{"paper_id":"0b04d3a0-99c3-42fb-a31a-0dcab4f224d8","body_text":"From patients to caregivers: A 38-year bibliometric study of fatigue and thematic analysis of research trends | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From patients to caregivers: A 38-year bibliometric study of fatigue and thematic analysis of research trends Christina Yeni KUSTANTI, Martina Sinta KRISTANTI This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8022998/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Despite the increasing interest in fatigue in palliative care, the current research is dispersed across disciplines, which makes it challenging to develop unified approaches. This study employs bibliometric analysis to identify global research trends and deficiencies in the field. Methods The analysis was conducted using a systematic search of Scopus and Web of Science. 420 documents were obtained during the search and duplicate entries were identified and eliminated using specialized bibliometric software within the R programming environment, resulting in a final dataset of 398 publications. Results The analysis demonstrated that nearly 1,900 authors published in 94 academic journals from 1987 to 2025, contributing to the literature. The complexity of fatigue in palliative care settings was reflected in the identification of twelve research clusters and six main themes through thematic analysis of keywords. The current bibliometric study has identified two distinct concepts in the publications: cancer-related fatigue, which is focused on the patient, and compassion fatigue, which is related to formal caregivers. Conclusions This study emphasizes the necessity of forthcoming research to investigate underexplored areas, such as potential biological markers, psychosocial outcomes (e.g., resilience and compassion satisfaction), and management strategies. fatigue palliative care nursing trends mapping bibliometrics Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Palliative care defines as an approach that aims to improve the quality of life for patients and family caregivers facing problems associated with life-threatening illness [ 1 ]. This care addresses physical, emotional, psychosocial, and spiritual challenges. Among the symptoms commonly experienced by patients in palliative care, fatigue is one of the most distressing [ 2 ]. Other frequent symptoms include pain, nausea, vomiting, and anorexia [ 3 ]. However, fatigue stands out due to its high prevalence and impact on daily functioning. The European Association of Palliative Care (EAPC) defines fatigue as a subjective sensation of tiredness, weakness or lack of energy that us not necessarily relieved by rest [ 4 ]. Unlike normal tiredness, fatigue in palliative care is persistent, more intense, and often unrelated to exertion. Fatigue is a universally experienced concept [ 5 ], a key barrier to physical activity [ 4 ], and is associated to decrease of quality of life, reduced adherence to treatment plans, and lowered productivity or engagement in daily life [ 6 ]. Fatigue has been identified as one of the highest-ranked symptoms in patients with advanced cancer [ 6 ]. According to a meta-analysis, fatigue was experienced by approximately 49% of cancer patients [ 7 ]. However, this issue is not limited to oncology. Fatigue affects both patients with cancer and those with non-cancer diagnoses. Patients with chronic progressive illnesses such as health failure, chronic renal failure, end-stage lung pathology, neurodegenerative disease and HIV/AIDS also report significant levels of fatigue [ 8 ]. It is reported that up to 80% of patients receiving palliative care, regardless of diagnosis [ 9 ]. This symptom becomes more severe in the last stages of life, particularly during the final two months [ 9 ]. During this period, fatigue affects patients not only physically, by limiting activity and movement, but also emotionally, by reducing motivation and contributing to psychological distress. A recent bibliometric study on cancer-related fatigue (CRF) highlighted that research has mainly focused on its association with insomnia, anxiety and depression [ 10 ]. In non-oncological conditions, a review study defined fatigue as a multidimensional experience, although it has mostly been measured through its physical aspect [ 11 ]. Beyond this, fatigue in non-cancer conditions has not been comprehensively mapped yet. Despite its prevalence and negative impact, fatigue remains under-recognized and undertreated in palliative care settings. Studies have shown that compared to symptoms like pain or breathlessness, fatigue received less clinical attention [ 12 ]. One of the reasons for this may be the complexity of fatigue, which includes physical, psychological, and existential dimensions. Fatigue cannot be measured as easily as other symptoms, making assessment and intervention more difficult [ 13 ]. There is also a lack of high-quality research on how best to manage fatigue in palliative care. Existing studies indicate that there are few Randomized Control Trial (RCT) focuses on non-pharmacological interventions for fatigue [ 8 , 14 ]. The evidence for pharmacological treatments is also weak and inconclusive, particularly for cancer related fatigue in palliative care populations [ 15 ]. As a result, clinicians have limited guidance for managing this symptom effectively. Healthcare professionals, especially nurses, report significant challenges in assessing and treating fatigue. One study found that less than half of nurses do not confident to in assessing and managing fatigue among palliative care patients [ 16 ]. The same study highlighted that nurses frequently found fatigue harder to address than other symptoms. This lack of confidence may be related to insufficient coverage of fatigue management in basic nursing education [ 17 ]. For example, cancer-related fatigue, although common, is often given minimal attention in undergraduate training programs. These challenges point to several gaps in the literature. First, research on fatigue in palliative care is growing but remains fragmented across different disciplines, including oncology, geriatrics and chronic illness management. This makes it difficult to synthesize knowledge or identify common approaches. Second, there has been little effort to map how the field is evolving. Most reviews focus on specific treatments or populations rather than providing a broader picture of research trends and directions. A bibliometric analysis can help address these gaps. Bibliometric methods involve quantitative analysis of published literature to identify trends, research outputs, key contributors, and influential articles. This type of analysis helps to map the research landscape and can support more strategic planning for future studies. By identifying patterns in authorship, publication sources, keyword usage, and collaboration networks, bibliometric analysis provides a structures overview of how field is developing. Previous bibliometric analyses have been conducted on fatigue, with a particular emphasis on cancer-related fatigue [ 10 ]. This current study aimed to analyze global research output on fatigue in palliative care using bibliometric method. This information can be used to guide future research efforts and inform clinical practice. Materials and methods Study design In a variety of disciplines, bibliometrics is a structured and methodical approach that is used to consolidate and synthesize research findings related to a specific subject or critical query [ 18 ]. Bibliometrics contributes to the advancement and improvement of knowledge in the field under investigation. Similar to other literature review forms, the methodology of bibliometric studies comprises four main stages: (1) the development of search strategies, (2) the screening process and the data extraction, (3) the summarization of the findings, and (4) the analysis of the findings [ 19 ]. In Fig. 1 , the bibliometric phases that were implemented are illustrated, with modifications from the works from Sánchez-Sánchez, et al. [ 20 ], Altarturi, et al. [ 19 ], Kustanti, et al. [ 21 ], and Kustanti, et al. [ 22 ]. The reporting guidelines of this paper were based on the BIBLIO checklist, which functions as the reporting standard for bibliometric assessments of biomedical literature [ 23 ]. Database and search strategy Scopus, published by Elsevier, and Web of Science, published by Clarivate Analytics, are the predominant databases utilised for obtaining bibliometric data in literature searches [ 24 ]. These two databases were searched on June 25, 2025, to conduct the current bibliometric analysis. The fundamental principles of \"fatigue among patients and caregivers in the field of palliative care\" constituted the basis of the search methodology. Upon the conclusion of a preliminary search, we implemented a search strategy that included a combination of Boolean operators (“AND” and “OR”) and keywords for \"palliative care\" and \"fatigue”. There were no restrictions on the publication dates. Complete syntaxes were included in Supplement 1 . Data cleaning and screening The bibliometric analysis dataset included the literature title, abstract, author list, journal name, keywords, publication year, countries/regions, affiliations, reference list, and citations. The primary reviewer executed the