Mind–Body Connection and Satisfaction: The Correlation Between Holistic Nursing Care and Patient Satisfaction in Patients With Advanced Cancer

Mind–Body Connection and Satisfaction: The Correlation Between Holistic Nursing Care and Patient Satisfaction in Patients With Advanced Cancer | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Mind–Body Connection and Satisfaction: The Correlation Between Holistic Nursing Care and Patient Satisfaction in Patients With Advanced Cancer Parvin Mangolian Shahrbabaki, Zoalfghar Divdel, Amin Haghgoo, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7944758/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Holistic care plays a pivotal role in the treatment of patients with advanced cancer, with patient satisfaction serving as a key indicator of healthcare quality. This study aimed to examine the relationship between patients’ perceptions of holistic nursing care and their overall satisfaction with the care received. Methods This cross-sectional study was conducted in 2022 among 98 patients with advanced cancer in the oncology department of Bahonar Hospital, Kerman. Participants were selected through convenience sampling. Data were collected using the standardized Holistic Caring Inventory (HCI) and the Patient Satisfaction Instrument (PSI). Analyses were performed with SPSS software, employing descriptive statistics, Pearson correlation, and linear regression. Results The mean score for patients’ perception of holistic care was 114.8 ± 19.3, while the mean satisfaction score was 62.7 ± 10.9. Correlation analysis revealed a significant positive relationship between perceptions of holistic care and patient satisfaction (r = 0.22, p = 0.02). Moreover, patients with a history of hospitalization and more frequent admissions reported significantly higher perceptions of holistic care (p < 0.05). In terms of satisfaction, significant differences were found based on gender—with female patients reporting higher satisfaction (p = 0.04)—and marital status, with unmarried individuals reporting greater satisfaction (p = 0.04). No other demographic variables were significantly associated with satisfaction. Multivariate regression analysis did not identify any variable as a significant predictor of patient satisfaction. Conclusion Although patients with advanced cancer generally perceive holistic care positively, its impact on overall satisfaction is limited. This finding suggests that patient satisfaction is a multifaceted phenomenon shaped not only by the quality of direct care but also by systemic, organizational factors and the psychosocial burden of illness. To achieve substantial improvements in patient satisfaction, interventions should adopt a comprehensive and structural approach. Biological sciences/Cancer Health sciences/Health care Health sciences/Oncology Biological sciences/Psychology Social science/Psychology Holistic Nursing Care Patient Satisfaction Cancer Oncology Nursing Introduction Cancer is a significant public health issue characterized by the uncontrolled growth of abnormal cells and their invasion of surrounding tissues ( 1 ). The American Cancer Society (ACS) reports approximately 1.9 million new cases and 609,000 deaths in the United States in 2022 ( 2 ). Similarly, projections for Iran indicate that by 2025, over 130,000 new cases will be diagnosed annually ( 3 ).This significant burden underscores the urgent need to develop and implement effective, comprehensive care strategies tailored to address the diverse needs of patients, particularly those in advanced stages of disease. The patient care approach has evolved from focusing solely on disease to adopting a holistic view. According to the American Holistic Nurses Association, this means healing the whole person ( 4 ), extending beyond just treating physical symptoms. Holistic care encompasses a comprehensive assessment and management of various aspects of health, such as physical, psychological, spiritual, social, economic, and environmental factors ( 5 ) .Unlike conventional biomedical models, it acknowledges that disruptions in any of these areas can harm an individual’s overall health( 6 ). Extensive research has demonstrated that holistic care enhances the quality of life, improves physical and social functioning, and reduces psychological distress in patients with cancer ( 7 ). Meng et al. (2019) demonstrated that patients receiving holistic care experienced greater overall health and better social functioning than those in the control group ( 8 ). Likewise, Liang et al. (2019) found that this care model promotes interdisciplinary teamwork, provides more comprehensive support to patients and their families, and thus enhances its clinical and scientific credibility ( 9 ), Oncology nurses play a crucial role in providing comprehensive care. Their continuous, close interactions with patients from diagnosis through treatment and palliative or end-of-life care place them at the forefront of applying holistic principles in practice( 10 ). Their duties go beyond merely executing treatment protocols; they also include evaluating psychosocial needs, offering emotional support to patients and their families, and maintaining patient dignity. Consequently, the effectiveness of holistic care heavily relies on the nurses' knowledge, skills, and professional competence ( 11 ). The quality of nursing care has a direct impact on patients’ health outcomes. Recent research (2020–2025) suggests that high-quality nursing interventions, particularly those grounded in holistic principles, lead to more effective symptom control, enhanced psychological adaptation to illness, and overall improved health in patients with advanced cancer. These results validate that nurses are not merely service providers but serve as independent therapeutic agents, influencing patients' experiences and markedly affecting clinical outcomes( 12 , 13 ). Despite a solid theoretical basis and increasing evidence, applying holistic care in practice encounters notable obstacles. Many healthcare systems, including those in Iran, face challenges such as time constraints, staff burnout, an emphasis on conventional biomedical approaches by administrators, and an insufficient incorporation of holistic ideas into nursing education. These issues can lead nurses to feel unprepared to deliver holistic care ( 14 ). The gap between ideal standards and actual practice might result in reduced service quality and lower patient satisfaction. Patient satisfaction is a key indicator for assessing the effectiveness of care services. It measures how well patients' expectations align with their perceptions of the care they receive ( 15 , 16 )Research indicates that holistic nursing care, by fostering empathetic communication, involving patients in shared decision making, and respecting their individual values, greatly enhances patient satisfaction and enriches the overall treatment experience ( 8 ). Given these considerations and the identified gaps in existing research, this study aims to investigate the impact of holistic nursing care on patient satisfaction in individuals with advanced cancer. The results are anticipated to provide valuable empirical data that can enhance nursing practices, inform the development of evidence-based clinical guidelines, and support specialized educational programs for nurses. Ultimately, these initiatives can help health policy reforms that promote comprehensive and effective care for this vulnerable patient group. Methods Study Design and