Hospice Care Unit Research Articles

Exploring unmet concerns in home hospice cancer care: Perspectives of patients, informal caregivers, palliative care providers, and family physicians.

The study examines perspectives of patients in home hospice care; their informal caregivers; palliative health-care providers (HCPs); and family physicians, all regarding patients' unmet needs and quality of life (QoL)-related concerns. Participants from all 4 groups were approached within 2 months after the patient's admission to the home hospice care unit. Participants completed Edmonton Symptom Assessment Scale (ESAS) and Measure Yourself Concerns and Wellbeing (MYCAW) questionnaires, for patient's QoL-related concerns. Qualitative analysis of short narratives was conducted using ATLAS.ti software for systematic coding. In total, 78 participants completed the study questionnaires: 24 patients, 22 informal caregivers, 22 palliative HCPs, and 11 family physicians. Informal caregivers gave higher scores (i.e., greater severity) than patients for fatigue on ESAS (p = 0.009); and family physicians lower scores than patients for ESAS drowsiness (p = 0.046). Compared with patients, palliative HCPs gave higher scores for patient emotional-spiritual concerns (77.2% vs. 41.7%, p = 0.02); lower scores for gastrointestinal concerns (p = 0.048); and higher scores for overall function (p = 0.049). Qualitative assessment identified a gap between how patients/informal caregivers vs. palliative HCPs/family physicians regard emotional-spiritual themes, including discussing issues related to death and dying. The findings of the present study suggest that exploring a multifaceted cohort of home hospice patients, informal caregivers, palliative HCPs, and family physicians may provide insight on how to reduce communication gaps and address unmet needs of patients, particularly regarding emotional and spiritual concerns. While the 4 groups were similar in their scoring of patient QoL-related concerns, there were discrepancies for some concerns (e.g., patient fatigue) and expectations regarding the need to discuss emotional and spiritual concerns, including on death and dying. Educational initiatives with programs providing training to all 4 groups may help bridge this gap, creating a more open and collaborative hospice care environment.

Профілактика професійного вигорання медичних сестер при наданні паліативної і хоспісної допомоги

The risk of burnout syndrome ranks one of the leading places among nurses, especially at the primary care level and in palliative and hospice care units. In the article are reflected results of the study of emotional resources, «organizational precursors of burnout», also are discussed clinical manifestations and methods of prevention of professional burnout syndrome in nurses. As a part of the educational process for the prevention of this condition, the primary task is to train students and medical personnel, help in organizing work in specific institutions in order to carry out preventive or corrective measures. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Deep-Learning Approach to Predict Survival Outcomes Using Wearable Actigraphy Device Among End-Stage Cancer Patients.

Survival prediction is highly valued in end-of-life care clinical practice, and patient performance status evaluation stands as a predominant component in survival prognostication. While current performance status evaluation tools are limited to their subjective nature, the advent of wearable technology enables continual recordings of patients' activity and has the potential to measure performance status objectively. We hypothesize that wristband actigraphy monitoring devices can predict in-hospital death of end-stage cancer patients during the time of their hospital admissions. The objective of this study was to train and validate a long short-term memory (LSTM) deep-learning prediction model based on activity data of wearable actigraphy devices. The study recruited 60 end-stage cancer patients in a hospice care unit, with 28 deaths and 32 discharged in stable condition at the end of their hospital stay. The standard Karnofsky Performance Status score had an overall prognostic accuracy of 0.83. The LSTM prediction model based on patients' continual actigraphy monitoring had an overall prognostic accuracy of 0.83. Furthermore, the model performance improved with longer input data length up to 48 h. In conclusion, our research suggests the potential feasibility of wristband actigraphy to predict end-of-life admission outcomes in palliative care for end-stage cancer patients.Clinical Trial Registration: The study protocol was registered on ClinicalTrials.gov (ID: NCT04883879).

Characteristics Associated with Survival in Patients Receiving Continuous Deep Sedation in a Hospice Care Unit.

