Associations between gastrointestinal symptoms and coexisting symptoms amongst patients in a palliative care unit: a PCOC-based longitudinal study.

backgroundGastrointestinal (GI) symptoms are both common and distressing in patients receiving palliative care, however their relationships with coexisting symptoms and clinical factors, including functional status, clinician-rated problem severity, and palliative care phase, remain unclear in hospice ward settings. The Palliative Care Outcomes Collaboration (PCOC) framework enables for standardized daily symptom assessment and longitudinal evaluation. This study aimed to longitudinally investigate the associations between GI symptoms and related symptoms and clinical domains among patients admitted to a hospice ward.

methodsThis retrospective cohort study included 1,008 unique adult patients admitted to the hospice ward of a tertiary medical center in central Taiwan between March 1, 2021 and September 30, 2023. Each patient contributed one hospice ward admission course and was followed from admission until death or transfer to home hospice care. Routine daily PCOC assessments collected throughout the admission course were analyzed longitudinally as repeated measurements within patients. Patients younger than 18 years, those with missing identification information, or those with incomplete PCOC data were excluded. Separate generalized estimating equation (GEE) models were constructed for the appetite, nausea, and bowel domains of the Symptom Assessment Scale (SAS), adjusting for demographic, clinical, functional, and symptom-related variables. Subgroup analyses were performed for cancer and non-cancer patients.

resultsAmongst the 1,008 patients, the mean age was 68.0 years, with 59.1% being male, and 86.5% having cancer. At admission, mean SAS scores were 2.45 for appetite loss, 1.91 for bowel discomfort, and 0.69 for nausea, indicating that appetite loss was the most prominent GI symptom. Nausea was significantly associated with sleep disturbance, appetite loss, bowel discomfort, and pain, while older age was associated with lower nausea severity. Appetite loss was associated with sleep disturbance, nausea, bowel discomfort, fatigue, pain, greater clinician-rated "other" and family problems, as well as deteriorating phase; referral from the general ward was associated with lower appetite distress. Bowel discomfort was associated with appetite loss, nausea, breathlessness, fatigue, pain, higher clinician-rated "other" problems, and higher Australia-modified Karnofsky Performance Status (AKPS). Subgroup analyses showed that symptom associations were generally more extensive in cancer patients than in non-cancer patients, particularly for appetite loss and bowel discomfort.

conclusionGI symptoms in hospice ward patients are closely linked to coexisting symptoms, functional status, clinician-rated problem severity, and palliative care phase, and should not be assessed in isolation. Daily standardized assessment using the PCOC framework may help support more individualized symptom management for palliative care patients.