Setting This cross-sectional study was conducted in the oncology department of Bahonar Hospital, the primary regional referral center for oncology patients in Kerman, southeastern Iran, from June to September 2022. The study protocol received ethical approval from the Ethics Committee of Kerman University of Medical Sciences (Approval Code: IR.KMU.REC.1399.621). All methods were carried out in accordance with the relevant guidelines and regulations, including the tenets of the Declaration of Helsinki. Participants and Sampling Method The study population included patients with advanced-stage cancer. A non-probability convenience sampling method was used for recruitment. Based on prior research indicating a correlation coefficient of 0.14, with a significance level of (α = 0.05) and a power of 90%, the required sample size was calculated to be 90. To account for an expected 10% dropout rate(14), the final target sample size was increased to 98 participants. The inclusion criteria for the study were: (1) at least 18 years old and literate; (2) confirmed diagnosis of metastatic cancer or stage 4 lymphoma; (3) in the terminal stage with an estimated 50% chance of survival; and (4) awareness of their diagnosis and prognosis. Exclusion criteria included: (1) outpatients or pediatric patients; (2) unwillingness to participate or incomplete questionnaire submissions; and (3) inability due to physical or mental reasons to respond to questions. Data collection involved three standardized tools: Demographic and Clinical Information Questionnaire: This researcher made a questionnaire to collect data on age, gender, marital status, education, occupation, and history of hospitalization. Holistic Caring Inventory (HCI): This 40-item tool, developed by Latham (1996), assesses patients' perceptions of holistic nursing care. It explores four care dimensions: Physical, Interpretive, Spiritual, and Sensitive, based on Howard's (1975) theoretical framework. Responses are rated on a 4-point Likert scale from 1 (Strongly Disagree) to 4 (Strongly Agree). Total scores range from 40 to 160, with scores below 80 indicating poor perception, 80–120 indicating moderate perception, and scores above 120 indicating a strong perception of holistic care(17). The Persian version's validity and reliability have been confirmed in previous local studies, with a Cronbach's alpha of 0.88(14). The Patient Satisfaction Instrument (PSI): This 25-item questionnaire, initially developed by Risser (1975) and subsequently revised by Hinshaw and Atwood (1981), assesses patient satisfaction concerning nursing care. It encompasses three domains: Technical Professional Care (7 items), Trust (11 items), and Patient Education (7 items). Responses are measured on a 5-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The total scores span from 25 to 125, with scores below 58 indicating low satisfaction, scores between 58 and 92 denoting moderate satisfaction, and scores exceeding 92 representing high satisfaction(18). In Iranian research contexts, its content validity has been affirmed, and its reliability verified with a Cronbach's alpha coefficient of 0.90(18). Data Collection Procedure After securing necessary approvals from hospital authorities and the head nurse of the oncology department, the researcher visited the unit. With the assistance of charge nurses, the patients' disease status, diagnostic stage, and awareness of their condition were reviewed to confirm eligibility. Patients who were unaware of their diagnosis due to family requests were excluded. The research aims were then explained to each eligible participant, and written informed consent was obtained. The questionnaires were distributed when patients were in a suitable physical and psychological state and had sufficient time to respond, typically outside of physician rounds or visiting hours. The researcher remained present during questionnaire completion to clarify any questions. Data Analysis The data were input and analyzed using SPSS version 25. Descriptive statistics, including mean and standard deviation, summarized the demographic characteristics of the sample. To examine the relationship between the primary variables, perception of holistic care, and satisfaction with care, the Pearson correlation coefficient was employed. Furthermore, linear regression analysis was conducted to predict the influence of these variables on each other. All statistical tests were deemed significant at p < 0.05. Results The demographic and background details of the 98 participants are summarized in Table 1. Of these, 54.1% were female. The age distribution revealed that the largest group was aged 41 to 60 years (35.7%), while the smallest was under 20 years old (1.4%). Regarding marital status, 83.7% of the participants were married. In terms of education, 41.8% did not complete high school, and only 4% held a doctoral degree. Employment data indicated that 57.1% of the population was employed. Concerning treatment history, 39.8% received a combination of chemotherapy, radiotherapy, and surgery. A history of hospitalization was reported by 75.5%, with 44.9% hospitalized more than three times. Additionally, 55.1% reported hospital stays exceeding one week. As demonstrated in Table 1, an independent samples t-test indicated a statistically significant correlation between hospitalization history and patients' perception of holistic care (p < 0.05). Patients with a history of hospitalization reported a markedly higher perception of holistic care. Furthermore, ANOVA analysis revealed that the number of hospitalizations was also significantly associated with patients' perception of holistic care (p < 0.05). Patients hospitalized three or more times exhibited a substantially higher perception of holistic care. In contrast, an analysis of how demographic characteristics relate to patient satisfaction with nursing care (see Table 1) using an independent samples t-test revealed significant links between gender and marital status with satisfaction levels (p < 0.05). Specifically, female and unmarried patients reported higher satisfaction. Additionally, the ANOVA results in the same table indicated that age, education level, and the length and frequency of hospital stays did not have a significant impact on patient satisfaction with nursing care (p > 0.05). Table 2 presents the descriptive statistics, showing that patients' perception of holistic care has a mean score of 114.8 ± 19.35, indicating a high level. The mean score for patient satisfaction with nursing care is 62.7 ± 10.94, representing a moderate level. The Kolmogorov-Smirnov test verified that both variables are normally distributed (p > 0.05). Additionally, Pearson correlation analysis, shown in the table, identified a significant positive correlation between patients' perception of holistic care and their satisfaction with nursing care at the end of life (r = 0.22, p = 0.02). This suggests that a greater perception of holistic care is associated with higher levels of satisfaction. A multiple linear regression analysis was conducted to identify independent predictors of patient satisfaction, including patient perception of holistic care and demographic factors as variables (Table 3). The study revealed that, at a 0.05 significance level, none of these variables significantly predicted patient satisfaction (p > 0.05). These results indicate that, while perception of holistic care correlates with satisfaction, this relationship was not statistically significant in