{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T14:35:02Z","timestamp":1792420502968,"version":"4.5.0"},"reference-count":58,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T00:00:00Z","timestamp":1766707200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951525101247_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>End-of-life dreams and visions (ELDVs) and delirium frequently occur near death but differ in core features. Clinical differentiation becomes challenging when they co-occur. This case report illustrates the interplay between ELDVs and delirium, examines the limits of current diagnostic criteria in mixed cases, and outlines a nuanced approach to distinction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525101247_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We report the case of an elderly Brazilian woman with metastatic cancer who exhibited both ELDVs and delirium. Mental status was serially assessed using the Confusion Assessment Method (CAM). ELDV accounts were prospectively triangulated across patient, family, and clinician reports to enhance reliability and contextual understanding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525101247_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient\u2019s experiences showed ELDV hallmarks \u2013 vivid, realistic encounters with deceased relatives, biographical relevance, and preparatory themes \u2013 yet many were affectively distressing and occurred alongside fluctuating attention and consciousness consistent with delirium. CAM effectively identified delirium but could not, on its own, distinguish ELDVs within delirious states. When co-occurring, ELDVs often emerged during \u201cwindows of lucidity\u201d marked by preserved autobiographical context, intact recall with subsequent coherent narration, and insight, despite intense emotional valence. Distress alone was not discriminatory, probably being shaped by psychosocial and cultural factors. These observations indicate the need to supplement CAM with qualitative and phenomenological criteria, including content, vividness, biographical meaning, insight, cultural fit, and acuity\/recall.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525101247_sec4d\">\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>To our knowledge, this is the first case to map evolving end-of-life mental status using serial CAM while prospectively documenting ELDVs via triangulated reports. The findings highlight the complexity of differentiating co-occurring ELDVs and delirium and challenge the sufficiency of CAM alone. An integrated approach \u2013 combining CAM screening with structured ELDV assessment \u2013 may prevent misclassification and support holistic, dignified palliative care. As a single case in an underexplored domain, these insights require confirmation in larger, prospective studies to assess generalizability.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951525101247","type":"journal-article","created":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T06:04:20Z","timestamp":1766729060000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":1,"title":["End-of-life dreams and visions in a patient with delirium: A Brazilian case report and narrative review"],"prefix":"10.1017","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2706-3047","authenticated-orcid":false,"given":"Ta\u00eds Oliveira","family":"Silva","sequence":"first","affiliation":[{"name":"Psychology Department, Federal University of Juiz de Fora"},{"name":"School of Medicine, Federal University of Juiz de Fora"},{"name":"Institute of Health Sciences, Federal University of Bahia"},{"name":"Institute of Psychiatry, Clinical Hospital - University of S\u00e3o Paulo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Angeli-Faez","sequence":"additional","affiliation":[{"name":"Psychology Department, Federal University of Juiz de Fora"},{"name":"School of Medicine, Federal University of Juiz de Fora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorena C\u00e2ndida Ferreira","family":"Paix\u00e3o","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Juiz de Fora"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Everton de Oliveira","family":"Maraldi","sequence":"additional","affiliation":[{"name":"Institute of Psychiatry, Clinical Hospital - University of S\u00e3o Paulo"},{"name":"Postgraduate Program in Medical Sciences at the D\u2019Or Institute for Research and Teaching (IDOR)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Moreira-Almeida","sequence":"additional","affiliation":[{"name":"School of Medicine, Federal University of Juiz de Fora"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,12,26]]},"reference":[{"key":"S1478951525101247_ref25","doi-asserted-by":"publisher","DOI":"10.1177\/0269216312457214"},{"key":"S1478951525101247_ref28","unstructured":"Kerr, CW (2022) Experiences of the dying: evidence of survival of human consciousness. Consciousness Bigelow Institute . https:\/\/www.bigelowinstitute.org\/Winning_Essays\/5_Christopher_Kerr.pdf (accessed 2 February 2025)."},{"key":"S1478951525101247_ref51","doi-asserted-by":"publisher","DOI":"10.1177\/0269216308099210"},{"key":"S1478951525101247_ref54","doi-asserted-by":"publisher","DOI":"10.1093\/oso\/9780190872472.001.0001"},{"key":"S1478951525101247_ref26","doi-asserted-by":"publisher","DOI":"10.1177\/23337214231183243"},{"key":"S1478951525101247_ref32","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0547"},{"key":"S1478951525101247_ref18","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000224876.63035.23"},{"key":"S1478951525101247_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/jan.16079"},{"key":"S1478951525101247_ref19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-041214"},{"key":"S1478951525101247_ref11","doi-asserted-by":"publisher","DOI":"10.1089\/pmr.2020.0037"},{"key":"S1478951525101247_ref5","doi-asserted-by":"crossref","first-page":"2898","DOI":"10.1001\/jama.2008.885","article-title":"Agitation and delirium at the end of life: \u201cWe couldn\u2019t manage him.