Kyriaki Mystakidou

Background: Specialist palliative care remains highly uneven in rural and remote settings for patients with life-limiting illness and their families . This review aimed to examine the implementation characteristics, clinical and service-level outcomes, and patient experiences of tele-palliative care interventions for individuals living in rural or remote settings with limited access to specialist palliative care. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines across PubMed, Scopus, CINAHL, and Google Scholar (August-October 2025). Eligible studies were published within the past 20 years and evaluated tele-palliative care interventions among rural populations. Data were extracted and outcomes were narratively synthesized. Results: Thirteen primary studies were included, conducted in the United States (n = 8), Australia (n = 2), Canada (n = 1), Japan (n = 1), and England (n = 1). Interventions included video consultations, hybrid tele-palliative programs, and remote symptom monitoring. Across studies, reported outcomes included implementation and process outcomes, patient and caregiver experiences and communication outcomes, clinical and care-process outcomes and health service utilization and economic outcomes. Challenges included technological instability, internet access limitations and inconsistent implementation fidelity. Conclusions: Tele-palliative care can extend specialist palliative care to rural and remote communities by reducing travel burden and supporting continuity, particularly when delivered through hybrid models embedded in local care pathways. However, the evidence base remains limited and concentrated in high-income settings, with heterogeneity in intervention models and outcome reporting. Future studies should use standardized implementation outcomes, evaluate equity impacts, and compare hybrid tele-palliative models with usual care in diverse rural contexts.

Background and Objectives: Autologous hematopoietic stem cell transplantation (AHSCT) offers life-saving treatment for hematologic malignancies but can result in persistent sexual dysfunction and relationship challenges. Attachment theory provides a valuable framework for understanding how enduring relational patterns influence sexual well-being. This study aimed to assess sexual function and attachment styles in AHSCT survivors and examine correlations between attachment and sexual health outcomes. Materials and Methods: A multicenter, cross-sectional study was conducted from December 2019 to March 2022 in five public hospitals in Athens, Greece. Participants were 127 adult survivors who had undergone AHSCT between 6 months and 5 years before enrollment. Sexual function was evaluated with the International Index of Erectile Function (IIEF) for men and the Female Sexual Function Index (FSFI) for women. Attachment style was measured using the Experience in Close Relationships Scale–Short Form (ECRSHORT-FORMSCALE). Results: Men demonstrated high erectile function (IIEF total: 54.10 ± 20.1), whereas women reported moderate sexual dysfunction (FSFI total: 22.51 ± 8.95). Both genders showed average attachment levels, with anxiety scoring lowest and discomfort with closeness highest. Between-group comparisons revealed no significant difference in anxiety (p = 0.95), a near-significant difference in avoidance (p = 0.056), and a significant difference in discomfort with closeness (p < 0.0001), with women scoring higher. In men, no significant correlations emerged between attachment and sexual function. In women, higher attachment anxiety correlated negatively with all FSFI domains except pain, avoidance correlated positively with lubrication, and discomfort with closeness correlated negatively with desire and pain. Conclusions: Findings reveal gender-specific patterns in attachment and their influence on sexual function of AHSCT survivors, highlighting the need for attachment-informed interventions to support intimacy, relationship satisfaction, and overall quality of life in survivorship care.

