Objective The quality of end-of-life care for cancer patients in China remains unsatisfactory, particularly during their last days and hours, highlighting an urgent need for improvement. This study is aimed to develop and implement a hospital-based quality improvement (QI) program to provide supportive care for terminally ill cancer patients, with the goal of improving the quality of death of cancer patients and family satisfaction. Methods This QI program primarily included three phases: developing evidence-based practice standards and related materials; conducting stratified training and providing the bundled supportive care strategies; and implementing quality supervision. The supportive care provided to terminally ill cancer patients and their families consists 30 bundled strategies divided into 5 parts: recognition and confirmation that the person may enter the last few days of life, end-of-life communication, patient-centered supportive care, family-centered supportive care and bereavement support for the family. The quality of death of cancer patients was assessed from the perspective of charge nurses and family members using the Good Death Inventory (GDI), and family satisfaction was evaluated using the Family Satisfaction with Advanced Cancer Care-2 (FAMCARE-2) scale. Results One hundred and fourteen patients from five hospitals located in Beijing, Nanjing, and Kunming were provided the supportive care between May 2023 to August 2024, and 112 (98.2%) nurses and 103 (90.4%) families completed the follow-up evaluation. The total GDI score, which ranges from 54 to 378 with higher score indicating a better quality of death, was recorded as 299.81 ± 53.70 from the perspectives of nurses and 310.76 ± 49.55 from family members. The FAMCARE-2 score ranging from 17 to 85 with higher scores indicating greater satisfaction was 80.52 ± 8.75, with scores for symptom control, information support, family support, and patient psychological support at 23.73 ± 2.80, 18.87 ± 2.25, 18.94 ± 2.35, and 18.98 ± 1.95, respectively. Conclusions This study systematically implemented supportive care strategies tailored to the needs of patients and their families at the end of life through a hospital-based program and achieving satisfactory outcomes. The systematic approach and innovation of the program are worthy of further promotion.

OBJECTIVES:Care of the dying is an essential part of holistic cancer nursing. Improving nurses' attitudes and behaviors regarding care of the dying is one of the critical factors in increasing the quality of nursing service. This study aims to examine the impact of an educational program based on the CARES tool on nurses' attitudes and behaviors toward care of the dying. METHODS:A quasi-experimental study with pre- and post-intervention measures was conducted. A total of 222 oncology nurses from 14 hospitals in Beijing, China, were enrolled using a convenient sampling method. This online educational course developed based on the CARES framework comprised 7 modules and 10 sessions. Each session was carried out twice a week over 30-60 min. Data were collected using a sociodemographic characteristics questionnaire, the Frommelt Attitude Towards Care of the Dying Scale (FATCOD) and the Nurses' Practice Behavior Toward Care of the Dying Questionnaire (NPBTCOD). Reassessment of attitudes and behaviors was conducted when completed the learning and 6 months after the learning, respectively. The sociodemographic characteristics of the nurses were analyzed using descriptive statistics, and differences in attitudes and behaviors were reported and compared by the paired t-test. RESULTS:All the 222 oncology nurses completed educational courses, and 218 nurses (98.20%) completed the pre- and post-attitudes evaluation and 213 (95.9%) nurses completed the pre- and post-behaviors evaluation. The mean (SD) FATCOD score before and after the educational program was 108.83 (12.07) versus 115.09 (14.91), respectively (t = -8.546, p ≥ 0.001). The mean (SD) NPBTCOD score before and after the educational program was 69.14 (17.56) versus 73.40 (18.96), respectively (t = -3.231, p = 0.001). SIGNIFICANCE OF RESULTS:This educational intervention was found to be an effective method for improving oncology nurses' attitudes and behaviors toward caring for dying patients.

Objective:To develop training course about care of the dying for cancer patients based on the CARES framework and explore its clinical application effect.Methods:Based on the CARES framework, the first draft of training course about care of the dying for cancer patients was constructed. From November 2021 to January 2022, the Delphi method was used to conduct two rounds of expert correspondence with 23 experts nationwide, forming the final version of training course about care of the dying for cancer patients. From January to March 2022, 235 oncology nurses from Beijing Cancer Hospital were selected as research objects by the convenient sampling method, and were given training course about the care of the dying for cancer patients. The Evaluation Questionnaire on Training Course about Care of the Dying for Cancer Patients was used to evaluate the satisfaction of nurses to the course setting and implementation.Results:The final training course about care of the dying for cancer patients included 7 first-level indicators, 16 second-level indicators and 44 third-level indicators. The overall satisfaction rate of training course about care of the dying for cancer patients in oncology nurses was 100.00% (235/235) .Conclusions:The development process of training course about care of the dying for cancer patients based on CARES framework is standardized, and the students have high satisfaction with the course setting and implementation process, which can be used as an educational resource for clinical nurses to improve professional nursing ability in the dying period.

