BACKGROUND: Reiki and Therapeutic Touch are complementary therapies sometimes used in palliative and end-of-life care. AIM: To examine the available evidence regarding the effects of Reiki and Therapeutic Touch, compared...BACKGROUND: Reiki and Therapeutic Touch are complementary therapies sometimes used in palliative and end-of-life care. AIM: To examine the available evidence regarding the effects of Reiki and Therapeutic Touch, compared to usual care, in palliative and end-of-life care. DESIGN: Systematic review registered in PROSPERO (CRD420251059364; May 23, 2025). DATA SOURCES: MEDLINE, Web of Science, and Scopus were searched for English-language studies published between 2013 and 2024. Eligible studies included patients receiving palliative care who underwent Reiki and/or Therapeutic Touch compared with usual care. Any primary study design was eligible. Risk of bias was assessed and findings synthesized narratively. RESULTS: Nine studies involving 415 participants were included: five mixed-methods studies, three randomized controlled trials, and one qualitative cross-sectional study conducted in North America ( = 6) and Europe ( = 3). Cancer was the predominant diagnosis. Risk of bias raised some concerns in randomized trials and was moderate to high in qualitative and non-randomized designs. Some studies reported improvements in symptoms (pain, anxiety, depression, fatigue, and stress), and in quality-of-life domains (sleep, relaxation, energy, hope, and emotional well-being). Qualitative findings described perceived relaxation, comfort, and emotional support. Reporting of harms was limited; only one study monitored adverse events and reported one serious event considered potentially related to the intervention. CONCLUSIONS: Evidence regarding Reiki and Therapeutic Touch in palliative and end-of-life care remains limited and heterogeneous. The very low certainty of evidence precludes firm conclusions regarding their effectiveness. Further well-designed studies are needed to clarify their potential role in palliative care.
Nouri S, Lyles CR, Zapata C
… +10 more, Martinez R, Gonzalez J, Le V, Wang Y, Quinn M, Huang C, Perez-Vaughan C, Pantilat SZ, Ritchie CS, Sudore RL
J Palliat Med
· 2026 May · PMID 42099245
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BACKGROUND: Use of digital communication tools (e.g., telehealth, patient portals) is increasing in outpatient palliative care (OPC). OBJECTIVE: Assess patient/caregiver experiences with digital communication tools. DESI...BACKGROUND: Use of digital communication tools (e.g., telehealth, patient portals) is increasing in outpatient palliative care (OPC). OBJECTIVE: Assess patient/caregiver experiences with digital communication tools. DESIGN: Qualitative. SETTING/SUBJECTS: Inclusion criteria were age ≥18 years, English/Spanish/Cantonese-speaking, and ≥1 telehealth OPC visit in the prior year. If patients could not converse by phone, we interviewed their caregivers. MEASURES: We developed an interview guide using the Capability-Opportunity-Motivation-Behavior framework. We analyzed semi-structured interviews using thematic analysis. RESULTS: Among 32 participants, 10 were caregivers, 11 Spanish-speaking, 9 Cantonese-speaking. Theme 1: Video and in-person visits have important and distinct roles. Theme 2: Establishing a trusting rapport over video is possible. Theme 3: Engagement can be high with the patient portal despite poor usability. CONCLUSIONS: A flexible approach offering both video and in-person visits is ideal. Usability is a key factor in patient portal engagement. Our findings underscore the need to advocate for a permanent Medicare telehealth extension.
Guzman G, Cronin A, Stal J
… +15 more, Uno H, Xu L, Laurent CA, Fisher L, Cannizzaro N, Munneke J, Cooper RM, Lakin JR, Schwartz CM, Casperson M, Altschuler A, Kushi LH, Chao CR, Wiener L, Mack JW
J Palliat Med
· 2026 May · PMID 42095288
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BACLGROUND: Quality of end-of-life care for adolescents and young adults (AYAs) with cancer is often measured using administrative measures. METHODS: We surveyed 200 bereaved caregivers of AYAs (died 2003-2019 at age 12-...BACLGROUND: Quality of end-of-life care for adolescents and young adults (AYAs) with cancer is often measured using administrative measures. METHODS: We surveyed 200 bereaved caregivers of AYAs (died 2003-2019 at age 12-39 after receiving care at one of three sites) to elicit perspectives about care quality in 7 domains. RESULTS: Quality of care was highest for relationships with clinicians (63% caregivers considered all aspects high quality), and lowest for psychosocial and spiritual care (32%). Comfort and symptom management, quality of life, relationships with clinicians, medical care and treatment, and care needs and independence were rated as highly important to caregivers and AYAs, with all items exceeding a prespecified threshold for importance ( < 0.001); most communication and decision-making items also met this threshold, while most psychosocial and spiritual support items fell below this threshold. CONCLUSION: Caregivers affirmed priorities in AYA end-of-life care, which may help align care delivery with what matters most to patients and families.
