Hospice Research Articles

The Impact of Hospice Care on the Prognosis, Quality of Life, and Emotional Well-being of Patients With Chronic Heart Failure.

Chronic heart failure (CHF) represents a substantial public health challenge, impacting patients' emotional well-being, quality of life, and overall prognosis. Palliative care and hospice services are increasingly recognized in managing advanced CHF, yet their evidence-based benefits remain underexplored. This study aimed to assess the influence of hospice care on CHF patient outcomes. A total of 120 inpatients with CHF were randomly assigned to receive either hospice care in addition to standard treatment (experimental group) or standard care alone (control group). Patient assessments included heart function classification, activities of daily living, Minnesota Living With Heart Failure Questionnaire, anxiety scale, and pain assessment. Results demonstrated significant improvements in cardiac function, activities of daily living, anxiety levels, pain scores, and heart failure-related quality of life in the experimental group compared with controls. Reduced anxiety, enhanced emotional well-being, and overall health status improvements were particularly notable postintervention. Hospice care was associated with enhanced functional abilities, emotional well-being, pain management, and overall quality of life for CHF patients. In conclusion, this study underscores hospice care's positive impact on prognosis, quality of life, and emotional well-being in CHF, emphasizing its potential as a critical component in comprehensive CHF management strategies.

Effects of Inpatient Hospice Care on Cost and Medication Use in Patients with Lung Cancer: A Population-Based Retrospective Study in South Korea.

Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. Methods: Using the South Korean national health insurance claim database, we identified 31,139 patients with lung cancer who died between 2017 and 2020. Their daily hospitalization costs were analyzed using a generalized linear model stratified by time of first hospitalization before death. Medication use was examined using a negative binomial model. Results: IHs spent $134, and $21 less on patients during days 1-7, and 8-30 before death, but $18, $44, $36, and $54 more during days 31-60, 61-90, and 91-180, respectively, compared with non-IHs (all p < 0.05). However, total hospitalization costs in the year preceding death did not differ (relative risk: 0.990, 95% confidence interval [CI]: 0.972-1.007, p > 0.05). IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.

‘O le toe Fa’amoemoe ‘o le ‘Aiga - A Family’s Last Hope

Introduction: In general, populations worldwide are aging with non-communicable diseases more likely to affect the elderly; and this group is prone to suffer from more than one chronic condition often resulting in complex clinical and psychosocial situations. As a result, the need for hospice and palliative care services will increase. However, Pacific people prefer to be cared for at home by their family, and they are therefore less likely to access and use hospice and palliative care services. There is limited evidence as to why there is less use of hospice and palliative care services, and there is a gap in strategies aimed at improving access within a Pacific context. This aligns with a poor understanding of the availability of health services more generally within a Pacific context. This research explores the understanding of these services by Samoan female family caregivers who cared for an elderly relative diagnosed with a life limiting condition, in Auckland, New Zealand. Methods: Qualitative methodology was used, and was underpinned by two approaches: Talanoa, and Constructivist Grounded Theory. Participants were interviewed and the data was subjected to thematic analysis. Results: Findings from the research acknowledge the importance of understanding cultural beliefs and values, and the relationship between these and the understanding and utilization of, hospice and palliative care services. Conclusion: Several opportunities are identified to enhance engagement by Samoan families with these services.

The Effects of Symptom Distress and Depression on Quality of Life in Patients With Terminal Cancer: The Mediating Role of Meaning in Life and Spiritual Well-being.

Terminal cancer patients experience worsening physical symptoms, psychological challenges, and spiritual difficulties. Improving the quality of life (QOL) and reconstructing the meaning of life (MIL) for these patients ensure a dignified end-of-life experience. Spiritual well-being is necessary to promote effective end-of-life coping strategies. This study aimed to construct and verify the suitability of a model that explains the impact of physical and psychological factors on the QOL of patients with terminal cancer using MIL and spiritual well-being as mediating factors. The participants were patients with terminal cancer 25 years or older hospitalized in 40 nationally designated hospices. A total of 172 patients were included in the final analysis. Data analysis was performed using structural equation modeling. In the effect analysis of the final model, the variables affecting QOL were depression (β = -.62, P < .001), symptom distress (β = -.33, P = .001), and spiritual well-being (β = .36, P = .002), and a significant indirect effect of MIL was found in the depression-MIL-spiritual well-being and depression-MIL-QOL paths. Spiritual interventions that help people find their MIL can serve as an important component of optimal hospice and palliative care for patients with terminal cancer. In clinical practice, interventions that increase the MIL and spiritual well-being of patients with terminal cancer are needed. Additionally, the practice will see other benefits including enhanced patient care, psychological support, effective treatment planning, family caregiver support, and further research advancement.