the multivariate model. Three variables showed a trend toward statistical significance: marital status (β = -0.26, p = 0.07), age (β = -0.24, p = 0.08), and perception of holistic care (β = 0.23, p = 0.09). The standardized beta coefficients revealed that marital status and age had the most substantial relative effects on patient satisfaction. Specifically, married patients reported satisfaction scores approximately 9.59 points lower than unmarried patients (B = -9.59), and older age was associated with an average decrease in satisfaction of 3.02 points (B = -3.02). Table 1. Demographic Characteristics of Patients and Their Correlation with Perceptions of Holistic Care and Satisfaction Variable Category Frequency (%) Mean Holistic care ± SD P-value (Holistic care) Mean Satisfaction ± SD P-value (Satisfaction) Age <20 4 (1.4%) 63 ± 3.16 0.74 63 ± 3.16 0.90 21-40 30 (30.6%) 65.23 ± 8.48 65.23 ± 8.48 41-60 35 (35.7%) 62.5 ± 11.83 62.05 ± 11.83 61-80 29 (29.6%) 60.89 ± 12.59 60.89 ± 12.59 Gender Male 45 (45.9%) 114.41 ± 20.03 0.94 60.41 ± 12.38 0.04 Female 53 (54.1%) 114.12 ± 18.54 64.98 ± 9.47 Marital Status Single 16 (16.3%) 105.69 ± 11.38 0.09 68.46 ± 7.88 0.04 Married 82 (83.7%) 115.32 ± 19.91 62.39 ± 10.2 Education < High School 41 (41.8%) 118.16 ± 19.27 0.45 62.83 ± 11.92 0.45 Diploma/Associate 33 (33.6%) 112.65 ± 21.56 61.62 ± 12.46 Bachelor/Master 21 (21.4%) 112.14 ± 21.56 63.23 ± 6.61 Doctorate 4 (4.2%) 105 ± 7.41 65.5 ± 9.57 Occupation Unemployed 42 (42.8%) 116.42 ± 19.66 0.57 65.15 ± 10.11 0.06 Employed 56 (57.1%) 114.01 ± 20.40 60.64 ± 11.86 Hospitalization History Yes 74 (75.5%) 119.32 ± 19.22 0.001 63.66 ± 12.01 0.13 No 24 (24.5%) 104.29 ± 15.45 65.58 ± 7.66 Number of Hospitalizations 1 17 (17.3%) 103.82 ± 21.24 0.021 63.41 ± 7.16 0.51 2-3 37 (37.8%) 115.08 ± 17.29 64.16 ± 11.13 >3 44 (44.9%) 119.13 ± 19.14 61.37 ± 12.08 Table 2. Descriptive Statistics and Correlations of Perception of Holistic Care and Satisfaction Variable Number Mean ± SD Normality Test (K-S) Correlation with Satisfaction (r, p) Patients' Perception of Holistic Care 98 114.80 ± 19.35 p=0.48 r=0.22 , p=0.02 Patients' Satisfaction with End-of-Life Care 98 62.72 ± 10.94 p=0.32 Table 3. Results of Multiple Regression for Predicting Patient Satisfaction Variable Unstandardized β Std. Error Standardized β t-statistic P-value of Perception of Holistic Care 0.12 0.07 0.23 1.69 0.09 Age -3.02 1.73 -0.24 -1.74 0.08 Gender 3.01 3.66 0.14 0.82 0.41 Marital Status -9.59 5.24 -0.26 -1.83 0.07 Education -1.7 1.81 -0.14 -0.94 0.35 Occupation 1.73 3.88 0.08 0.44 0.65 Treatment (Chemo/Surgery) 1.25 2.86 0.05 0.44 0.66 Length of Stay 0.25 1.76 0.02 0.14 0.88 Hospitalization History 1.76 3.70 0.07 0.47 0.63 Number of Hospitalizations 1.01 2.04 0.07 0.49 0.62 Discussion This investigation examined the correlation between patients' perceptions of holistic care and their levels of satisfaction within an oncology setting for advanced cancer. The findings showed that patients rated holistic care highly, but their overall satisfaction with nursing services was moderate. These results align with Beneberu et al. (2024), who found high ratings for palliative care quality but only moderate overall satisfaction( 19 ). Likewise, Gültekin et al. (2022) noted that patients with greater care needs reported lower levels of satisfaction( 20 ). This difference can be attributed to the complex nature of satisfaction, which is influenced by systemic factors such as nurse to patient ratios, specialized training, and cultural differences. Although holistic care aims to improve quality of life and encourage patient involvement (38), patients may view the care positively but still feel moderately satisfied overall due to systemic issues or the emotional toll of their illness. Additionally, the study found a positive, albeit weak and statistically significant, link between perceptions of holistic care and patient satisfaction. This aligns with research by Rajabpour et al(2019) and Almaghrabi & Saati (2022), which also demonstrated a significant and positive relationship( 14 , 21 ), supporting the hypothesis that a safe, holistic care system can increase patient satisfaction (( 22 ). Conversely, Gültekin et al(2022), reported a moderate-strength correlation( 20 ). The weak correlation may be due to the fact that overall satisfaction is influenced by factors beyond the quality of holistic care, such as organizational elements like care coordination and psychosocial crises related to the illness. Another key finding of this research was the significant statistical association between demographic variables (gender and marital status) and the level of satisfaction with holistic care, with female and unmarried patients expressing higher levels of satisfaction. This result aligns with research by Fang et al. (2024), which suggests that relationshipcentered care models, combined with empathetic communication styles, lead to greater satisfy action among women( 23 ). Additionally, Jiang et al (2015) showed that although family support is generally beneficial, it can increase stress when family adaptability is low( 24 ).These findings contrast with those of Guo et al. (2023), who reported higher satisfaction with general nursing services among married men( 25 ), and with Kasa et al. (2019), who observed greater satisfaction in married patients ( 26 ).This highlights that the influence of demographic variables is not fixed but is shaped by the specific care model and cultural context. The higher satisfaction reported by women is probably due to the alignment of holistic care’s communicative and empathetic aspects with their expectations. This alignment is less evident in general care settings. Similarly, unmarried individuals may experience greater satisfaction because their care is less impacted by psychosocial stressors from family relationships. This study found a positive and significant link between patients' hospitalization history and their perception of holistic care. This extends earlier findings by Rajabpour et al. (2019), who showed this link with overall satisfaction, to a more specific view of a complex care model ( 14 ). The phenomenon can be explained through the theoretical framework of personalized nursing and the idea of experiential health literacy ( 27 ). According to this framework, repeated interactions with the healthcare system boost patients' ability to distinguish and appreciate multidimensional care. Patients with more experience are better at identifying care that meets their personal and psychosocial needs beyond standard protocols( 28 ). Thus, high perception of holistic care among this group reflects not just satisfaction but also their capacity to recognize practical therapeutic approaches that enhance their psychological and emotional well-being. Finally, the multivariate regression analysis revealed that none of the predictor variables had a significant relationship with patient satisfaction. However, three variables, marital status, age, and perception of holistic care, were nearly significant. The absence of a considerable effect from demographic factors aligns with the findings of Nguyen et al. (2023) and Gonul Akbulut et al. (2017)( 29 , 30 ). Likewise, Gomez-Cano et al. (2020) indicated that operational and care coordination factors have a more significant influence on patient satisfaction( 31 ). The difference from studies that identified these variables as substantial may be due to methodological differences, varied assessment tools, cultural contexts, and