Continuous deep sedation (CDS) is an extreme form of palliative sedation to relieve refractory symptoms at the end of life. In this study, we shared our experiences with CDS and examined the clinical characteristics associated with survival in patients with terminal cancer who received CDS. We conducted a chart audit of 106 consecutive patients with terminal cancer who received CDS at a single hospice care unit between January 2014 and December 2016. Survival was defined as the first day of admission to the date of death. The associations between clinical characteristics and survival were presented as hazard ratios and 95% confidence intervals using a Cox proportional hazard model. The mean age of participants was 65.2 years, and 33.0% (n=35) were women. Diazepam was the most commonly administered drug, and haloperidol or lorazepam were also used if needed. One sedative was enough for a majority of the patients. Stepwise multivariate analysis identified poor functioning, a high Palliative Prognostic Index score, hyperbilirubinemia, high serum ferritin levels, and a low number of sedatives as independent poor prognostic factors. Our experiences and findings are expected to be helpful for shared decision-making and further research on palliative sedation.

Factors of Hospitals Associated With an Independent Hospice Care Unit: A Quantitative Empirical Study.

Few studies have examined why some hospitals operate independent hospice units (IHUs) and others do not. This study aims to investigate the organizational factors of hospitals having IHU. The units of analysis were individual hospitals. The study had a cross-sectional design and used health insurance claims data of 349 hospitals in Korea from January 1 to December 31, 2019. The dependent variable was whether a hospital operated an IHU. The independent variables were the percentage of patients with cancer, overall severity of patients, percentage of patients 60 years and older, health care cost per patient, percentage of inpatients, and nurse staffing level. Independent hospice units were present at 21.2% of the hospitals (74/349). The odds of having an IHU were significantly associated with the following factors: the percentage of patients with cancer (odds ratio [OR], 1.228; 95% confidence interval [CI], 1.071-1.408; P = .003), disease severity (OR, 5.129; 95% CI, 2.477-10.622; P < .001), percentage of patients 60 years and older (OR, 1.053; 95% CI, 1.015-1.092; P = .006), health care cost per patient (OR, 1.018; 95% CI, 1.009-1.027; P < .001), and nurse staffing level (OR, 0.439; 95% CI, 0.292-0.661; P < .001). The organizational factors of hospitals operating IHUs were similar to those of hospice facilities.

Moderating Effect of Nurse's Character on the Relationship between Attitudes toward Nursing Care of the Dying and Performance of Terminal Care in South Korea.

This study aimed to investigate the moderating effect of nurses’ characteristics on the relationship between attitudes toward nursing care and terminal care performance of hospice nurses. The participants included nurses working in hospice care units in general hospitals in South Korea. Data collected from August 1 to 31, 2020 were analyzed using t-test, ANOVA, Pearson′s correlation coefficients, and hierarchical multiple regression. The performance of terminal care was positively correlated with attitudes toward nursing care of the dying (r = 0.45, p < 0.001) and nurses’ characteristics (r = 0.60, p < 0.001). There was also a positive correlation (r = 0.58, p < 0.001) between attitudes toward nursing care for dying patients and nurses′ characteristics. Nurses’ characteristics had a significant moderating effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care. This means that the nurses’ character had a buffering effect on the relationship between attitudes toward nursing care of the dying and performance of terminal care in hospice care units. These findings suggest that continuous and repetitive educational programs on terminal care need to be enhanced, and strategies to strengthen attitudes toward nursing care of the dying and nurses’ character need to be included in these programs.

Delirium-Related Knowledge, Caregiving Performance, Stress Levels, and Mental Health of Family Caregivers of Terminal Cancer Patients with Delirium in a Hospice Care Unit.

The purpose of this study was to examine the knowledge, caregiving performance, stress levels, and mental health of family caregivers of terminal cancer patients with delirium, insofar as these characteristics are relevant for delirium. Between May 1, 2019, and June 1, 2020, 96 family caregivers of terminal cancer patients with delirium completed a structured survey, the results of which were analyzed. The average correct answer rate for delirium-related knowledge was 53.2% across all subcategories, which included knowledge of causes (41.5%), symptoms (65.4%), and caregiving (51.7%). The average score for family caregivers' performance of caregiving for delirium was 2.60±0.5, with subcategories including caregiving for patients without delirium (2.16±0.95), caregiving for patients with delirium (2.84±1.01), and stress related to caregiving for delirium (39.88±16.55), as well as categories such as patient-related caregiving (44.32±28.98), duty-related caregiving (44.21±30.15), and interpersonal relationship-related caregiving (22.35±25.03). For mental health, the average score among family caregivers was 1.96±0.70, with the highest score being for the category of additional items (2.28±0.84). Family caregivers of patients with hyperactive delirium as the delirium subtype had higher scores for caregiving performance than caregivers of patients with mixed delirium. Scores for the delirium-related knowledge and caregiving performance of family caregivers were low, while their caregiving stress levels were high due to their lack of knowledge and experience. This indicates the importance of delirium-related education for family members of patients with delirium and the necessity of developing nursing intervention programs to help manage stress and promote mental health among family caregivers.

