This article reviewed the origin,core components,and current application status of the consolidated framework for implementation research(CFIR) in oncology nursing,and analyzed its developments,limitations, and future prospects.The aim was to promote the development of CFIR in China.

Background:Patients with chronic diseases often struggle to maintain sufficient physical activity (PA) and reduce sedentary behavior in daily life. Just-in-time adaptive interventions (JITAIs), delivered through mobile health technologies such as mobile apps, wearable devices, sensors, and ecological momentary assessment, offer timely and personalized support based on individuals' changing needs. However, the evidence base for their use in promoting PA and reducing sedentary behavior among patients with chronic diseases remains fragmented. Objective:This review aimed to describe study characteristics and design features of JITAIs, summarize reported evaluation findings related to PA and sedentary behavior, and identify barriers and facilitators related to engagement and use of JITAIs. Methods:A comprehensive literature search was conducted in PubMed, Embase, Web of Science, CINAHL, and Scopus from database inception to June 2025. Two researchers independently screened the records, selected eligible studies, and performed data charting to ensure rigor and consistency. Results:A total of 14 studies were included in this review. Of these, 6 primarily targeted PA, 1 focused solely on sedentary behavior, and 5 addressed both PA and sedentary behavior. Of the remaining, 6 studies provided preliminary evidence supporting the positive effects of JITAIs in promoting PA among individuals with chronic diseases, while 3 studies suggested positive effects on reducing sedentary behavior. Barriers and facilitators influencing the use of JITAIs in this population were identified. Barriers included technological usability and literacy, burden and intrusiveness of the intervention, perceived value and acceptability, external and contextual barriers, and privacy and data security concerns. Facilitators included enhanced motivation and behavioral engagement, increased awareness and self-monitoring, usability and integration into daily life, timely and personalized support, and support from health care professionals and the care environment. Conclusions:This scoping review identified preliminary evidence suggesting that JITAIs may help reduce sedentary behavior and promote PA among patients with chronic diseases. However, more large-scale, high-quality randomized controlled trial studies are needed to strengthen evidence and generalizability.

Background:Nursing interns often experience transition shock upon entering clinical practice, which may diminish their professional identity and potentially lead to future turnover. Self-efficacy and feedback-seeking behavior are positive psychological resources for coping with occupational stressors and may be associated with a stronger sense of professional identity. This study aimed to investigate the relationship between transition shock and professional identity among nursing interns and to examine the mediating role of feedback-seeking behavior and the moderating role of self-efficacy in this process. Methods:A cross-sectional survey was conducted among 450 clinical nursing interns in China using an online questionnaire. The survey comprised the Transition Shock Scale for Undergraduate Nursing Students, the General Self-efficacy Scale, the Feedback-seeking Behavior Scale, and the Professional Identity Questionnaire for Nurse Students. The R package "mediation" and the bootstrap method were used to examine the mediating effect. The R package "lavaan" was further used to test the moderated mediation model. A two-sided p-value < 0.05 was considered statistically significant. Results:Transition shock was negatively correlated with professional identity (r = -0.754, p < 0.001). Feedback-seeking behavior was negatively correlated with transition shock (r = -0.711, p < 0.001) and positively correlated with professional identity (r = 0.862, p < 0.001). Feedback-seeking behavior partially mediated the relationship between transition shock and professional identity (indirect effect = -0.473, 95% CI: -0.557 to -0.391), with the indirect effect accounting for 56.3% of the total effect. Self-efficacy significantly moderated the first stage of the mediation pathway (transition shock to feedback-seeking behavior; β = 0.042, p < 0.001), thereby buffering the negative impact of transition shock on feedback-seeking behavior. Conclusion:Transition shock has a direct negative association with nursing interns' professional identity, and feedback-seeking behavior acts as a partial mediator in this relationship. Self-efficacy plays a significant moderating role by buffering the negative association of transition shock with feedback-seeking behavior. These findings provide an empirical basis for hospitals and nursing schools to develop effective strategies aimed at mitigating the impact of transition shock, thereby potentially enhancing professional identity and contributing to the stabilization of the nursing workforce.

