Mapping Integrative Decision-Making Frameworks in Advanced Cancer Care: A Scoping Review of Diagnostic, Supportive-Care, and Therapeutic Integration
Abstract
Background/Objectives: Decision-making in advanced cancer care is intertwined with diagnostic profiling, prognostic communication, supportive care, and anticancer treatment selection. An author-developed D-S-T × B/C/E conceptual mapping scaffold—three decision/action domains (Diagnosis, Supportive care, Therapy) and three evaluative dimensions (Biological, Clinical, Existential)—was used to organise the literature, to identify coverage gaps and recurring framework categories, and, as a secondary conceptual synthesis objective, to derive a candidate integrative framework. Methods: The review was conducted according to the Joanna Briggs Institute (JBI) methodology for scoping reviews, pre-registered on OSF, and reported per PRISMA-ScR. PubMed was searched on 21 June 2026, and the final evidence set was derived solely from this search. Eligible records concerning adults with advanced cancer were dual-screened and charted using a structured form. Results: Eighty-two records (2010–2026) were included. Under the strict D-S-T × B/C/E matrix, Supportive care showed the highest joint coverage, particularly S × C (59/82, 72.0%), whereas D × B and D × E were the least represented cells (13/82 each, 15.9%). Eight recurring framework categories were inductively derived from the charted framework descriptors, led by early integrated palliative care (30/82) and prognosis-informed shared decision-making (27/82). Twenty-two records met an emergence-candidate screen defined at the synthesis stage, of which three received the maximum cross-axis coupling score of 6/6 from both reviewers. Conclusions: The advanced-cancer decision-framework literature clusters around a small number of architectures with uneven D-S-T × B/C/E coverage. Diagnosis-centred frameworks coupled with biological or existential dimensions were relatively under-represented within our mapping and represent priority targets for future primary research; the proposed Adaptive framework provides one structure in which this research could be conducted.