Development and validation of the tiredness identification index: a combined scale for the assessment of fatigue and sleepiness.

The World Health Organization (WHO) defined palliative care in 2002 as a holistic approach aimed at improving the quality of life for patients and their families facing challenges associated with life-threatening illnesses. However, numerous economic, social, legal, cultural, and health policy barriers hinder the early implementation of palliative care (PC) in neurology, particularly for people with Parkinson's disease (PwP) and related disorders. Despite growing awareness and an expanding body of research on PC, several factors continue to obstruct its integration into clinical practice. First, PC remains a linguistically and conceptually misunderstood term, often equated with end-of-life or terminal care, even among healthcare professionals (HCPs). Governments have been hesitant to invest in PC services due to uncertain implementation timelines, limited supporting evidence, and a lack of consensus on planning strategies. Furthermore, access to educational programmes at both basic and specialist levels remains insufficient. Surveys reveal that only a small proportion of HCPs have received PC training specific to managing PwPs. This lack of training undermines the availability and quality of specialized PC for PwPs, as untrained HCPs are often ill-equipped to address these needs and may undervalue the benefits of PC. Existing PC models, predominantly developed in Western healthcare systems, lack adequate racial and ethnic diversity in their design and implementation. Socioeconomic status, race, and ethnicity have been associated with decreased PC engagement and a higher likelihood of aggressive end-of-life treatments, highlighting significant disparities in access and outcomes.