Educational researchers could test whether trainees taught with the integrated framework gather more complete psychosocial histories or identify more health promotion opportunities than controls taught with the Stott and Davis model alone. Health services researchers could examine whether the framework improves patient-reported measures of person-centredness or reduces consultation-related dissatisfaction. Implementation scientists could ask whether the framework survives contact with real appointment schedules, electronic medical record templates, and the cognitive load of a busy clinic—the same pressures that have historically eroded holistic ideals. The authors’ mention of electronic medical records in their abbreviations suggests they anticipate these practical integration questions, even though the published abstract does not detail EMR-specific workflows.

The significance of the paper lies less in any single novel claim than in its synthesis. Medical education has long taught consultation models and clinical reasoning as separate subjects, and holistic care as a vague aspiration. By binding the organizational completeness of Stott and Davis, the dimensional breadth of BPSS, and the cognitive transparency of the Clinical Reasoning Cycle into one framework, Tshitenge and Bogatsu offer primary care a structured way to be holistic—something that can be taught, practiced, assessed, and refined. Whether it will change what actually happens in consultations between a clinician and a patient with three chronic diseases, a sick child, and a recent bereavement is an empirical question the authors themselves put squarely on the research agenda. For now, they have provided a testable blueprint for one of medicine’s most stubborn challenges: seeing the whole person in the time available.

Subject of Research: An integrated clinical reasoning and consultation framework combining the Stott and Davis model with the biopsychosocial–spiritual framework for primary care and medical education

Article Title: Integrating the Stott and Davis model with the biopsychosocial–spiritual framework: a comprehensive approach to clinical reasoning in primary care

Article References: Tshitenge, S., & Bogatsu, Y. (2026). Integrating the Stott and Davis model with the biopsychosocial–spiritual framework: a comprehensive approach to clinical reasoning in primary care. BMC Medical Education. https://doi.org/10.1186/s12909-026-10459-5

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10459-5

Keywords: clinical reasoning, Stott and Davis model, biopsychosocial–spiritual model, primary care, medical education, consultation models, Clinical Reasoning Cycle, person-centred care, holistic care, family medicine, resource-limited settings, reflective practice