Descriptive study of the therapeutic aggressiveness in oncology patients in the hospital area of Huelva.

e18645 Background: The therapeutic aggressiveness (TA) criteria or Earle criteria (EC) (Table) explore indicators that reflect the quality of end-of-life cancer patients (pts). They are considered the gold standard to evaluate TA. The aim of our study is to analyze TA by applying EC in deceased cancer patients (pts) in the hospital area of Huelva. Methods: Observational and descriptive study of deceased cancer pts in the area of Juan Ramón Jiménez (HJRJ) and Vázquez Díaz (HVD) hospitals (2017– 2019). We used the IBM SPSS Statistics 22 program to analyze the overuse of oncology therapies (OT) and invasive therapies near death, as well as underutilization of hospice services (HS). Results: 922 pts were classified according to the type of tumor. The most prevalent was lung-pleural cancer (LC) 27%, followed by colorectal cancer (CRC) 17.7%. 25.3% died in an acute care unit of the HJRJ, 48.7% in the hospice care unit (HCU) of the HVD and 26% at home with follow-up by HCU. 70.3% received OT in the last month of life. 11% started a new treatment and 17% received it in the last 14 days of life. 75.8% of the pts were included in the HCU before death. Of these, 4.3% were included in the 72 hours before death. 18.5% of pts went to the Emergency Service more than once in the last month of life. We also analyzed the previous data according to the type of tumor (Table). Conclusions: Our study reflects an overuse of oncology therapies near death. This produces a greater use of resources, such as assistance to the Emergency Service or aggressive actions to alleviate the adverse effects secondary to the treatments. There is a greater TA in pts with head and neck cancer (HNC). These pts usually initially show malnutrition, comorbidities (heart disease, liver disease) and a borderline performance status before starting the treatment. Our data show that the rise of new therapeutic options in LC and breast cancer generated an overuse of treatment near the end-of-life.[Table: see text]

The Effects of Counseling about Death and Dying on Perceptions, Preparedness, and Anxiety Regarding Death among Family Caregivers Caring for Hospice Patients: A Pilot Study.

This pilot study aimed to examine the influence of death counseling on perceptions, preparedness, and anxiety regarding death and dying among family caregivers of hospice patients. Death counseling developed based on the SPIKES model was provided to 37 family caregivers in a hospice and palliative care unit. Perceptions, preparedness, and anxiety regarding death were assessed with a self-administered structured questionnaire, and participants' scores before and after counseling were compared using the paired t-test. Significant changes were found in perceptions, preparedness, and anxiety regarding death after counseling. Compared to before counseling, the scores for perceptions of death (t=-4.90, P<0.001) and preparedness for death and dying (t=-16.23, P<0.001) improved, while anxiety (t=3.72, P=0.001) decreased after counseling. Some changes were also found in the types of support that family caregivers needed to prepare for the death of their family members in the hospice care unit. The findings demonstrate that death counseling could help family caregivers prepare for the death of their loved ones. Hospice and palliative care providers should play a key role in supporting family caregivers of hospice patients by developing strategies for counseling.