The quality of care provided to patients with cancer at the end of their lives remains unsatisfactory, especially during their last days and hours of life. This study aimed to investigate knowledge and practice behaviors of oncology nurses in relation to the care of the dying and to analyze the influencing factors. A convenience sample of 222 oncology nurses was recruited from 14 hospitals in Beijing, China, in January 2022. These nurses completed an online survey that included a demographic and work characteristics questionnaire and knowledge and practice behavior questionnaires regarding the care needs of dying cancer patients. The self-perceived knowledge and practice behavior of oncology nurses toward the care of the dying were found to be moderate. However, their understanding of airway management, restlessness, and delirium management was insufficient. In addition, their ability to effectively communicate recommendations for discontinuing unnecessary procedures, medications, treatments, and monitoring was inadequate. Nurses' previous end-of-life care education and experience of caring for dying patients influenced their knowledge. Nurses' practice settings, experience of caring for dying patients, and their knowledge were key factors in shaping their behaviors. Providing targeted continuing education for nurses in hospital settings and exploring the nursing pathway may be important ways to bridge their knowledge gap and enhance their practice behaviors toward caring for dying patients.

Objective: To develop the Nurses’ Practice Behavior in Caring of the Dying Evaluation Questionnaire and to test its psychometric properties. Methods: An item pool was development based on the CARES framework. The items were selected and modified by expert assessment, and then totally 210 oncology nurses were investigated with the questionnaire to test its psychometric properties. Through item analysis, factor analysis, internal consistency analysis, test-retest reliability to screen items of the questionnaire and conduct reliability and validity tests. Results: The final questionnaire consisted of 31items. Exploratory factor analysis identified four principal factors which could explain 72.459% of the variance. Considering the items content, the final questionnaire was adjusted to 5 factors, namely pain management and comfort, airway management, restlessness and delirium management, emotional and spiritual support, and nurse self-care. The I-CVI was 0.80-1.00, and the S-CVI/Ave was 0.98. The Cronbach’s α coefficient of the overall questionnaire was 0.945 and the test-retest reliability was 0.785. Conclusion: The Nurses’ Practice Behavior in Caring of the Dying Evaluation Questionnaire has good validity and reliability, which can assess nurses’ practice behaviors in providing the care for the dying.

[This corrects the article DOI: 10.1016/j.apjon.2021.12.017.].

描述化疗期间发生跌倒的肺癌患者的临床特征,分析跌倒的原因,为预防肺癌患者化疗期间跌倒及降低跌倒发生率提供防范措施.研究表明,护理管理人员应完善约翰霍普金斯风险评估量表评估内容,增加化疗方案、脑转移及症状的相关评估内容,或将高风险项目纳入自定义项目中,以保证该评估量表更具特异性及临床使用价值.同时要加强护士和患者跌倒预防相关知识培训,制定防范措施时应充分考虑患者夜间活动行为的管理以及化疗期间的注意事项.

目的:构建癌症患者濒死期支持性照护策略清单,为临床护士实施濒死期护理提供实践指引.方法:依据支持性照护框架,在充分回顾濒死期癌症患者照护相关文献的基础上构建癌症患者濒死期支持性照护策略清单初稿,采用德尔菲法于2022年5月-8月对19名专家进行函询,依据专家对指标的评分以及提出的意见对清单进行修改和完善.结果:共开展2轮专家函询.最终确立的癌症患者濒死期支持性照护策略清单包括一级指标5个、二级指标30个.2轮函询的专家积极系数均为100％;专家的判断依据系数为0.94,熟悉程度系数为0.86,权威系数为0.90;2轮函询专家评分的变异系数分别为0～0.206和0～0.222,肯德尔和谐系数分别为0.116(P＜0.001)和0.075(P=0.052).结论:癌症患者濒死期支持性照护策略清单具有可靠性和临床实用价值,可为临床护士对濒死期癌症患者实施照护提供科学、规范、便捷的实践指引.

