The PIPOST model developed by the Evidence-based Nursing Center of FUDAN University was used to propose structured evidence-based questions (16).The target Population of evidence application is cancer patients; Intervention is a series of measures to improve the meaning of life of cancer patients; Evidence implementation professionals are clinical caregivers; The outcome indicator is the improvement of the meaning of life; The Setting for evidence application is the clinical department with tumor patients; The types of evidence included clinical decisions, practice guidelines, systematic reviews, various original studies. This study has been registered on the Evidence Summary registration platform of the Evidence-based Nursing Center of FUDAN University (Registration No: ES20220915).

Firstly, based on the “6S” pyramid model, through the combination of subject words and free words, top-down searches were conducted on system, summaries, synopses of syntheses, synthesis, synopses of studies, and studies (17). Literature and data extraction were screened based on the inclusion and exclusion criteria of evidence-based questions constructed by PIPOST. Then evaluate the quality of the literature, extract the evidence and classify the evidence, and finally summarize to form the evidence summary.

English search terms “ tumor* OR cancer* OR malignancy* OR neoplasm* ” AND “ ‘meaning in life’ OR ‘meaning of life’ OR ‘life meaning’ OR ‘the meaning of life’ OR ‘Sense of meaning in life’ ” AND “guideline* OR consensus OR review* OR meta OR analysis OR study OR practice OR research OR trial”. Computer searches Up To Date, Joanna Briggs Institute (JBI), National Comprehensive Cancer Network (NCCN), Guidelines International Network (GIN), MEDLIVE, BMJ Best Practice, National Guideline Clearinghouse (NGC), New Zealand Guidelines Group (NZGG), Scottish Intercollegiate Guidelines Network (SIGN), Australian Clinical Practice Guidelines, CMA INFOBASE, WHO, Registered Nurses’ Association of Ontario (RNAO), Web of Science, COCHRANE Library, EMBASE, PUBMED, Ovid, EBSCO, WANFANG Database, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Institute for Clinical Systems Improvement (ICSI), European Society for Medical Oncology (ESMO), World Hospice Palliative Care Alliance (WHPCA), International Society for Hospice and Palliative Care (IAHPC), Canadian Association for Psycho-social Oncology (CAPO), National Council Palliative Care (NCPC), Irish Hospice Foundation, Japanese Society for Palliative Medicine (JSPM), European Association for Palliative Care (EAPC), National Hospice and Palliative Care Organization etc. comprehensive database. The literature was searched for publications from the establishment of the database to Oct 2023.

Inclusion Criteria: (i) The types of literature were best practices, guidelines, expert consensus, systematic reviews, and the latest randomized controlled trials that were not included in the above evidence-based resources, and evidence-based resources such as systematic reviews and guidelines were the latest versions; (ii) The content of the literature included the meaning of life intervention for cancer patients; (iii) Published Chinese and English literature. Exclusion Criteria: (i) Translation the Chinese version of foreign literature; (ii) Literature with incomplete data or data that could not be extracted; (iii) Conference Papers; (iv) Duplicate published literature; (v) Scientific instruction manual; (vi) Relevant discussion drafts, conference abstracts, excerpts, interpretations, and draft guidelines specified in the guidelines.

Two researchers with systematic evidence-based training independently screened the literature for inclusion and exclusion criteria by reviewing the titles, abstracts, and full texts. They extracted basic information and data from the selected studies and cross-checked the results. Any discrepancies were resolved through discussion with a third researcher to reach a consensus.

Two researchers, who are Master’s students trained in a systematic evidence-based program, independently evaluated and graded the quality of evidence for inclusion. If any disagreements arise, a third investigator was sought to participate in decision-making and proofread the translation of the English evidence. 1) Guidelines: Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) (18), which includes six domains: scope objectives, personnel involved, and development rigor, with 23 entries each representing a score of 1–7 from “strongly disagree” to “strongly agree”. Scores were standardized to the highest possible percentage of scores in the domain. 2) Systematic reviews or Meta-analysis: the quality of the evaluation was assessed using the Assessment of Multiple Systematic Reviews II (AMASTAR-2) tool (19), 3) Expert consensus and experimental research: the evaluation criteria developed by the JBI Center for Evidence-Based Health Care in its 2016 edition was used (20), which included six entries to label sources of opinion, reference to other literature, and state conclusions.

The content analysis method was used to extract evidence from the literature, which included general characteristics, research themes, and main contents of the literature. When evidence from different sources had complementary or consistent conclusions, a combined or general expression was used. However, if there were conflicting evidence from different sources, the principles of evidence-based priority, high-quality evidence priority, and latest published authoritative literature priority were followed. We graded the aggregated evidence using the Joanna Briggs Institute (JBI) Levels of Evidence and Grades of Recommendation system (2014 version) (21) from the Australian JBI Centre for Evidence-Based Healthcare. This system categorizes the evidence into five levels, from high to low, based on the study design of the included literature.

