Prediction of Prognosis in Hospice Patients: Integrating Multidimensional Symptoms and Concerns

Background/aims: Patient-centered care is key in hospice care, as it aligns with survival prognosis, allowing for personalized care for each patient. Despite this imperative, palliative prognostic models rarely incorporate multidimensional (MD) patient-reported outcomes. It is unclear how the burden of MD symptoms and concerns (MDSC) relates to palliative survival prognosis. This study aimed to identify MDSC associated with 4-week survival in hospice care while including clinical and demographic factors. Methods: A cohort study was performed in Dutch hospice patients using survival and one patient-reported Utrecht Symptom Diary4Dimensional (USD-4D) data collected in the first week of admission from 2015 to 2023. The USD-4D covers physical symptoms: pain, sleep issues, dry mouth, dysphagia, appetite loss, defecation pattern, nausea, shortness of breath, and fatigue. Psychological symptoms: anxiety and depression. Socio-spiritual concerns: taking time for oneself, bearing what happened, readiness to let loved ones go, a sense of balance in life, and end of life thoughts give peace along with wellbeing and value of life. Cox regression with backward selection was applied, and the model’s performance was assessed. Results: Analyzed data from 886 unique patients yielded a prognostic model (see table) with a median survival of 27 days. The model exhibits a sensitivity of 0.64, specificity of 0.69, positive and negative predictive values of 0.44 and 0.83, and an area under the curve of 0.68. Internal validation exhibited a concordance index of 0.72. Conclusions: The findings imply that integrating MDSC may enhance survival prognosis in hospice care. Despite assuming a constant hazard over time, the model hints at a positive impact when using MDSC data. This emphasizes the need for research on time-varying models using repeated longitudinal data associating dynamic MDSC trajectories and survival prognosis.