Numata K, Higuchi M, Kashiwagi H
… +5 more, Kosugi S, Quest TE, Hauser J, Engel KG, Ouchi K
J Palliat Med
· 2026 May · PMID 42095285
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INTRODUCTION: Japan's aging population has increased emergency presentations among patients near the end of life, yet formal palliative care training for emergency physicians remains limited. The U.S.-developed Education...INTRODUCTION: Japan's aging population has increased emergency presentations among patients near the end of life, yet formal palliative care training for emergency physicians remains limited. The U.S.-developed Education in Palliative and End-of-Life Care for Emergency Medicine (EPEC-EM) program offers structured education in communication and symptom management. We piloted a cultural adaptation of selected modules for the Japanese emergency care context. METHODOLOGY: A multidisciplinary Japan-United States team adapted three modules (Trajectories & Prognoses, Breaking Bad News, and Dyspnea Management) through an iterative process involving preliminary redesign, pilot delivery, and refinement across four online sessions. DISCUSSION: Concepts such as goals-of-care discussions and communication around limiting resuscitation required clearer explanation for Japanese physicians. Iterative revisions improved clarity and cultural relevance. CONCLUSION: This pilot demonstrates the feasibility of culturally adapting EPEC-EM for Japan. The process provides a foundation for developing a tailored curriculum and informs future broader implementation.
Rajasekhara S, Bitar HN, Loggers ET
… +13 more, Norton K, Sam C, Case AA, Tulsky JA, Chwistek M, Epstein AS, Grossman SR, Nelson JE, Nortjé N, Papio J, Phung P, Kolosky J, McNiff Landrum K
J Palliat Med
· 2026 May · PMID 42095282
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PURPOSE: Effective communication about goals of care is critical in oncology but limited by insufficient training and system barriers. As part of a multicomponent intervention, the Improving Goal Concordant Care (IGCC) i...PURPOSE: Effective communication about goals of care is critical in oncology but limited by insufficient training and system barriers. As part of a multicomponent intervention, the Improving Goal Concordant Care (IGCC) initiative aimed to implement structured communication skills training (CST) for oncology clinicians. This study reports on the implementation and evaluation of CST across 10 dedicated cancer centers. PATIENTS AND METHODS: IGCC was a collaborative improvement project led by the Alliance of Dedicated Cancer Centers between 2020 and 2023. Centers selected or developed CST programs meeting IGCC criteria and adapted local implementation and enabling strategies. The primary measure was the percentage of eligible oncology clinicians completing CST (target ≥65%). Post-training evaluation and training impact surveys assessed clinicians' experience and perceived benefit of CST. RESULTS: Nine centers completed CST implementation, training 2271 of 2841 eligible clinicians (80%). CST completion rates at all but one site exceeded the target, as did rates for medical oncologists, hematological oncologists, and advanced practice providers. CST completion was higher when incentives or mandates were used. Post-training evaluations showed high satisfaction with aggregated top-box scores of 93% for training quality, 94% for recommending to colleagues, and 94% for likelihood to use skills. Training impact surveys administered 6-12 months after training suggested improved self-efficacy and reduced distress, with a strong correlation between self-efficacy improvement and distress reduction. CONCLUSIONS: IGCC demonstrated that CST can be effectively scaled across cancer centers and positively impact trained clinicians. Successful uptake was supported by leadership engagement, incentives, and mandates, while barriers included leadership transitions, time and resource constraints, and competing priorities. CST is a core component for advancing goal-concordant care.