selection process, assessing the abstract and title based on the criteria of population (individuals with life-threatening illnesses and their caregivers), concept (fatigue), and context (palliative care). During the research meetings, the screening technique was corroborated by the second reviewer, and any inconsistencies among team members were addressed. The data cleaning and study selection process were performed utilizing Microsoft Excel. Data analysis The data was analysed using R Studio version 4.2.2 and R Base version 4.2.2 (Posit, Massachusetts, USA) [ 25 ]. The open-source packages Bibliometrix and Biblioshiny were implemented using the R language environment. The Biblioshiny package is a visually appealing application that provides a web interface for the Bibliometrix package, thereby simplifying the acquisition of substantial bibliometric indicators [ 24 , 25 ]. This program is widely utilised for bibliometric analysis across various scientific disciplines. The analysis encompasses yearly scientific output, the most prolific authors, journals with the greatest publication rates, frequently cited documents, keyword analysis, conceptual framework, and thematic trends. Furthermore, we compiled a compilation of keywords from the Scopus and Web of Science databases to discern the gaps and trends in the topic area. The map is presented in a graphical format. Results General information On June 25, 2025, a search of the Scopus and Web of Science databases yielded a total of 420 articles. Eight duplicates were identified and eliminated from the subsequent analysis using R software. All of the population, concept, and context frameworks ( Fig. 1 ) were incorporated into the screening procedure by both of the authors. We identified 398 articles for inclusion in the bibliometric analysis following the screening procedure. In order to acquire a thorough comprehension of the literature, it is essential to embrace an inclusive perspective on fatigue in the field of palliative care. The summary information, which includes the fundamental statistics of the literature dataset that was analyzed, is the initial output of Biblioshiny. The literature that was retrieved was published in 94 distinct journals between 1987 and 2025 and was authored by 1,876 authors. Single-author articles accounted for 7.79% of the total. Table 1 also displays the average number of citations per document, which was 36.87. Articles constitute over 87.69% of the literature items. Table 1 Summary information Item Results Main information Timespan 1987–2025 Sources (Journals, Books, etc) (n) 145 Documents (n) 398 Annual Growth Rate (%) 7.19 Document average age (mean) 9.85 Average citation per document (mean) 36.87 Authors Authors 1,876 Authors of single-authored docs 31 International co-authorship (%) 19.6 Co-author per document 5.85 Content Keywords Plus 1,093 Author’s Keywords 770 Document types Article 349 Review 46 Others (editorial material, abstract, etc.) 3 3.2 Pattern of publication The literature on fatigue in palliative care is of significant scholarly value, as evidenced by the annual growth rate of 7.19% and the significant discrepancy between the count of articles and the count of other literature categories ( Table 1 ). This section examines the annual increase in the number of articles and citations in the dataset. Figure 2 illustrates the annual progression of publications regarding fatigue in palliative care. The initial publication on fatigue in palliative care was published in 1987; however, no further publications were identified in this field until 1996. In 1997, research activity resumed with a single publication, and it has since experienced a gradual increase, particularly from 2006 onward, when the number of publications reached 15. The volume of literature in this field has continued to increase since that time, reaching its highest point in 2015 and 2020 with 27 articles each year. By the end of June 2025, a total of 14 papers had also been indexed in the Scopus and Web of Science databases. This bibliometric analysis revealed 22 countries with authors who published works on fatigue in palliative care ( Fig. 3 ). The United States of America (USA) has the largest number of contributing authors, at 553, which represents approximately 29.48% of the total authors (1,876). Subsequent to the USA, China accounted for the second highest percentage of corresponding authors at 7.99%, followed by the United Kingdom at 6.61%. 3.3 Authors and sources The scientific output and influence of authors are quantified using a variety of metrics, including the number of articles published, the number of citations received, the h-index, the g-index, and the degree of article fractionalization. At the outset, this section evaluates the citation metric, which is the aggregate number of citations that a document has received since its publication ( Fig. 4 (A)) . The article written by Berger, et al. [ 26 ] was the most highly cited on a global scale, with 558 citations. Berger, et al. [ 26 ] delineate the Clinical Practice Guidelines in Oncology for Cancer-Related Fatigue (Version 2.2015), offering evidence-based directives for the evaluation and management of fatigue in cancer patients along the continuum of care. In this field, Bruera E. was the most productive author among 1,876 authors, having published 11 articles ( Fig. 4 (B)). Immediately following were Kober K., Miaskowski C., and Paul S., each of whom has ten articles. In addition, a score is ascribed to each article that an individual has authored or co-authored for each piece of literature that it references. The procedure of fractionalization in articles is used to distribute the contributions of co-authors. Each of the authors or co-authors of an article is assigned a score that is equivalent to the reciprocal of the total number of authors. Again, Bruera E. currently has the highest article fractionalization score of 2.62, with Voss J. and Saligan L. following closely behind with scores of 1.94 and 1.58, respectively. Figure 4 (C) illustrates that the Journal of Pain and Symptom Management published the most articles on this subject, with a total of 85 publications. In addition, 31 articles on this subject were published in the journal Supportive Care in Cancer. 3.4 Subject area Due to the fact that the purpose of this bibliometric study was to ascertain the publication trend on fatigue in palliative care, the subjects of the publications are particularly pertinent to the investigation. Therefore, it is essential to evaluate the content of the literature items in accordance with the abstracts and keywords provided by the authors. The study of these abstracts provides valuable insights into research trends and identifies gaps in the field of fatigue in palliative care. A comprehensive comprehension of the trend subjects is necessary to assess the feasibility of conducting future research in this field. The most frequently used terminologies associated with fatigue in palliative care were \"fatigue\" (209 document), \"cancer\" (67 document), \"quality of life\" (59 document), and \"palliative care\" (55 document) ( Fig. 5 ). Additionally, the phrase “cancer-related fatigue” has been used a lot in this field. The high clinical relevance and prevalence of fatigue among cancer patients may be the basis for this trend, which has made it one of the most frequently reported and studied symptoms in oncology. Furthermore, clinical guidelines and research frameworks have fully acknowledged cancer-related fatigue, resulting in increased funding, standardized definitions, and targeted interventions. This has further concentrated research efforts in this field in comparison to other conditions associated with fatigue. Future researchers who intend to conduct a literature review in this field should consider the development of search strategies in this field. Bibliographic coupling is employed to establish connections between authors, organizations, sources, countries, and documents. This occurs when two distinct works reference a shared third work in their respective bibliographies [ 27 ]. With the expansion of the number of shared works, the coupling's vitality also increases [ 28 ]. A node in a network represents an entity, such as a journal, author, country, institution, keyword, or article [ 29 ]. The network was depicted in Fig. 5 (B) through the use of keyword entities, which also exhibited the co-occurrence analysis of all keywords within the domain of fatigue in palliative care. The larger nodes indicate the links connecting nodes of varied sizes and the more co-occurrence links with other terms in the entire network. The research demonstrates the existence of 12 distinct groupings, each of which is represented by a distinct color. Each cluster lead by the keyword of “fatigue” (cluster 1), “compassion fatigue” (cluster 2), “reliability” (cluster 3), “cancer-related fatigue” (cluster 4), “radiation therapy” (cluster 5), “inflammation” (cluster 6), “hospice” (cluster 7), “resilience” (cluster 8), “biomarkers” (cluster 9), “cancer survivors” (cluster 10), “complementary medicine” (cluster 11), and “complementary therapies” (cluster 12) (Fig. 5 (B)) . These clusters will serve as a framework for future researchers to establish connections between their research in this field and other concepts or contexts, such as the outcomes that are typically investigated in the context of fatigue in palliative care. Then, the keywords utilized in the articles from the Scopus and Web of Science databases were organized into themes. The subsequent categorization of the subjects extracted from the 50 most frequently used author keywords led to the identification of six groupings: (1) fatigue-linked conditions, (2) fatigue inducing interventions, (3) symptoms associated with fatigue, (4) fatigue management, (5) fatigue study endpoints, and (6) study designs. The bibliometric analysis revealed that \"cancer-related fatigue\" was the most frequently used keyword, in addition to \"fatigue.