the cross-sectional nature of our research. Despite this, the near-significant trends for these variables are notable. These borderline results suggest that, although not statistically significant, these factors may be clinically relevant, underscoring the importance of understanding the complex interactions among variables in various settings. Conclusion This investigation demonstrated that, despite patients with advanced cancer possessing a high perception of holistic nursing care, this perception corresponds to only a modest positive correlation with their overall satisfaction with nursing services. Overall, patient satisfaction was evaluated as moderate, exposing a discrepancy between the perception of care quality and actual satisfaction. This divergence highlights the importance of systemic and contextual factors in shaping the patient experience. The findings also indicate that demographic factors, such as gender and marital status, significantly influence satisfaction levels, with women and unmarried individuals generally reporting higher satisfaction. These results underscore the importance of shifting away from one-size-fits-all strategies and adopting patient-centered care models. Holistic care plays a crucial role in enhancing the patient experience; however, interventions should adopt a more comprehensive approach to boost patient satisfaction significantly. This involves not only enhancing nurses' skills but also tackling structural barriers in healthcare. Based on this study, practical, evidence-based recommendations include allowing sufficient time for thorough consultations, training staff in non-clinical skills, and optimizing nurse-to-patient ratios to facilitate more effective therapeutic interactions. Limitations This study had some limitations. First, its cross-sectional design prevents drawing causal conclusions between variables. Second, using a single-center sample restricts the extent to which the results can be applied to other populations and healthcare environments. These limitations emphasize the importance of conducting longitudinal and interventional studies to confirm and build upon the current findings. Declarations The authors state that they utilized artificial intelligence tools, including ChatGPT (version 5) and Gemini (version 2.5), to enhance sentence fluency and coherence. Grammarly was used to correct grammar issues, and Scispace was employed to review and improve the research background. The authors carefully reviewed and verified the manuscript's accuracy and precision, ensuring it is both linguistically clear and scientifically sound. Ethical Considerations All phases of data collection, analysis, and interpretation adhered to ethical and professional standards, fully respecting intellectual property rights. This study was reviewed and approved by the Ethics Committee of Kerman University of Medical Sciences, under the approval code IR.KMU.REC.1399.621. Funding Declaration This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Consent to Participate All participants were informed about the purpose and procedures of the study, and written informed consent was obtained prior to participation. Participation was voluntary, and confidentiality and anonymity were maintained throughout the study. Data Availability The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request. Conflict of Interest The authors declare that they have no financial, organizational, or personal conflicts of interest related to the topic, design, execution, or publication of this article. Author Contributions P. Mangolian Shahrbabaki designed and supervised the study. Z. Divdel and M. Moradi-Joo performed the data analysis and interpretation. A. Haghgoo and F. Nazari collected the data and drafted the manuscript. F. Nazari and M. Moradi-Joo served as the corresponding authors. All authors reviewed, revised, and approved the final version of the manuscript. 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BMC cancer. 2014;14(1):42. Akbulut G, Kant E, Ozmen S, Akpinar RB. Determining patients' satisfaction with the nursing services provided in an oncology clinic of Eastern Turkey. International Journal of Caring Sciences. 2017;10(3):1276-85. Gomez-Cano M, Lyratzopoulos G, Abel GA. Patient experience drivers of overall satisfaction with care in cancer patients: evidence from responders to the English cancer patient experience survey. Journal of Patient Experience. 2020;7(5):758-65. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7944758","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":553001672,"identity":"558ff817-7de3-4909-8530-e3aa9f3f9f41","order_by":0,"name":"Parvin Mangolian Shahrbabaki","email":"","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Parvin","middleName":"Mangolian","lastName":"Shahrbabaki","suffix":""},{"id":553001673,"identity":"5cfd22a2-b763-41a7-88b5-a3cc67147a17","order_by":1,"name":"Zoalfghar Divdel","email":"","orcid":"","institution":"Yasuj University of Medical 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Nazari","email":"data:image/png;base64,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","orcid":"","institution":"Kerman University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Faezeh","middleName":"","lastName":"Nazari","suffix":""}],"badges":[],"createdAt":"2025-10-27 08:31:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7944758/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7944758/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97124883,"identity":"b98d6f8a-9fe2-4cca-952b-a8d79e0e1097","added_by":"auto","created_at":"2025-12-01 08:13:01","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":42719,"visible":true,"origin":"","legend":"","description":"","filename":"14040809.docx","url":"https://assets-eu.researchsquare.com/files/rs-7944758/v1/74a4ce53a28d96a8ebdc3bd1.docx"},{"id":97124881,"identity":"348fe53f-edfd-407a-bf56-1f2cb59f7015","added_by":"auto","created_at":"2025-12-01 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08:13:01","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":87712,"visible":true,"origin":"","legend":"","description":"","filename":"b7aa7f2363544cf4a27a5c1f44aed3de1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7944758/v1/33ae3b3cd50660bf900b658c.xml"},{"id":97141976,"identity":"064d0f51-f1ca-4cdd-be74-ac0d75eae944","added_by":"auto","created_at":"2025-12-01 10:07:14","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":98288,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7944758/v1/746c0e3a1b80d4ef481f6893.html"},{"id":97897609,"identity":"b5abb443-4d9b-41cc-8178-cb3e2eeeedf0","added_by":"auto","created_at":"2025-12-10 15:37:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":695736,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7944758/v1/39aa18b5-c52f-4096-9994-1dc0df252f19.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mind–Body Connection and Satisfaction: The Correlation Between Holistic Nursing Care and Patient Satisfaction in Patients With Advanced Cancer","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCancer is a significant public health issue characterized by the uncontrolled growth of abnormal cells and their invasion of surrounding tissues (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The American Cancer Society (ACS) reports approximately 1.9\u0026nbsp;million new cases and 609,000 deaths in the United States in 2022 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Similarly, projections for Iran indicate that by 2025, over 130,000 new cases will be diagnosed annually (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).This significant burden underscores the urgent need to develop and implement effective, comprehensive care strategies tailored to address the diverse needs of patients, particularly those in advanced stages of disease.