Best Evidence for Life-Sustaining Treatment Decision-Making Assessment in Hospitalized Adults with Advanced Cancer in Chinese Clinical Practice.

Abstract

This study aimed to retrieve, appraise, and synthesize the best available evidence for life-sustaining treatment (LST) decision-making assessment in patients with advanced cancer and to explore its applicability within the Chinese clinical and cultural context. Systematic searches were conducted in BMJ Best Practice, UpToDate, DynaMed, JBI, GIN, NICE, SIGN, NCCN, Cochrane Library, MEDLINE, CINAHL, Embase, China National Knowledge Infrastructure, Wanfang Data, and SinoMed from March 3, 2019, to March 3, 2024, with additional retrospective searches. Eligible evidence sources included clinical decision-support resources, guidelines, expert consensus documents, evidence summaries, systematic reviews, and meta-analyses. Two reviewers independently screened the literature, appraised methodological quality, and extracted evidence, with disagreements resolved through consensus and, when necessary, adjudication by a senior third reviewer. Eight documents were included: two guidelines, one evidence summary, three clinical decision-support resources, and two systematic reviews. Nine evidence items were generated and assessed using the FAME framework, covering patient identification, prognosis and palliative care needs, family-system assessment, decision-making capacity, structured assessment tools, communication about LST preferences, documentation, and dynamic reassessment near the end of life. Evidence-based LST decision-making assessment may help reduce overtreatment and support high-quality end-of-life care for patients with advanced cancer. By translating the summarized evidence into a culturally adapted workflow, this study provides a practical reference for integrating patient preferences, family participation, and clinical assessment in Chinese palliative care practice.