\" Additionally, the concept of \"compassion fatigue\" was identified. Themes that were derived from the authors' keywords were depicted in Fig. 6 . Future research and keyword selection will be guided by Fig. 6 , which will cover the aspects that have been examined and any additional concepts that require further investigation. Discussions This bibliometric analysis offers a comprehensive investigation of research patterns on fatigue in palliative care across multiple decades. This current study identifies a consistent rise in academic interest from the late 1980s, with significant surges in publication activity from the mid-2010s forward. The findings indicate that fatigue has increasingly emerged as a focal point in palliative care literature, garnering contributions from an international research community, especially from authors in the United States of America (USA). The preeminent work in the subject has profoundly influenced later research, as evidenced by citation trends. The variety of author keywords revealed several topic clusters, which were consolidated into six principal themes, emphasizing the complex character of fatigue in palliative care and the expanding spectrum of research in the field. The current bibliometric study identified two distinct concepts: cancer-related fatigue which focuses on the patient, and compassion fatigue which related to formal caregivers. We examined the articles contained in the Scopus and Web of Science databases. The annual growth rate of 7.19% indicates an increasing interest among academics in the investigation of fatigue in palliative care, reflecting an increasing trend in this domain throughout time. The co-authorship ratio per document is 5.85, suggesting that the researchers may have either generated a significant number of distinctive publications or conveyed the impression that they did so through collaboration without actually increasing their overall output rate. The primary contributors to research on fatigue in palliative care are the USA, the United Kingdom (UK), and China. While the contemporary palliative care movement began in the UK due to the groundbreaking efforts of Dame Cicely Saunders [ 30 ], the USA has become the leading nation in studies about fatigue in palliative care. This may result from the swift proliferation and formal establishment of palliative care services in the U.S., especially within prominent academic medical centers and cancer institutes. The Journal of Pain and Symptom Management (JPSM) has been identified as having the highest number of published articles specifically focused on the topic of fatigue in palliative care. As the official publication of the American Academy of Hospice and Palliative Medicine (AAHPM) and the National Hospice and Palliative Care Organization ( https://www.jpsmjournal.com/content/aims ), JPSM has wide visibility among researchers and clinicians in the field, attracting high-quality submissions. Fatigue, being one of the most prevalent and distressing symptoms in palliative care, fits well within the journal’s core mission. JPSM also supports interdisciplinary research, encouraging contributions from medicine, nursing, psychology, and other fields, which aligns with the multifaceted nature of fatigue. Furthermore, the journal enables monthly publications. Its strong reputation, relevance, and commitment to advancing symptom science make it the primary outlet for studies on fatigue in palliative care. Additional journals that regularly publish articles in this field include Supportive Care in Cancer, Cancer Nursing, and American Journal of Hospice & Palliative Medicine. An article by Berger, et al. [ 26 ] was the most frequently cited. Initially, this article functions as a clinical practice guideline that has been endorsed by the National Comprehensive Cancer Network (NCCN), rendering it a highly authoritative and widely referenced source for clinicians who are managing cancer-related fatigue, a common and debilitating symptom in palliative care. Secondly, the article's credibility is further enhanced by the involvement of a large, multidisciplinary panel of experts, which promotes its widespread adoption across various specialties. Third, it serves as a fundamental reference for both clinical applications and future research by offering comprehensive, evidence-based recommendations for diagnosis, assessment, and management. The second place of the most influential articles on fatigue in palliative care is an articles from Dimitrova and Dimitrov [ 31 ]. This paper offers a critical examination of electromyographic (EMG) alterations that are linked to fatigue. It emphasizes primary physiological mechanisms and addresses common misconceptions and methodological pitfalls in EMG interpretation. The other most influential articles in this field with more than 100 citations can be retrieved from Supplement 2 . These articles may provide valuable insights into the factors that contribute to the widespread use and influence of research. Researchers can enhance the effectiveness of their research by utilizing the knowledge gained from these articles to devise more impactful studies, enhance knowledge translation, and advance the field. Keywords are the essential components of an article. Keyword analysis allows for the consolidation of study subjects within a specific domain and the examination of the most recent research areas and prevailing patterns [ 32 ]. The themes developed from the keywords in this bibliometric study are (1) fatigue-linked conditions, (2) fatigue inducing interventions, (3) symptoms associated with fatigue, (4) fatigue management, (5) fatigue study endpoints, and (6) study designs. From the fatigue-linked conditions, we can see that most of the articles focused on the cancer cases. The World Health Organization has identified other life-threatening conditions that can still being researched in relation to fatigue, including diabetes, chronic respiratory conditions, and cardiovascular disorders [ 1 ]. The second theme, fatigue inducing interventions, also shows that the majority of the studies focused on examining fatigue associated with hemodialysis, radiation therapy, and chemotherapy. Future research can examine fatigue associated with non-cancer diagnoses, and different treatments or interventions. Future researchers can develop a more thorough comprehension of fatigue in palliative care by investigating critical themes, including the symptoms associated with fatigue and the strategies for its management. These regions continue to be essential, as fatigue is frequently associated with other intricate symptoms and necessitates multifaceted treatment strategies. In addition to the outcomes that are frequently studied, such as quality of life, survivorship, resilience, compassion satisfaction, and biomarkers, there are other outcomes that are underexplored and offer valuable opportunities for further investigation. It is important to note that this bibliometric analysis did not identify a substantial number of intervention studies, such as randomized controlled trials or quasi-experimental designs. This suggests a deficiency in rigorous research that evaluates the efficacy of fatigue-related interventions. Future research could contribute to the advancement of evidence-based practices and the enhancement of patient outcomes in palliative care settings by addressing these areas. Further investigation of compassion fatigue may be considered in future research. While the term \"compassion fatigue\" is referenced in this bibliometric analysis, there is still a scarcity of research that explores this subject. The reason for this discrepancy may be the difficulty of objectively assessing compassion fatigue, the limited awareness, or the inclination to prioritize physical symptoms and outcomes in palliative care research over the emotional and psychological impacts on healthcare providers [ 33 , 34 ]. Compassion fatigue is defined as the state in which compassion and empathy diminish. It can manifest across emotional, psychological, intellectual, physical, social and spiritual and professional domains. This condition may lead to disinterest, moral distress, burnout and even breakdown [ 34 , 35 ]. 