Demoralization is a syndrome of existential distress characterized by helplessness, hopelessness, loss of meaning, personal failure, and difficulty coping. This study explored the correlation between demoralization, social support, and attachment to health care providers in cancer patients. We conducted an observational, cross-sectional study with 150 inpatients and outpatients (≥ 18 years) from two hospitals. Personal and medical data were collected; patients completed psychometric instruments: Demoralization Scale II (DS-II), Experiences in Close Relationship Scale-Modified Short Form (ECR-M16), and Medical Outcomes Study (MOS) Social Support Survey. Participants’ mean age was 62 years (range 20–85); 59.3% were women. Diagnoses included breast (33%), gastrointestinal (24%), and lung cancer (15%). Women had significantly higher DS-II factor 2 scores (p = 0.058). DS-II factor 2 correlated positively with age (p = 0.016). Multiple linear regression indicated that ECR-Discomfort significantly impacted DS-II factor 1 (p = 0.011, R2 = 9.3%) and factor 2 (p < 0.001, R2 = 12.1%). ECR-Anxiety also influenced DS-II factor 1 (p = 0.055, R2 = 2.7%) and factor 2 (p = 0.054, R2 = 2.4%). No significant correlation was found between demoralization and social support. Anxious and discomfort attachment patterns to health care providers exacerbate demoralization in cancer patients. Early identification of attachment styles may help reduce existential distress. These findings underscore the importance of incorporating psychological training into oncology education to better equip professionals in recognizing and addressing emotional vulnerability.

Background: Artificial Intelligence (AI) is increasingly integrated into healthcare systems, presenting opportunities to improve clinical outcomes. In the context of palliative care, AI holds potential to enhance quality of life through improved symptom management, effective communication, and greater prognostic accuracy. For this review, AI refers to computational systems capable of learning, reasoning, or predicting outcomes. As integration advances, a critical examination of its applications, practical challenges, and ethical implications in palliative care is warranted. Methods: A scoping review was conducted using 4 major databases: PubMed, Google Scholar, Scopus, and CINAHL. A total of 7 studies were included, each addressing the use of AI technologies in palliative care settings, with a focus on clinical implementation, ethical challenges, and system integration. Both quantitative and qualitative studies were considered. Results: AI applications in palliative care include predictive analytics, symptom control, and enhanced patient-caregiver communication. These tools demonstrate potential in facilitating early identification of patient needs and supporting timely interventions. However, significant challenges persist, particularly around data privacy, patient autonomy, algorithmic bias, and the “black box” nature of many AI models. Additional practical limitations include integration into clinician workflows, clinician trust, and concerns about the depersonalization of care. Conclusion: AI offers substantial potential to improve palliative care, but implementation must be grounded in ethical frameworks prioritizing dignity, compassion, and patient-centeredness. Multidisciplinary collaboration is essential to ensure that AI augments rather than replaces the humanistic core of palliative care. Ongoing research and development of transparent, equitable algorithms are critical to responsibly harnessing AI’s transformative potential.

Background: Autolοgous Hematopoietic Stem Cell Transplantation (AHSCT) is a treatment οption fοr patients with hematological malignancies that improves prοgnοsis and survival. Thus, it is necessary tο deal with its long-term cοmplications, such as sexual dysfunction and trauma that significantly affect survivors’ quality οf life. Objective: The aim οf this study was to evaluate the Sexual Function (SF) and the Pοst-traumatic Stress Disorder (PTSD) οf survivοrs οf hematolοgical malignancy and AHSCT. Methods: A multicenter, quantitative, crοss-sectional, descriptive, and cοrrelational study was cοnducted from December 2019 to March 2022. Thrοugh cοnvenience sampling, 127 adults and sexually active survivors οf hematolοgic malignancy whο underwent AHSCT frοm 6 mοnths tο 5 years were recruited frοm 5 hοspitals in Athens. The survivοrs cοmpleted questionnaires on demοgraphic and clinical data, a male or female SF assessment tοοl (Internatiοnal Index Erectile Functiοn (IIEF) and Female Sexual Functiοn Index (FSFI), respectively), and the Impact of Event Scale-Revised (IES-R). Results: Patients’ mean age was 45.6 (±12.8) years. The median time frοm transplant was 3 years and the majοrity οf the survivοrs had Hodgkin's lymphοma. Accοrding tο the FSFI, wοmen had a mοderate level of SF, with a better functional area the “pain” and wοrse the “οr-gasm”. Accοrding tο the IIEF, men had a high level of SF, with a better functional area the “erection” and wοrse the “οverall satisfaction”. Survivοrs had lοw levels οf PTSD based οn the IES-R, with nο differences between men and women. The subscale οf “hyperarοusal” had the lοwest values and the subscale οf “avοidance” had the highest values fοr bοth men and wοmen survivοrs. There was a lοw tο mοderate negative statistically significant cοrrelation between the IES-R and bοth FSFI and IIEF, suggesting a high level οf PTSD to be correlated with wοrse sexual function. Conclusion: Survivοrs οf AHSCT had impaired SF tο varying degrees and areas of functionality depending οn their gender, but lοw levels of PTSD and lοw correlations between these twο variables. This matter is impοrtant in survivοrship care and needs further investigatiοn.

