Nurse intervention process for the thoughts and concerns of people with cancer at the end of their life: A structural equation modeling approach

Abstract

Over the last decade, the importance of Advanced Care Planning has been recognized in Japan. However, it is still difficult for healthcare providers and patients to verbalize how they want to spend the last days of their lives and what unfinished business they have left to accomplish. This study aimed to clarify how nurses intervened to assist patients with cancer at the end of life to express their thoughts and concerns. Twenty-four nurses were interviewed regarding how they intervened for patients' thoughts and concerns, and data were analyzed qualitatively using a modified grounded theory approach. A 25-item scale was selected, and the questionnaires, which included the scale, were distributed to nurses in general wards, palliative care units, and home visiting nurse services. A total of 1864 responses were analyzed. Factor analysis and structural equation model analysis were used, and three factors were identified: "assessment and intervention," "basic care," and "knowledge and communication," which led to the formulation of an intervention structure model for uncovering thoughts and concerns. These results indicate the importance of basic care and communication during interventions for patients.cancer, end-of-life care, nursing, terminal care, thoughts and concerns, unfinished business Key points• Three factors were identified for nurses' interventions that reveal unexpressed thoughts and concerns of people with cancer at the end of life. These were "basic care," "assessment and intervention," and "knowledge and communication".• The strength of the relationship among the three factors was identical for general wards, palliative care wards, and home visiting nurse services.• Basic care, communication, and knowledge are pivotal in nurses' ability to intervene therapeutically for patients' thoughts and concerns at the end of life. | INTRODUCTIONIn recent years, advance care planning (ACP) has become more widespread for people with cancer and others toward the end of life (EOL).ACP is defined as "a process that supports adults at any age or stage of health in understanding and sharing their values, life goals, and preferences regarding future medical care" (Sudore et al., 2017, p. 826). In addition, it facilitates autonomy, ensuring that patients