Family conferences (FC) are a structured and therapeutic tool in palliative care, promoting effective communication between the healthcare team, patient and family. They are especially relevant for patients with high clinical complexity, both in hospital settings and in primary care.To evaluate the impact of FC on patients followed by palliative care teams and on complex patients dependent on primary health care (PHC), as well as the perception of caregivers on the quality of care provided.Observational, analytical and cross-sectional study, with application of a specific questionnaire to caregivers of patients followed by a community palliative care team and a family health team. Sociodemographic and clinical variables and perceptions of the impact of FC on the understanding of the disease and its trajectory, on satisfaction and on the feeling of security and trust were analyzed.The total sample included 38 caregivers, of whom 20 were accompanied by a team specialized in palliative care and 18 by a family health team. There was a high percentage of female caregivers (78.9%), with a mean age of 58.1 years, and the mean age of patients was 80.7 years. FC was associated with improved perception of communication (9.36 ± 0.65), collaboration (9.50 ± 0.86) and implementation of care strategies (9.45 ± 0.83). The presence of professionals such as social workers and psychologists in the FC of the palliative care team associated with greater family participation (p = 0.002) and greater perceived support (p = 0.001). Among the patients who died, there was a significant correspondence between the desired and actual place of death (p = 0.007), demonstrating FC as an effective instrument for planning. The presence of more family members in the FC correlated with greater hospital use in the previous month (p < 0.001) and with greater case complexity.FCs have proven to be effective in improving communication, planning and aligning care with patient and family preferences. Their regular implementation, especially in PHC, should be promoted with multidisciplinary teams and specific training.The study shows FCs improve teamwork, communication, care planning, and align preferred and actual death places. They boost end-of-life care quality, psychosocial support, and treatment confidence, emphasizing health literacy, team training, and routine use.

Palliative care addresses not only patients but also the physical, psychological, and social well-being of caregivers. Caregiving burden may negatively affect sleep quality and overall health, making it essential to understand its impact to improve caregiver well-being and palliative care quality.This study aims to examine the relationship between caregiver burden and sleep quality among caregivers of hospitalized palliative care patients and to contribute to identifying caregiver needs and improving person-centered, sustainable care.This cross-sectional study was conducted over three months with 102 caregivers using face-to-face surveys. Data were collected with a sociodemographic questionnaire, the Zarit Caregiver Burden Scale, and the PSQI, and analyzed using IBM SPSS 25.0 with appropriate statistical tests.Most caregivers were women over the age of 50, married, retired, of moderate income, and high school graduates. The majority were spouses or children of the patients. The mean caregiver burden score was 35.37±15.16, indicating a moderate level of burden, while the mean PSQI score was 10.86±3.48. Overall, 79.4% of caregivers had poor sleep quality. Caregiver burden and sleep quality did not differ significantly according to age, gender, marital status, number of children, or income level. However, caregiver burden was significantly associated with degree of relationship to the patient, longer caregiving hours, presence of chronic disease, education level, and receiving financial compensation. A strong, positive, and statistically significant correlation was found between caregiver burden and PSQI scores.The presence of chronic diseases, psychiatric comorbidities, the nature of caregiving, and environmental factors in which care is provided emerged as key determinants influencing both caregiver burden and sleep quality. These results emphasize the importance of psychosocial interventions, sleep hygiene education, and regular follow-up programs aimed at supporting caregivers, and suggest that reducing caregiver burden may improve sleep quality.This study shows that increased caregiver burden negatively affects sleep quality. Family medicine, with its holistic and continuous care approach, plays a key role in the early identification of caregivers at risk. Regular follow-up, psychosocial support, and appropriate referrals provided by family physicians may reduce caregiver burden and improve sleep quality, contributing to more effective and person-centered palliative care.