\u201d","volume":"300","author":"Breitbart","year":"2008","journal-title":"JAMA"},{"key":"S1478951525101247_ref23","first-page":"1","article-title":"End-of-life dreams and visions: a systematic integrative review","author":"Hession","year":"2022","journal-title":"Palliative and Supportive Care"},{"key":"S1478951525101247_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2023.10.023"},{"key":"S1478951525101247_ref50","doi-asserted-by":"publisher","DOI":"10.1177\/1049909112451868"},{"key":"S1478951525101247_ref46","doi-asserted-by":"publisher","DOI":"10.1089\/109662102753641287"},{"key":"S1478951525101247_ref21","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2022.0419"},{"key":"S1478951525101247_ref6","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231152441"},{"key":"S1478951525101247_ref57","doi-asserted-by":"publisher","DOI":"10.1007\/s41603-024-00230-3"},{"key":"S1478951525101247_ref16","first-page":"CD004770","article-title":"Drug therapy for delirium in terminally ill adults","volume":"1","author":"Finucane","year":"2020","journal-title":"The Cochrane Database of Systematic Reviews"},{"key":"S1478951525101247_ref55","doi-asserted-by":"publisher","DOI":"10.1136\/spcare-2022-004055"},{"key":"S1478951525101247_ref22","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.772387"},{"key":"S1478951525101247_ref14","doi-asserted-by":"publisher","DOI":"10.1590\/S0004-282X2001000200004"},{"key":"S1478951525101247_ref29","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2013.0371"},{"key":"S1478951525101247_ref34","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4823"},{"key":"S1478951525101247_ref37","doi-asserted-by":"publisher","DOI":"10.1007\/s10943-023-01875-8"},{"key":"S1478951525101247_ref52","first-page":"165","volume-title":"Exploring Frontiers of the Mind-Brain Relationship. Mindfulness in Behavioral Health","author":"Santos","year":"2011"},{"key":"S1478951525101247_ref53","doi-asserted-by":"publisher","DOI":"10.1177\/1542305015616103"},{"key":"S1478951525101247_ref30","volume-title":"Death Is but a Dream: Finding Hope and Meaning in End of Life Dreams","author":"Kerr","year":"2020"},{"key":"S1478951525101247_ref41","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2016.04.013"},{"key":"S1478951525101247_ref33","first-page":"79","volume-title":"Spirituality and Mental Health across Cultures","author":"Machado","year":"2021"},{"key":"S1478951525101247_ref2","doi-asserted-by":"publisher","DOI":"10.2190\/188Q-BHFK-Q7DM-JHR4"},{"key":"S1478951525101247_ref42","first-page":"506","article-title":"Brazilian psychiatric association guidelines on the integration of spirituality into mental health clinical practice: part 1. Spiritual history and differential diagnosis","volume":"45","author":"Mosqueiro","year":"2023","journal-title":"Revista Brasileira de Psiquiatria (Sao Paulo, Brazil: 1999)"},{"key":"S1478951525101247_ref38","doi-asserted-by":"publisher","DOI":"10.1177\/1049909109347328"},{"key":"S1478951525101247_ref58","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854944"},{"key":"S1478951525101247_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2010.03.015"},{"key":"S1478951525101247_ref27","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-113-12-941"},{"key":"S1478951525101247_ref1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951509990873"},{"key":"S1478951525101247_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s10943-018-0723-y"},{"key":"S1478951525101247_ref49","doi-asserted-by":"publisher","DOI":"10.1177\/1049909117725271"},{"key":"S1478951525101247_ref47","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231163571"},{"key":"S1478951525101247_ref45","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2020.0785"},{"key":"S1478951525101247_ref40","doi-asserted-by":"publisher","DOI":"10.1177\/13634615221088701"},{"key":"S1478951525101247_ref39","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2004.08.002"},{"key":"S1478951525101247_ref36","first-page":"306","article-title":"Cross-cultural research on anomalous experiences: theoretical issues and methodological challenges","volume":"6","author":"Maraldi","year":"2019","journal-title":"Psychology of Consciousness: Theory, Research, and Practice"},{"key":"S1478951525101247_ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s10943-012-9608-7"},{"key":"S1478951525101247_ref31","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0269"},{"key":"S1478951525101247_ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s41603-020-00107-1"},{"key":"S1478951525101247_ref4","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13235893"},{"key":"S1478951525101247_ref48","doi-asserted-by":"publisher","DOI":"10.7312\/columbia\/9780231170888.001.0001"},{"key":"S1478951525101247_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssresearch.2009.02.002"},{"key":"S1478951525101247_ref7","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000112"},{"key":"S1478951525101247_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211006313"},{"key":"S1478951525101247_ref44","doi-asserted-by":"publisher","DOI":"10.1177\/1049909120969133"},{"key":"S1478951525101247_ref13","doi-asserted-by":"publisher","DOI":"10.1177\/1043454204273735"},{"key":"S1478951525101247_ref43","doi-asserted-by":"publisher","DOI":"10.1177\/1049909113517291"},{"key":"S1478951525101247_ref56","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-92578-1"},{"key":"S1478951525101247_ref20","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0093"},{"key":"S1478951525101247_ref10","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1075.179600"}],"container-title":["Palliative and Supportive Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1478951525101247","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,26]],"date-time":"2025-12-26T06:04:23Z","timestamp":1766729063000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1478951525101247\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,26]]},"references-count":58,"alternative-id":["S1478951525101247"],"URL":"https:\/\/doi.org\/10.1017\/s1478951525101247","relation":{},"ISSN":["1478-9515","1478-9523"],"issn-type":[{"value":"1478-9515","type":"print"},{"value":"1478-9523","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,26]]},"assertion":[{"value":"\u00a9 The Author(s), 2025. Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e4"}}