\u003c/p\u003e\u003cp\u003eThe patient care approach has evolved from focusing solely on disease to adopting a holistic view. According to the American Holistic Nurses Association, this means healing the whole person (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), extending beyond just treating physical symptoms. Holistic care encompasses a comprehensive assessment and management of various aspects of health, such as physical, psychological, spiritual, social, economic, and environmental factors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) .Unlike conventional biomedical models, it acknowledges that disruptions in any of these areas can harm an individual\u0026rsquo;s overall health(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eExtensive research has demonstrated that holistic care enhances the quality of life, improves physical and social functioning, and reduces psychological distress in patients with cancer (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eMeng et al. (2019) demonstrated that patients receiving holistic care experienced greater overall health and better social functioning than those in the control group (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Likewise, Liang et al. (2019) found that this care model promotes interdisciplinary teamwork, provides more comprehensive support to patients and their families, and thus enhances its clinical and scientific credibility (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e),\u003c/p\u003e\u003cp\u003eOncology nurses play a crucial role in providing comprehensive care. Their continuous, close interactions with patients from diagnosis through treatment and palliative or end-of-life care place them at the forefront of applying holistic principles in practice(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Their duties go beyond merely executing treatment protocols; they also include evaluating psychosocial needs, offering emotional support to patients and their families, and maintaining patient dignity. Consequently, the effectiveness of holistic care heavily relies on the nurses' knowledge, skills, and professional competence (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe quality of nursing care has a direct impact on patients\u0026rsquo; health outcomes. Recent research (2020\u0026ndash;2025) suggests that high-quality nursing interventions, particularly those grounded in holistic principles, lead to more effective symptom control, enhanced psychological adaptation to illness, and overall improved health in patients with advanced cancer. These results validate that nurses are not merely service providers but serve as independent therapeutic agents, influencing patients' experiences and markedly affecting clinical outcomes(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDespite a solid theoretical basis and increasing evidence, applying holistic care in practice encounters notable obstacles. Many healthcare systems, including those in Iran, face challenges such as time constraints, staff burnout, an emphasis on conventional biomedical approaches by administrators, and an insufficient incorporation of holistic ideas into nursing education. These issues can lead nurses to feel unprepared to deliver holistic care (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The gap between ideal standards and actual practice might result in reduced service quality and lower patient satisfaction.\u003c/p\u003e\u003cp\u003ePatient satisfaction is a key indicator for assessing the effectiveness of care services. It measures how well patients' expectations align with their perceptions of the care they receive (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e)Research indicates that holistic nursing care, by fostering empathetic communication, involving patients in shared decision making, and respecting their individual values, greatly enhances patient satisfaction and enriches the overall treatment experience (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGiven these considerations and the identified gaps in existing research, this study aims to investigate the impact of holistic nursing care on patient satisfaction in individuals with advanced cancer. The results are anticipated to provide valuable empirical data that can enhance nursing practices, inform the development of evidence-based clinical guidelines, and support specialized educational programs for nurses. Ultimately, these initiatives can help health policy reforms that promote comprehensive and effective care for this vulnerable patient group.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted in the oncology department of Bahonar Hospital, the primary regional referral center for oncology patients in Kerman, southeastern Iran, from June to September 2022. The study protocol received ethical approval from the Ethics Committee of Kerman University of Medical Sciences (Approval Code: IR.KMU.REC.1399.621). All methods were carried out in accordance with the relevant guidelines and regulations, including the tenets of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants and Sampling Method\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population included patients with advanced-stage cancer. A non-probability convenience sampling method was used for recruitment. Based on prior research indicating a correlation\u0026nbsp;coefficient of 0.14, with a significance level of (\u0026alpha; = 0.05) and a power of 90%, the required sample size was calculated to be 90. To account for an expected 10% dropout rate(14), the final target sample size was increased to 98 participants.\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for the study were: (1) at least 18 years old and literate; (2) confirmed diagnosis of metastatic cancer or stage 4 lymphoma; (3) in the terminal stage with an estimated 50% chance of survival; and (4) awareness of their diagnosis and prognosis. Exclusion criteria included: (1) outpatients or pediatric patients; (2) unwillingness to participate or incomplete questionnaire submissions; and (3) inability due to physical or mental reasons to respond to questions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection involved three standardized tools:\u003c/strong\u003e\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eDemographic and Clinical Information Questionnaire:\u0026nbsp;This researcher made a questionnaire to collect data on age, gender, marital status, education, occupation, and history of hospitalization.\u003c/li\u003e\n \u003cli\u003eHolistic Caring Inventory (HCI):\u0026nbsp;This 40-item tool, developed by Latham (1996), assesses patients\u0026apos; perceptions of holistic nursing care. It explores four care dimensions: Physical, Interpretive, Spiritual, and Sensitive,\u0026nbsp;based on Howard\u0026apos;s (1975) theoretical framework. Responses are rated on a 4-point Likert scale from 1 (Strongly Disagree) to 4 (Strongly Agree). Total scores range from 40 to 160, with scores below 80 indicating poor perception, 80\u0026ndash;120 indicating moderate perception, and scores above 120 indicating a strong perception of holistic care(17). The Persian version\u0026apos;s validity and reliability have been confirmed in previous local studies, with a Cronbach\u0026apos;s alpha of 0.88(14).