BACKGROUND:Although previous literature has centered on the needs of family caregivers for terminally ill patients, most review articles published in the last twenty years have focused on such caregivers in specific conditions or settings, lacking an updated, holistic overview of relevant research. PURPOSE:To summarize the literature on the expressed needs of family caregivers of patients at the end-of-life stage over the last two decades and to lay a scientific foundation for formulating future policies, regulations, and action strategies. METHODS:A systematic search of relevant literature published between January 2004 and September 2024 in China National Knowledge Infrastructure, Wanfang Data Knowledge Service, VIP Data Knowledge Service, Web of Science, Scopus, PubMed, CINAHL, Ovid, and ProQuest databases. The literature was screened and included using the scoping review method. The contents of the included literature were extracted and summarized. DISCUSSION:A total of 57 articles were included. Of these, 30 were qualitative studies, 23 were quantitative studies, and four were mixed-method studies. The needs of family caregivers of the terminally ill extend to multiple domains. The needs of family caregivers are predominantly characterized by the enabling needs that caregivers must fulfill in order to care for the patient. These include information and communication needs, as well as healthcare and other services. Of the direct needs related to the caregivers themselves, psychological and social needs are the most common. The following factors have been identified as being associated with the needs of caregivers: caregiver, the patient, and the caregiving situation. However, the findings of the study were not consistently replicable. CONCLUSION:The needs of family caregivers of the terminally ill are multidimensional, dynamic, and individualized. The national government should implement dedicated strategies and enact legislation to clarify their rights and protections, while integrating key support services into the medical insurance payment system. At the institutional level, healthcare providers must establish standardized needs assessment and referral mechanisms, and set up in-hospital support centers to provide caregivers with ongoing information, skills training, and resource navigation.

Objectives:Identifying high-performing advanced practice nursing roles and understanding the factors that contribute to their effectiveness are critical for advancing professional development, optimizing workforce deployment, and ensuring long-term sustainability in nursing. This study aimed to (1) identify distinct latent profiles of advanced practice nursing among specialist nurses in mainland China, (2) quantitatively examine the individual and contextual factors associated with high performance, as characterized by these profiles, and (3) qualitatively confirm the significant factors using explanatory semistructured interviews in the high-performance groups. Methods:A mixed-methods sequential explanatory design was used, in which quantitative data were collected first and subsequently explained through qualitative interviews. Certified specialist nurses from 16 hospitals across urban and rural areas of Shanghai were included. Latent profile analysis (LPA) was conducted using the five domains from the Advanced Practice Role Delineation tool as manifest indicators to classify nurses into distinct performance profiles. Multinomial logistic regression was used to examine potential determinants (e.g., job position) of group membership. Additionally, a backpropagation neural network (BPNN) was developed to rank the importance of contributing factors. Specialist nurses identified as high performers in the quantitative phase were purposively sampled for explanatory semistructured qualitative interviews. Results:Three latent profiles emerged: high performance (26.1%), moderate performance (46.3%), and low performance (27.6%). Compared to APNs, staff nurses had significantly lower odds of belonging to the high-performance group (β = -1.715, p < 0.001). Nurses with higher professional career ladder (e.g., Level 4) were more likely to be in the high-performance group (β = -1.163, p = 0.042). BPNN analysis identified the professional career ladder and job position as the most influential predictors of high performance. Qualitative findings from interviews with 17 participants reinforced these results, highlighting contextual factors such as leadership support (e.g., formal APN designation, physician endorsement, and organizational recognition) and individual attributes including specialized knowledge, extensive clinical experience, and advanced training. Conclusion:Identifying the profiles of advanced practice nursing roles provides valuable insights for optimizing APN performance and informing targeted management and policy strategies. High-performing specialist nurses are positioned at the nexus of individual capability, interdisciplinary collaboration, and institutional support.