Protocol of a nation-wide post-bereavement survey on quality of hospice and palliative care: J-HOPE 5 study

BackgroundMaintaining quality of care and improving the quality of life (QOL) of patients and their families are important issues in palliative care. Therefore, there is a need to continuously evaluate the quality and outcomes of the care provided. In Japan, the Japan hospice and palliative evaluation (J-HOPE) study series has been conducted every three to four years since 2010, and we will conduct the fifth J-HOPE study (J-HOPE5). In the present paper, we describe the protocol of the J-HOPE5 study. The main objectives are: (1) to evaluate the processes, structures and outcomes of care at hospices or palliative care units; (2) to examine bereaved family members’ self-reported psychosocial condition, such as grief and depression as bereavement outcomes; (3) to provide data to ensure and improve the quality of care provided by participating institutions via feedback based on the results from each institution; and (4) to provide clinical and academic information regarding the implications of various issues in palliative care by conducting specific research.MethodsWe will conduct a cross-sectional, anonymous, self-reported questionnaire survey. In total, 153 institutions have agreed to participate in this study, meaning that approximately 12,240 bereaved family members (n = 80/institution) will be sent a questionnaire.DiscussionThis is one of the largest cross-sectional bereavement surveys to evaluate the quality of specialized palliative care for patients with cancer, both in Japan and worldwide. The large sample size of this study will enable wide analyses of specific targets and topics.

The mediating role of professional identity between work environment and caring behavior: a cross-sectional survey among hospice nurses in China

BackgroundAs core members of hospice care team, the hospice nurses’ ability to care for patients not only directly affects the standard of patient care, but also significantly impacts patient quality of life. It can be seen that it is very meaningful for patients to improve the caring behavior of hospice nurses. Therefore, it is necessary to deeply explore the influencing factors of nurses’ caring behavior and further clarify the mechanism between them.MethodsThe STROBE guideline was performed to report this study. We conducted a cross-sectional survey from December 2023 to February 2024. In this study, 392 hospice nurses were recruited from tertiary public hospitals in East China by convenient sampling method. Participants were investigated using the Practice Environment Scale, Professional Identity Scale, and Caring Behaviors Inventory. Structural equation modelling was utilized to verify the research hypotheses.ResultsThe results revealed that there were significant and positive correlations between work environment, professional identity and caring behavior. Furthermore, professional identity partially mediated the relationship between work environment and caring behavior.ConclusionWork environment is critical to improving hospice nurses’ caring behavior. Professional identity plays an intermediary role impacting how work environment promotes caring behavior among Chinese hospice nurses. Nursing managers should have a correct understanding of the relationship between them. Targeted measures and coping strategies need to be actively taken to create a better working environment for hospice nurses. This would enhance professional identity, and thereby promote caring behavior.

Terminal Care Performance of Nurses Caring for COVID-19 Patients: A Cross-Sectional Descriptive Study.

To identify the effects of moral distress and terminal care stress on the terminal care performance of nurses who cared for COVID-19 patients. This study was cross-sectional descriptive research. Using a convenience sampling method from June to October 2022, nurses who provided terminal care for COVID-19 patients in a Korean tertiary hospital within the last 6 months from the time of the study were selected as participants. Socio-demographic and work characteristics of the participants were collected, and COVID-19 moral distress, terminal care stress and terminal care performance were assessed. A total of 140 self-report questionnaires were distributed and returned (response rate: 100%). In the terminal care performance, it was found that nurses performed relatively well in the physical area, but less well in the emotional and spiritual areas. Moral distress and terminal care stress were both positively correlated with terminal care performance for nurses who cared for COVID-19 patients. The predictors of terminal care performance were moral distress (β = 0.27, p = 0.003), gender (β = 0.20, p = 0.015) and experience in a dedicated COVID-19 unit (β = 0.22, p = 0.020). The study identified moral distress as the most significant factor influencing terminal care performance among nurses caring for COVID-19 patients. To enhance terminal care performance, it is crucial to address moral distress and provide clear guidelines and support, especially in the emotional and spiritual care domains. Future research should explore additional factors that may influence terminal care performance in pandemic situations. No patient or public contribution.