Agosta M, Jimenez-Torres GJ, Bruera E
… +1 more, Carmack C
J Palliat Med
· 2026 May · PMID 42095281
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BACKGROUND: Family separation due to immigration policies may act as a powerful social determinant of psychological suffering in patients with advanced cancer. CASE DESCRIPTION: Two patients are described. Case 1: A late...BACKGROUND: Family separation due to immigration policies may act as a powerful social determinant of psychological suffering in patients with advanced cancer. CASE DESCRIPTION: Two patients are described. Case 1: A late teenage male with advanced cancer is unable to receive maternal support due to border denial, navigating severe pain and isolation with limited English proficiency and access to care. Case 2: A woman with advanced cancer whose husband and primary caregiver was deported, leaving her solely responsible for childcare, finances, and decision-making amid grief and institutional barriers. CONCLUSIONS: These cases illustrate how systemic separation from key attachment figures can amplify distress and complicate palliative care. Recommendations include virtual family involvement, designated in-person surrogate supporters, and integration of independent community advocates to support decision-making and emotional resilience.
BACKGROUND: The Attentive Visitors training was developed to increase community volunteers' knowledge, skills and confidence regarding their role, signposting, and communication to address palliative care needs with comm...BACKGROUND: The Attentive Visitors training was developed to increase community volunteers' knowledge, skills and confidence regarding their role, signposting, and communication to address palliative care needs with community residents and healthcare professionals. AIMS: To pilot-test and evaluate the effectiveness and acceptability of the training at the volunteer level. DESIGN: Multi-method design utilizing a quantitative pre-test/post-test survey before (T0), immediately after (T1) and 2 months after (T2) the training to assess effectiveness; focus groups and interviews to evaluate subjective effectiveness and acceptability; and the Most Significant Change Technique to capture the wider impact of the training. SETTINGS/PARTICIPANTS: Participants included community volunteers and stakeholders involved in palliative home care, primary care, and volunteer coordination in Flanders, Belgium. They were purposively sampled through Samana, a nonprofit organization supporting people with chronic illness and their informal caregivers. RESULTS: The training was pilot-tested among 59 community volunteers across six locations in Flanders, Belgium. Thirty-seven (63%) volunteers completed both modules (i.e. the didactic and follow-up session). Nineteen volunteers participated in interviews and eight stakeholders took part in a group discussion. The training had a positive effect (at T2) on knowledge about palliative care (0.58 fewer incorrect answers at T2; = 0.011) and self-efficacy in discussing identified needs with a community resident (+0.51 at T2; < 0001) and healthcare professional (+0.42 at T2; = 0022). Community volunteers reported increased awareness of their own importance, more self-efficacy in setting boundaries, and more self-confidence in communicating with community residents and healthcare professionals. Community volunteers indicated that the training met their expectations, was useful, and that benefits were proportionate to required efforts. CONCLUSIONS: The training was evaluated positively on effectiveness and acceptability, enabling volunteers to respond better to palliative care needs and to support them in their signposting role. Findings of this early evaluation, focusing on short-term outcomes, suggest that this training program can be scaled up and integrated into educational programs of stakeholder organizations.
Fennessy R, Paterson A, Ward J
… +2 more, Clarkson PJ, Bowers B
Palliat Med
· 2026 Jul · PMID 42087461
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BACKGROUND: Injectable anticipatory medications are routinely prescribed ahead of need in many countries to help manage distressing end-of-life symptoms. However, little is known about the lived experience of patients an...BACKGROUND: Injectable anticipatory medications are routinely prescribed ahead of need in many countries to help manage distressing end-of-life symptoms. However, little is known about the lived experience of patients and informal caregivers as they navigate their prescription, supply and use. AIM: To explore and map patient journeys in navigating anticipatory medication care, and to identify healthcare interactions with the greatest potential for enhancing patient and informal caregiver experiences of care. DESIGN: Qualitative secondary analysis of longitudinal interview data using framework analysis and patient journey mapping techniques. SETTING/PARTICIPANTS: Adults (18+) prescribed anticipatory medications ( = 6), informal caregivers ( = 9) and health care professionals involved in their care ( = 5). RESULTS: Visually mapping journeys highlighted that patients and informal caregivers' experiences of anticipatory medication processes varied greatly and were influenced by the context of care. All participants appreciated access to injectable medications for future symptom control. However, journeys repeatedly highlighted suboptimal information exchange between patients, informal caregivers and healthcare professionals, regarding their purpose and threshold for use. Navigating unfamiliar and complex end-of-life medication support systems was more challenging when patients lived alone or experienced communication difficulties. CONCLUSIONS: Patient and informal caregiver experiences of timely symptom control could be improved by healthcare professionals having open and ongoing conversations about the role of anticipatory medications. Simplified and well-signposted routes for accessing healthcare professional advice and medication input are needed. Using journey mapping offers a novel way to visually illustrate different patient and informal caregivers lived experience and can be adapted for researching experiences of various care pathways.