4.1 Strengths and limitations This is the first attempt to examine the publication trend on fatigue in palliative care, despite the fact that the majority of literature and bibliometric studies have focused on the overarching concept of fatigue. We also employed the Scopus and Web of Science databases, which are renowned for their capacity to retrieve the majority of articles in this field. However, it is possible that a significant number of supplementary articles will be published in other databases. A potential solution to this bias in future research is to integrate multiple databases, including PubMed. Furthermore, we limited the number of articles published in English, which may have led to the exclusion of relevant studies published in other languages or databases. Besides, it also depended completely on author-supplied keywords, potentially omitting untagged yet important issues. Furthermore, the study did not evaluate the quality or methodological rigor of the included papers. Conclusion This bibliometric analysis offers a thorough examination of the changing research landscape on fatigue in palliative care over the course of several decades. The research emphasizes a consistent rise in scholarly interest since the late 1980s, with a significant increase in publications from the mid-2010s onward. Fatigue has become a central topic in the palliative care literature, with substantial contributions from a globally distributed research community, with a particular emphasis on the United States. The impact of seminal works on subsequent research is emphasized by citation patterns. The complexity and multidimensional nature of fatigue in this context were illustrated by the analysis of author keywords, which uncovered 12 clusters and further refined these into six themes. Future research should investigate understudied areas, including fatigue management strategies, symptoms associated with fatigue, and emerging outcomes such as resilience, biomarkers, and compassion satisfaction. The limited number of intervention studies, also indicates a void that requires attention. These voids must be addressed in order to establish a more robust, evidence-based foundation for the management of fatigue in palliative care. Declarations Acknowledgement The findings and conclusions in this document are those of the authors, who are responsible for its contents. Funding Statement The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing interest The authors have no relevant financial or non-financial interests to disclose. Author contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CYK and MSK. The first draft of the manuscript was written by CYK and MSK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethical approval statement Not required. Patient consent statement Not required. Data Availability As this study is a review of previous data, no new data were generated in support of this research. 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Dimitrov, \"Interpretation of EMG changes with fatigue: facts, pitfalls, and fallacies,\" (in eng), J Electromyogr Kinesiol , vol. 13, no. 1, pp. 13–36, Feb 2003, doi: 10.1016/s1050-6411(02)00083-4 . D. Ma et al. , \"A Bibliometric Analysis of Pyroptosis From 2001 to 2021,\" (in eng), Front Immunol , vol. 12, p. 731933, 2021, doi: 10.3389/fimmu.2021.731933 . M. H. Baqeas, J. Davis, and B. Copnell, \"Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review,\" (in eng), BMC palliative care , vol. 20, no. 1, p. 88, Jun 23 2021, doi: 10.1186/s12904-021-00784-5 . A. Garnett, L. Hui, C. Oleynikov, and S. Boamah, \"Compassion fatigue in healthcare providers: a scoping review,\" (in eng), BMC Health Serv Res , vol. 23, no. 1, p. 1336, Dec 1 2023, doi: 10.1186/s12913-023-10356-3 . L. A. Cross, \"Compassion Fatigue in Palliative Care Nursing: A Concept Analysis,\" (in eng), J Hosp Palliat Nurs , vol. 21, no. 1, pp. 21–28, Feb 2019, doi: 10.1097/njh.0000000000000477 . Additional Declarations No competing interests reported. Supplementary Files 4SupplementaryMaterials.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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(C) Most relevant sources\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8022998/v1/0d0d04772656197058cdff89.png\"},{\"id\":98424687,\"identity\":\"9658d349-453a-48c5-96b5-03cff0367581\",\"added_by\":\"auto\",\"created_at\":\"2025-12-17 16:33:41\",\"extension\":\"png\",\"order_by\":5,\"title\":\"Figure 5\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":253477,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e(A) Trend topics and (B) Co-occurrence network\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image5.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8022998/v1/c397048d34f9dd97b3dd05be.png\"},{\"id\":98424318,\"identity\":\"b9000b56-8316-4839-aa5e-7a523ba03f73\",\"added_by\":\"auto\",\"created_at\":\"2025-12-17 16:33:11\",\"extension\":\"jpeg\",\"order_by\":6,\"title\":\"Figure 6\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":174567,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThemes\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"image6.jpeg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8022998/v1/bdf9fa5366eaf226da9ecf7f.jpeg\"},{\"id\":100736080,\"identity\":\"c4176ae3-d92a-4617-b85c-fd2bf0a5ece4\",\"added_by\":\"auto\",\"created_at\":\"2026-01-20 22:33:48\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1614908,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8022998/v1/cc77c89c-4f1d-4e8c-a51e-8d44224e1349.pdf\"},{\"id\":97988434,\"identity\":\"4ac3d8a9-119a-494b-9fb8-449d29c16237\",\"added_by\":\"auto\",\"created_at\":\"2025-12-11 14:11:23\",\"extension\":\"docx\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":23574,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"4SupplementaryMaterials.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8022998/v1/ef6e2d3201622c5d2ed6e978.docx\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"From patients to caregivers: A 38-year bibliometric study of fatigue and thematic analysis of research trends\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003ePalliative care defines as an approach that aims to improve the quality of life for patients and family caregivers facing problems associated with life-threatening illness [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. This care addresses physical, emotional, psychosocial, and spiritual challenges. Among the symptoms commonly experienced by patients in palliative care, fatigue is one of the most distressing [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Other frequent symptoms include pain, nausea, vomiting, and anorexia [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. However, fatigue stands out due to its high prevalence and impact on daily functioning. The European Association of Palliative Care (EAPC) defines fatigue as a subjective sensation of tiredness, weakness or lack of energy that us not necessarily relieved by rest [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Unlike normal tiredness, fatigue in palliative care is persistent, more intense, and often unrelated to exertion. Fatigue is a universally experienced concept [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e], a key barrier to physical activity [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e], and is associated to decrease of quality of life, reduced adherence to treatment plans, and lowered productivity or engagement in daily life [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eFatigue has been identified as one of the highest-ranked symptoms in patients with advanced cancer [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. According to a meta-analysis, fatigue was experienced by approximately 49% of cancer patients [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. However, this issue is not limited to oncology. Fatigue affects both patients with cancer and those with non-cancer diagnoses. Patients with chronic progressive illnesses such as health failure, chronic renal failure, end-stage lung pathology, neurodegenerative disease and HIV/AIDS also report significant levels of fatigue [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. It is reported that up to 80% of patients receiving palliative care, regardless of diagnosis [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. This symptom becomes more severe in the last stages of life, particularly during the final two months [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]. During this period, fatigue affects patients not only physically, by limiting activity and movement, but also emotionally, by reducing motivation and contributing to psychological distress. A recent bibliometric study on cancer-related fatigue (CRF) highlighted that research has mainly focused on its association with insomnia, anxiety and depression [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. In non-oncological conditions, a review study defined fatigue as a multidimensional experience, although it has mostly been measured through its physical aspect [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Beyond this, fatigue in non-cancer conditions has not been comprehensively mapped yet.