A Noddings' caring theory-based intervention to enhance coping with death competence in advanced lung cancer patients: a randomized controlled trial
Clinical Snapshot
PICO Framework
| P — Population | Inpatients with advanced lung cancer (n=70) |
| I — Intervention | Noddings' caring theory-based intervention comprising modeling, dialogue, practice, and recognition phases over 3 weeks |
| C — Comparator | Control group (standard care) |
| O — Outcomes | Primary: Coping with death competence (CDC); Secondary: Death attitudes, anxiety, and depression scores |
Bottom Line
This RCT suggests that a Noddings' caring theory-based nursing intervention may improve death coping competence and reduce psychological distress in advanced lung cancer patients. However, the study has significant methodological limitations including inadequate randomization reporting, lack of blinding, and missing statistical details. While the intervention appears promising for addressing death anxiety in terminal cancer patients, the evidence quality is insufficient to support widespread implementation. The 3-week structured program involving modeling, dialogue, practice, and recognition phases represents a novel approach to death preparation in oncology nursing. Clinicians should await higher-quality replication studies before adopting this intervention, particularly given potential cultural differences between Chinese and Australian patient populations. The intervention's focus on death competence addresses an important gap in supportive cancer care, but stronger evidence is needed to establish clinical effectiveness and cost-effectiveness in Australian healthcare settings.
Key Findings
P Value: Significant differences reported but specific p-values not provided
Effect Size: Not reported
Primary Outcome: Coping with death competence total and subscale scores significantly higher in intervention group
Nnt Or Sensitivity: Not calculable from available data
Confidence Interval: Not reported
Clinical Application
Requires trained nursing staff and 3-week structured program implementation. Resource intensive but potentially feasible in specialized oncology units Would need adaptation for Australian cultural context. Could align with Cancer Australia supportive care guidelines and palliative care frameworks. No specific PBS or TGA implications as this is a nursing intervention Advanced lung cancer patients in inpatient settings, though cultural considerations may limit direct applicability
Abstract
PURPOSE: This randomized controlled trial aimed to evaluate the effects of a Noddings' caring theory-based intervention on coping with death competence (CDC), death attitudes, and psychological distress in patients with advanced lung cancer. METHODS: Seventy inpatients were randomly allocated to the intervention group (n = 35) or the control group (n = 35). The 3-week intervention comprised modeling, dialogue, practice, and recognition phases. Outcomes, including CDC, attitude toward death, anxiety, and depression, were assessed at baseline (T0), post-intervention (T1), and 1-month follow-up (T2). RESULTS: No significant between-group differences were observed at baseline. Following the intervention, patients in the intervention group demonstrated significantly higher CDC total and subscale scores, more positive death attitudes, and lower anxiety and depression scores than those in the control group at both post-intervention and 1-month follow-up. CONCLUSION: The Noddings-based program effectively enhanced death-coping competence, improved death attitudes, and reduced psychological distress in patients with advanced lung cancer. TRIAL REGISTRATION: ChiCTR2600118530, 2/6/2026 retrospectively registered.
References
- 1.Li, J., Huang, R., Luo, X., Zhan, Y., Yan, C., Yang, S., Tian, X., He, G., & Li, Y. (2026). A Noddings' caring theory-based intervention to enhance coping with death competence in advanced lung cancer patients: a randomized controlled trial. Supportive Care in Cancer. https://doi.org/10.1186/s12889-024-21209-x
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