\u003c/li\u003e\n \u003cli\u003eThe Patient Satisfaction Instrument (PSI):\u0026nbsp;This 25-item questionnaire, initially developed by Risser (1975) and subsequently revised by Hinshaw and Atwood (1981), assesses patient satisfaction concerning nursing care. It encompasses three domains: Technical Professional Care (7 items), Trust (11 items), and Patient Education (7 items). Responses are measured on a 5-point Likert scale, ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The total scores span from 25 to 125, with scores below 58 indicating low satisfaction, scores between 58 and 92 denoting moderate satisfaction, and scores exceeding 92 representing high satisfaction(18). In Iranian research contexts, its content validity has been affirmed, and its reliability verified with a Cronbach\u0026apos;s alpha coefficient of 0.90(18).\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Procedure\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;After securing necessary approvals from hospital authorities and the head nurse of the oncology department, the researcher visited the unit. With the assistance of charge nurses, the patients\u0026apos; disease status, diagnostic stage, and awareness of their condition were reviewed to confirm eligibility. Patients who were unaware of their diagnosis due to family requests were excluded. The research aims were then explained to each eligible participant, and written informed consent was obtained. The questionnaires were distributed when patients were in a suitable physical and psychological state and had sufficient time to respond, typically outside of physician rounds or visiting hours. The researcher remained present during questionnaire completion to clarify any questions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003cbr\u003eThe data were input and analyzed using SPSS version 25. Descriptive statistics, including mean and standard deviation, summarized the demographic characteristics of the sample. To examine the relationship between the primary variables, perception of holistic care, and satisfaction with care,\u0026nbsp;the Pearson correlation coefficient was employed. Furthermore, linear regression analysis was conducted to predict the influence of these variables on each other. All statistical tests were deemed significant at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe demographic and background details of the 98 participants are summarized in Table 1. Of these, 54.1% were female. The age distribution revealed that the largest group was aged 41 to 60 years (35.7%), while the smallest was under 20 years old (1.4%). Regarding marital status, 83.7% of the participants were married. In terms of education, 41.8% did not complete high school, and only 4% held a doctoral degree. Employment data indicated that 57.1% of the population was employed. Concerning treatment history, 39.8% received a combination of chemotherapy, radiotherapy, and surgery. A history of hospitalization was reported by 75.5%, with 44.9% hospitalized more than three times. Additionally, 55.1% reported hospital stays exceeding one week. As demonstrated in Table 1, an independent samples t-test indicated a statistically significant correlation between hospitalization history and patients\u0026apos; perception of holistic care (p\u0026nbsp;\u0026lt; 0.05). Patients with a history of hospitalization reported a markedly higher perception of holistic care. Furthermore, ANOVA analysis revealed that the number of hospitalizations was also significantly associated with patients\u0026apos; perception of holistic care (p\u0026nbsp;\u0026lt; 0.05). Patients hospitalized three or more times exhibited a substantially higher perception of holistic care.\u003c/p\u003e\n\u003cp\u003eIn contrast, an analysis of how demographic characteristics relate to patient satisfaction with nursing care (see Table 1) using an independent samples t-test revealed significant links between gender and marital status with satisfaction levels (p\u0026nbsp;\u0026lt; 0.05). Specifically, female and unmarried patients reported higher satisfaction. Additionally, the ANOVA results in the same table indicated that age, education level, and the length and frequency of hospital stays did not have a significant impact on patient satisfaction with nursing care (p\u0026nbsp;\u0026gt; 0.05).\u003c/p\u003e\n\u003cp\u003eTable 2 presents the descriptive statistics, showing that patients\u0026apos; perception of holistic care has a mean score of 114.8 \u0026plusmn; 19.35, indicating a high level. The mean score for patient satisfaction with nursing care is 62.7 \u0026plusmn; 10.94, representing a moderate level. The Kolmogorov-Smirnov test verified that both variables are normally distributed (p\u0026nbsp;\u0026gt; 0.05). Additionally, Pearson correlation analysis, shown in the table, identified a significant positive correlation between patients\u0026apos; perception of holistic care and their satisfaction with nursing care at the end of life (r\u0026nbsp;= 0.22,\u0026nbsp;p\u0026nbsp;= 0.02). This suggests that a greater perception of holistic care is associated with higher levels of satisfaction.\u003cbr\u003e\u0026nbsp;A multiple linear regression analysis was conducted to identify independent predictors of patient satisfaction, including patient perception of holistic care and demographic factors as variables (Table 3). The study revealed that, at a 0.05 significance level, none of these variables significantly predicted patient satisfaction (p \u0026gt; 0.05). These results indicate that, while perception of holistic care correlates with satisfaction, this relationship was not statistically significant in the multivariate model.\u003c/p\u003e\n\u003cp\u003eThree variables showed a trend toward statistical significance: marital status (\u0026beta; = -0.26,\u0026nbsp;p\u0026nbsp;= 0.07), age (\u0026beta; = -0.24,\u0026nbsp;p\u0026nbsp;= 0.08), and perception of holistic care (\u0026beta; = 0.23,\u0026nbsp;p\u0026nbsp;= 0.09). The standardized beta coefficients revealed that marital status and age had the most substantial relative effects on patient satisfaction. Specifically, married patients reported satisfaction scores approximately 9.59 points lower than unmarried patients (B = -9.59), and older age was associated with an average decrease in satisfaction of 3.02 points (B = -3.02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic Characteristics of Patients and Their Correlation with Perceptions of Holistic Care and Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"709\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eFrequency (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMean Holistic care\u003c/p\u003e\n \u003cp\u003e\u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-value (Holistic care)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eMean Satisfaction \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-value\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e(Satisfaction)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026lt;20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e63 \u0026plusmn; 3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e63 \u0026plusmn; 3.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e21-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e30 (30.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e65.23 \u0026plusmn; 8.