\\u003c/p\\u003e\\u003cp\\u003eDespite its prevalence and negative impact, fatigue remains under-recognized and undertreated in palliative care settings. Studies have shown that compared to symptoms like pain or breathlessness, fatigue received less clinical attention [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. One of the reasons for this may be the complexity of fatigue, which includes physical, psychological, and existential dimensions. Fatigue cannot be measured as easily as other symptoms, making assessment and intervention more difficult [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. There is also a lack of high-quality research on how best to manage fatigue in palliative care. Existing studies indicate that there are few Randomized Control Trial (RCT) focuses on non-pharmacological interventions for fatigue [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. The evidence for pharmacological treatments is also weak and inconclusive, particularly for cancer related fatigue in palliative care populations [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. As a result, clinicians have limited guidance for managing this symptom effectively.\\u003c/p\\u003e\\u003cp\\u003eHealthcare professionals, especially nurses, report significant challenges in assessing and treating fatigue. One study found that less than half of nurses do not confident to in assessing and managing fatigue among palliative care patients [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. The same study highlighted that nurses frequently found fatigue harder to address than other symptoms. This lack of confidence may be related to insufficient coverage of fatigue management in basic nursing education [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. For example, cancer-related fatigue, although common, is often given minimal attention in undergraduate training programs. These challenges point to several gaps in the literature. First, research on fatigue in palliative care is growing but remains fragmented across different disciplines, including oncology, geriatrics and chronic illness management. This makes it difficult to synthesize knowledge or identify common approaches. Second, there has been little effort to map how the field is evolving. Most reviews focus on specific treatments or populations rather than providing a broader picture of research trends and directions.\\u003c/p\\u003e\\u003cp\\u003eA bibliometric analysis can help address these gaps. Bibliometric methods involve quantitative analysis of published literature to identify trends, research outputs, key contributors, and influential articles. This type of analysis helps to map the research landscape and can support more strategic planning for future studies. By identifying patterns in authorship, publication sources, keyword usage, and collaboration networks, bibliometric analysis provides a structures overview of how field is developing. Previous bibliometric analyses have been conducted on fatigue, with a particular emphasis on cancer-related fatigue [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. This current study aimed to analyze global research output on fatigue in palliative care using bibliometric method. This information can be used to guide future research efforts and inform clinical practice.\\u003c/p\\u003e\"},{\"header\":\"Materials and methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eStudy design\\u003c/h2\\u003e\\u003cp\\u003eIn a variety of disciplines, bibliometrics is a structured and methodical approach that is used to consolidate and synthesize research findings related to a specific subject or critical query [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. Bibliometrics contributes to the advancement and improvement of knowledge in the field under investigation. Similar to other literature review forms, the methodology of bibliometric studies comprises four main stages: (1) the development of search strategies, (2) the screening process and the data extraction, (3) the summarization of the findings, and (4) the analysis of the findings [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e]. In Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, the bibliometric phases that were implemented are illustrated, with modifications from the works from S\\u0026aacute;nchez-S\\u0026aacute;nchez, et al. [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e], Altarturi, et al. [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e], Kustanti, et al. [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e], and Kustanti, et al. [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e]. The reporting guidelines of this paper were based on the BIBLIO checklist, which functions as the reporting standard for bibliometric assessments of biomedical literature [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\\n\\u003ch3\\u003eDatabase and search strategy\\u003c/h3\\u003e\\n\\u003cp\\u003eScopus, published by Elsevier, and Web of Science, published by Clarivate Analytics, are the predominant databases utilised for obtaining bibliometric data in literature searches [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e]. These two databases were searched on June 25, 2025, to conduct the current bibliometric analysis. The fundamental principles of \\\"fatigue among patients and caregivers in the field of palliative care\\\" constituted the basis of the search methodology. Upon the conclusion of a preliminary search, we implemented a search strategy that included a combination of Boolean operators (\\u0026ldquo;AND\\u0026rdquo; and \\u0026ldquo;OR\\u0026rdquo;) and keywords for \\\"palliative care\\\" and \\\"fatigue\\u0026rdquo;. There were no restrictions on the publication dates. Complete syntaxes were included in \\u003cb\\u003eSupplement 1\\u003c/b\\u003e.\\u003c/p\\u003e\\n\\u003ch3\\u003eData cleaning and screening\\u003c/h3\\u003e\\n\\u003cp\\u003eThe bibliometric analysis dataset included the literature title, abstract, author list, journal name, keywords, publication year, countries/regions, affiliations, reference list, and citations. The primary reviewer executed the selection process, assessing the abstract and title based on the criteria of population (individuals with life-threatening illnesses and their caregivers), concept (fatigue), and context (palliative care). During the research meetings, the screening technique was corroborated by the second reviewer, and any inconsistencies among team members were addressed. The data cleaning and study selection process were performed utilizing Microsoft Excel.\\u003c/p\\u003e\\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eData analysis\\u003c/h2\\u003e\\u003cp\\u003eThe data was analysed using R Studio version 4.2.2 and R Base version 4.2.2 (Posit, Massachusetts, USA) [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. The open-source packages Bibliometrix and Biblioshiny were implemented using the R language environment. The Biblioshiny package is a visually appealing application that provides a web interface for the Bibliometrix package, thereby simplifying the acquisition of substantial bibliometric indicators [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. This program is widely utilised for bibliometric analysis across various scientific disciplines. The analysis encompasses yearly scientific output, the most prolific authors, journals with the greatest publication rates, frequently cited documents, keyword analysis, conceptual framework, and thematic trends. Furthermore, we compiled a compilation of keywords from the Scopus and Web of Science databases to discern the gaps and trends in the topic area. The map is presented in a graphical format.\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e\\u003ch2\\u003eGeneral information\\u003c/h2\\u003e\\u003cp\\u003eOn June 25, 2025, a search of the Scopus and Web of Science databases yielded a total of 420 articles. Eight duplicates were identified and eliminated from the subsequent analysis using R software. All of the population, concept, and context frameworks \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003cb\\u003e)\\u003c/b\\u003e were incorporated into the screening procedure by both of the authors. We identified 398 articles for inclusion in the bibliometric analysis following the screening procedure.\\u003c/p\\u003e\\u003cp\\u003eIn order to acquire a thorough comprehension of the literature, it is essential to embrace an inclusive perspective on fatigue in the field of palliative care. The summary information, which includes the fundamental statistics of the literature dataset that was analyzed, is the initial output of Biblioshiny. The literature that was retrieved was published in 94 distinct journals between 1987 and 2025 and was authored by 1,876 authors. Single-author articles accounted for 7.79% of the total. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e also displays the average number of citations per document, which was 36.87. Articles constitute over 87.69% of the literature items.\\u003c/p\\u003e\\u003cp\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e\\u003ccaption language=\\\"En\\\"\\u003e\\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e\\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\u003cp\\u003eSummary information\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/caption\\u003e\\u003ccolgroup cols=\\\"2\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eItem\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eResults\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMain information\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eTimespan\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1987\\u0026ndash;2025\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSources (Journals, Books, etc) (n)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e145\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDocuments (n)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e398\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAnnual Growth Rate (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e7.19\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eDocument average age (mean)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e9.