Robbins-Welty GA, Childers J, Morgan E
… +10 more, Davis B, Newport K, Patterson B, Meyerson JL, Golden M, Certo M, Sajjad F, Conviser JH, Jones CA, Rosenberg L
J Palliat Med
· 2026 May · PMID 42080350
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Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As pal...Eating disorders (ED), particularly anorexia nervosa (AN), represent high-morbidity, high-mortality psychiatric illnesses with multisystem medical complications, frequent relapse, and substantial caregiver burden. As palliative care (PC) clinicians increasingly encounter patients with severe and enduring ED, they may be asked to help manage complex symptom distress, navigate treatment refusals, support families, and participate in values-based goals of care discussions amid prognostic uncertainty. At the same time, the emerging and contested discourse around "terminal anorexia nervosa" underscores the need for careful clinical reasoning, nuanced capacity assessment, and ethically rigorous, interdisciplinary deliberation. In this article, an interdisciplinary group of PC, psychiatry, psychology, and eating-disorder specialist clinicians presents a practical "Top Ten Tips" framework to support real-world care. Tips emphasize early recognition of countertransference and moral distress, medical severity assessment and refeeding risk, trauma-informed and harm-reduction approaches, task-specific decision-making capacity evaluations, communication strategies that prioritize values and meaning over labels, and collaboration with eating-disorder specialty teams, ethics consultation, and community resources. We aim to provide actionable guidance that strengthens PC clinicians' confidence and consistency when caring for patients with severe EDs.
Tang L, Yang L, Chen Z
… +9 more, Lei Y, Gao W, Liu J, Zhu S, Guo Z, He Y, Wen G, Zhao W, Qin C
J Palliat Med
· 2026 May · PMID 42080349
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BACKGROUND: Accurately estimating short-term survival in individuals receiving palliative care is crucial for guiding personalized clinical decisions. Existing tools often rely on subjective assessments and have limited...BACKGROUND: Accurately estimating short-term survival in individuals receiving palliative care is crucial for guiding personalized clinical decisions. Existing tools often rely on subjective assessments and have limited applicability. This study aimed to develop a simple, interpretable nomogram integrating objective biomarkers and functional status, applicable to a diverse population of end-stage patients. METHODS: A total of 167 patients who began working with the palliative care team were retrospectively reviewed, and the cohort was randomly partitioned into a 7:3 training (n = 117) and an internal validation set (n = 50). From an initial pool of 31 variables, independent prognostic factors were identified using least absolute shrinkage and selection operator (LASSO) Cox regression, while optimal thresholds for continuous measures were determined via maximally selected rank statistics. A nomogram was subsequently developed, and its performance was evaluated through time-dependent receiver operating characteristic analysis, calibration curves, and decision curve analysis, as well as sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios (LR+ and LR-) in the validation set at 30, 60, and 90 days. RESULTS: The LASSO model ultimately highlighted three principal predictors: C-reactive protein (CRP), estimated glomerular filtration rate (eGFR), and the Barthel Activities of Daily Living (BADL) score. Elevated CRP (hazard ratio [HR] = 1.005, = 0.01) and decreased eGFR (HR = 0.99, = 0.01) were independent risk factors for mortality. The nomogram demonstrated 30-/60-/90-day AUCs of 0.764/0.716/0.705 in the training set and 0.770/0.748/0.788 in the validation set. Calibration plots showed excellent agreement between predicted and observed survival, and Decision curve analysis indicated clinical net benefit across commonly used risk thresholds. In the validation set, the nomogram showed sensitivity/specificity of 69.05%/75.00%, 83.33%/87.50%, and 88.10%/87.50% at 30, 60, and 90 days, respectively; the corresponding LR+ values were 2.762, 6.666, and 7.048, and LR- values were 0.413, 0.191, and 0.136. CONCLUSIONS: We successfully developed and internally validated a simple, interpretable nomogram integrating CRP, eGFR, and BADL scores, capable of rapidly predicting short-term survival in palliative care patients. In addition to favorable discrimination and calibration, the model demonstrated clinically informative classification performance at 30, 60, and 90 days. The model is applicable to a diverse patient population and may assist in clinical decision-making and resource optimization.