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65.23 \u0026plusmn; 8.48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e41-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e35 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e62.5 \u0026plusmn; 11.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62.05 \u0026plusmn; 11.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e61-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29 (29.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e60.89 \u0026plusmn; 12.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60.89 \u0026plusmn; 12.59\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e45 (45.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e114.41 \u0026plusmn; 20.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60.41 \u0026plusmn; 12.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (54.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e114.12 \u0026plusmn; 18.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e64.98 \u0026plusmn; 9.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e16 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e105.69 \u0026plusmn; 11.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e68.46 \u0026plusmn; 7.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e82 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e115.32 \u0026plusmn; 19.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62.39 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026lt; High School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e41 (41.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e118.16 \u0026plusmn; 19.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e62.83 \u0026plusmn; 11.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eDiploma/Associate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (33.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e112.65 \u0026plusmn; 21.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e61.62 \u0026plusmn; 12.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eBachelor/Master\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e21 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e112.14 \u0026plusmn; 21.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e63.23 \u0026plusmn; 6.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eDoctorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e4 (4.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e105 \u0026plusmn; 7.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65.5 \u0026plusmn; 9.57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eUnemployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e42 (42.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e116.42 \u0026plusmn; 19.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65.15 \u0026plusmn; 10.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.06\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eEmployed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e56 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e114.01 \u0026plusmn; 20.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e60.64 \u0026plusmn; 11.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eHospitalization History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e74 (75.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e119.32 \u0026plusmn; 19.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e63.66 \u0026plusmn; 12.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (24.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e104.29 \u0026plusmn; 15.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65.58 \u0026plusmn; 7.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eNumber of Hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e17 (17.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e103.82 \u0026plusmn; 21.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e63.41 \u0026plusmn; 7.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e37 (37.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e115.08 \u0026plusmn; 17.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e64.16 \u0026plusmn; 11.13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026gt;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e44 (44.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e119.13 \u0026plusmn; 19.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e61.37 \u0026plusmn; 12.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Descriptive Statistics and Correlations of Perception of Holistic Care and Satisfaction\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"662\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNormality Test (K-S)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003eCorrelation with Satisfaction (r, p)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePatients\u0026apos; Perception of Holistic Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e114.80 \u0026plusmn; 19.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ep=0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003er=0.22 , p=0.02\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePatients\u0026apos; Satisfaction with End-of-Life Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 89px;\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e62.72 \u0026plusmn; 10.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ep=0.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Results of Multiple Regression for Predicting Patient Satisfaction\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"650\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUnstandardized \u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eStd. Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003eStandardized \u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003et-statistic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eof Perception of Holistic Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e1.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-3.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e-0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e-1.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e3.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e3.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eMarital Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-9.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e5.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e-0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e-1.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e-1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e-0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e3.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTreatment (Chemo/Surgery)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eLength of Stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHospitalization History\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e3.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNumber of Hospitalizations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis investigation examined the correlation between patients' perceptions of holistic care and their levels of satisfaction within an oncology setting for advanced cancer.