Background: Approximately 60% of patients with advanced cancer experience the distress of cancer-related fatigue (CRF), which significantly worsens their daily function and quality of life. Baduanjin has been regarded as a promising nonpharmacological intervention for alleviating CRF, anxiety, and depression and improving quality of life. Owing to varying degrees of CRF in patients with advanced cancer, patients may have insufficient endurance, making it difficult to implement standing Baduanjin. However, relevant evidence on sitting Baduanjin for CRF in patients with advanced cancer is lacking. Objective: This study aims to design a sitting Baduanjin intervention and explore the efficacy and safety of sitting Baduanjin in reducing CRF among patients with advanced cancer. Methods: This study will be a single-blind pilot randomized controlled trial. Patients with CRF will be enlisted from a tertiary cancer hospital in China. The participants (N=98) will be randomly assigned to either a sitting Baduanjin group or a control group at a 1:1 ratio using a block-randomized scheme. The participants in the sitting Baduanjin group will undergo a 16-week sitting Baduanjin intervention in addition to standard care, whereas the participants in the control group will receive standard care in the form of a booklet on the self-management of cancer symptoms. CRF will constitute the primary outcome, whereas anxiety, depression, and quality of life will serve as the secondary outcomes. These outcomes will be assessed at baseline (T0), 12 weeks (T1), and 16 weeks (T2). Results: The study was approved by the Medical Ethics Review Committee of Hunan Cancer Hospital in March 2024 (ethics approval number 2024.50). Before this full-scale randomized controlled trial, we conducted a pilot study, which demonstrated the feasibility and acceptability of sitting Baduanjin for patients with advanced cancer, with potential benefits for relieving fatigue. Conclusions: This randomized trial will evaluate the effectiveness of sitting Baduanjin exercises in alleviating CRF among patients with advanced cancer. If proven effective, it will provide a promising alternative intervention for patients with advanced cancer. Trial Registration: Chinese Clinical Trial Register ChiCTR-2400092148; https://www.chictr.org.cn/showproj.html? proj=242990 International Registered Report Identifier (IRRID): IRRID: DERR1-10.2196/84925

BACKGROUND:Global aging and rising severe illnesses prevalence have increased demand for palliative care, widening service gaps. Policy support is vital for advancing high-value services. AIM:To unveil the 35-year evolution of palliative care policy in mainland China. DESIGN:An in-depth analysis of the external and internal characteristics of palliative care policy documents. Developmental periods were delineated using core characteristics, key events, and annual releases. Network analysis mapped intersectoral collaboration in palliative care policy-making. Text mining techniques, including burst words and word frequency analysis, identified policy priorities and inclinations. Policy instruments were classified using Rothwell and Zegveld's framework to analyze the policy landscape and its evolution. SETTING/PARTICIPANTS:Palliative care policies, the research subject of this study, were retrieved from Chinese legal databases and government websites. RESULTS:Policy evolution spanned five periods: germination (1991-2002), exploration (2003-2010), expansion (2011-2015), rapid development (2016-2019), and stable development (2020-2023). Intersectoral collaboration among policymakers evolved from single-department regulation to multi-sectoral governance, with the National Health Commission serving as the pivotal entity. Policy priorities and inclinations reflected the unification of policy terminology, the establishment of an institution-community-home continuum, and the active incorporation of local elements. Policy instruments transitioned from imbalance to greater balance over time, although several sub-instruments remained underutilized. CONCLUSIONS:Mainland China has established a comprehensive palliative care policy framework with distinctive features, with development particularly accelerating after 2016. Nonetheless, gaps persist in dedicated legislation or planning, financially sustainable funding strategies, integration into health professional education, and supportive digital infrastructure. Future efforts should prioritize the transition from framework-building to ensuring equitable access.

