Potentials and challenges of an integrative medicine protocol in intensive care: the perspective of intensive care nurses.

The Global Burden of Disease Study reported approximately 18.5 million new cancer cases globally in 2023, with around 10.4 million cancer-related deaths []. Against this backdrop, cancer patients experience psychological distress at a rate nearly three times higher than the general population []. Such distress is not transient but persists throughout the treatment trajectory: from initial diagnostic shock and fear, to anxiety induced by chemotherapy-related pain [], disease progression, and inadequate health information during treatment []. Even during survivorship, many patients endure persistent fears of cancer recurrence [–]. Beneath these overt emotional concerns lies a fundamental fear of death, commonly defined as “death anxiety.” Death anxiety is a complex emotional state marked by fear, unease, and worry, triggered by individuals’ awareness of death’s inevitability, unpredictability, and the finitude of human life []. To clearly delineate the research scope, this study distinguishes death anxiety from existential anxiety. Though both share core features of psychological distress and reflections on life value, existential anxiety mainly arises from confusion over one’s existential status and is typically diffuse and abstract []. By contrast, death anxiety centres on “the end of life”, with clear directionality and definite objects. Owing to such conceptual specificity, the present review focuses exclusively on the well-defined psychological construct of death anxiety. Death anxiety exerts marked adverse effects on cancer patients’ physical and mental health, as well as the overall medical intervention process. It may impair treatment adherence, prompting patients to avoid disease-related information or discontinue standard therapeutic regimens []. In the terminal stage, severe death fear frequently hinders communication between patients and medical staff, thereby obstructing shared clinical decision-making []. Such barriers disrupt the delivery of palliative and end-of-life care, ultimately compromising the efficacy of clinical interventions [, ]. Furthermore, death anxiety may drive overtreatment tendencies, including frequent hospital attendance and redundant examinations, which aggravate patients’ psychological and economic burdens and waste limited personal and public healthcare resources [, ]. Considering these multiple detrimental outcomes, targeted and effective interventions to mitigate death anxiety are clinically imperative.