Objectives: Parents who have children with complex lifelong and life-limiting neurological conditions experienced many stresses and anxieties throughout their lives as caregivers. However, this information is still very limited. The study aimed to explore the challenges faced by parents with children who have complex neurological conditions, their coping strategies, needs, and expectations. Materials and Methods: A semi-structured, in-depth interviews were conducted in the either Malay or English language among the parents of children with complex lifelong neurological conditions and have been on long-term in-patient hospital care. The interviews were audio-recorded and transcribed for thematic analysis. The qualitative study was conducted from October to November 2016 at the Paediatric Institute of Hospital Kuala Lumpur. Grounded theory was used to examine the qualitative data with inductive and deductive types of coding. The transcripts were read repeatedly to allow familiarity to the themes presented by the participants. Further discussions were conducted among the researchers to triangulate the information. Results: A total of 11 parents were interviewed for this study. The thematic analysis resulted in 8 challenges: Physical wellbeing, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual. Coping strategies comprised problem focused issues related to the key challenges in the caregivers’ context. Similar to the needs and expectations, the key themes were derived from the key understandings of the challenges and looking at the palliative care impacts for these children. Conclusion: There are various challenges faced by parents of children with life-limiting neurological disorders. Physical, Environment, Relationship, Financial, Occupational, Rational, Mental, and Spiritual Wellbeing can be a platform for the assessment of the caregivers’ needs and the planning for palliative care support.

Background: Physicians working with multicultural populations need to know how to determine the patients understanding of their illness. Physician working in Saudi Arabia must be aware of the diverse cultural and linguistic properties of people living there. They need to know how language and culture can influence clinical communication with patients and the way they provide them care. Aim: This study aims to explore physicians' self-assessment in intercultural communication in relation to care for patients from diverse ethnic/cultural backgrounds in order to identify training needs of physicians. Subjects and Methods: A descriptive cross-sectional study using self-administered questionnaire filled in by 254 working physician in Jeddah, Kingdom of Saudi Arabia (KSA). A good internal consistency coefficient (Cronbach's alpha) of the questionnaire was obtained. Descriptive statistics were used and ANOVA has been employed for assessing statistical differences between groups. Results: Respondents rated themselves more competent in basic clinical skills with mean score 4.33±0.58, then general intercultural skills came next (3.89±0.69) followed lastly by intercultural communication skills (3.29±1.00). Regarding intercultural communication skills and general intercultural skills, we found statistically significant differences (p < 0.05) in mean scores between respondents with reference to their age group, rank, total duration of work in KSA, previous work experience in other countries than home country and exposure to training in cultural competence. Conclusion: Training in cultural competence is an important factor that leads to better self-rating in intercultural communication skills. Physicians should be provided with real opportunities for training in cultural competence.

Psychosocial issues have been seen as minor in medicine despite the importance for holistic medical care involving emotional, spiritual and psychological domains. Most patients with chronic conditions have complex and complicated psychosocial needs especially when dealing children with life limiting conditions. These needs have a dynamic extension to patients' care as their impact can also affect the extended family members. Across the trajectory of the illnesses, the pattern of psychosocial needs changes and, this demands attending physicians to perform accurate psychosocial assessment and understanding issues from patients and caregivers perspective. Non-judgmental decision making is essential to avoid friction and misunderstanding between the healthcare providers and caregivers especially during the consultative process. Resolving psychosocial issue may involve various techniques from moral support, bridging the services to helping the family, counseling on relationship issues and many other areas. There is a need to equip healthcare workers with different skills in order to deliver a better psychosocial care and input even after the bereavement period.

Palliative care for life limiting conditions usually starts at birth. In neonatal period, planning, discussion and goal of care should focus towards improving the baby quality of life. It does not mean palliative care in this age group mainly as end of life care. We illustrate a complex 30 weeks baby who was born with genetic abnormality complicated with intracranial bleeding and acute myeloid leukaemia. There were various ethical issues related to the approach of death and dying infant and psychosocial challenges surrounding the case.