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAverage citation per document (mean)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e36.87\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eAuthors\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAuthors\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1,876\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAuthors of single-authored docs\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e31\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eInternational co-authorship (%)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e19.6\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCo-author per document\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e5.85\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eContent\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eKeywords Plus\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e1,093\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eAuthor\\u0026rsquo;s Keywords\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e770\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003e\\u003cb\\u003eDocument types\\u003c/b\\u003e\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eArticle\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e349\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eReview\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e46\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eOthers (editorial material, abstract, etc.)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003e3\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/colgroup\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e3.2 Pattern of publication\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe literature on fatigue in palliative care is of significant scholarly value, as evidenced by the annual growth rate of 7.19% and the significant discrepancy between the count of articles and the count of other literature categories \\u003cb\\u003e(\\u003c/b\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003cb\\u003e).\\u003c/b\\u003e This section examines the annual increase in the number of articles and citations in the dataset. Figure\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e illustrates the annual progression of publications regarding fatigue in palliative care. The initial publication on fatigue in palliative care was published in 1987; however, no further publications were identified in this field until 1996. In 1997, research activity resumed with a single publication, and it has since experienced a gradual increase, particularly from 2006 onward, when the number of publications reached 15. The volume of literature in this field has continued to increase since that time, reaching its highest point in 2015 and 2020 with 27 articles each year. By the end of June 2025, a total of 14 papers had also been indexed in the Scopus and Web of Science databases.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis bibliometric analysis revealed 22 countries with authors who published works on fatigue in palliative care \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e\\u003cb\\u003e).\\u003c/b\\u003e The United States of America (USA) has the largest number of contributing authors, at 553, which represents approximately 29.48% of the total authors (1,876). Subsequent to the USA, China accounted for the second highest percentage of corresponding authors at 7.99%, followed by the United Kingdom at 6.61%.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e3.3 Authors and sources\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe scientific output and influence of authors are quantified using a variety of metrics, including the number of articles published, the number of citations received, the h-index, the g-index, and the degree of article fractionalization. At the outset, this section evaluates the citation metric, which is the aggregate number of citations that a document has received since its publication \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e\\u003cb\\u003e(A))\\u003c/b\\u003e. The article written by Berger, et al. [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e] was the most highly cited on a global scale, with 558 citations. Berger, et al. [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e] delineate the Clinical Practice Guidelines in Oncology for Cancer-Related Fatigue (Version 2.2015), offering evidence-based directives for the evaluation and management of fatigue in cancer patients along the continuum of care.\\u003c/p\\u003e\\u003cp\\u003eIn this field, Bruera E. was the most productive author among 1,876 authors, having published 11 articles \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e\\u003cb\\u003e(B)).\\u003c/b\\u003e Immediately following were Kober K., Miaskowski C., and Paul S., each of whom has ten articles. In addition, a score is ascribed to each article that an individual has authored or co-authored for each piece of literature that it references. The procedure of fractionalization in articles is used to distribute the contributions of co-authors. Each of the authors or co-authors of an article is assigned a score that is equivalent to the reciprocal of the total number of authors. Again, Bruera E. currently has the highest article fractionalization score of 2.62, with Voss J. and Saligan L. following closely behind with scores of 1.94 and 1.58, respectively.\\u003c/p\\u003e\\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e\\u003cb\\u003e(C)\\u003c/b\\u003e illustrates that the Journal of Pain and Symptom Management published the most articles on this subject, with a total of 85 publications. In addition, 31 articles on this subject were published in the journal Supportive Care in Cancer.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e3.4 Subject area\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eDue to the fact that the purpose of this bibliometric study was to ascertain the publication trend on fatigue in palliative care, the subjects of the publications are particularly pertinent to the investigation. Therefore, it is essential to evaluate the content of the literature items in accordance with the abstracts and keywords provided by the authors. The study of these abstracts provides valuable insights into research trends and identifies gaps in the field of fatigue in palliative care. A comprehensive comprehension of the trend subjects is necessary to assess the feasibility of conducting future research in this field.\\u003c/p\\u003e\\u003cp\\u003eThe most frequently used terminologies associated with fatigue in palliative care were \\\"fatigue\\\" (209 document), \\\"cancer\\\" (67 document), \\\"quality of life\\\" (59 document), and \\\"palliative care\\\" (55 document) \\u003cb\\u003e(\\u003c/b\\u003eFig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e\\u003cb\\u003e).\\u003c/b\\u003e Additionally, the phrase \\u0026ldquo;cancer-related fatigue\\u0026rdquo; has been used a lot in this field. The high clinical relevance and prevalence of fatigue among cancer patients may be the basis for this trend, which has made it one of the most frequently reported and studied symptoms in oncology. Furthermore, clinical guidelines and research frameworks have fully acknowledged cancer-related fatigue, resulting in increased funding, standardized definitions, and targeted interventions. This has further concentrated research efforts in this field in comparison to other conditions associated with fatigue. Future researchers who intend to conduct a literature review in this field should consider the development of search strategies in this field.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eBibliographic coupling is employed to establish connections between authors, organizations, sources, countries, and documents. This occurs when two distinct works reference a shared third work in their respective bibliographies [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. With the expansion of the number of shared works, the coupling's vitality also increases [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e]. A node in a network represents an entity, such as a journal, author, country, institution, keyword, or article [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. The network was depicted in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e\\u003cb\\u003e(B)\\u003c/b\\u003e through the use of keyword entities, which also exhibited the co-occurrence analysis of all keywords within the domain of fatigue in palliative care. The larger nodes indicate the links connecting nodes of varied sizes and the more co-occurrence links with other terms in the entire network.