Development and implementation of a supportive care model for cancer patients in the last days of life: A...

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.

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.

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.

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.