China's demographic landscape is undergoing a dramatic transformation. With over 297 million people aged 60 and above-comprising 21.1% of the total population-the nation faces unprecedented challenges in providing adequate end-of-life care for its elderly citizens. It is against this backdrop that the National Health Commission of the People's Republic of China released the "Standard for Geriatric Hospice Care Wards (WS/T844-2024)" on July 24, 2024, which aims to fill the institutional gap and promote the critical transition of hospice care services from "empirical exploration" to "standardized development". This Standard specifies the configuration requirements for geriatric hospice care wards in terms of ward configuration, staffing models, age-appropriate equipment, and quality assurance mechanisms. While the WS/T 844-2024 standard establishes a much-needed framework for service standardization, its ultimate outcome will depend on how well it can be adapted to China's diverse healthcare landscape and resource constraints. This critique aims to identify both the strengths and potential limitations of the WS/T 844-2024 standard, offering insights for policymakers and healthcare providers tasked with its implementation. By doing so, the article addresses the following questions: What blueprint does the WS/T 844-2024 standard outline for geriatric hospice care in China? What key tensions may arise when this blueprint confronts the practical challenges of China's uneven distribution of medical resources, shortage of professional workforce, and cultural traditions? And how can a pragmatic implementation pathway be constructed to bridge the gap between the ideal and the reality?

Traditional approaches examining isolated symptoms fail to capture dynamic network structures in palliative care. This study aimed to decompose physiological and psychological symptom networks across multiple levels and identify central symptoms that may inform hypothesis-generating targets for future intervention studies in advanced cancer patients. This secondary retrospective longitudinal study utilized diary-based design and multilevel network analysis at a tertiary cancer hospital in mainland China. 166 advanced cancer patients receiving palliative care completed ≥ 20 consecutive daily assessments using standardized PCOC tools: Symptom Assessment Scale (SAS), Palliative Care Problem Severity Score (PCPSS), and Resource Utilisation Group-Activities of Daily Living (RUG-ADL). Multilevel vector autoregressive (mlVAR) models estimated temporal networks (lag-1 effects), contemporaneous networks (same-day associations), and between-subjects networks. Network centrality was quantified using expected influence (EI), with stability evaluated through bootstrap procedures. Time-series stationarity was confirmed via Augmented Dickey-Fuller (ADF) tests, and autocorrelation function (ACF) analysis was conducted to assess temporal persistence patterns across symptom domains. Four distinct network patterns emerged. In SAS networks, nausea showed highest temporal centrality (temEI = 0.102) with cross-lagged associations with appetite loss and bowel distress, while sleep distress (conEI = 0.836) and appetite (conEI = 1.018) were contemporaneously central. PCPSS networks revealed psychological/spiritual issues were associated with subsequent family/carer problems (r = 0.059) with highest between-subjects centrality (0.891). ADL networks identified toileting dependency as temporally central (temEI = 0.199), associated with subsequent changes in functional decline. The comprehensive network highlighted psychological/spiritual problems with strongest temporal influence (temEI = 0.251) and six significant connections, particularly associated with ADL deterioration. Autocorrelation analysis revealed distinct persistence patterns: ADL measures showed strongest persistence; SAS demonstrated moderate decay; PCPSS exhibited scale-specific patterns with psychological/spiritual concerns showing greater persistence (0.814 → 0.258) than pain (0.544 → 0.020). This study identified distinct symptom network patterns across temporal, contemporaneous, and between-subjects levels. Findings provide preliminary evidence that may guide future intervention studies targeting central symptoms to investigate potential cascading effects and optimize monitoring strategies based on symptom persistence characteristics.

