The Role of Nursing Diagnoses in Enhancing Prognostic Accuracy in Home-Based Cancer Care: Insights From a Retrospective Cohort Study

Aims: To (1) describe the characteristics of patients with advanced cancer receiving home-based care, (2) identify the nursing diagnoses associated with 6-month mortality and (3) explore the predictive power of nursing diagnoses on 6-month mortality for patients with an advanced cancer diagnosis. Background: Nursing diagnoses have been shown to capture the complexity of patients' experiences and the specific nursing care related to patients' responses to illness, including increased mortality risk. However, there is a lack of studies investigating the relationship between nursing diagnoses and mortality among cancer patients receiving home-based care. Design: Retrospective cohort study. Methods: Between July 2021 and June 2023, patients with advanced cancer were consecutively admitted to a home-based care service. Medical data, prognostic indexes and nursing assessment data, including nursing diagnoses from NANDA International, assigned during the first home visit, were extracted from patient health records. Survival analysis was performed over the first 6 months using the Kaplan-Meier method and Cox proportional hazards model. Results: Among 344 enrolled patients, the most frequent nursing diagnoses were chronic pain and constipation. The 45.9% of patients died at home within 6 months after discharge. Multivariate Cox regression identified a Palliative Prognostic Index ≥ 5, palliative status, terminal phase of illness and two nursing diagnoses-imbalanced nutrition: less than body requirements and death anxiety-as significant predictors of 6-month mortality. Conclusions: Survival in advanced cancer patients receiving home care was primarily predicted by the terminal phase of illness, Palliative Prognostic Index, palliative status and two specific nursing diagnoses: imbalanced nutrition: less than body requirements and death anxiety. Reporting method: The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adopted in this study. Patient or public contribution: No Patient or Public Contribution.