OBJECTIVE:To examine end-of-life knowledge, attitudes and behaviours associated with hospice care preference in community-dwelling older adults from Shanghai, China. DESIGN:This was a cross-sectional study recruiting community-dwelling older adults from Shanghai. Bivariate analysis and multivariate logistic regression models were conducted to identify associated factors. SETTING:Seven community health service centres in Shanghai, China. PARTICIPANTS:A total of 404 community-dwelling older adults. OUTCOME MEASURES:Participants were asked to provide their hospice care preference ('If you were to become critically ill with limited life expectancy, would you choose hospice care?') and related reasons. To evaluate knowledge, attitudes and planning behaviours related to end-of-life issues, a structured questionnaire was developed through a multistep process. Demographic and clinical characteristics were also collected. RESULTS:Nearly two-thirds of participants (65.8%) reported awareness of hospice care. Most of the participants (81.2%) reported they would choose hospice care at the end-of-life stage. Bivariate analyses showed that marital status, living status, education background and disposable personal income were significantly associated with hospice care preference. After controlling for confounding variables, the logistic regression analysis suggested the significant effects of knowledge level of hospice care (β=0.318, 95% CI (1.156 to 1.636), p<0.001), truth-telling about terminal prognosis (β=1.005, 95% CI (1.071 to 7.704), p=0.036) and preferred place of death (β=-1.073, 95% CI (0.120 to 0.972), p=0.044) on opting for hospice care. CONCLUSIONS:The Chinese older adults' knowledge, attitudes and behaviours towards end-of-life issues in metropolitan areas has been changing. Their preference towards hospice care provides a good foundation for the utilisation of hospice care in the future. Community-based educational interventions should target demographic characteristics such as being unmarried, living alone and having lower levels of education and income among older adults to enhance their knowledge and family communication about hospice care.

BACKGROUND:Mainland China's end-of-life care system remained underdeveloped marked by underutilization of hospice care services. Physicians-initiated end-of-life communication is likely to result in immediate enrollment in hospice care. However, there is a lack of empirical evidence on how physicians in China undertake end-of-life communication in advanced cancer. This qualitative study aimed to explore physicians' experiences on discussing end-of-life matters and facilitating hospice care transition within families of patients with advanced cancer. METHODS:A descriptive qualitative study was conducted. Using the purpose sampling, physicians were recruited from 8 hospitals in Shanghai, China. Physicians were eligible if they had experiences in treating patients with advanced cancer and were ineligible if they did not directly participate in end-of-life discussions with patients/families. Semi-structured interviews were conducted from August 2022 to February 2023. Qualitative data were analyzed by content analysis approach. RESULTS:Among 18 physicians, three major themes emerged regarding barriers to effective end-of-life communication at physician, family, and system levels: (1) Physician avoidance in disclosing terminal prognosis: Prognostic uncertainty, Skill deficiency, Emotional burden, Concerns about therapeutic hope, and Systematic avoidance; (2) Family priority in end-of-life decision-making: Complex family dynamics, Cultural stigma, and Unstructured family coping; (3) Systematic fragmentation in hospice care integration: Limited awareness and understanding, Ineffective referral mechanisms, and Insufficient leadership support. CONCLUSION:End-of-life communication in Shanghai is hindered by physician challenges, cultural norms favoring family decisions, and systemic gaps. Targeted training for non-hospice physicians, balanced approaches to patient autonomy and family roles, and strengthened referral/reimbursement policies are needed to improve hospice transitions.

Objective There are currently an increasing number of mobile health (mHealth) programs offered to patients with breast cancer undergoing chemotherapy, but their rate of adherence to app usage has remained low. This study aimed to examine the feasibility of an mHealth app-based program such as the adherence rate of app usage and determine the preliminary effects on self-efficacy, quality of life, symptom burden and healthcare utilization in these patients. Methods We conducted a randomized controlled pilot trial. Ninety-six participants were randomly allocated into either an intervention group or a control group (routine care plus a placebo app). The intervention group engaged in a 6-week self-regulation activity and received nurse-led social support via the app. The intention-to-treat principle was adopted. The generalized estimating equation was utilized to analyze the between-group, within-group and interaction effectiveness of this program. Results Totally 96 participants were enrolled from 16 May to 23 August 2022. The average rate of adherence to app usage increased from 4.8% at week 3 to 51.2% at week 6. There was a statistically significant reduction in the physiological efficacy scores of the intervention (p < .001) and control groups (p < .001) at week 6, compared with the baseline. At week 6, the intervention group reported a significantly lower symptom burden (p = .042) and significantly better physical well-being than the control group (p = .024). Conclusions It is feasible to perform an mHealth app-based self-management program for patients with breast cancer receiving chemotherapy. Nurses can utilize this program to facilitate patient self-management of symptoms during chemotherapy. Registration Clinicaltrials.gov, https://clinicaltrials.gov, (NCT05192525).

