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Working in the field of end-of-life and palliative care with individuals, families, and professionals often gives us reason to pause and consider the situations in a new light. Through such reflection, we may become fortified to continue the work and truly see the effect of these powerful experiences on everyone involved. Through the journal’s “Reflection” section, it has been our honor to give a voice to practitioners who wish to share their experiences and thoughts about challenging situations encountered in their work. Thus, in this issue, a special focus on reflections begins with a poem (“Grief”) and continues through stories and cases that take us through a wide range of topics in caring for individuals near or at the end of their lives. I hope that these may also give you reason to reflect on situations in your own practice and consider how they may be looked at as more than just difficult ‘cases’ but as opportunities for personal/professional growth.

A range of issues and research methodologies can be seen in the studies presented in this issue. Cagle and Bunting present an examination of factors that may account for reluctance to talk about pain and therefore may leave pain inadequately treated. They reviewed the literature and found a range of attitudes and beliefs that contribute to hesitancy to openly admit pain including stigma and denial. Social workers should not only assess (verbal and non-verbal) and ask about pain itself but also how comfortable individuals are in discussing their pain.

The loss of a parent to cancer is undoubtedly a significant one. Bereavement support for these children through a support group was examined by Olsson and colleagues (in an international context). They prospectively studied the psychosocial well-being of children who participated in the support group. The group offered through a palliative care setting in Sweden which offers an international perspective. Participants reported positive changes in sense of meaning in future life that may be contributed to the usefulness of the group, perhaps through the fellowship created by being with others in a similar situation. The authors urge more attention to the providing psychosocial support for bereaved children through group interventions.

Finally, Reinhardt and colleagues used a retrospective secondary data analysis of long-stay nursing home residents to examine the presence of do-not-resuscitate orders, do-not-hospitalize, no intubation, no artificial feeding, no artificial hydration, and no antibiotic orders. Existence of these orders varied but largely when these existed, the orders were followed. The authors advocate for end-of-life and palliative care discussions to be more integrated into the nursing home setting, thus helping to avoid unwanted medical interventions near the end of life.

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