Grouping and Intervention

Palliative Care Department and Oncology Department are two relatively independent medical units in the hospital, there are significant differences between in terms of patient access criteria, the path of therapy, expectations and post healing goals. PC is mainly applied to the treatment of some life-limiting diseases, and focusing on effective management of pain and other distressing symptoms to reduce patients’ and their families’ suffering and to support the best possible QoL in the path of therapy. While appropriate CAT performed in oncology Department is aligned with stated patient goals and priorities, through the selection of chemotherapy, radiation therapy, immunotherapy and other appropriate treatments, to help patients control their disease and prolong their lifetime.

The choice of therapy method largely depends on the doctor’s opinion and patients' and their families' willingness. Typically, oncologists will follow the medical guidelines and recommend eligible patients who have a life expectancy of 6–12 months referrals to PC unit. An interdisciplinary PC team will work together with the oncologist to provide consultative and assessment according to the patient's situation, and deciding whether to transfer to the palliative ward for supportive care. But some patients and their families may refuse or delay transfer to PC and encourage efforts to cure over the alleviation of suffering for cultural values, economic or other reasons. Thus, we distinguish participants in the PC group or in CAT group according to whether the patient was normally referred from Oncology Department to the regimen provided by PC team, as shown in \* MERGEFORMAT Fig. 1.

Questionnaire inclusion and exclusion criteria

Patients in the PC group usually received 10 to 20 days of supportive interventions during hospitalization. PC doctors make appropriate supportive intervention plans according to the patient's specific situation, including analgesic treatment, symptom management, palliative sedation, spiritual support, acupuncture and so on. Specialist nurses provide patients with lymphedema massage, psychosocial and spiritual support, comfort care, health education and other supportive care services, the average nursing time for per patient per day is about 4.9 h. While patients in the CAT group usually received 10 to 15 days of anticancer therapies including chemotherapy, immunotherapy, targeted therapy and standard nursing services during their hospitalization. Although CAT patients would also receive symptom management, palliative sedation and other PC services according to the needs of their situation, they could not receive a systematic PC intervention compared with patients in the PC group. The average nursing time is about 2.8 h for per patient per day.