PurposeBreast cancer (BC) patients who are undergoing outpatient chemotherapy encounter difficulties in symptom self-management at home. We have developed a mobile app with the support of self-regulation activities and nurse-led social service to empower self-management of BC patients during outpatient chemotherapy. The study aimed to explore the perceptions of breast cancer patients and nurses in utilizing an app with the functions of proactive nursing support and empowerment.MethodsThis is a qualitative study including group interviews with nurses and patients with breast cancer receiving outpatient chemotherapy. A total of eleven patients and five nurses were enrolled from August 2022 to October 2022. Thematic analysis was adopted to analyze the interview transcripts. Main themes and related sub-themes were drawn from the transcripts.ResultsBarriers (the lack of a contractual spirit) and facilitators (social support and native high-adherence) to app usage were identified. Following the six-week program, patients underwent various transformations such as improved health awareness and a tendency to pay more attention to psychological symptoms. This program also led to various changes in the nurses, including a transformation from taking the reactive emergency calls to a proactive approach of incorporating a self-regulation process and social support.ConclusionsThe findings from the group interviews stressed the importance of integrating technology and nursing social support in facilitating patient symptom self-management.

ObjectiveTo translate the Advanced Practice Nursing Self⁃Appraisal Tool into Chinese，and to test its reliability and validity.MethodsBrislin transliteration⁃translation method was used to translate the Australian Advanced Practice Nursing Self⁃Appraisal Tool，and expert consultation method and cognitive interview were used for cross⁃cultural adaptation.A total of 1 224 nurses from 17 hospitals in Shanghai were selected by convenience sampling method to test the reliability and validity.ResultsThe Chinese version of Advanced Practice Nursing Self⁃Appraisal Tool had 5 dimensions and 37 items.The Cronbach's alpha coefficient of the total scale was 0.889，the test⁃retest reliability coefficient was 0.982. The item⁃level content validity index(I⁃CVI) ranged from 0.8 to 1.0.The average scale⁃level content validity index(S⁃CVI/Ave) was 0.97，and the universal agreement of scale⁃level content validity index(S⁃CVI/UA) was 0.86.Confirmatory factor analysis showed that the model fit well.There were statistically significant differences in scores of nurses in different positions(P<0.05).Effect size(ES) and standardised response mean(SRM) for each dimension were>0.8.ConclusionsThe Chinese version of the Advanced Practice Nursing Self⁃Appraisal Tool has good reliability，validity，responsiveness and good cultural appropriateness.It can be used to measure the practice level of nurses in China and provide important evidences for distinguishing different nursing practice levels.

Objective: To evaluate the quality of dying and death among deceased patients with cancer in Shanghai from the perspective of healthcare providers. Methods: This cross-sectional study was conducted in Shanghai from April to July 2023. A convenience sample of 261 healthcare providers working at eight healthcare institutions participated. Each participant was asked to evaluate the quality of dying and death of one deceased patient who had been cared for recently using the Good Death Scale for patients in China (GDS-PCN). The scale included family companionship (eight items), dying with peace (six items), professional care (six items), preparation & no regrets (five items), maintaining dignity (four items), keeping autonomy (four items), and physical wellbeing (three items) seven dimensions, 36 items. Results: The total GDS-PCN score was 144.11 +/- 17.86. The professional care dimension scored the highest (4.21 +/- 0.58), whereas the preparation and no regret dimension scored the lowest (3.75 +/- 0.70). Significant differences in the GDS-PCN scores were based on the healthcare institution grade, ward type, hospitalization duration, communication about the condition, treatment, and death-related topics with the healthcare provider, and decision-making style (P < 0.05). The quality of dying and death of the deceased patients was higher among those who received care in community health service centers and hospice wards, those who had been hospitalized for more than 15 days, those who had discussed their personal conditions, treatment, and death-related topics with healthcare providers to a greater extent; and those who were involved in decision-making (P < 0.05). Conclusion: The overall quality of dying and death among cancer patients in Shanghai is moderate to high, but the quality of dying and death in the preparation and no regret dimension and the keeping autonomy dimension still have room for improvement. Increased utilization of hospice care and better communication between patients and healthcare providers may enhance decedents' quality of dying and death. Future research on this topic is required from different perspectives and on a broader scale in the mainland of China. (c) 2024 The authors. Published by Elsevier B.V. on behalf of the Chinese Nursing Association. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