BACKGROUND:Digital health (DH) provides a valuable opportunity for accessible and efficient palliative care delivery. In recent years, an expanding body of systematic reviews and meta-analyses has examined DH-based interventions in palliative care. However, their conclusions regarding effects remain inconsistent, often constrained by methodological limitations and the variable quality of primary studies, making it difficult to form a coherent appraisal. OBJECTIVE:This umbrella review aimed to examine, appraise, and synthesize previous systematic reviews and evaluate the role of DH-based services on palliative care, and to identify barriers to using DH-based services in these settings. METHODS:Systematic reviews with or without meta-analysis focusing on DH within palliative care settings were considered eligible. Seven electronic databases, including PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wangfang, and VIP, were searched for eligible studies published from inception to April 2024. The inclusion criteria were identified based on the principles of the PICOS (Population, Intervention, Comparison, Outcomes, and Study Type) framework. Two reviewers independently screened records and extracted data. Eligible studies were appraised for methodological quality using the JBI (Joanna Briggs Institute) Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. A narrative synthesis, supported by tabulated summaries of the results, was used in this umbrella review. RESULTS:A total of 25 systematic reviews (4 with meta-analyses) published between 2012 and 2024 met our inclusion criteria, most of which were evaluated as moderate quality. Reported outcomes ranged from symptom management effectiveness to psycho-social burden (ie, mood, distress, and emotional well-being), quality of life, caregiver burden, decision-making, cost-effectiveness, communication, self-efficacy and self-management efficacy, resource use, family empowerment, and acceptability. The effect of DH-based interventions for palliative care was basically consistent, with all included reviews reporting either significant improvements or noninferiority of DH-based interventions as compared to usual care. Technical challenges, organizational factors, ethical concerns, resource constraints, nonverbal communication, and perceptions were considered as barriers to the use of DH-based services. CONCLUSIONS:Across included reviews, DH was found to be beneficial or noninferior to standard care, with no reported adverse effects, supporting its safety and feasibility as a mode of service delivery. To ensure successful implementation and long-term sustainability, a multifaceted strategy is needed that integrates technological enhancements and training, organizational commitment, ethical safeguards, infrastructure development, and equitable access. TRIAL REGISTRATION:PROSPERO CRD42024539963; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024539963.

Background Humanistic caring in China has developed rapidly in recent years; however, patients' satisfaction with nurses' humanistic caring remains moderate. To date, there has been no nationwide, multi-centre, large-sample survey exploring nurses' knowledge, attitudes, and practices (KAP) regarding humanistic caring, which limits the identification of gaps and evidence-based strategies for improvement. Aim This study aimed to assess the levels of knowledge, attitude, and practices regarding humanistic caring among nurses in tertiary hospitals across China, and to analyze the associated influencing factors, thereby providing a data-driven foundation and practical evidence for developing targeted improvement strategies. Method A multi-centre cross-sectional survey was conducted from July to August 2022 in 25 provinces (cities and districts) across China. Nurses meeting the inclusion and exclusion criteria were recruited through convenience sampling in tertiary hospitals. Data were collected using a self-developed demographic questionnaire and The Knowledge, Attitudes and Practices of Clinical Nursing Staff on Humanistic Care Questionnaire developed by Li Yuqin. The original scale demonstrated excellent reliability and validity (content validity index = 0.980; Cronbach's alpha = 0.982; test-retest reliability = 0.983), and the Cronbach's alpha in the present study was 0.991 (P < 0.001). Questionnaires were distributed and collected via the online platform Questionnaire Star. A total of 14,305 valid responses were obtained, yielding an effective response rate of 99.72%. Data were analyzed using SPSS version 26.0 for descriptive and inferential statistics. Result Among the 14,305 participants from 25 provinces, 95.48% were female, with a mean age of 32.37 +/- 6.62 years; 85.53% held at least a bachelor's degree. Notably, 42.17% had never received humanistic caring training. The mean scores for knowledge, attitude, and practice were 80.24%, 83.62%, and 87.95%, respectively, with practice scoring highest and knowledge lowest. Significant differences in KAP scores were observed across gender, region, department, professional title, work experience, and job-related factors (all P < 0.05). Nurses who expressed love for nursing, engaged in self-caring, received family support, and were satisfied with their work and salary or had undergone humanistic caring training achieved significantly higher scores in all three dimensions (P < 0.001). Stepwise multiple regression identified job and salary satisfaction, enthusiasm for nursing, self-caring awareness, and prior training as major positive predictors of knowledge and attitude, whereas knowledge and attitude significantly predicted humanistic caring practices. Correlation analysis confirmed strong positive associations among the three dimensions (r = 0.636-0.827, P < 0.001), aligning with the KAP theoretical model. Conclusion Chinese clinical nurses demonstrate moderate levels of knowledge and attitudes toward humanistic caring but relatively strong humanistic caring behaviors. Training programs should be strengthened, with content emphasizing the concept, significance, and core competencies of humanistic caring. Hospitals are encouraged to integrate humanistic values into organizational management and promote a supportive humanistic caring culture to enhance nurses' humanistic practice.