Abstract PS6-43: The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease

Abstract Background: Most patients with metastatic cancer request information regarding their prognosis, most notably when death is clearly approaching. Several clinical indices are used to predict the prognosis of end-stage cancer based on performance status and clinical factors. For example, the Palliative Prognostic Index (PPI) includes a range of scores from 0-15 based on factors that include performance status, oral intake, presence of edema, dyspnea at rest, and delirium. For scores greater than six, survival for an additional three weeks was predicted with a sensitivity of 80% and a specificity of 85%. However, the predictive power of these indices is currently insufficient; the quality of life of end-stage breast cancer patients would be markedly improved with a more accurate prediction model. Breast cancer subtypes based on the hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses are important prognostic factors with respect to the outcome of initial breast cancer therapy; the subtype defined by these parameters was also identified as an independent prognostic factor for outcomes in cases of metastatic breast cancer. However, the prognostic impact of breast cancer subtype with respect to end-stage disease remains unclear. In this retrospective observational study, we evaluated the relationship between survival time and associated clinicopathological factors, including breast cancer subtype, in order to develop a more accurate prognostic model for end-stage breast cancer patients. Methods: Seventy-three patients with end-stage breast cancer who were admitted to our hospice care unit from January 2014 to December 2018 were enrolled in the study. Patients in this unit were not provided with anticancer therapy but did receive highest-quality supportive care. The primary endpoint was survival time from the admission. Patient information, including age, PPI, disease-free interval (DFI), the number of treatments for the metastatic disease, metastatic site, and breast cancer subtypes were collected from medical records. Breast cancer subtypes included Luminal (Lum), Lum-HER2, HER2, and triple negative (TN) with respect to those that were HR+HER2−, HR+HER2−, HR−HER2+, and HR−HER2−, respectively. The study was approved by the ethical committee of the Oikawa Hospital (OHCT022). Results: The median survival time was 23 days (1-359 days). From the univariate analysis, PPI scores of less than six were associated with significantly shorter survival (14 days vs. 36.5 days, P = 0.001). Patients diagnosed with Lum-HER2 subtype, those who were older and were without liver metastasis, those with a shorter DFI, and those who underwent fewer treatments for metastatic disease showed a tendency toward a favorable prognosis, although these findings did not reach statistical significance. Multivariate logistic regression analysis revealed that a PPI score less than six (P = 0.001), Lum-HER2 subtype (P = 0.003), absence of liver metastasis (P = 0.001), and DFI lower than the median (33 months; P = 0.028) all contributed to longer survival time. Discussion &amp; Conclusion: In addition to the PPI, breast cancer subtype can be used to provide more precise prognoses for end-stage breast cancer patients. Survival of patients diagnosed with the Lum-HER2 subtype was longer than that observed among those with any of the other subtypes who had not undergone any anticancer treatment for metastatic disease; these results suggest that anti-HER2 therapy may be associated with critical immunological modifications. Taken together, our results indicate that breast cancer subtype should be included to provide a more accurate prognostic model for end-stage breast cancer patients. Citation Format: Masahiro Oikawa, Yumika Setoguchi, Yasuko Enomoto, Kazuhumi Hisamatsu, Tetsuaki Inamitsu, Tatsuji Oikawa. The prognostic impact of breast cancer subtype based on hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) statuses for end-stage disease [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-43.

Variation in out-of-hospital death among palliative care inpatients across public hospitals in New South Wales, Australia.

Place of death is an important indicator in palliative care, as out-of-hospital death is often preferred by patients and is less costly for the healthcare system. To examine variation and contributing factors in out-of-hospital death after receiving palliative care in hospital to inform improvement in transition of care between hospitals and communities. Using hospital linked data (July 2010, June 2015) we followed individuals aged 50 or older who received palliative care in hospital and within 3 months to death who were last admitted to a public acute-care hospital in New South Wales, Australia (73 hospitals). Among 25 359 palliative care inpatients, 3677 (14%) died out of hospital. The out-of-hospital death rate was lower for younger patients, males and those living in the most deprived areas; it was higher for cancer patients and those who received palliative care before their last admission. Hospital size, location and availability of hospice care unit were not influential. Across hospitals, the median crude rate of out-of-hospital death was 14% (interquartile range 10-19%). The contributing factors explained 19% of the variation, resulting in a rate difference of 44% between hospitals with high versus low rates; 25% of hospitals had a higher and 14% had a lower than average adjusted out-of-hospital death rate. The majority of patients who received palliative care in hospital stayed in hospital until death. The variation in out-of-hospital death across hospitals was considerable and mostly remained unexplained. This variability warrants investigation into transition of palliative care between hospitals and communities to inform interventions.

Hope of patients in the terminal phase of cancer and place of residence.