How do work in oncology unit nurses experience hospice care provision in China? A descriptive phenomenological study

ObjectivesTo explore the experiences and perceptions of oncology nurses providing hospice care in Chinese mainland.MethodsA descriptive phenomenological research method was utilized to describe experience of hospice care among oncology nurses. Eighteen oncology nurses were selected for interviews using purposive sampling from four grade A tertiary hospitals in Wuhan, Hubei province, China. The face-to-face semi-structured interviews were used to collect data. Data were recorded using NVivo 12.0 and analyzed using the Colaizzi’s 7-step phenomenological data analysis method.ResultsThe interview data generated five major themes: (1) end-of-life care for oncology patients, (2) support and care for family members, (3) self-limitation and psychological distress, (4) culture and external environment constraints, and (5) self-coping and gains.ConclusionsIn Chinese mainland, oncology nurses encountered barriers and negative emotions in conducting hospice care, but have also made strides in the promotion of hospice care. In the future, the use of different traditional Chinese medicine technology to facilitate symptom management in end-of-life patients should be explored, and more tools to assist in providing psychological care and communication should be developed.

Medicare’s comprehensive care for joint replacement model increased public hospitals' inpatient length of stay

BackgroundThe Comprehensive Care for Joint Replacement (CJR) model is an alternative Medicare payment model for joint replacement that mandated participation by hospitals in randomly selected Metropolitan Statistical Areas (MSAs). On average, the program decreased inpatient length of stay and increased home discharge rates. It is unclear if these effects differed based on hospital ownership type, even though ownership may impact care redesign opportunities.MethodsWe used the 2014–2017 California Patient Discharge Datasets. The study included 113,590 hospitalizations for hip and knee joint replacement from 287 hospitals in the treated and control MSAs in California. The primary outcomes were inpatient length of stay and home discharge rates. Home discharge status included self-care, the use of home health, and hospice care at home. To determine whether the impact of the CJR model differed by hospital ownership type, we used event study, difference-in-differences (DID), and triple differences (DDD) models to estimate changes in health care services utilization in treated relative to control areas before versus after CJR implementation (April 2016) by hospital ownership type.ResultsOf the 113,590 hospitalizations, 51,708 (45.52%) were in treated MSAs and 61,882 (54.48%) were in control MSAs; 81,649 (71.88%) were from nonprofit hospitals, 20,247 (17.82%) were from for-profit hospitals, and 11,694 (10.29%) were from government-owned hospitals. DID analyses showed that after policy implementation, nonprofit and for-profit hospitals experienced a decrease in inpatient length of stay of 0.02 days (95% CI, -0.04 to -0.01) and 0.04 days (95% CI, -0.06 to -0.01), respectively, while government-owned hospitals experienced an increase by 0.11 days (95% CI, 0.04 to 0.18). For home discharge rates, nonprofit hospitals experienced an increase of 0.02 (95% CI, 0.01 to 0.03), while other hospitals did not show statistically significant changes. DDD analyses confirmed that inpatient length of stay increased in public compared to nonprofit hospitals in treated relative to control MSAs after policy implementation.ConclusionsThe impacts of the CJR program differed by hospital ownership type. Government-owned hospitals, with their unique financial circumstances, may have faced challenges that hindered the reductions in inpatient length of stay observed in other types of hospitals under the CJR Model.

Using Collective Intelligence to Develop Design Requirements for a Complex Intervention for Advance Care Planning in the Community.