This policy brief aims to help policymakers develop inter-sectoral interventions in megacities to prevent and control COVID-19. Based on the case of Changning District in Shanghai, China, several policy options are identified. The guiding principles include ensuring a coordinated national response (i.e., moderation is required in epidemic prevention and control); making science-based, precise, and differentiated epidemic control strategies; and establishing a joint prevention and control mechanism. Policy tools include localized management, closed-loop management, community grid management, digital management, and sub-population management. There is no “one size fits all” policy; however, it will be helpful to learn by trial and error through on-the-ground experience with minimal information in real time.

Abstract Background: The reasons for hospice underuse in China needs exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference of healthcare at the end-of-life stage of care, and the predictors of hospice preference.Methods: This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference of healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and logistic regression were conducted to analyze the data.Results: Only 29.7% of the participants had heard of hospice care. Most participants (78.2%) reported no introduction of hospice care from their doctors. More than half of the participants (58.2%) did not have a preference of healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on having a preference for healthcare at the end-of-life stage (OR=14.346, 95%CI 7.219-28.509, p<0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (OR=0.180, 95%CI 0.052-0.617, p=0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (OR=2.739, 95%CI 1.159-6.470, p=0.022).Conclusion: The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the families. Additionally, the impact of at-home care burden on the hospice choice of families with cancer patients requires further study.

Background The global pandemic has caused breast cancer (BC) patients who are receiving chemotherapy to face more challenges in taking care of themselves than usual. A novel nurse-led mHealth program (mChemotherapy) is designed to foster self-management for this population. The aim of the pilot study is to determine the feasibility, usability, and acceptability of an mChemotherapy program for breast cancer patients undergoing chemotherapy. The objective also is to evaluate the preliminary effects of this program on adherence to app usage, self-efficacy, quality of life, symptom burden, and healthcare utilization among this group of patients. Methods This is a single-blinded randomized controlled pilot study that includes one intervention group (mChemotherapy group) and one control group (routine care group). Ninety-four breast cancer patients who commence chemotherapy in a university-affiliated hospital will be recruited. Based on the Individual and Family Self-management Theory, this 6-week mChemotherapy program, which includes a combination of self-regulation activities and nurse-led support, will be provided. Data collection will be conducted at baseline, week 3 (T1), and week 6 (T2). A general linear model will be utilized for identifying the between-group, within-group, and interaction effects. Qualitative content analysis will be adopted to analyze, extract, and categorize the interview transcripts. Discussions Breast cancer patients receiving chemotherapy are a population that often experiences a heavy symptom burden. During the pandemic, they have had difficulties in self-managing the side effects of chemotherapy due to the lack of face-to-face professional support. An mChemotherapy program will be adopted through a self-regulation process and with the provision of nurse-led real-time professional support for these patients. If proven effective, BC patients who engage in this program will be more likely to take an active role in managing their symptoms, take responsibility for their own health, and subsequently improve their self-efficacy and adherence to the use of the app.

Objectives:To investigate why patients with terminal illness and their families in Shanghai choose the hospice ward and their decision-making process.Methods:This was a mixed-method study consisting of a cross-sectional survey and a descriptive quali-tative study.Medical decision-makers for patients hospitalized in hospice wards were recruited between September 2019 and July 2021.A medical decision-maker is a family member who makes medical decisions for a patient.All 146 participants completed a self-developed 10-item questionnaire that included five items about their demographic characteristics and five items about the decision-making process.The semi-structured interviews were conducted with nine participants to understand the family's decision-making process when they chose a hospice ward.The interviews were analyzed using qualitative content analysis.Results:The mean age of the 146 participants was 57.6 years old.Of the decision-makers,56.85％ were the patients' children.Family-dominated discussions involving other family members were the main decision-making mode (84.93％).Patient participation in the decision-making process was reported in 43.15％ of families.The participation of doctors (17.81％) and nurses (2.05％) were reported in a small number of families.The most common reason for choosing the hospice ward was the inability to find any other hospital for the patients (82.19％).The most common ways to learn about the service were neighbors and friends (38.36％) and social media (28.77％).Two themes and six categories emerged from the interviews.The first theme was reasons for choosing hospice wards.The reasons included being unable to care for the patients at home,staying in a hospice ward could reduce the psychological stress for home care,being unable to be admitted into tertiary/secondary hospitals,and thinking a hospice ward was a suitable place for the family.The second theme was the decision process of choosing a hospice ward.This theme included the following two categories,i.e.,ways to learn about the hospice ward and family-discussion decision mode.Conclusion:To most families having dying patients,a hospice ward is a reasonable and balanced choice after the families experience huge care stress and practical difficulties.The participation of patients should be encouraged in the family discussion so that their wishes can be known.More efforts will be needed to guide the families with dying patients to make reasonable medical choices.Social media can be a good way to improve public awareness of hospice services in the future.Meanwhile,healthcare providers should be more involved in the decision-making process.