The aim of the study is to compare the hope of rural and urban inhabitants in the terminal stage of a neoplastic disease covered by stationary hospice care. The study was carried out among patients in the terminal phase of a neoplastic disease. They were patients of both 24-hour and daily palliative and hospice care units throughout the country. The study group consisted of 246 patients, average age - 59.5, the youngest respondent was 18 and the oldest - 90. The B. L. Block (NCN-36) test, prepared for people struggling with serious life-threatening diseases, was used. Comparison of the results with regard to the place of residence was based on the test Friedman ANOVA and Kendall compatibility factor. The general comparison of hope in individual dimensions and globally with the division into the degree of urbanization, was based on the Kruskal-Wallis test. On the basis of factor analysis, 4 scales constructed from 8 items branch were distinguished. The following scales are used to study hope in the situational dimension - health, the telek-temporal dimension - goals, the spiritual dimension - religious beliefs and in the emotional-affective (affective) dimension - motivations. The strength of hope in people in the terminal phase of cancer, residing in villages, settlements, small, medium and large cities, was similar and depended on its magnitude. Of all the manifestations of hope, the greatest variation in results occurred in the subjects when they encountered serious problems and difficulties. The inhabitants of medium-sized cities were characterized by a higher hope at that time.

The Exploratory Study Experience: Developing as a Researcher

Abstract This article presents the experience of the researcher during the exploratory study, within the scope of her research in a qualitative paradigm, using the Grounded Theory as a methodological approach, which aims to understand the process of nursing care to the end-of-life patient in the performing activity of living eating and drinking. While structuring the research project, it became important to explore the field of data collection (hospice care unit of a hospital in the Lisbon region) in order to achieve a contact with the reality (represented by the actors), allowing an overview and approximation of the phenomenon under study, the break with the investigator's prentices and the modification of these ideas as well as the construction of the researcher's acceptance by the actors (potential participants), and the decision making during the research course. The sharing of this experience as well as the critical reflections presented here, enabled the researcher to review the difficulties encountered and the strategies used to overcome them, to become aware of the lessons learned and to consolidate them. It is also hoped that the sharing of this experience will help other researchers in their path, allow them to perceive that the mishaps / difficulties of the course they are carrying out are common, that a lot of critical reflection is needed on this trajectory, eventually finding strategies for the problems they might face.

Perspectives on Hospice and Palliative Care among the Family Caregivers of Cancer Patients in South Korea

Background/Objectives: The utilization of hospice and palliative care services has been limited yet in South Korea. The purpose of this study is to investigate perception and needs toward hospice and palliative care. Methods/Statistical Analysis: A cross-sectional design was used to examine perception and needs on hospice and palliative care. Data were collected from 19th August to 30th September in 2014. 250 family caregivers of cancer patients in South Korea were surveyed from cancer wards or hospice care units using a structured questionnaire. Chi-square tests were conducted to determine the differences in the perception and needs on hospice and palliative care according to participant's characteristics. Findings: Around 50% of the respondents replied that they had no or vague idea on hospice and palliative care services. Over 80% of the respondents perceived that hospice and palliative care is necessary and they want to use those services. Religion of the respondents, type of ward, dependence of patient, and length of caring were related to perception on Hospice and Palliative care. Type of ward, cancer stage of patient, dependence of patient, type of insurance, length of caring were related to need on those services. Those who had more awareness on hospice and palliative care were more likely to recognize the necessity of those services. Application/Improvements: These findings represent that caregivers' needs on hospice and palliative care services are high, but its perception is relatively low. To improve awareness about it, public education should be required.

From the Warehouse to the Deathbed: Challenging the Conditions of Mass Death in Prison

The purpose of this project is to analyze the crisis of mass incarceration by placing the conditions faced by elderly, terminally ill, and dying prisoners, as its main point of focus. Much of this crisis was built through post-1970s American penal policies which set in place tough sentencing laws, increased prosecutorial power, and ultimately, led to a significant growth in the prisoner population. Today, elderly and terminally ill prisoners make up the fastest growing population inside of prisons. Few of these prisoners are approved for early release, and instead die while incarcerated. This has resulted in a condition of mass death within a system of mass incarceration. In order to manage the crisis of mass death, many prisons have constructed specialized hospice care units, internal to the prison facility. As the practice of providing hospice care inside of prisons becomes more and more commonplace, it is crucial to document their functions. The following project attempts to provide a critical analysis of the origins of prison-hospice care, the benefits and limitations of these facilities, and the experiences of prisoners within these spaces. Ultimately, this project seeks to highlight the conditions which have naturalized mass death inside of American prisons, and invites its readers to look beyond the horizon of mass incarceration.