Thomas TH, Byrom A, Xiao J
… +2 more, Bhattia G, Miller R
J Palliat Med
· 2026 May · PMID 42065287
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BACKGROUND: Cancer care increasingly emphasizes holistic, patient-centered support across the disease trajectory; however, many health systems lack sufficient resources to address patients' physical, psychosocial, and lo...BACKGROUND: Cancer care increasingly emphasizes holistic, patient-centered support across the disease trajectory; however, many health systems lack sufficient resources to address patients' physical, psychosocial, and logistical care needs, particularly in under-resourced settings. Patient navigation, delivered by trained non-clinician, peer, or community-based navigators, has demonstrated effectiveness in improving cancer screening and treatment initiation, yet its role in addressing the ongoing health and related care needs of people living with cancer remains less well characterized. METHODS: This scoping review aimed to synthesize peer-reviewed and gray literature evaluating patient navigation interventions focused on the care needs of people living with cancer to summarize program characteristics, facilitators, and barriers. A search of Ovid MEDLINE (1990-June 2024) identified 4300 records. RESULTS: Following rigorous screening and data extraction, 17 studies met the inclusion criteria. Most studies were conducted in the United States (88%), and over half employed randomized or cohort designs. Navigation programs varied widely in patient populations, cancer types, intervention duration, delivery modality, and navigator training and roles. Nearly half of the studies targeted under-resourced or marginalized populations. Interventions commonly addressed unmet needs, symptom management, care coordination, survivorship, palliative and end-of-life care, insurance, or psychosocial support. Across heterogeneous outcomes, most studies reported statistically significant improvements in patient-reported outcomes (e.g., quality of life, self-efficacy, psychosocial well-being), navigation process outcomes (e.g., satisfaction, feasibility, navigator-patient relationships), and, less frequently, health-related outcomes such as health care access and utilization. Key facilitators included strong institutional infrastructure, integration within oncology teams, flexible and accessible delivery, cultural responsiveness, and robust navigator training and supervision. Barriers included limited perceived need among lower-acuity patients, role ambiguity, technological challenges, insufficient follow-up, reimbursement constraints, and mismatches between program intensity and patient or caregiver needs. CONCLUSIONS: Findings highlight the importance of flexible, relationship-centered, and well-integrated patient navigation models and underscore the need for standardized training, sustainable reimbursement, and patient-driven programs designed to optimize impact and equity.
Wode K, Björ O, Klein R
… +8 more, Elander NO, Fransson P, Henriksson R, Sharp L, Scheibling U, Johansson B, Hök Nordberg J, Kienle GS
Palliat Med
· 2026 Jul · PMID 42059487
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BACKGROUND: Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies...BACKGROUND: Mistletoe extract is a widespread complementary therapy mainly used for quality-of-life improvement in cancer patients. Advanced pancreatic cancer is associated with poor quality of life and better therapies for symptomatic relief are highly needed. AIM: MISTRAL aimed to assess the impact of mistletoe extract on quality of life, body weight, observed costs and blood biomarkers in patients with advanced pancreatic cancer. DESIGN: MISTRAL was an investigator-initiated, phase III, randomized, double-blind, placebo-controlled, parallel-group, superiority, multicenter, clinical trial with a nested biomarker study. Registration EudraCT 2014-004552-64, NCT02948309. SETTING AND PARTICIPANTS: At 9 oncology centers, 290 participants were randomized to standard treatment (palliative chemotherapy or best supportive care) plus subcutaneous mistletoe extract or placebo. Main inclusion criteria were advanced pancreatic cancer, performance status 0-2, main exclusion criteria neuroendocrine pancreatic tumor. EORTC-QLQ-C30, EORTC-QLQ-PAN26, body weight, cost parameters and biomarkers were assessed from baseline up until 9 months. RESULTS: No statistically significant differences for quality of life and weight were evident between treatment arms. Parameters for observed costs for supportive and inpatient care (days at hospital, parenteral nutrition infusions, nutritional supplement drinks, number of visits of palliative home care teams, symptom-relieving medication) were similar in both arms. Thus, calculation of costs was not performed. No effect on explored biomarkers (differential blood count, lymphocyte subpopulations, C-reactive protein, albumin and Ca19-9) was found except for a statistically significant increase of eosinophils in the mistletoe arm without association to clinical effect. CONCLUSIONS: Since no benefit was observed, there is no clinical reason to recommend mistletoe extract in patients with advanced pancreatic cancer.