Given that diverse life contexts of older adults may impede effective physician communication and exacerbate dependency, understanding triadic interactions (physician–patient–caregiver) within Primary Health Care (PHC) systems, such as Brazil’s Unified Health System, is critical. Poor treatment adherence among older adults and evidence showing that nearly 40% of medical errors in this population stem from communication failures highlight the urgency of addressing this issue to improve patient safety and health outcomes.To analyze the multidimensional aspects of triadic communication in Primary Health Care through a literature review.An integrative review was conducted using the Virtual Health Library databases. The search strategy applied Boolean operators with combined terms: (elderly OR “older adults”) AND (caregivers OR family) AND (“primary health care”) AND (communication OR “physician–patient relationship”). Studies published between 2010 and 2025 addressing communication involving older adults and/or caregivers were included and analyzed through thematic synthesis. Articles unrelated to the topic, duplicates or those outside the Primary Health Care context were excluded. Data were synthesized thematically to identify key dimensions and recurring patterns. The methodological rigor aimed to ensure reliability in the selection and interpretation of evidence.Of 325 articles identified, 17 addressed the topic broadly, 9 aligned with the study focus, and 317 were excluded. Findings reveal weaknesses in professional training, predominance of biomedical practices, and gaps in teamwork. Cultural competence and contextual factors are critical for effective communication.Triadic communication is a complex and multifaceted phenomenon. Evidence highlights a persistent tension between respecting patient autonomy and effectively integrating the caregiver. The caregiver’s role is paradoxical, acting either as a facilitator or diverting attention from the older adult’s care needs. The use of digital tools and structured checklists enhances interaction. Developing skills to mediate conflicts and adapt communication strategies according to cognitive level and patient context is essential for improving care quality.It is concluded that triadic communication requires professionals to develop relational and expressive competencies, demonstrate flexibility in adopting context-specific strategies, and apply creativity in designing tools that support person-centered care. Future studies should evaluate interventions that strengthen triadic communication and measure their impact on patient safety and health outcomes.

The sandwich generation comprises adults who simultaneously care for their aging parents and dependent children. This growing phenomenon reflects global demographic changes such as increased life expectancy, delayed parenthood, and economic pressures. These dual caregiving roles expose individuals to multifaceted physical, emotional, and financial challenges that affect overall well-being.This systematic review aims to examine existing literature on the challenges and coping strategies experienced by the sandwich generation and identify implications for health and social policy.Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review was conducted. Three independent reviewers searched PubMed, Medline, ScienceDirect, CENTRAL, the Wiley Online Library, JBJS, and Google Scholar for studies published from January 2020 to November 2024. Search terms included “sandwich generation,” “challenges,” “coping strategies,” “physical health,” and “mental health.” Eligible articles included English-language studies with quantitative or qualitative designs addressing caregiving experiences within the sandwich generation. Data extraction and quality appraisal followed the Cochrane Review Group’s 10-item assessment tool.Out of 1,268 records identified, five studies met the inclusion criteria. The reviewed literature revealed consistent themes of emotional strain, time pressure, and financial burden. Caregivers reported stress, fatigue, and reduced self-care. Common coping strategies included seeking social support, practicing mindfulness, and time management. Gender disparities were observed, with women experiencing greater caregiving load and emotional distress.Findings highlight the dual challenges and adaptive resilience of the sandwich generation. Strengthening institutional support, workplace flexibility, and community-based programs is crucial to sustain their well-being and caregiving capacity.This review demonstrates that sandwich-generation caregivers shoulder significant emotional, physical, financial, and time-related burdens that compromise their well-being. Nonetheless, caregivers display considerable resilience through adaptive coping strategies and social support systems. Gender disparities further intensify the caregiving experience, disproportionately affecting women across emotional, physical, and economic dimensions. Supporting these caregivers is not merely a matter of individual well-being but a societal imperative, as their ability to function effectively influences family stability, workforce participation, and the health of dependents across two generations.