Objectives: Cancer patients endure a significant burden, both physically and psychologically. This burden encompasses the symptoms of the disease itself, treatment toxicity, alterations in body image, diminished performance status, pain, lack of a supportive environment and existential distress. These factors contribute to a reduced quality of life and may ultimately erode the patient’s dignity. This study aims to assess the overall quality of life and dignity experienced by patients with cancer, utilising established inventories in the Greek context. In addition, the study seeks to investigate the potential impact of quality of life on patients’ sense of dignity. Materials and Methods: The study sample comprises 100 cancer patients undergoing definitive or palliative radiotherapy, with Eastern Cooperative Oncology Group (ECOG) performance status ranging from 0 to 3. Among the participants, 46% were male and 54% were female, with a median age of 63 years (range: 32–87 years). Assessment tools included the Greek versions of three inventories: The MD Anderson symptom inventory, the patient dignity inventory and the Functional Assessment of Chronic Illness Therapy (FACIT)-Palliative, version 4. Results: Demographic analysis revealed that ECOG performance status emerged as the sole characteristic significantly impacting patients’ dignity. Regarding quality of life, factors such as FACIT-emotional well-being, FACIT-physical well-being and additional concerns demonstrated a discernible influence on patients’ sense of dignity. Conclusion: This study underscores the significance of dignity preservation as a pertinent concern among cancer patients. Furthermore, it identifies quality of life-related factors as prognostic indicators for the erosion of patient dignity.

Objectives: The objective of this study is to conduct an in-depth exploration of the psychological well-being, hope, and expectations of cancer patients receiving care in a palliative care unit, utilizing a qualitative research approach. Methods: We employed the methodology of interpretative phenomenological analysis (IPA). Our data collection involved conducting 1-hour semi-structured interviews with the patients. In the subsequent data analysis, we applied investigator triangulation to ensure rigor and reliability. Results: Understanding patients’ hope and expectations from palliative care is crucial as it can serve as an indicator of the quality of care and motivate care providers to fulfill these expectations as much as possible. Throughout the IPA, 3 superordinate themes emerged from the qualitative data: cancer diagnosis and the spectrum of emotions, hope and cancer patient, and oncology patient expectations of palliative care. Significance of results: From the patient’s perspective, making sense of their cancer experience involves managing symptoms, redefining their understanding of illness, adapting to functional changes, and fostering open communication among themselves, their families, physicians, and the palliative care team. This underscores the crucial necessity for an interdisciplinary approach and emphasizes the importance of reinforcing positive support systems. In essence, our study delves into the multifaceted psychological aspects of cancer patients in the context of palliative care, shedding light on their hope and expectations as they navigate the challenging terrain of cancer treatment and palliative support.

Dr. George Papanicolaou, a distinguished Greek physician, biologist, and researcher, made monumental contributions to medical science, particularly in the field of cytopathology. His groundbreaking work in the early detection of cervical cancer through the development of the Pap smear has had an enduring global impact, transforming women's healthcare and significantly reducing mortality rates associated with cervical cancer. Papanicolaou's journey from his early education in Greece to his pioneering research in the United States exemplifies a relentless pursuit of scientific discovery and innovation. Papanicolaou's life and achievements continue to serve as a beacon of innovation in medical research, illustrating the profound impact that one individual's dedication can have on public health and the ongoing fight against cancer.