BACKGROUND AND OBJECTIVES: Heart failure (HF) is a significant public health challenge, particularly for patients with advanced HF who endure severe symptom burdens and high mortality. Palliative care is designed to alle...BACKGROUND AND OBJECTIVES: Heart failure (HF) is a significant public health challenge, particularly for patients with advanced HF who endure severe symptom burdens and high mortality. Palliative care is designed to alleviate multidimensional suffering and improve quality of life. However, integration into routine clinical practice for HF remains limited. Furthermore, there is a lack of bibliometric research mapping the knowledge structure and scholarly networks within this field. Therefore, this bibliometric review aims to analyze the current research status, collaboration patterns, hotspots, and evolutionary trends in palliative care for HF. METHODS: We retrieved English-language articles and reviews published between 2000 and 2025 from the Web of Science Core Collection and Scopus. A total of 1619 publications were identified for final analysis following computational deduplication and manual screening. Bibliometric analysis and visualization were conducted using CiteSpace, VOSviewer, SCImago Graphica, and the bibliometrix package in R. RESULTS: Annual publication volume has grown steadily, reaching approximately 160 publications per year recently. The collaboration network indicates that research partnerships are predominantly regionally concentrated, with the United States acting as a central hub. The keyword co-occurrence analysis identified four primary thematic areas: End-of-Life Care and Patient Experience, Geriatric Care and Chronic Disease Management, Clinical Interventions and Guidelines, and Advanced Therapeutics. Temporal analyses suggest a gradual broadening of scholarly interest. Early studies frequently discussed survival and basic disease management, whereas recent literature increasingly explores complex care coordination and prognostic tools for vulnerable populations, as reflected in emerging keywords such as "frailty" and "surprise question." CONCLUSION: Bibliometric indicators show that academic interest in HF palliative care has increased steadily. Scholarly discourse has gradually expanded to encompass holistic symptom control, multimorbidity, and the ethical complexities of advanced therapeutics. Future research may benefit from leveraging implementation science to help bridge the gap between academic concepts and equitable clinical integration.
van der Meulen AI, Stoppelenburg A, Theunissen M
… +3 more, de Nijs EJM, van den Beuken-van Everdingen MHJ, van der Linden YM
Palliat Med
· 2026 Jul · PMID 42051234
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BACKGROUND: Dry mouth is a disruptive symptom in patients with life-limiting illnesses. It has one of the highest symptom burdens in palliative care and a significant impact on quality of life. Nonetheless, dry mouth rem...BACKGROUND: Dry mouth is a disruptive symptom in patients with life-limiting illnesses. It has one of the highest symptom burdens in palliative care and a significant impact on quality of life. Nonetheless, dry mouth remains an underacknowledged and undertreated symptom with limited evidence-based interventions. AIM: To examine the quality and content of guidelines for the treatment of dry mouth in patients with life-limiting illnesses. DESIGN: A systematic review of clinical practice guidelines was conducted (preregistered in PROSPERO in 2023). PRISMA reporting guidelines were followed. The search strategy involved 4 scientific databases and 9 guideline databases, targeted searches and stakeholder outreach for 183 countries/regions. Quality and content were analysed using the AGREE II instrument and directed content analysis, respectively. DATA SOURCES: Seventy-two clinical practice guidelines from 42 countries across 6 continents were included. RESULTS: Only two guidelines were recommended for use based on the AGREE II quality appraisal. Four main themes emerged from the content analysis: (1) Assessment of dry mouth by medical history, oral examination and measuring instruments ( = 32, = 36 and = 19 guidelines respectively); (2) Oral care ( = 68); (3) Management by treating causes ( = 40), saliva substitutes ( = 66) and stimulants ( = 62), diet ( = 45), and medication ( = 40); and (4) Patient and family involvement ( = 43). CONCLUSION: Despite differences in quality and comprehensiveness of guidelines for treatment of dry mouth in palliative care, many care practices are shared worldwide. This review highlights the need for methodologically robust guidelines with a strong evidence base that specifically focus on dry mouth.