Abstract Background The reasons for hospice underuse in China need exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference for healthcare at the end-of-life stage of care, and the predictors of hospice preference. Methods This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data. Results Only 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on preferring healthcare at the end-of-life stage (adjusted OR = 14.346, 95%CI 7.219–28.509, p < 0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (adjusted OR = 0.180, 95%CI 0.052–0.617, p = 0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (adjusted OR = 2.739, 95%CI 1.159–6.470, p = 0.022). Conclusion The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the patients’ families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.

Objective: This study aimed to explore the understanding of healthcare providers working in the internal medicine department in Shanghai regarding a good death. Methods: The data of the study was collected using face-to-face semi-structured interviews. Through purposive sampling, 16 physicians and 13 nurses who had experiences of caring for adult patients with life-threatening illnesses at the end-of-life stage in Shanghai were interviewed. The interviews were analyzed using qualitative content analysis. Results: Six characteristics of a good death emerged: no suffering, companionship and care, no worries or concerns, dying with dignity, involvement and acceptance, and less impact on the family. Eighteen categories were identified: dying without experiencing suffering; being relieved of symptoms and suffering; being relieved of psychological suffering; avoiding the use of futile treatment and resuscitation; being cared for and accompanied by family; receiving good health care; having a meaningful life without regrets; making good arrangements for family issues; having a chance to say goodbye; having a quality life before death; dying in a decent environment; the personal will to be respected; maintaining the integrity of the body; death of the patient being accepted by the family and healthcare providers; the death occurred despite the best efforts to care for the patient; limited financial and care burden; shortly affected quality of life of the patient; and improved family cohesion. Conclusion: Family members’ early involvement in caring for patients at the end-of-life stage helps achieve a good death. For patients with a terminal illness, avoiding unnecessary medical treatment and resuscitation could be the first step in achieving better patient death and promoting the development of advanced care planning in the mainland of China.

ObjectiveTo review the studies on the home-based end⁃of⁃life care both at home and aboard，in order to shine a light on the future development of the home⁃based end⁃of⁃life care in China.MethodsLiteratures on home⁃based end⁃of⁃life care were searched in PubMed，Web of science，CINAHL，Scopus，OVID，PubMed，Sino⁃Med，CNKI，Wanfang data and VIP databases from January 2009 to July 2019 using summary evaluation.The literatures on home⁃based end⁃of⁃life care were included，and the structure，process，and outcome of services were described and summarized using the Donabedian evaluation framework.ResultsA total of 92 articles including 58 end⁃of⁃life care programs in foreign countries and 25 end⁃of⁃life care programs in China were reviewed.Patients in most Chinese end⁃of⁃life care programs were cancer patients，while service objects in foreign countries were more diversified.Doctors and nurses were the main care providers.The multidisciplinary team of the end⁃of⁃life care in China still need to develop.Home visits and telephone follow⁃ups were the most common service form.The frequency of the service in foreign countries was higher than that in China.The frequency of nurse visits were higher than that of doctor visits.The knowledge education of end⁃of⁃life care and death education were the characteristics of domestic service.Domestic literatures mostly focused on outcomes of patients，while foreign literatures focused on the outcomes related to medical resources.ConclusionThe domestic home⁃based end⁃of⁃life care could appropriately expand the scope of admission，build the multidisciplinary service team，give full play to the important role of nurses，increase the service frequency，and add the indicators related to the medical service system in the service evaluation.