Engaging people in advance care planning is a challenging systemic problem that requires a social innovation approach and a conceptual framework to guide behavioural and social change efforts. To identify stakeholders' perspectives on barriers to advance care planning engagement, options for overcoming these barriers, and user needs. The findings will inform the design of a health behaviour change intervention for engaging older adults (50+) in advance care planning. To advance co-production and intervention design goals, the study used collective intelligence and scenario-based design methods. Following a systematic stakeholder analysis, 22 participants were recruited to three online collective intelligence sessions. The socioecological perspective informed framing of integrated findings and specifying factors at the individual, interpersonal, service, and system levels. Identified barriers (n = 109) were grouped into seven categories: (i) Psychological, (ii) Advance Care Planning Literacy, (iii) Interpersonal and Interprofessional, (iv) Service-Related, (v) Resources and Supports, (vi) Advance Care Planning Process and Methods, (vii) Cultural and Societal. Stakeholders generated 222 options for overcoming these barriers and specified 230 service user needs. The need to change perceptions of advance care planning, increase psychological readiness, and target advance care planning literacy was highlighted (individual-level). Timely, focused, and meaningful interaction between the key ACP actors must be facilitated using creative strategies (interpersonal-level). Need- and value-based services, including high quality resources, support systems, and infrastructure, should be co-designed (service-level). Cultural and societal transformation is required (system-level). Findings integration offered insight into the complexity of the design context and problem situation and identified directions for context-specific advance care planning intervention development. The use of design thinking methodologies is recommended for the next phase of complex intervention development. The study presents a roadmap of actions required from policy-makers, practitioners, and researchers to ensure the design of adequate advance care planning interventions. Quality of reporting was assured by adherence to Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines (International Journal for Quality in Health Care, 19, 2007, 349). Patient and public representatives participated in the collective intelligence sessions. Members of the All Ireland Institute of Hospice and Palliative Care Voices4Care facilitated that process. Findings from the first CI session (involving patients and caregivers) informed the content, format, and methods used in subsequent CI sessions.

Evaluation of Equity in Hospice Care Utilization Among Medicare-Enrolled Autistic Older Adults

Evaluation of Equity in Hospice Care Utilization Among Medicare-Enrolled Autistic Older Adults

The Association Between Psychological Resilience and Spiritual Well-Being Among Family Caregivers of Terminally Ill Cancer Patients: A Multicenter Cross-Sectional Study.

Purpose: This study was undertaken to determine the nature of the relationship between psychological resilience and spiritual well-being (SWB) among family caregivers (FCs) of patients with terminal cancer. Methods: This multicenter cross-sectional study included 173 FCs from nine inpatient hospice care units. SWB was assessed using the Functional Assessment of Chronic Illness Therapy-Spiritual well-being questionnaire, and various psychosocial variables, including psychological resilience, were also measured. Factors associated with SWB were identified by multivariate regression analysis adjusted for potential covariates. Results: Various factors were found to be associated with the SWB of FCs as determined by total FACIT-Sp-12 scores and the scores of its three domains. FC resilience was significantly associated with SWB as determined by total FACIT-Sp-12 scores and scores of the meaning and peace domains. Conclusion: Assessing FC psychological resilience would help palliative care providers improve their SWB.

Robert Geoffrey Twycross: palliative care physician, pioneer of the modern hospice movement, and staunch opponent of assisted dying

Robert Geoffrey Twycross: palliative care physician, pioneer of the modern hospice movement, and staunch opponent of assisted dying

Adrenal Cortical Carcinoma Presenting as CSCR.

We describe a case of bilateral chronic central serous chorioretinopathy (CSCR) secondary to adrenal cortical carcinoma. Case report of a 70-year-old Hispanic man presenting with bilateral multifocal CSCR. Clinical findings of bilateral chronic CSCR along with 160 µm of subretinal fluid (SRF) and choroidal thickness greater than 400 µm without enhanced depth optical coherence tomography was noted in a patient presenting with distortion in vision in both eyes and weight gain of 15 pounds, weakness, and fatigue starting 8 months prior. Further endocrine testing showed an elevated 24-hour urinary free cortisol level of 137 µg with no change in serum cortisol levels following low-dose dexamethasone suppression test and undetectable serum adrenocorticotropic hormone (ACTH) levels consistent with ACTH-independent Cushing's syndrome. Imaging of the abdomen revealed heterogeneously enhancing masses, and biopsy of the adrenal tumor led to the diagnosis of adrenal cortical carcinoma. He died 3 weeks after starting hospice care, and only completed one round of chemotherapy. Adrenal tumors including adrenal cortical carcinoma may present as bilateral chronic central serous chorioretinopathy.

