Abstract:

Objective To develop a nursing practice program for early intervention in end-of-life discussions with advanced cancer patients. Methods A literature review was conducted to extract relevant content from four evidence summaries，eight clinical practice guidelines，and four systematic reviews. Combined with interview results from eight nurses，an initial draft of a nursing practice plan for early intervention in end-of-life discussions with advanced cancer patients was developed. The protocol was refined through two rounds of experts consultation using the Delphi method. Results The effective response rate for both rounds of the Delphi survey was 100%；the Kendall’s coefficient of concordance was 0.194 and 0.291，respectively，and the expert authority coefficient was 0.92. The final nursing practice program for early intervention in end-of-life discussion with advanced cancer patients includes 16 recommended topics：timing of the initial discussion，basic principles and objectives of the discussion，developing a discussion plan，communication attitudes and methods，communication skills and strategies，optimal participants for discussion，required professional skills for participants，discussion of physical symptoms，discussion of psychological emotions，discussion of social support，spiritual care discussion，care goals discussion，Chinese traditional culture in end-of-life discussion，timing for re-discussion，communication strategies for conflicting goals，and evaluation indicators for the discussion. Conclusion The nursing practice program developed in this study is rigorously constructed，with well-defined and practical themes that are suitable for guiding end-of-life discussions with patients in advanced-stage cancer.

Key words: Nurses, Cancer patients, Delphi Technique, End-of-life, Practice program