Despite the large number of people with cancer who need hospice care, utilization rates at community hospice service in Shanghai are low. This study aimed to review the care provided in these hospice wards and examine the difficulties in delivering service. Fourteen hospice care providers were interviewed, and the data analyzed using qualitative content analysis. Three themes emerged from the interviews: (i) characteristics of hospice patients, mostly cancer patients at the end-of-life stage (within 3-months of life expectancy) who were admitted without awareness of their condition; (ii) components of care, from physicians and nurses who focused mainly on physical problems as psycho-spiritual care stagnated at a superficial level; and (iii) difficulties in care, including a lack of patients as well as inadequacies in service, along with suggestions for the future. Efforts at improvement should be made in both the health care system and society. To address the lack of patients, doctors in secondary/tertiary care hospitals need improved skills in discussing end-of-life care, while the general public needs better awareness and acceptance of hospice care. Solutions should respect the perspective of patients and their families, while hospice care providers must also enhance their skills of communication and psycho-spiritual care.

An ongoing outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread in the world, whereas asymptomatic carriers may also play a critical role in the pandemic. We report a familial cluster of COVID-19 caused by one family member before his onset of illness, indicating that it seems to be potentially infectious during the incubation period, even earlier than we expected. Close contact, especially in a small enclosed space, might be the cause of familial transmission. The unsynchronized changes in the clinical symptoms and COVID-19 nucleic acid were found in this case, so consecutive nucleic acid detection of pretty suspected cases was recommended. Family members, especially of whom the confirmed cases contacted with since one incubation period before onset rather than 2 days before onset, should be regarded as close contact and centrally isolated in case of asymptomatic infection already existed in the family.

ABSTRACT Objectives: The objective was to promote evidence-based practice in screening for delirium in patients in the palliative care ward of a cancer hospital in Shanghai. Introduction: Delirium is common but under recognized among patients in palliative care settings. Early detection is essential for timely management. Practice guidelines recommend an initial screening at first contact, followed by continuous screening. Methods: The Joanna Briggs Institute's three-phase Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback tool were used to enhance evidence-based practice. In phase 1, four audit criteria were developed and a baseline audit was conducted. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted. Results: In the baseline audit, no delirium screening was performed, either on admission or regularly during hospitalization, hence compliance with these two audit criteria was 0%. Two out of 18 nurses had received training in delirium management, however neither had been trained to use the delirium screening tool. Compliance with the two criteria for nurse training was 11% and 0%, respectively. Four barriers were identified, including lack of a standardized screening tool, lack of a standardized screening procedure, inadequate knowledge on the part of the nurses, and potential inconsistencies between nurses in the rating of screening criteria. After applying strategies to address these barriers, compliance with the four audit criteria was 100%, 100%, 72%, and 72%, respectively, in the follow-up audit. Conclusions: Best practice in delirium screening was successfully established in the ward.

Background Only a small number of patients have utilized the home-based end-of-life care service in Shanghai that has been offered since 2012. This study explores how home-based end-of-life care is delivered in community health service centers in Shanghai and examines the difficulties in the delivery of the care. Methods This was a qualitative study in which data were collected from interviews and analyzed using qualitative content analysis. Nineteen health care providers with experience in delivering home-based end-of-life care in 12 community health service centers were recruited. The interviews were conducted between August 2018 and February 2019. Results Four themes emerged from the interviews: (i) Patients under home-based end-of-life care: Patients receiving the care were cancer patients with less than 1 year of life expectancy. The criteria for patients were broad. (ii) Service structure: The service was delivered regularly by the physicians and nurses using the approaches of home visits and/or telephone follow-ups. (iii) Service process: The service consisted of multiple components, including monitoring the patient’s condition, managing the patient’s symptoms, giving daily care instructions, performing nursing procedures, and giving psychological support. However, most of the care focused on monitoring the patients and managing their physical discomfort. (iv) Difficulties in delivering care: Being unable to provide the service and feeling powerless when facing psycho-spiritual problems were the two major difficulties. Three factors contributed to the suspension of the service: The gap between the service and the needs of the patients, a lack of patients, and low work motivation. The demand that the truth be concealed from the families and their attitude of avoiding talking about death were the key factors of the failure of psycho-spiritual care. Conclusions Several issues should be addressed before the service can be further developed, including fully understanding the needs and preferences of local patients and their families, securing more financial support and a better supply of drugs, delivering better training for staff, and ensuring greater rewards for individuals and institutions providing the service.