\\u003c/p\\u003e\\u003cp\\u003eThe research demonstrates the existence of 12 distinct groupings, each of which is represented by a distinct color. Each cluster lead by the keyword of \\u0026ldquo;fatigue\\u0026rdquo; (cluster 1), \\u0026ldquo;compassion fatigue\\u0026rdquo; (cluster 2), \\u0026ldquo;reliability\\u0026rdquo; (cluster 3), \\u0026ldquo;cancer-related fatigue\\u0026rdquo; (cluster 4), \\u0026ldquo;radiation therapy\\u0026rdquo; (cluster 5), \\u0026ldquo;inflammation\\u0026rdquo; (cluster 6), \\u0026ldquo;hospice\\u0026rdquo; (cluster 7), \\u0026ldquo;resilience\\u0026rdquo; (cluster 8), \\u0026ldquo;biomarkers\\u0026rdquo; (cluster 9), \\u0026ldquo;cancer survivors\\u0026rdquo; (cluster 10), \\u0026ldquo;complementary medicine\\u0026rdquo; (cluster 11), and \\u0026ldquo;complementary therapies\\u0026rdquo; (cluster 12) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e\\u003cb\\u003e(B))\\u003c/b\\u003e. These clusters will serve as a framework for future researchers to establish connections between their research in this field and other concepts or contexts, such as the outcomes that are typically investigated in the context of fatigue in palliative care.\\u003c/p\\u003e\\u003cp\\u003eThen, the keywords utilized in the articles from the Scopus and Web of Science databases were organized into themes. The subsequent categorization of the subjects extracted from the 50 most frequently used author keywords led to the identification of six groupings: (1) fatigue-linked conditions, (2) fatigue inducing interventions, (3) symptoms associated with fatigue, (4) fatigue management, (5) fatigue study endpoints, and (6) study designs. The bibliometric analysis revealed that \\\"cancer-related fatigue\\\" was the most frequently used keyword, in addition to \\\"fatigue.\\\" Additionally, the concept of \\\"compassion fatigue\\\" was identified. Themes that were derived from the authors' keywords were depicted in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e. Future research and keyword selection will be guided by Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e, which will cover the aspects that have been examined and any additional concepts that require further investigation.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003c/div\\u003e\"},{\"header\":\"Discussions\",\"content\":\"\\u003cp\\u003eThis bibliometric analysis offers a comprehensive investigation of research patterns on fatigue in palliative care across multiple decades. This current study identifies a consistent rise in academic interest from the late 1980s, with significant surges in publication activity from the mid-2010s forward. The findings indicate that fatigue has increasingly emerged as a focal point in palliative care literature, garnering contributions from an international research community, especially from authors in the United States of America (USA). The preeminent work in the subject has profoundly influenced later research, as evidenced by citation trends. The variety of author keywords revealed several topic clusters, which were consolidated into six principal themes, emphasizing the complex character of fatigue in palliative care and the expanding spectrum of research in the field. The current bibliometric study identified two distinct concepts: cancer-related fatigue which focuses on the patient, and compassion fatigue which related to formal caregivers.\\u003c/p\\u003e\\u003cp\\u003eWe examined the articles contained in the Scopus and Web of Science databases. The annual growth rate of 7.19% indicates an increasing interest among academics in the investigation of fatigue in palliative care, reflecting an increasing trend in this domain throughout time. The co-authorship ratio per document is 5.85, suggesting that the researchers may have either generated a significant number of distinctive publications or conveyed the impression that they did so through collaboration without actually increasing their overall output rate. The primary contributors to research on fatigue in palliative care are the USA, the United Kingdom (UK), and China. While the contemporary palliative care movement began in the UK due to the groundbreaking efforts of Dame Cicely Saunders [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e], the USA has become the leading nation in studies about fatigue in palliative care. This may result from the swift proliferation and formal establishment of palliative care services in the U.S., especially within prominent academic medical centers and cancer institutes.\\u003c/p\\u003e\\u003cp\\u003eThe Journal of Pain and Symptom Management (JPSM) has been identified as having the highest number of published articles specifically focused on the topic of fatigue in palliative care. As the official publication of the American Academy of Hospice and Palliative Medicine (AAHPM) and the National Hospice and Palliative Care Organization (\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.jpsmjournal.com/content/aims\\u003c/span\\u003e\\u003cspan address=\\\"https://www.jpsmjournal.com/content/aims\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e), JPSM has wide visibility among researchers and clinicians in the field, attracting high-quality submissions. Fatigue, being one of the most prevalent and distressing symptoms in palliative care, fits well within the journal\\u0026rsquo;s core mission. JPSM also supports interdisciplinary research, encouraging contributions from medicine, nursing, psychology, and other fields, which aligns with the multifaceted nature of fatigue. Furthermore, the journal enables monthly publications. Its strong reputation, relevance, and commitment to advancing symptom science make it the primary outlet for studies on fatigue in palliative care. Additional journals that regularly publish articles in this field include Supportive Care in Cancer, Cancer Nursing, and American Journal of Hospice \\u0026amp; Palliative Medicine.\\u003c/p\\u003e\\u003cp\\u003eAn article by Berger, et al. [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e] was the most frequently cited. Initially, this article functions as a clinical practice guideline that has been endorsed by the National Comprehensive Cancer Network (NCCN), rendering it a highly authoritative and widely referenced source for clinicians who are managing cancer-related fatigue, a common and debilitating symptom in palliative care. Secondly, the article's credibility is further enhanced by the involvement of a large, multidisciplinary panel of experts, which promotes its widespread adoption across various specialties. Third, it serves as a fundamental reference for both clinical applications and future research by offering comprehensive, evidence-based recommendations for diagnosis, assessment, and management. The second place of the most influential articles on fatigue in palliative care is an articles from Dimitrova and Dimitrov [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e]. This paper offers a critical examination of electromyographic (EMG) alterations that are linked to fatigue. It emphasizes primary physiological mechanisms and addresses common misconceptions and methodological pitfalls in EMG interpretation. The other most influential articles in this field with more than 100 citations can be retrieved from \\u003cb\\u003eSupplement 2\\u003c/b\\u003e. These articles may provide valuable insights into the factors that contribute to the widespread use and influence of research. Researchers can enhance the effectiveness of their research by utilizing the knowledge gained from these articles to devise more impactful studies, enhance knowledge translation, and advance the field.\\u003c/p\\u003e\\u003cp\\u003eKeywords are the essential components of an article. Keyword analysis allows for the consolidation of study subjects within a specific domain and the examination of the most recent research areas and prevailing patterns [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. The themes developed from the keywords in this bibliometric study are (1) fatigue-linked conditions, (2) fatigue inducing interventions, (3) symptoms associated with fatigue, (4) fatigue management, (5) fatigue study endpoints, and (6) study designs. From the fatigue-linked conditions, we can see that most of the articles focused on the cancer cases. The World Health Organization has identified other life-threatening conditions that can still being researched in relation to fatigue, including diabetes, chronic respiratory conditions, and cardiovascular disorders [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. The second theme, fatigue inducing interventions, also shows that the majority of the studies focused on examining fatigue associated with hemodialysis, radiation therapy, and chemotherapy. Future research can examine fatigue associated with non-cancer diagnoses, and different treatments or interventions.\\u003c/p\\u003e\\u003cp\\u003eFuture researchers can develop a more thorough comprehension of fatigue in palliative care by investigating critical themes, including the symptoms associated with fatigue and the strategies for its management. These regions continue to be essential, as fatigue is frequently associated with other intricate symptoms and necessitates multifaceted treatment strategies. In addition to the outcomes that are frequently studied, such as quality of life, survivorship, resilience, compassion satisfaction, and biomarkers, there are other outcomes that are underexplored and offer valuable opportunities for further investigation. It is important to note that this bibliometric analysis did not identify a substantial number of intervention studies, such as randomized controlled trials or quasi-experimental designs. This suggests a deficiency in rigorous research that evaluates the efficacy of fatigue-related interventions. Future research could contribute to the advancement of evidence-based practices and the enhancement of patient outcomes in palliative care settings by addressing these areas.