Objective:To evaluate the quality of domestic and foreign hospice care practice guidelines for cancer patients, so as to provide a basis for the future development of scientific and systematic hospice care guidelines for cancer patients or the formulation of evidence-based nursing practice plans for hospice care of cancer patients in China.Methods:Practice guidelines on hospice care for cancer patients were systematically retrieved from domestic and foreign databases, guidelines and professional society websites from the establishment of the database to July 25, 2020. Two investigators screened the guidelines strictly according to the inclusion and exclusion criteria, and evaluated the methodological quality of the included guidelines by using the currently internationally recognized guideline evaluation tool, the Appraisal of Guidelines for Research and Evaluation version Ⅱ (AGREE Ⅱ) .Results:A total of 14 guidelines were included for quality analysis, 9 guidelines were Grade A, 1 guidelines was Grade B, and 4 guidelines were Grade C. The average standardized scores of the 6 areas in AGREEⅡ of the 14 guidelines from high to low were scope and purpose (91.87%) , clarity (83.73%) , stakeholder (72.82%) , applicability (66.81%) , rigor (63.84%) and independence (58.04%) . The subject content analysis of 9 Grade A guidelines showed that common topics in the practice guidelines for hospice care of cancer patients included forming interdisciplinary teams, identification of end-of-life patients, assessment of end-of-life needs, end-of-life communication, providing of individualized nursing, end-of-life symptom management, bereavement support, support and training for nurses.Conclusions:Evidence-based guidelines for hospice care of cancer patients are lacking in China. The existing practice guidelines for hospice care of cancer patients in foreign countries are of high quality and cover a comprehensive range of topics, which can provide a reference for our country to formulate hospice care guidelines in line with national conditions or to transform the best evidence into our country's hospice care practice.

This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture. Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg’s Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student’s t test, Pearson correlation test, and linear regression. Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were “I fear dying a painful death” (3.59 ± 1.41), “I often think about how shortly life really is” (3.11 ± 1.33), and “1 am not particularly afraid of getting cancer” (3.09 ± 1.35). Associated factors of death anxiety (R2 = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants’ adult children, the patient-primary caregivers’ relationship, resilience, and the level of activity of daily living. Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.

Objective:The aim of this study was to evaluate the effects of whole process management model interventions based on information system benefits reported by patients with cancer pain. Methods:We performed a quantitative, prospective nonrandomized controlled design from June to October 2020. A total of 124 cancer patients with pain were enrolled. Patients in the experimental group received a whole process management model intervention based on an information system compared to the control group who received routine cancer pain management. Data were collected at baseline and after a four-week follow-up, acting as a test-retest control. The primary outcome was pain management quality, which was measured using the American Pain Society Patient Outcome Questionnaire-Chinese version (APS-POQ-C). Secondary outcomes were patient-related attitudinal barriers and analgesic adherence. The Barrier Questionnaire (BQ) and a single-item questionnaire were used. Chi-square tests were used to compare the pain intensity and analgesic adherence, independent sample t-test and Mann-Whitney U test were performed to test the differences in the pain management quality and patient-related attitudinal barriers between control and experimental groups. Results:Baseline characteristics and outcomes of the participants did not differ significantly (P ​> ​0.05). Primary outcomes were changes in four aspect of the quality of pain management (APS-POQ-C) between the two groups (P ​< ​0.05). Patients in the whole process management group reported significantly better pain control and perception of care than the control group. With respect to secondary endpoints, a significant difference in favor of the experimental group was found for barriers (P ​< ​0.05) and medication adherence (60.0% vs. 40.0%; P ​< ​0.05) after the interventions. Conclusions:The whole process management of patients with cancer pain effectively improves patient-reported quality of pain management, reduces patient-perceived barriers, enhances patient adherence to analgesic drugs and is worthy of clinical application.

This study aimed to develop a model that specifies the predictive effects of factors on death anxiety among Chinese patients with cancer using structural equation modeling. Using convenience sampling, data were collected from 353 cancer patients. Self-administered questionnaires included Social Support Rating Scale, Rosenberg Self-Esteem Scale, Connor Davidson Resilience Scale, Templer’s Death Anxiety Scale, and socio-demographic factors. The results showed that social support, self-esteem, and resilience significantly impacted death anxiety. The final model fitted the data acceptably (χ2 = 37.319, df =31, p = 0.201). Social support mediated death anxiety through self-esteem and resilience. Resilience mediated the buffer effect of self-esteem on death anxiety as an intermediary factor. Findings suggest the need for further studies to explore effective interventions to provide social support and improve self-esteem and resilience among patients with cancer to alleviate death anxiety.

目的:探讨晚期肿瘤患者心理弹性水平并分析其与应对方式、社会支持的相关性,为探讨提高晚期肿瘤患者心理弹性的干预措施提供依据.方法:采用横断面、便利抽样的设计方法,采用一般资料调查表、心理弹性量表(CD-RISC)、医学应对问卷(MCMQ)、社会支持量表对244例晚期肿瘤患者进行问卷调查.结果:晚期肿瘤患者CD-RISC总分为(71.23±13.64)分,处于较高水平;在应对方式中面对维度、回避维度与心理弹性呈正相关(r=0.153,r=0.242,P<0.05),屈服维度与心理弹性呈负相关(r=-0.375,P<0.01);社会支持3个维度均与心理弹性呈正相关(P<0.05).多元线性回归结果显示,在控制人口学资料的情况下,晚期肿瘤患者应对中回避维度和屈服维度是心理弹性的主要影响因素,共解释变异变量的22.7％(F=17.558,P<0.001).结论:临床医护人员应关注晚期肿瘤患者的医学应对方式、社会支持对其心理弹性水平的影响,提高社会支持与积极应对的能力,进一步提高晚期肿瘤患者的心理弹性.