Understanding healthcare professionals’ perspectives on the quality of death and dying is essential for improving palliative care in China, especially as hospice and palliative services expand. This study examined how Chinese healthcare professionals’ assessments of death and dying quality vary by institutional setting, sociodemographic factors, professional background, and training experience. A cross-sectional design was conducted. Between November 2023 and January 2024, 2,465 healthcare professionals engaged in palliative and hospice care (including doctors, nurses, and social workers) participated in the survey. Multivariate linear regression models and propensity score matching were used to identify factors associated with Quality of Death and Dying Index ratings. Higher ratings on the Index were observed among respondents working in institutions with multidisciplinary end-of-life care teams, those who were female, born in the 1970s, held a bachelor’s degree, had longer years of service, cared for patients with a survival period of three to six months, and participated in palliative care training programs. These findings suggest that institutional collaboration, professional experience, and targeted training are closely linked to more favorable perceptions of death and dying quality among healthcare workers. Enhancing multidisciplinary coordination and ensuring equitable access to training opportunities may help improve end-of-life care quality within healthcare institutions. The results provide evidence-based insights into the determinants of death and dying quality in China, offering practical guidance for strengthening palliative and hospice care development in rapidly aging societies where end-of-life service systems are still evolving.

Background:Transition shock commonly occurs as nursing interns move from student roles to professional practice, leading to confusion, uncertainty, and a lack of clarity in their psychological, physiological, knowledge and skills development. Aim:This study aims to investigate the status of transition shock among Chinese nursing interns and explore the mediating role of feedback-seeking behavior in the relationship between self-efficacy and transition shock. Methods:This is a cross-sectional survey study following the STROBE guidelines. A convenience sample of 450 nursing interns were surveyed from February to March 2025. Participants completed a questionnaire that included socio-demographic information, Transition Shock Scale, General Self-Efficacy Scale (GSES), and Feedback-Seeking Behavior Scale. The Bootstrap method was applied to assess the mediating effects. Results:The mean ± SD for transition shock among nursing interns was 59.28 ± 4.53. Factors influencing transition shock included gender, reasons for choosing nursing, physical health status, enjoyment of the nursing major, class leadership roles, only-child status, and parental education levels. Self-efficacy (r = -0.651, p < 0.001) and feedback-seeking behavior (r = -0.711, p < 0.001) were negatively correlated with transition shock. Feedback-seeking behavior was found to mediate the relationship between self-efficacy and transition shock (indirect effect = -0.585, 95% CI: -0.766 to -0.389), accounting for 66.1% of the total effect. Conclusion:Feedback-seeking behavior is the mediating variable between self-efficacy and transition shock of nursing interns. These insights provide evidence-based strategies for targeted interventions aimed at alleviating transition shock among nursing interns.

Developing an accurate predictive model for palliative care phases is crucial for improving cancer patient management, enabling healthcare providers to identify those in need of specific care plans and streamlining decision-making process for patients and caregivers. This study aims to identify symptom and functional indicators from Palliative Care Outcomes Collaboration (PCOC) data and develop a predictive model capable of accurately categorizing palliative care phases in advanced cancer patients. A retrospective cohort study design was adopted in this study. Data on PCOC information were collected and analyzed from patients admitted to a palliative care unit at a cancer hospital in China between April 2023 and December 2024. The Gradient Boosting Decision Tree in the machine learning algorithm to establish a palliative care phase prediction model and evaluated the prediction performance of this model. A total of 9,787 assessments from 793 patients were included in the analysis of this study. Significant differences were identified among the four PCOC phases of care in terms of the symptom distress, palliative care problem severity, functional status and daily living activities. The machine learning model developed in this study achieved areas under the curve (AUCs) of 0.997, 0.996, 0.999, and 0.999 for predicting the stable, unstable, deteriorating, and terminal phases in the training group, respectively. In the testing group, the corresponding AUCs were 0.976, 0.965, 0.971, and 0.998. The prediction model developed in this study based on the machine learning algorithm showed good performance, offering significant potential for facilitating timely interventions, enhancing symptom management, and optimizing palliative care resource allocation in advanced cancer patients in mainland China.