\\u003c/p\\u003e\\u003cp\\u003eFurther investigation of compassion fatigue may be considered in future research. While the term \\\"compassion fatigue\\\" is referenced in this bibliometric analysis, there is still a scarcity of research that explores this subject. The reason for this discrepancy may be the difficulty of objectively assessing compassion fatigue, the limited awareness, or the inclination to prioritize physical symptoms and outcomes in palliative care research over the emotional and psychological impacts on healthcare providers [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. Compassion fatigue is defined as the state in which compassion and empathy diminish. It can manifest across emotional, psychological, intellectual, physical, social and spiritual and professional domains. This condition may lead to disinterest, moral distress, burnout and even breakdown [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003e\\u003cem\\u003e4.1 Strengths and limitations\\u003c/em\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis is the first attempt to examine the publication trend on fatigue in palliative care, despite the fact that the majority of literature and bibliometric studies have focused on the overarching concept of fatigue. We also employed the Scopus and Web of Science databases, which are renowned for their capacity to retrieve the majority of articles in this field. However, it is possible that a significant number of supplementary articles will be published in other databases. A potential solution to this bias in future research is to integrate multiple databases, including PubMed. Furthermore, we limited the number of articles published in English, which may have led to the exclusion of relevant studies published in other languages or databases. Besides, it also depended completely on author-supplied keywords, potentially omitting untagged yet important issues. Furthermore, the study did not evaluate the quality or methodological rigor of the included papers.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eThis bibliometric analysis offers a thorough examination of the changing research landscape on fatigue in palliative care over the course of several decades. The research emphasizes a consistent rise in scholarly interest since the late 1980s, with a significant increase in publications from the mid-2010s onward. Fatigue has become a central topic in the palliative care literature, with substantial contributions from a globally distributed research community, with a particular emphasis on the United States. The impact of seminal works on subsequent research is emphasized by citation patterns. The complexity and multidimensional nature of fatigue in this context were illustrated by the analysis of author keywords, which uncovered 12 clusters and further refined these into six themes.\\u003c/p\\u003e\\u003cp\\u003eFuture research should investigate understudied areas, including fatigue management strategies, symptoms associated with fatigue, and emerging outcomes such as resilience, biomarkers, and compassion satisfaction. The limited number of intervention studies, also indicates a void that requires attention. These voids must be addressed in order to establish a more robust, evidence-based foundation for the management of fatigue in palliative care.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe findings and conclusions in this document are those of the authors, who are responsible for its contents.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding Statement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interest\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors have no relevant financial or non-financial interests to disclose.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by CYK and MSK. The first draft of the manuscript was written by CYK and MSK, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical approval statement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot required.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003ePatient consent statement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot required.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAs this study is a review of previous data, no new data were generated in support of this research.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWHO. \\\"Palliative care.\\\" \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.who.int/news-room/fact-sheets/detail/palliative-care\\u003c/span\\u003e\\u003cspan address=\\\"https://www.who.int/news-room/fact-sheets/detail/palliative-care\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e (accessed July 20, 2023.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eL. 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Ma \\u003cem\\u003eet al.\\u003c/em\\u003e, \\\"A Bibliometric Analysis of Pyroptosis From 2001 to 2021,\\\" (in eng), \\u003cem\\u003eFront Immunol\\u003c/em\\u003e, vol. 12, p. 731933, 2021, doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3389/fimmu.2021.731933\\u003c/span\\u003e\\u003cspan address=\\\"10.3389/fimmu.2021.731933\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eM. H. Baqeas, J. Davis, and B. Copnell, \\\"Compassion fatigue and compassion satisfaction among palliative care health providers: a scoping review,\\\" (in eng), \\u003cem\\u003eBMC palliative care\\u003c/em\\u003e, vol. 20, no. 1, p. 88, Jun 23 2021, doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12904-021-00784-5\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12904-021-00784-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eA. Garnett, L. Hui, C. Oleynikov, and S. Boamah, \\\"Compassion fatigue in healthcare providers: a scoping review,\\\" (in eng), \\u003cem\\u003eBMC Health Serv Res\\u003c/em\\u003e, vol. 23, no. 1, p. 1336, Dec 1 2023, doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12913-023-10356-3\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12913-023-10356-3\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eL. A. Cross, \\\"Compassion Fatigue in Palliative Care Nursing: A Concept Analysis,\\\" (in eng), \\u003cem\\u003eJ Hosp Palliat Nurs\\u003c/em\\u003e, vol. 21, no. 1, pp. 21\\u0026ndash;28, Feb 2019, doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1097/njh.0000000000000477\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/njh.0000000000000477\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"fatigue, palliative care, nursing, trends, mapping, bibliometrics\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8022998/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8022998/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003eDespite the increasing interest in fatigue in palliative care, the current research is dispersed across disciplines, which makes it challenging to develop unified approaches. This study employs bibliometric analysis to identify global research trends and deficiencies in the field.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003eThe analysis was conducted using a systematic search of Scopus and Web of Science. 420 documents were obtained during the search and duplicate entries were identified and eliminated using specialized bibliometric software within the R programming environment, resulting in a final dataset of 398 publications.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eThe analysis demonstrated that nearly 1,900 authors published in 94 academic journals from 1987 to 2025, contributing to the literature. The complexity of fatigue in palliative care settings was reflected in the identification of twelve research clusters and six main themes through thematic analysis of keywords. The current bibliometric study has identified two distinct concepts in the publications: cancer-related fatigue, which is focused on the patient, and compassion fatigue, which is related to formal caregivers.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eThis study emphasizes the necessity of forthcoming research to investigate underexplored areas, such as potential biological markers, psychosocial outcomes (e.g., resilience and compassion satisfaction), and management strategies.\\u003c/p\\u003e\",\"manuscriptTitle\":\"From patients to caregivers: A 38-year bibliometric study of fatigue and thematic analysis of research trends\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-12-11 14:11:18\",\"doi\":\"10.21203/rs.3.rs-8022998/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"d3dccddc-38eb-404c-b29f-0976112311c5\",\"owner\":[],\"postedDate\":\"December 11th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-01-20T21:52:17+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-12-11 14:11:18\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8022998\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8022998\",\"identity\":\"rs-8022998\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}