An initial search yielded a total of 2,985 articles, which were reduced to 673 after removing duplicates. Following a review of titles, abstracts, and full texts to eliminate non-compliant literature, In total, 28 articles were ultimately included in the study, consisting of 4 guidelines, 2 Computerized decision support systems, 6 quasi-experimental studies, 9 randomized controlled trials, and 7 systematic reviews. Table 1 provides an overview of the basic characteristics of the literature included, while Figure 1 shows a flowchart detailing the literature screening process.

The evidence related to the 28 included literature will be extracted and summarized by this research team, resulting in a synthesis of evidence from five areas of Organization and management, evaluation, evaluation indicators, programs to improve the meaning of life, intervention skills and precautions, resulting in 48 pieces of evidence, with the aim of providing healthcare professionals with better guidance for improving meaning in the life of cancer patients provide an evidence-based basis in Table 3 .

A systematic literature search revealed that, At present, the interventions carried out at home and abroad to improve the meaning of life of cancer patients include dignity therapy, logo therapy, life review therapy, advance care planning, mindfulness therapy, narrative therapy, music therapy, psychological care, body-mind-spirit group therapy, multidisciplinary structured intervention, life review plan based on mind map, and nursing based on humanistic care theory Plans, and so on. Domestic meaning in life intervention research started late, and the depth and breadth of research are still limited. In China, there are mainly dignity therapy, logo therapy, life review therapy, mindfulness therapy, and narrative therapy. There were no superior or inferior interventions, and there was concern about the accuracy of generalizations about the strengths and weaknesses of different interventions. Since most of the intervention data come from abroad, there may be some differences with the cultural background of our country. Sociocultural adaptability is a key consideration for the localized implementation of intervention measures. Therefore, future research needs to summarize the previous evidence, combine with China’s cultural background, cognitive level, disease stage and cultural values to formulate a meaning in life intervention program for cancer patients suitable for China, and study and verify the feasibility and effectiveness of the intervention measures to ensure its practical value in the local environment.

Studies have shown that interventions based on the meaning of life can increase the inner peace of cancer patients, improve negative emotions such as anxiety, depression, and fear, help patients perceive and find meaning in life, maintain and improve the meaning of life, and reduce despair at the end of life. However, there is a lack of clear rankings of post-intervention effect sizes and specific recommendations for these interventions.It is recommended to analyze the effect size of different interventions on the improvement of the meaning of life of cancer patients through network Meta-analysis, and screen out the most effective intervention. For the long-term effect after intervention, multi-center collaborative longitudinal follow-up research can be carried out in the future, and electronic health databases or mobile health websites can be used to reasonably formulate research programs and coping strategies for loss to follow-up, and quantitative and qualitative research can be combined to comprehensively understand the changes in the meaning of life of patients.

Research has shown that the study of life meaning interventions for cancer patients is multidimensional and involves multiple disciplines such as psychology, medicine, and sociology. Not only does it require in-depth exploration of changes in the patient’s psychological state, physiological responses, social support network, and life values, but it also requires the effective integration of these different dimensions of knowledge to develop more individualized, comprehensive, and effective interventions. However, the current interdisciplinary cooperation in China is not close enough, resulting in limited research horizons and methods. Therefore, it is recommended that in the future, all disciplines should strengthen their cooperation and work together to promote the progress and development of meaningful life interventions for cancer patients, so as to provide patients with more comprehensive, precise and humanistic services.

To promote the implementation and effectiveness of meaning in life interventions for cancer patients, we need to work together from many aspects. Therefore, Interdisciplinary collaboration has thus become a key pathway for advancing the field (42, 43). Firstly, the active participation and recognition of professionals is the key to the success of meaning in life intervention. Ideally, membership should include executive leadership, physicians, advanced practice providers, nurses, social workers, information technology specialists, spiritual counselors or psychologists or chaplains, bereaved persons (35, 41–44). Professionals should give full play to their professional advantages, establish a trust relationship with patients, provide effective psychological support and guidance, enhance patients’ psychological resilience and stress resistance, so as to enhance patients’ meaning in life. At the same time, the professional competence of medical staff directly affects the effect of meaning in life intervention. Therefore, it is necessary to strengthen the mental health knowledge training of medical staff to improve their understanding and coping ability for mental health problems. Medical staff should fully respect the wishes and choices of patients, convey positive and optimistic attitudes and emotions, give patients confidence and hope, and provide personalized support and services according to their individual needs when carrying out meaning in life intervention. Interventions can achieve better results only if they truly focus on the needs and wishes of patients.

