end-stage cancer patients
Conditions
Interventions
Observational group:None
Sponsors
The Fifth Affiliated Hospital of Sun Yat-sen University
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Inclusion criteria
Inclusion criteria: 1. Family member qualitative interview:(1) Family members aged >=18 years, who are the primary decision-makers for the patient (e.g., spouse, children, etc.) and have personally participated in medical decision-making related to the current hospitalization; (2) Patients aged >=18 years with a clinical diagnosis of advanced or metastatic malignant tumor, and with an estimated survival of =24 hours during the current hospitalization and receiving at least one life-sustaining treatment (LST), such as endotracheal intubation/invasive or non-invasive ventilation, vasoactive drugs, CRRT/dialysis, ECMO, CPR, etc.; (4) Clear documentation of a shift in treatment goals in medical records/physician orders (e.g., "palliative care only," "no further resuscitation," DNR, DNI, "no escalation of treatment"), followed by corresponding changes in management (e.g., extubation, discontinuation or no escalation of LST, transfer to general ward or hospice ward); (5) Family members with good communication and cognitive ability who can complete interviews in Chinese; (6) Voluntary participation and signed informed consent. 2. Qualitative Interviews with Physicians: Inclusion Criteria: (1) Possess a medical practitioner qualification and currently working as an active clinician; (2) >=1 year of clinical work experience; (3) From relevant departments such as Oncology, ICU, Respiratory Medicine, Cardiology, and Geriatrics; (4) Have consulted end-of-life patients and participated in treatment decision-making within the past 6 months; (5) Voluntarily participate and sign the informed consent form; 3. Case Analysis: Inclusion Criteria: (1) Age >=18 years; (2) Advanced or metastatic malignancy; (3) Admitted to the ICU during the current hospitalization and received >=1 form of life-sustaining treatment (LST) (e.g., intubation/mechanical ventilation, vasoactive medications, CRRT/dialysis, ECMO, CPR); (4) Medical records/orders clearly document a shift in treatment goals (e.g., "palliative-only care," "do not resuscitate (DNR)," "do not intubate (DNI)," "no further escalation of treatment"); (5) Appropriate management actions followed the goal shift (e.g., extubation, discontinuation of LST, no further escalation of care, transfer to general ward/hospice, or discharge for home-based palliation).
Exclusion criteria
Exclusion criteria: 1. Family Member Qualitative Interviews: (Exclusion if any one criterion applies): (1) Experiencing acute grief or obvious psychological crisis at the time of interview, deemed unsuitable for participation by the research team or clinical assessment; (2) Not the primary decision-maker or insufficiently informed about the key decision-making process; (3) Presence of severe cognitive impairment, mental disorder, or language communication barrier preventing completion of the interview; (4) Involved in ongoing medical disputes or legal litigation that makes participation inadvisable. 2. Physician Qualitative Interviews: (1) Did not directly participate in end-of-life decision-making or are not frontline clinicians; (2) Refused audio recording or was unable to complete the interview; (3) Recently participated in a study on the same topic. 3. Case Analysis: (1) No definitive diagnosis of advanced cancer; (2) Critical medical records missing, making it impossible to confirm whether a shift in treatment goals or corresponding management occurred; (3) Emergency department visits only with no hospital admission (e.g., not aligned with the study scope).
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Key influencing factors for the decision to transfer end-of-life cancer patients from ICU to general ward after withdrawal of ICU treatment; | — |
Secondary
| Measure | Time frame |
|---|---|
| Influencing factors and support needs for the decision to transfer end-of-life cancer patients from ICU to general ward after withdrawal of ICU treatment; | — |
Countries
China
Contacts
Public ContactZeng Dongyan
The Fifth Affiliated Hospital of Sun Yat-sen University
Outcome results
None listed