Editorial: Palliative and end of life care in the post-pandemic era: Old problems and new perspectives.

Barbara Sena^1*Enrico De Luca²Guido Giarelli³

• ¹University of Bergamo, Bergamo, Italy
• ²University of Birmingham, Birmingham, United Kingdom
• ³Universita degli Studi Magna Graecia di Catanzaro, Catanzaro, Italy

The problem of prolonging life or accompanying death is not new in the social sciences and healthcare field and has been a subject of discussion for many years. It remains one of modern medical science's most emblematic issues, which Ivan Illich (1976) defined as the "medicalisation of dying", highlighting its impact on how death is approached in modern culture. Sociological interest in this topic began with Glaser and Strauss's work (1965) on awareness of dying and continues today with studies on the challenges of managing dying patients in various care settings (e.g. Sudnow, 1967; Broom, 2015; Bandini, 2020; Sena & De Luca, 2022). In this context, palliative care (initially called "terminal care") has become synonymous with end-of-life management. It can be considered a postmodern specialty because it lacks a specific disease, bodily organ, or life stage to call its own. Therefore, it continues to be subject to prejudice, which relegates the role of palliative care only to treating pain in dying patients (Masel & Kreye, 2018). During the most critical phases of the COVID-19 pandemic, managing end of life became exceedingly complex, especially within emergency wards and intensive care units. This complexity extended even to countries and regions that had previously experienced high mortality rates and whose healthcare workers were well versed at providing compassionate palliative care despite resource limitations and during humanitarian crises. However, the significant global rise in COVID-19-related deaths further intensified and complicated the delivery of end-of-life and palliative care, requiring innovative approaches beyond existing approaches. Many healthcare professionals were unprepared to navigate the ethical dilemmas between proper treatment and dignified death (Nicoli & Gasparetto, 2020). As healthcare resources and facilities faced unprecedented pressure, valuable lessons can be learnt from models of care in other settings around the world. Three years after the pandemic, end-of-life and palliative care still remains underexplored in health sociology. This special issue addresses that gap through seven contributions. The first article, by Clancy et al., presents a co-produced Creative Toolkit© to support palliative care professionals' wellbeing—especially under COVID-19-related stress. This arts-based resource, incorporating music, visuals, and theatre, addresses holistic needs. Organisations like Hospiscare UK reported emotional benefits and stronger team bonds. The study aligns with wider evidence on art's role in mental health and calls for broader implementation. The second article, by Hodge et al., examines barriers to palliative care in South-West England—a region facing ageing and rural healthcare challenges. From 13 focus groups, they identify issues such as poor out-of-hours services, fragmented communication, and discomfort around death. The authors call for more coordinated, person-centred practices to reflect patient values and support equitable, compassionate end-of-life experiences. Next, Zhang et al. analyse attitudes toward palliative care among 541 cancer patients in China, using a multi-method approach. Despite its benefits, acceptance was low. Education, occupation, caregiving experience, insurance, cancer stage, and anxiety influenced perceptions. From a sociological perspective, the study shows how culture and inequality shape understanding and stresses the need for education and culturally sensitive approaches. Darryl Juan et al. address Singapore's underuse of palliative services, attributing it to limited provider knowledge. Through a nationwide cross-sectional online survey conducted among primary and tertiary healthcare providers, they assessed challenges faced, palliative education, confidence in managing patients undergoing palliative care, and knowledge of palliative surgery. Their findings confirm that healthcare providers in Singapore have poor knowledge and misconceptions about palliative care and surgery, making it essential to improve awareness and education among those caring for seriously ill adults. Barasteh et al. explore Iran's palliative care landscape through a three-phase qualitative study (2018–2020), outlining future scenarios up to 2030. Their results show that the development of palliative care in the Iranian healthcare system faces with serious uncertainties and that palliative care development efforts need to focus on two axes: social acceptance and the need for consistent governance by the Ministry of Health. Joel Vieira Vitorino et al. reflect on the COVID-19 pandemic's disruption of end-of-life care and the importance of strengthening community support networks (family, friends, neighbours, and community members) as the foundation of compassionate community efforts to enhance their capacity to care for others and improves the overall experience of death, including the process of dying and the ensuing bereavement period. Therefore, active community participation and death education can strengthen a community's capacity to assist people coping with death, dying, and bereavement. The final article introduces spiritual care models in palliative care. While Western healthcare increasingly recognises spirituality, integration into daily practice remains rare. Palliative care has begun addressing psychological and existential dimensions through holistic models that transcend biomedical frameworks. This concept analysis examines the challenges faced by clinicians in implementing shared, patient-centred spiritual practices. Drawing on case studies from Thailand and Italy, and introducing two UK-based conceptual models, this analysis advocates for shared, patient-centred spiritual practices and assessments Such models enable meaningful dialogue, enhancing the therapeutic relationship and fostering compassionate, person-centred care. The variety of contexts, approaches and issues addressed in these articles demonstrates the growing attention being given to end-of-life care and management issues in both Western and Eastern contexts. The aim of this special issue was therefore to draw the attention of medical sociology scholars to this topic, in the hope of encouraging further research.