Factors influencing demand and acceptance of hospice care among Chinese older adults: A meta-analysis

ABSTRACT This study aimed to systematically integrate existing research findings on relevant factors influencing Chinese older adults to choose hospice care, thus providing targeted theoretical support and a basis for the promotion of hospice care services in China. The literature on factors affecting the older adults’ choice of hospice care services were retrieved from nine databases, including PubMed, Embase, Web of Science, The Cochrane Library, CNKI, Wanfang Data, VIP, CBM, and SinoMed. The data were extracted and analyzed using Revman5.3 and Stata17.0. A total of 11 articles are incorporated, and 13 related factors are extracted. The meta-analysis results show that the demand and acceptance of hospice care services in the older adults are related to age (RR = 1.39, 95% CI (1.17,1.65), p = 0.0002), education level (RR = 1.94, 95% CI (1.42,2.63), p < 0.001), marital status (RR = 1.21, 95% CI (1.05,1.40), P = 0.007), death attitude (RR = 1.21, 95% CI (1.53,9.45), p = 0.004), having experienced or witnessed emergency treatment (RR = 2.07, 95% CI (1.51,2.85), p < 0.001), and living condition (RR = 1.32, 95% CI (1.00,1.73), P = 0.05). The elders who are at an advanced age, well educated, unmarried in solitude, and have experienced or witnessed emergency treatment have a high demand and acceptance of hospice care services

Capacity Planning in Paediatric Palliative and Hospice Care: An Italian Case

Although the growing demand for healthcare services has enhanced the occurrence of inefficiencies in care provision, healthcare systems should ensure safe, timely and equitable access to care. In particular, the long waiting lists, the lack of beds, and the shortage of healthcare workforce have highlighted the necessity to effectively manage and strategically plan the available resources. Capacity Planning (CP) contributes to determine what, when, where and how much product or service to deliver, with the goal of analysing and optimizing the use and allocation of human and material resources (e.g., physical spaces, equipment, beds, workforce) based on the demand. CP demonstrates to be extremely relevant for hospital units to schedule appointments, diagnostics, surgeries and admissions. Complex contexts and broader healthcare networks could benefit even more from this approach, helping to coordinate multiple care providers and aligning the available resources with the demand pace. The current research presents the implementation of CP in the context of Paediatric Palliative and Hospice Care (PPHC), delivered in an Italian facility. PPHC provides long-term, interdisciplinary and coordinated care between territorial, ambulatory and hospice services. It encompasses follow-up activities, parental training, end-of-life and respite care. In the Italian case analysed, the shortage of beds affects the quality of care delivered to these patients, in terms of accessibility to the service, effectiveness and timeliness of care. Hence, a CP analysis has been performed to pursue a twofold objective: a) to understand if the current capacity of the facility meets the demand for care; b) to improve productivity through an optimized allocation of resources, particularly the available beds and the healthcare workforce. The expected results involve a more effective use of resources, an increased bed occupancy rate and a reduction in rescheduled admissions due to inadequate planning. Optimizing capacity in this specific setting can serve as a pilot project for other similar contexts, aiming to improve patients’ access to healthcare services, their quality of life and supporting the workforce involved in PPHC. This research offers new insights from both the academic and managerial point of view, providing evidence about the implementation of CP in complex healthcare settings.

Certified Child Life Specialists in Hospice and Palliative Care Organizations: A State of the Profession.

Certified Child Life Specialists (CCLSs) provide developmentally appropriate psychosocial care to children to promote positive coping. However, little is known about the current professional landscape and opportunities for professional growth, especially in hospice and palliative care. To conduct a needs assessment among CCLS and examine the role in hospice and palliative care. CCLSs were surveyed on their experience and needs in providing care in hospice and palliative care organizations. The online survey contained questions about demographics and work environment. The survey included multiple choice, yes/no, and open-ended questions. Descriptive statistics were generated from the survey items and comments/open-ended questions were coded and assessed for themes. Among the 191 respondents, most were females (96.3%), under 40 years of age (63.8%), Caucasian (87.4%), and non-Hispanic (95.3%) with under 12 years of full-time work experience (57.0%). CCLSs commonly worked in urban/suburban (67.5%) pediatric programs (62.3%) with clients ranging from perinatal (33.5%) to adult caregivers of children (60.2%). Themes from the open-ended questions were: (a) role clarification, (b) staffing, (c) funding, (d) training/education, (e) professionality, and (f) self-care. Key insights into the profession, along with challenges and opportunities of working within the hospice and palliative care setting were identified. The findings highlighted the unique need for professional development among CCLSs.

