Measuring Complexity in Symptom Prevalence and Severity Among Palliative Care Patients Using Patient-Centered Outcome Measures in Real World Setting: A Multi-Center, Cross-Sectional Study

Abstract

Purpose Palliative care patients experience symptoms and concerns in the physical, psychological, social, and spiritual domains, which can negatively affect their quality of life. Understanding the prevalence of symptoms and problems is crucial in the face of increasing palliative care needs to tailor individualized patient-centered care plans. This study aimed to examine the prevalence and severity of symptom burden and explore the factors associated with high symptom burden in palliative care patients. Methods This multicenter cross-sectional study included adult palliative care patients at the beginning of an episode of care across four palliative care units in Malaysia between July and September 2024. Demographic data, functional status, and the Integrated Palliative Care Outcome Scale (IPOS) were extracted from medical records and clinical databases. Results This study recruited 405 patients with a mean age of 65.4±14.1 years and a slight predominance of men (53%) and cancer diagnoses (58%). Most patients were in the unstable phase of illness (62%), with 8.5±4.8 symptoms per patient. The most prevalent symptoms/concerns were family anxiety (86%), poor mobility (82%), and lethargy (80%). At least 50% of the patients had ≥5 items with an IPOS score ≥2. Cancer diagnosis (adjusted OR 2.350; 95% CI 1.030, 5.358) and unstable phase (4.272; 1.657, 11.011) were factors associated with severe overall and physical symptom burdens (≥1 item with IPOS score ≥2), after adjusting for other possible confounders. Conclusion The prevalence and severity of symptoms and concerns among palliative care patients were high, suggesting complex needs.