PURPOSE:This study aimed to understand Chinese palliative care clinicians' experience in integrating the Palliative Care Outcome Collaboration (PCOC) model into their clinical practice and to learn lessons for sustainability. METHODS:An explanatory mixed-methods study was conducted. Combing semi-structured in-depth interviews with palliative care clinicians guided by Normalization Process Theory (NPT) with analysis of clinical documents to examine implementation outcomes. Qualitative data were analysed using a combination of inductive and deductive content analysis, quantitative data were presented using frequencies and percentages. RESULTS:Twelve out of 16 clinicians participated in this study. Six months post-implementation, over half reported successful integration of the model into their unit. Implementation outcomes indicated strong clinician adherence, with all inpatients assessed and 75% of clinicians participating. Eleven sub-themes were identified within the NPT constructs, explaining the mechanisms contributing to its success and failure. These included clinicians' perception of the model's value and effectiveness (Coherence), accurate assessment and effective use of results and quality reports (Collective Action), and a supportive network that fully incorporated clinicians' views (Cognitive Participation), and aligning the PCOC model with existing workflows, reducing redundant tools, and streamlining documentation (Reflexive Monitoring). CONCLUSIONS:To effectively implement a PCOMs-based quality improvement program into routine clinical practice, a "top-down" followed by a "bottom-up" implementation approach is recommended. Effectively utilizing the program to achieve its value and fit into existing workflows without adding unnecessary workload could ensure its sustainability. Furthermore, in countries and regions where palliative care is emerging, priorities should focus on enhancing clinicians' knowledge, self-efficacy, and supporting multidisciplinary collaboration.

Background A person-centered outcomes-based quality improvement program is lacking within palliative care in Mainland China. The well-established Australian Palliative Care Outcome Collaboration (PCOC) national model improves palliative care quality.Objectives This study aimed to explore the barriers and facilitators perceived by healthcare providers to integrating the PCOC model in a Chinese hospital-based palliative care unit.Methods A qualitative descriptive study was conducted using semi-structured focus group and individual interviews. A rapid deductive analysis approach was selected for data analysis. The Consolidated Framework for Implementation Research framework was used to guide the study design, data collection, analysis, and interpretation.Results Eighteen healthcare professionals participated in this study, four focus group interviews and five individual interviews were completed. Barriers to the PCOC integration included clinical application and workload concerns (patients in terminal stage, patients' dialects, workload concerns, and staff shortages); attitudinal barriers (negative attitudes toward PCOC); psychological barriers (numbness to their work) and barriers related to knowledge and self-efficacy (lack of knowledge, capacity, and self-efficacy in palliative care). Facilitators included adapting the program to local contexts, ongoing education and feedback, effective PCOC data use, a supportive work and clinical environment and staff's perceived advantages of the model across clinical, research and process domains.Significance of Results The successful integration of the PCOC program hinges on local adaptation, improved data utilization, education, and IT support. In regions with less developed palliative care, enhancing professionals' knowledge and self-efficacy is crucial. Incorporating assessment and clinical response protocols into technology can accelerate palliative care development and implementation.

Objective:Shared-care management (SCM) in palliative care is a collaborative model where shared care teams work in partnership with patients' original health care providers, employing multimodal strategies including consultations and coordinated referrals to enhance quality of care for patients. The evidence regarding its implementation remains fragmented and lacks detailed explanations, which impedes its application in clinical practice. This study aimed to develop a SCM standard of palliative care in adults in mainland regions of China. Methods:Initial standard framework identification was achieved via literature evidence summary. From April to August 2024, two rounds of Delphi method was conducted with the purposes of modifying the standard. To establish consensus, items with a mean importance score > 3.50 and the coefficient of variation of item scores < 0.25 were retained. Results:The first round involved 35 experts, with a follow-up participation of 33 in the second round. The Kendall concordance coefficients of the two rounds of experts consultation were 0.128 and 0.134, respectively (all P ​< ​0.001), indicating consensus among the experts. At the end of the second round, the average importance score of each item was 4.73-5.00. A total of 8 modules including SCM team, applicable population, process of SCM, contents of SCM, start time, precautions, effectiveness evaluation and quality control, and the corresponding 22 items were finally identified in this standard. Conclusions:The establishment of the standard in this study provides a critical framework that can be adopted by health care institutions to ensure that SCM services are delivered uniformly and effectively in mainland regions of China.