The Influence of Spiritual Well-being on the Quality of Life of Cancer patients in Palliative care, Chennai.

Cancer has become a big threat to India as it has been estimated to have a mortality rate of 0.3 million deaths per day, also there have been recorded 80.6000 existing cases of Cancer patients by the end of the last century. This study is about the influences of spirituality on the quality of life of cancer patients in palliative care. The study was conducted in RMD palliative care and Jeevodaya hospice. All the institutions work with cancer patients who are in their end stage. The researcher used semi- semi-structured interview schedule consisting of Two scales formulated by the European Organization for Research and Treatment of Cancer. The scales were EORTC QLQ- C30 and EORTC QLQ-SWB32. The collected data is analyzed using SPSS software. Pearson’s correlation is done to find the relation between spiritual well-being and the Quality of Life of patients. It is found that spiritual well-being has a weak influence on the quality of life. In the Indian context, the patients relate spirituality only to their religious faith and hope. They don’t realize how to find meaning in their lives. All the questions answered were about religion, faith, and belief. They live without undergoing much pain, therefore they think their quality of life is good. According to them, pain determines their quality of life. Enhancing their bodily symptoms will not result in a good quality of life. Quality of life is achieved through holistic care. They measure their quality of life in the context of physical well-being and spirituality in the context of religion, due to which the perceived spirituality is different from the actual spirituality.

Facility- and community-level factors associated with hospice patient experience.

Mandated by the Affordable Care Act of 2010, hospices were required to provide information regarding the Hospice Quality Reporting Program, with a reduced reimbursement tied to hospices if they fail to submit data to the Centers for Medicare and Medicaid Services. The purpose of this study was to examine the association between hospice organizational and community factors and quality of hospice care as measured by patient experience through Hospice Consumer Assessment of Healthcare Providers & Systems (CAHPS®) survey. We used secondary data from Hospice Compare, Healthcare Cost Report Information System Dataset, Rural-urban commuting area codes, and the American Community Survey to examine the relationship between hospice patient/family experience and hospice organizational-level and community-level factors for the period 2017-2020. The unit of analysis was hospice-year observations. For-profit and chain-affiliated hospices were negatively associated with CAHPS® scores. Organizational longevity and Medicare payer mix were positively associated with CAHPS® scores. Hospice community factors including competition, per capita income, and the racial/ethnic minorities' percentage were negatively associated with CAHPS® scores. Hospice organizational and community factors were related to hospice quality of care. Interventions that account for organizational and community factors may be needed to improve patient/family experience of hospice care.

The Experience of Reflexive Hospice Care for Patients With Advanced Cancer: A Qualitative Study.

Hospice care for patients with advanced cancer mainly takes the family members and healthcare professionals as the main body and the patients as the object. There is a lack of relevant research on reflexive hospice care that considers patients as subjects. To explore the experience of reflexive hospice care for patients with advanced cancer. An empirical phenomenological approach to research was conducted. Data were collected using face-to-face semi-structured interviews between April 3, 2024 and May 27, 2024 in the oncology wards of two comprehensive hospitals. Purposive sampling was used to recruit 18 patients with advanced cancer receiving hospice care. Colaizzi's phenomenological analysis method was used to analyse the data. We followed the consolidated criteria for reporting qualitative research (COREQ). Four themes were identified as being relevant to the experience of reflexive hospice care for patients with advanced cancer: the absence of prior awareness, reconciling with self and others, care and concern for others, and pursuing the meaning of life. This study provides new insights into hospice care for patients with advanced cancer. It emphasises the importance of patients' participation as subjects in hospice care. In reflexive hospice care, patients can actively participate and express their care for others and their understanding of life, thus gaining more respect and care in the end-of-life stage. Therefore, placing patients as the subjects of hospice care and fully respecting and listening to their wishes and needs is one of the most important ways to promote the development of hospice care quality. No patient or public contribution.