End-of-life dreams and visions in palliative care: Perspectives, interpretations and practices from Italian professionals

Abstract

End‑of‑life dreams and visions (ELDVs) are coherent and emotionally meaningful experiences reported by lucid patients approaching death, yet their interpretation and clinical management remain uncertain. This study explored how Italian palliative care professionals and hospice volunteers encounter, understand, and respond to ELDVs in everyday practice. An online survey combining closed‑ and open‑ended items was completed by 239 participants working in end‑of‑life care settings. Findings show that ELDVs are frequently described as symbolically rich narratives involving deceased loved ones or imagery related to transition, typically disclosed spontaneously by patients. Participants drew on diverse interpretive frameworks—psychological, spiritual, existential, and, less often, biomedical—often navigating ambiguity when distinguishing ELDVs from delirium. Clinical responses centered on listening, reassurance, and emotional support, while limited training contributed to variable confidence and preparedness. Overall, ELDVs emerged as meaningful relational experiences in end‑of‑life care, underscoring the need for enhanced education and interdisciplinary dialogue.