AimTo synthesize available evidence about core competencies for nurses engaged in palliative care.DesignA scoping review conducted according to the framework from Joanna Briggs Institute.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist was adopted to report this scoping review. The PubMed, Web of Science, Embase, ScienceDriect, CNKI, WangFang, VIP and Sinomed databases were used to systematically search for published studies from their inception to December 2023. Two researchers independently screened and selected relevant studies and performed the data charting.ResultsTwenty-six studies were included in this scoping review. Among these, 14 studies identified core competency assessment instruments among nurses engaged in palliative care, with the Palliative Care Core Competence Questionnaire was used most frequently; 13 studies investigated the status of core competencies of nurses engaged in palliative care, the majority of included studies indicated that nurse's core competencies were at moderate levels; 11 studies explored the factors influencing the core competencies of the nurses engaged in palliative care, which were classified as sociodemographic-related factors, palliative care education-related factors, death attitude, palliative care practice-related experience and others.ConclusionThis scoping review offers a comprehensive overview of the current landscape of core competencies among nurses in palliative care. Findings suggested that the clinical nursing leaders need to develop tailored strategies and interventions to address specific factors and promote the continuous development of nurses' competencies in palliative care.Relevance to Clinical PracticeCore competency assessment instruments equip nurses and healthcare organizations with a range of validated tools for evaluating their proficiency in palliative care. Targeted core competency enhancement programmes need to be developed to foster a nursing workforce better equipped to improve the quality of life of end-of-life patients and their families.Patient or Public ContributionNo patient or public contribution.

Objectives Accurately assessing the self-efficacy levels of palliative care professionals’ is crucial, as low levels of self-efficacy may contribute to the suboptimal provision of palliative care. However, there is currently lacking a reliable and valid instrument for evaluating the self-efficacy of palliative care practitioners in China. Therefore, this study aimed to translate, adapt, and validate the Palliative Care Self-Efficacy Scale (PCSS) among Chinese palliative care professionals. Methods This study involved the translation and cross-cultural adaptation of the PCSS, and the evaluation of its psychometric properties through testing for homogeneity, content validity, construct validity, known-groups validity, and reliability. Results A total of 493 palliative care professionals participated in this study. The results showed the critical ratio value of each item was >3 ( p < 0.01), and the corrected item-total correlation coefficients of all items ranged from 0.733 to 0.818, indicating a good homogeneity of the items with the scale. Additionally, the scale was shown to have good validity, with item-level content validity index ranged from 0.857 to 1.000, and scale-level content validity index/Ave was 0.956. The exploratory factor analysis and confirmatory factor analysis (CFA) confirmed the 2-factor structure of the Chinese version of PCSS (C-PCSS), explaining 74.19% of the variance. CFA verified that the 2-factor model had a satisfactory model fit, with χ 2 / df = 2.724, RMSEA = 0.084, GFI = 0.916, CFI = 0.967, and TLI = 0.952. The known-groups validity of C-PCSS was demonstrated good with its sensitive in differentiating levels of self-efficacy between professionals with less than 1 year of palliative care experience ( p < 0.001) or without palliative care training ( p = 0.014) and their counterparts. Furthermore, the C-PCSS also exhibited an excellent internal consistency, with the Cronbach’s α for the total scale of 0.943. Significance of results The findings from this study affirmed good validity and reliability of the C-PCSS. It can be emerged as a valuable and reliable instrument for assessing the self-efficacy levels of palliative care professionals in China.