In order to enhance the sustainability and effect of intervention, we can understand the economic situation of patients and provide corresponding financial assistance and social support according to their needs to help them overcome economic difficulties, and at the same time, let patients develop a variety of interests to improve their quality of life and meaning of life (45). Unilateral power is limited. We need to establish interdisciplinary teams composed of professionals with different professional backgrounds. Cooperation and coordination among team members can improve the quality and effect of services, so that patients can receive better support and help (46). In addition, we also need policy support and attention from the leadership of the unit. It is necessary to strengthen the formulation and implementation of relevant policies, provide necessary resources and support, and promote the in-depth development of meaning in life intervention.

Studies have shown that early assessment and screening of cancer patients’ mental health, quality of life, anxiety, depression, and physical symptoms facilitates healthcare professionals to have a timely and comprehensive understanding of the patient’s current status in order to develop individualized interventions for the patient (42–44). The assessment should be carried out using a validated assessment tool (43). The person conducting the assessment may be a psychiatrist, psychologist, nurse, advanced practice clinician, or social worker, and assessors should be professionally trained and assessed (42). Key time points for evaluation of cancer patients are Initial diagnosis, initiation of treatment, periodic intervals during treatment, end of treatment, after treatment or transition to survival, relapse or progression, advanced disease, death, and during individual transition or reassessment (43). At present, there are many kinds of meaning in life scales used at home and abroad and they have not been unified. The main meaning life scales used abroad includes the Meaning sub-scale, the Quality of Life at the End of Life Scale, the Purpose of Life Scale, the Life Orientation Test using the LOT Scale, the Crumbaugh Scale, the sub-scale of the MC Gill Quality of Life Questionnaire, and the Attitude Toward Life Scale (23, 31). The life meaning scale used in China mainly includes the Life attitude Profile scale adapted by Taiwan scholar He Yingqi (37), meaning in Life scale for Advanced Cancer Patients developed by Wu Yongsheng (27, 29). and Chinese Version of meaning in Life Scale for Cancer Patients developed by XIA (47). According to literature review and group discussion, foreign scales may not be suitable for clinical Settings in China, so they are not recommended to be used directly. In China, the life attitude profile scale is mainly used in the study of the meaning of life of students, especially college students. meaning in Life scale for Advanced Cancer Patients is the only scale measuring meaning in life of patients with advanced cancer in China at present, which is widely used in the status quo of patients with advanced cancer and the evaluation of the effect of intervention research. Chinese Version of Meaning in Life Scale is mainly used to explore the level of meaning in life and related influencing factors of different types of cancer patients. Hamilton Anxiety Scale was used for anxiety. Hamilton Depression Scale was used for depression status. The quality of life was measured by the domestic quality of life scale for cancer patients developed by Wan Chonghua et al. Each scale has different characteristics, and researchers can evaluate the choice of scale according to the purpose of the study and the actual situation of the study subjects.

Research has shown the following considerations and tips when implementing interventions with cancer patients. The first step should be to establish a trusting relationship with the patient early in the disease and to understand the patient’s needs. Using empathetic listening skills to understand the patient’s pain, family relationships and functioning, and showing respect from the team so that the patient can open up and share their feelings (44, 48). Some studies have suggested that clinical interventions should be individualized, others have advocated group interventions for cancer populations with lower symptom burdens (26), and others have suggested that psycho-social interventions for patients and their families are more effective than individual interventions (42). Secondly the search for the meaning of life can be better facilitated by combining multiple modalities in a rational way. Teskereci et al. suggest that combining humanism and existentialism in the care of oncology patients may increase hope and meaning in the lives of gynecologic cancer patients (31). Gomez-Batiste et al. noted that integrating psycho-social support with existing outpatient palliative care services is also a proven model (41). Research suggests that the number of interventions is also critical, with a minimum of three interventions required for maximum benefit (26, 41). Also the long term impact of the intervention on the patient needs to be considered, especially for those who are long term survivors of cancer (26). Therefore in clinical work, medical staff should develop specific intervention models based on the combination of assessment results and the actual situation. This study has also some limitations. First, most of the included literature came from abroad, which may be different from the domestic in terms of cultural background and healthcare system, and the clinical application needs to consider the adaptability problem carefully. Second, due to limitations in the scope of the study, only the evidence was summarized and the effect sizes of the interventions were not analyzed, suggesting that future studies be conducted. In this study, an evidence-based evidence on meaning-of-life interventions for cancer patients was provided through a rigorous and scientific process of literature search and screening, literature quality evaluation and evidence aggregation. However, there are no clear findings on the effect size of meaning in life after intervention. In the future, more in-depth research is necessary to enrich the content of evidence and provide high-quality guidance for clinical practice. Therefore, it is recommended for nurses to use the best evidence combined with their own clinical experience, patient needs, and actual clinical scenarios, to develop individualized care and management plan and ultimately realize the transformation of the best evidence.