Nurses’ Knowledge of and Attitudes toward Pediatric Palliative Care of Korea

Kyung-Ah Kang, Hyun Sook Kim, So-Hi Kwon, Mi Jung Nam, Kyung-Sook Bang, Su Jeong Yu, Yun Jung, Sung Eun Choi, and Bok-Yae Chung. J Hosp Palliat Care 2014;17:289-300. https://doi.org/10.14475/kjhpc.2014.17.4.289

Examining family meetings at end of life: The model of practice in a hospice inpatient unit.

Our purpose was to rigorously examine the nature of family meetings as conducted in an inpatient hospice care unit in order to generate an inductive theoretical model. In this two-phase project, we first interviewed eight members of the interdisciplinary care team who participated in multiple family meetings each week. Interview questions explored why and how they conducted family meetings. Using an observation template created from these interview data, we subsequently conducted ethnographic observations during family meetings. Using the methods of grounded theory, our findings were synthesized into a theoretical model depicting the structure and process of formal family meetings within this setting. The core of the family meeting was characterized by cognitive and affective elements aimed at supporting the family and facilitating quality care by clarifying the past, easing the present, and protecting the future. This inductive model was subsequently found to be highly aligned with a sense of coherence, an important influence on coping, and adaptation to the stress of a life-limiting illness. Provider communication with family members is particularly critical during advanced illness and end-of-life care. The National Consensus Project clinical practice guidelines for quality palliative care list regular family meetings among the recommended practices for excellent communication during end-of-life care, but do not provide specific guidance on how and when to provide such meetings. Our findings provide a theoretical model that can inform the design of a family meeting to address family members' needs for meaningful and contextualized information, validation of their important contributions to care, and preparation for the patient's death.

Current state of palliative and end-of-life care in home versus inpatient facilities and urban versus rural settings in Africa

Because palliative care in sub-Saharan Africa may not fit the style of delivery of palliative care in the global north, exploring the evidence can serve to reduce existing barriers and help streamline national policies that determine the optimal setting to implement formal palliative and end-of-life services. A search was conducted in Ovid MEDLINE®, PubMed, and Google Scholar databases using the search terms nursing care, terminal care, end of life care, palliative care, dying, death, hospice, opioids, morphine, Africa, sub-Saharan Africa, caregivers, and place of death. Eighty-seven relevant articles were found using the search terms. Of these, 22 matched inclusion criteria and were reviewed. Opioid availability and distribution is best accessed at the inpatient level, and hence, pain and end-of-life symptoms are best managed at the inpatient level. Despite the great need, nurses' lack of prescription power in the home-based setting is a shortcoming. Home deaths have not been adequately studied, but research suggests that palliative care generally causes economic strain, psychosocial distress on family members, and increased risk of transmission of communicable disease. Hospice is understudied but shows favorable outcomes. Funding and research need to focus on development of inpatient palliative and hospice care units in urban areas. In rural areas, the priority should be a home-based care model that involves nurses who are privileged to prescribe opioids and adjunctive medication therapies.

415 Too Sick for Hospice? Acuity and Outcomes of Patients Admitted to a New Inpatient Hospice Care Unit

415 Too Sick for Hospice? Acuity and Outcomes of Patients Admitted to a New Inpatient Hospice Care Unit

The nursesʼ experiences of truth telling to the terminal cancer patients: A systematic review

Review Question The specific question of this review are: What are the experience of nurses telling a terminal cancer patient of a diagnosis or prognosis? Inclusion criteria Phenomena of interest This review will consider studies that explore the nurse’s experiences of truth telling of a diagnosis and prognosis to the terminal cancer patient. Types of Participants This review will consider studies that include nurses involved in truth telling to terminal cancer patients, and who have worked in an oncology unit or hospice care unit for greater than one year.