Foreign caregivers frequently experience emotional distress related to isolation, demanding work conditions, and limited access to mental-health resources. Communication barriers such as culturally shaped ways of expressing distress, indirect language, and unfamiliarity with mental-health terminology often challenge early detection in primary care. Family physicians require practical, low-cost tools that facilitate culturally sensitive dialogue during the consultation while preserving clinical judgment.We implemented a culturally adaptive AI chatbot, built on an open-source language-model architecture, to support real-time communication and early mental-health screening during primary-care encounters. Development was guided by mapping clinicians’ communication challenges and identifying culturally patterned expressions of distress among foreign caregivers. During the visit, the physician activates the chatbot on a shared screen and uses it interactively with the caregiver. The chatbot reformulates validated screening questions such as PHQ 9 and GAD 7, brief standard tools for detecting depression and anxiety, into culturally aligned and simplified language. It identifies potential indicators of distress and offers culturally appropriate phrasing options to facilitate deeper exploration. The tool functions as a real-time communication mediator, while the physician remains the sole interpreter and decision-maker.Early use suggested improved mutual understanding, greater patient engagement, and more reliable completion of screening tools. Physicians reported that the chatbot helped surface emotional concerns that might otherwise remain unspoken. Key challenges included integrating the tool into busy clinic flow, maintaining transparency about AI use, and managing risks such as misinterpretation or over-reliance on automated phrasing. The experience suggests potential applicability in other multicultural primary-care settings.Embedding AI as a live communication partner can help clinicians initiate mental-health discussions in multicultural settings while preserving clinical autonomy and human connection. This approach showed acceptability and added value in routine practice.A culturally adaptive AI chatbot used during primary-care encounters can strengthen early mental-health assessment among foreign caregivers by improving communication, diagnostic clarity, and engagement. This clinician-centered model offers a scalable and practical innovation for multicultural primary care.

Caregivers (CG) have been recently recognized by the law, but their status ends at the time of the caregiver's death. Thus, mourning is a major fragility period for CGs.General Practitioner remains a primary actor during caregiving period, but little is known about its role during CG mourning.The aim of this study was to assess CGs experience of the bereavement and what was the role played by GPs during this delicate period .A qualitative analysis based on grounded theory approach was carried out on bereaved CGs. Primary assumptions were set interviewing end-of-life professionals’ caretakers, then 14 CGs were interviewed using semi-structured interview methods. Analysis and triangulation coding with an external researcher were made, as well as an adaptation of the semi-structured interview until sufficiency of dataCG bereavement experience relates to caregiving experience as well. Gradual loss of control over the situation reach its climax with the loved one’s death. CG stars then a journey of a "double bereavement": the loved one’s and his caregiving role as well, in order to rebuildhis identity and become someone else. GP relationship may facilitate or hinder this path or remain independent of CG/caregiver role. In the background of this journey, we found two other actors influencing CG experience: health care system and family/social network. Covid-19 pandemic was another constraint bereaved CGs had to cope with.CGs listed some suggestions on their regards. They would like their expertise taken into account, as well as logistic help (home visits, address book, etc.). Moreover, they would like to open a discussion on end-of-life issues. This will allow them to prepare themselves, but also to express their feelings, in order to try to move forward during bereavement. GP seems to be a privileged partner to discuss these issues.Our findings highlight the pivotal role of the General Practitioner, whose empathic presence and proactive engagement can ease caregivers’ emotional burden, facilitate meaning-making, and support a healthier bereavement trajectory. Strengthening primary care involvement and discussion about end-of-life dialogue and post-loss follow-up may therefore significantly improve caregivers’ experiences and grief resolution.

Family and professional caregivers in remote and geographically isolated communities often experience substantial emotional and informational burdens due to limited access to continuous primary care. These caregivers frequently navigate complex health issues on behalf of older adults while lacking timely medical guidance and psychological support. Such inequities highlight the need for scalable and person-centered approaches to caregiver support.Using a mixed-methods design, this study focused primarily on caregivers who participated in regularly scheduled online health consultations. Quantitative surveys evaluated perceived clarity and empathy of communication, usefulness of medical advice, caregiver burden, stress levels, and trust in providers. Focus group interviews explored caregivers’ lived experiences, unmet needs, and perceptions of how online communication influenced their emotional well-being and caregiving confidence.Caregivers reported reduced anxiety, enhanced ability to make informed decisions, and improved confidence in managing daily care. Many emphasized the value of empathetic communication, noting that it alleviated their sense of isolation and provided validation for their caregiving roles. These findings underscore the potential for communication-centered digital primary care to better support caregivers in remote or resource-limited environments.The study demonstrates that online consultations can effectively reduce caregiver burden while strengthening continuity of care. However, limitations include a small sample size, variability in caregivers’ digital literacy, and dependence on stable technological infrastructure. Further research should assess long-term outcomes, explore culturally adaptable communication strategies, and examine integration into broader community-based primary care systems.SDG-aligned online consultations contributed to greater equity, psychological well-being, and informational support for caregivers in remote communities. While challenges remain regarding scalability and technology access, this model offers a promising framework for enhancing caregiver-centered primary care in underserved populations.