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Prognostic Items for the Last 10 and 3 Days of Life of Cancer Patients at Home

Kumagai, Yuki MSN, RN; Maekawa, Atsuko PhD, RN; Abe, Mayumi RN

doi: 10.1097/NCC.0b013e318235287d

Background: Prognostic indices are needed to optimize end-of-life care for cancer patients at home, but few prognostic indices predict the last 10 days.

Objective: The purpose of this study was to identify predictors for the last 10 and 3 days of life in patients with lung, gastric, or colorectal cancer at home.

Methods: Symptoms and signs were initially identified by literature review, and questionnaire was developed. Evaluation of these items and identification of additional items were then performed by 72 visiting nurses using the 3-round Delphi approach.

Results: The evaluation of 31 third-round responses is reported. The items for gastric and colorectal cancers were almost same; these cancers were treated as gastrointestinal cancer. To predict the last 10 and 3 days, there were 6 and 0 specific items for lung cancer, respectively, and 5 and 13 specific items for gastrointestinal cancer, respectively. There were 9 common items to predict the last 10 days and 29 common items to predict the last 3 days.

Conclusion: The specific and common items that could be used to predict the last 10 and 3 days in patients with lung or gastrointestinal cancer were identified. The prognostic items for the last 3 days of life were more numerous among the gastrointestinal cancers than those for the last 10 days.

Implications for Practice: Specific prognostic items for each cancer are useful for visiting nurses to offer individualized care to patients and families. Using the specific and common prognostic items, end-of-life care may be improved.

Author Affiliations: Department of Adult and Gerontological Nursing, Faculty of Medicine, Saga University, Japan (Ms Kumagai); and Department of Nursing, Nagoya University Graduate School, Aichi, Japan (Dr Maekawa and Ms Abe).

This study was supported by the Nagoya University Scholarship for Outstanding Graduate Students.

The authors have no conflicts of interest to disclose.

Correspondence: Yuki Kumagai, MSN, RN, Department of Adult and Gerontological Nursing, Faculty of Medicine Saga University, 5-1-1, Nabeshima, Saga 849-8501, Japan (

Accepted for publication August 27, 2011.

© 2012 Lippincott Williams & Wilkins, Inc.