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The article explores ethical issues raised by the use of technology in clinical work with clients and in the supervision of supervisees’ work with clients. In the first part, the new technologies are presented, as well as the benefits and drawbacks of their use in supervision. The literature reveals three fields in which ethical issues are raised: supervision process, legal and regulatory issues and technology. In more detail, major emphasis has been put on the supervisory working relationship and questions of process, informed consent (between a supervisor and a supervisee and between a supervisee and a client), evaluation of a supervisees’ efficacy and confidentiality.

Background: Awareness of preferences regarding medical care should be a central component of the care of patients with advanced cancer. Open communication can facilitate this but can occur in an ad hoc or variable manner. Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers about patients’ values and care preferences. It raises awareness of the need to anticipate possible future deterioration of health. ACP has the potential to improve current and future healthcare decision-making, provide patients with a sense of control, and improve their quality of life.Methods/Design: We will study the effects of the ACP program Respecting Choices on the quality of life of patients with advanced lung or colorectal cancer. In a phase III multicenter cluster randomised controlled trial, 22 hospitals in 6 countries will be randomised. In the intervention sites, patients will be offered interviews with a trained facilitator. In the control sites, patients will receive care as usual. In total, 1360 patients will be included. All participating patients will be asked to complete questionnaires at inclusion, and again after 2.5 and 4.5 months. If a patient dies within a year after inclusion, a relative will be asked to complete a questionnaire on end-of-life care. Use of medical care will be assessed by checking medical files. The primary endpoint is patients’ quality of life at 2.5 months post-inclusion. Secondary endpoints are the extent to which care as received is aligned with patients’ preferences, patients’ evaluation of decision-making processes, quality of end-of-life care and cost-effectiveness of the intervention. A complementary qualitative study will be carried out to explore the lived experience of engagement with the Respecting Choices program from the perspectives of patients, their Personal Representatives, healthcare providers and facilitators.Discussion: Transferring the concept of ACP from care of the elderly to patients with advanced cancer, who on average are younger and retain their mental capacity for a larger part of their disease trajectory, is an important next step in an era of increased focus on patient centered healthcare and shared decision-making.Trial registration: International Standard Randomised Controlled Trial Number: ISRCTN63110516 . Date of registration: 10/3/2014.

Purpose of review This review discusses the developments in spiritual needs assessments and measurements in end-of-life care. The review considers spiritual needs assessments from the perspective of palliative care patients, their families and caregivers, and healthcare professionals. Recent findings Spiritual needs assessments vary significantly along the dimensions of content and domains. These needs assessments have the potential to deepen our insight and to identify those who are most at risk for spiritual distress, but few are practical and simple enough to use in everyday clinical practice, and for the research, few are cross-culturally validated. Spirituality is a complex construct, although 'relatedness' was recognized as a core dimension of spirituality in addition to existential beliefs and values related to meaning and purpose. Little is known about the spiritual needs in elderly patients, in the cognitively impaired, and during the dying process. The spiritual needs of family caregivers need more support and attention. Summary Spirituality is considered to be one of the patient's vital signs and should be routinely screened and assessed. Research in spiritual care should be ongoing for all palliative care patients as well as for those with specific needs such as mental, neurological, or cognitive impairment. There is also a knowledge gap concerning how spiritual needs change during the progression of the disease trajectory. More work must be done on the spiritual concerns of family caregivers.

Purpose of review The support of family caregivers in palliative care is critical and well recognized; yet the fact that caregivers still face significant unmet needs highlights a considerable gap in addressing this issue. Current themes on the caregiving experience in palliative care are presented. Recent findings The recent literature suggests a shift towards a broader understanding of the caregiving experience in palliative care in terms of better integration of caregivers of patients with noncancer illnesses into palliative care, improved continuity of care among different settings and better integration of guidelines and evidence into practice. Several risk groups and factors of caregiving in palliative care have been identified. The literature review emphasizes a public health approach as an important step in addressing the caregivers' burden. While 'the right way' of supporting caregivers is still to be established, consideration of caregivers' roles as co-providers and co-recipients of care offers numerous implications for research and clinical practice. Summary This review demonstrates the need for the development of specific strategies aimed at supporting informal caregivers in caring for their loved ones in different settings and periods of advanced life-threatening illnesses. Open issues in searching for 'the right way' to care for caregivers in palliative care are presented.