This qualitative study aimed to gain a deep understanding of the spiritual needs of patients with advanced cancer. A qualitative study using semi-structured interviews was conducted. The interviews were audio-recorded, transcribed verbatim, and subjected to thematic analysis. Two researchers coded the interviews independently in NVivo 12 plus and developed major themes and subthemes by inductive and constant comparison. This study was conducted in the inpatient ward of a tertiary cancer hospital in Hunan Province, Chinese Mainland. Eligible participants with advanced cancer were recruited using the purposive sampling method. The sample size was determined by data saturation. All interviews were conducted face-to-face individually from May 2021 to July 2021. A total of 13 patients with advanced cancer patients were interviewed. Six themes were identified, namely being treated as normal and independent individuals, receiving and giving love, seeking inner peace, connecting with spiritual sources, finding meaning and purpose, and preparing for death. Different categories of spiritual needs of patients with advanced cancer were identified in this study. Healthcare professionals need to develop interventions that aim to meet patients’ spiritual needs.

BACKGROUND:Quality improvement (QI) programs based on person-centred outcome measures (PCOMs) play an important role in promoting optimal palliative care. However, routine use of PCOMs has been slow and difficult to implement, including within QI programs. OBJECTIVE:This study aimed to identify implementation strategies that support the implementation of PCOMs as routine practice in hospital-based palliative care, as well as the implementation theories, models and frameworks (TMFs) guiding the design of these implementation strategies. METHODS:A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Scoping Review framework. Four databases (Medline, CINAHL, Scopus and PubMed) were systematically searched for literature published between 1 January 1990 and 8 March 2024. RESULTS:One hundred and fifteen unique implementation strategies, identified from 11 included studies, were mapped onto the 73 Expert Recommendations for Implementing Change (ERIC) discrete implementation strategies, covering 52% of the ERIC strategies. The most commonly used categories were train and educate stakeholders, and support clinicians, followed by develop stakeholder interrelationships and use evaluation and iterative strategies. Three key themes emerged: what to do; how to do it; and who to do it with. Only four studies employed TMFs to guide the design of the implementation strategies in this review. CONCLUSIONS:To promote the implementation of PCOM-based QI programs, strategies should be developed based on identified/potential barriers and facilitators by using rigorous TMFs. The components of the implementation strategies must be reported transparently and consistently to enable replication and measurement in future research and practice. PATIENT AND PUBLIC CONTRIBUTION:This scoping review does not directly involve patients or the general public in its design or execution. However, it is part of an implementation study aimed at integrating the Palliative Care Outcome Collaboration (PCOC) model into routine clinical practice at a cancer hospital in China. Before the formal implementation, palliative care professionals from this hospital highlighted the need for a comprehensive analysis of existing evidence to support the effective adoption of the PCOC model in their specific clinical setting.

Purpose: To identify the factors affecting Chinese oncology nurses' competency in coping with death, and their relationship with death attitudes and educational needs. Methods: A national cross-sectional descriptive study was conducted using an online survey of Chinese oncology nurses. Data were collected using the Coping with Death, Death Attitude Profile-Revised, and Death Education Needs Scales. A Pearson's correlation analysis was used to examine the relationships among the research variables. A multiple linear regression analysis was used to analyze the factors influencing coping with death. Results: The total score of coping with death was 133.57 +/- 26.78, showing a moderate coping level among Chinese oncology nurses. The Pearson's correlation analysis showed that death attitude was significantly and positively correlated with coping with death competence, and there was a statistically significant positive relationship between coping with death competence and death education needs. Years of oncology care experience, bereavement experience, death attitude, and death education needs were identified as statistically significant factors influencing competency in coping with death. These factors explained 30.6% of the differences in coping with death. Conclusion: This study found that oncology nurses in China exhibited moderate levels of death coping competence, which needs to be improved to provide higher-quality end-of-life care. Further, death attitude and education needs were important factors affecting participants' coping with death competence. Tailored death education programs and continuing education on death should be provided for oncology nurses, to encourage them to actively participate in death competence-related training and promote an attitude of natural acceptance of death and positive care for terminally ill patients. In the future, virtual reality technology could complete course implementation designs with immersive, conceptual, and interactive characteristics, to enhance the death-coping education program. Nurses with less experience in oncology care and bereavement should improve their competency in coping with death.