Patterns for End-of-Life Care of Patients With Advanced Cancer: An Integrative Review

The patterns of care for patients with advanced cancer in the last week of life are critical for ensuring quality and dignity during a vulnerable time. As patients approach end of life, the focus typically shifts from aggressive treatment to palliative care, emphasizing comfort and symptom management. The term "non-comfortoriented care" describes a set of medical interventions and treatments that prioritize prolonging life. This can lead to increased physical discomfort, emotional burden, or reduced quality of life.

For those who die in a medical setting, end-of-life care practices vary greatly and the care can be either comfort-oriented or noncomfort-oriented. There is a need for a clear overview of patterns for end-of-life care for patients with advanced cancer.

Based on Whittemore's integrative review method, comprehensive searches were conducted in PubMed, Science Direct, Scopus, and Google Scholar databases. Population/Patient, Exposure, and Outcome format was used to formulate a research review question.

Twenty-four articles were included. The key components of the patterns of care implemented during the last week of life are settings, palliative care involvement, intensity of therapeutics interventions, duration, and planning in advance. The only setting where solely comfort-oriented care was delivered was the community. In hospital settings, both comfort and noncomfort-oriented care were offered. Palliative care involvement was associated with comfort-oriented care, early recognition of dying (median 6 days), medication rationalizing, and implementation of care pathways. Noncomfort-oriented care patterns occurred in emergency departments, oncology, and general wards in acute hospitals with late recognition of dying (median 2 days) and use of inappropriate therapeutics interventions.

To deliver the best care in the last week of life, new strategies are necessary to guide the clinical practices and to ensure patient-centered care.