目的:评价并整合国内外肿瘤患者便秘预防相关证据.方法:计算机检索指南网站、临床决策支持系统网站、各循证资源及文献数据库、专业协会网站中关于肿瘤患者便秘预防相关内容的指南和专家共识,进行方法学质量评价后,根据主题对证据进行提取与汇总.结果:最终共纳入5篇文献,包括4篇指南和1篇专家共识,通过阅读、提取最终获取证据34条,归类为评估风险因素、通用预防措施、特殊肿瘤人群预防措施(使用阿片类药物的肿瘤患者)、特殊肿瘤人群预防措施(老年肿瘤患者)4个方面.结论:医务人员应结合患者个体情况,遵照循证护理标准,根据实际情境选择实践证据,从而降低肿瘤患者便秘发生率,提高患者生活质量,推动循证知识向实践转化.

Objective: The objective of this study was to explore the interrelationship between anticipatory grief (AG), caregiver burden, communication, preparation for death, and coping style. Methods: A convenience sample of 256 Chinese family caregivers of patients with advanced cancer were recruited from an academic cancer hospital between April 2018 and May 2019. This cross-sectional survey included the AG Scale, caregiver burden (Caregiver Reaction Assessment), communication (Caregivers' Communication with Patients about Illness and Death Scale), preparation for death, and coping style (Simplified Coping Style Questionnaire). Structural equation modeling tested the interrelation between them. Results: The final model fitted the data acceptably (χ2 = 25.79, degrees of freedom = 17, P = 0.08, root mean square error of approximation = 0.05, goodness-of-fit index [GFI] = 0.98, adjusted GFI [AGFI] = 0.95, parsimony GFI [PGFI] = 0.46, normed fit index = 0.94, comparative fit index = 0.98). Poor communication contributed to less preparation for death and caregiver burden, which further aggravate AG. Communication was positively associated with AG. In addition, communication and positive coping style interacted to further influence caregiver burden. Conclusions: Preliminary results supported the model and showed that poor communication, less preparation for death, and caregiver burden contributed to AG while positive coping alleviated AG. Findings suggest the need for further studies to explore effective intervention for communication, preparation for death, burden, and coping style of caregivers to ultimately alleviate AG.

疼痛是癌症病人常见的症状之一,在中国,初诊癌症病人的疼痛发生率为25％,晚期癌症病人疼痛发生率高达60％～80％,严重影响病人的生活质量 [1].随着癌痛规范化治疗的推广和普及,虽然越来越多疼痛得到了有效缓解,但调查显示未缓解的疼痛仍普遍存在 [2].

晚期癌症患者的生存期预测是安宁疗护领域的一项重要内容,准确而可靠的预测方法不仅可以帮助医、患双方适时转换治疗时机接受最合时宜的治疗,而且可以帮助患者及家属及早做出计划和安排,从而促进患者实现舒适、安详和有尊严地离世.针对晚期癌症患者生存期预测的因素及工具进行综述,以期为安宁疗护的临床实践及开展相关研究提供参考依据.

护理人员的临终照护能力直接影响临终者的生活质量,临终护理培训课程是提高护理人员照护知识、态度及行为的有效措施,也是提高护士临终关怀质量而普遍采取的措施.该文综述了国外临终护理培训课程的内容、教学方法、效果评价方法的研究进展,可为今后探索临终护理培训、提高护理人员临终照护能力提供参考.

目的 集束化管理对肿瘤患者经外周置入的中心静脉导管(peripherally inserted central catheter,PICC)留置期间医用粘胶相关性皮肤损伤(medical adhesive related skin injury,MARSI)中的应用效果,为减少肿瘤患者留置PICC期间医用粘胶相关性皮肤损伤的发生提供参考.方法 将2016年4月至8月678例留置PICC的门诊肿瘤患者作为对照组,并对发生MARSI的病例进行回顾,从护理人员及患者两方面分析患者出现MARSI的原因,制订护理干预措施.2016年9月开始护理人员采取加强对MARSI知识的学习,对患者皮肤的评估、改进导管维护方法、选择合适的敷料种类等护理干预措施.将2017年4至8月采用护理干预措施的1109例患者作为观察组,比较两组发生MARSI的情况.结果 实施护理干预措施后,留置PICC的肿瘤患者MARSI的发生率由2016年的12.39％下降至2017年的2.61％,差异有显著性(x2=67.86,P<0.001).结论 实施预防控制等护理措施对降低MARSI在肿瘤患者PICC留置期间的发生具有一定临床应用价值.