\u003c/p\u003e\u003cp\u003eThe findings showed that patients rated holistic care highly, but their overall satisfaction with nursing services was moderate. These results align with Beneberu et al. (2024), who found high ratings for palliative care quality but only moderate overall satisfaction(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Likewise, G\u0026uuml;ltekin et al. (2022) noted that patients with greater care needs reported lower levels of satisfaction(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This difference can be attributed to the complex nature of satisfaction, which is influenced by systemic factors such as nurse to patient ratios, specialized training, and cultural differences. Although holistic care aims to improve quality of life and encourage patient involvement (38), patients may view the care positively but still feel moderately satisfied overall due to systemic issues or the emotional toll of their illness.\u003c/p\u003e\u003cp\u003eAdditionally, the study found a positive, albeit weak and statistically significant, link between perceptions of holistic care and patient satisfaction. This aligns with research by Rajabpour et al(2019) and Almaghrabi \u0026amp; Saati (2022), which also demonstrated a significant and positive relationship(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), supporting the hypothesis that a safe, holistic care system can increase patient satisfaction ((\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Conversely, G\u0026uuml;ltekin et al(2022), reported a moderate-strength correlation(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The weak correlation may be due to the fact that overall satisfaction is influenced by factors beyond the quality of holistic care, such as organizational elements like care coordination and psychosocial crises related to the illness.\u003c/p\u003e\u003cp\u003eAnother key finding of this research was the significant statistical association between demographic variables (gender and marital status) and the level of satisfaction with holistic care, with female and unmarried patients expressing higher levels of satisfaction. This result aligns with research by Fang et al. (2024), which suggests that relationshipcentered care models, combined with empathetic communication styles, lead to greater satisfy action among women(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Additionally, Jiang et al (2015) showed that although family support is generally beneficial, it can increase stress when family adaptability is low(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).These findings contrast with those of Guo et al. (2023), who reported higher satisfaction with general nursing services among married men(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), and with Kasa et al. (2019), who observed greater satisfaction in married patients (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).This highlights that the influence of demographic variables is not fixed but is shaped by the specific care model and cultural context. The higher satisfaction reported by women is probably due to the alignment of holistic care\u0026rsquo;s communicative and empathetic aspects with their expectations. This alignment is less evident in general care settings. Similarly, unmarried individuals may experience greater satisfaction because their care is less impacted by psychosocial stressors from family relationships.\u003c/p\u003e\u003cp\u003eThis study found a positive and significant link between patients' hospitalization history and their perception of holistic care. This extends earlier findings by Rajabpour et al. (2019), who showed this link with overall satisfaction, to a more specific view of a complex care model (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). The phenomenon can be explained through the theoretical framework of personalized nursing and the idea of experiential health literacy (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAccording to this framework, repeated interactions with the healthcare system boost patients' ability to distinguish and appreciate multidimensional care. Patients with more experience are better at identifying care that meets their personal and psychosocial needs beyond standard protocols(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). Thus, high perception of holistic care among this group reflects not just satisfaction but also their capacity to recognize practical therapeutic approaches that enhance their psychological and emotional well-being.\u003c/p\u003e\u003cp\u003eFinally, the multivariate regression analysis revealed that none of the predictor variables had a significant relationship with patient satisfaction. However, three variables, marital status, age, and perception of holistic care, were nearly significant. The absence of a considerable effect from demographic factors aligns with the findings of Nguyen et al. (2023) and Gonul Akbulut et al. (2017)(\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Likewise, Gomez-Cano et al. (2020) indicated that operational and care coordination factors have a more significant influence on patient satisfaction(\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The difference from studies that identified these variables as substantial may be due to methodological differences, varied assessment tools, cultural contexts, and the cross-sectional nature of our research. Despite this, the near-significant trends for these variables are notable. These borderline results suggest that, although not statistically significant, these factors may be clinically relevant, underscoring the importance of understanding the complex interactions among variables in various settings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis investigation demonstrated that, despite patients with advanced cancer possessing a high perception of holistic nursing care, this perception corresponds to only a modest positive correlation with their overall satisfaction with nursing services. Overall, patient satisfaction was evaluated as moderate, exposing a discrepancy between the perception of care quality and actual satisfaction. This divergence highlights the importance of systemic and contextual factors in shaping the patient experience.\u003c/p\u003e\n\u003cp\u003eThe findings also indicate that demographic factors, such as gender and marital status, significantly influence satisfaction levels, with women and unmarried individuals generally reporting higher satisfaction. These results underscore the importance of shifting away from one-size-fits-all strategies and adopting patient-centered care models.\u003c/p\u003e\n\u003cp\u003eHolistic care plays a crucial role in enhancing the patient experience; however, interventions should adopt a more comprehensive approach to boost patient satisfaction significantly. This involves not only enhancing nurses' skills but also tackling structural barriers in healthcare. Based on this study, practical, evidence-based recommendations include allowing sufficient time for thorough consultations, training staff in non-clinical skills, and optimizing nurse-to-patient ratios to facilitate more effective therapeutic interactions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study had some limitations. First, its cross-sectional design prevents drawing causal conclusions between variables. Second, using a single-center sample restricts the extent to which the results can be applied to other populations and healthcare environments. These limitations emphasize the importance of conducting longitudinal and interventional studies to confirm and build upon the current findings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eThe authors state that they utilized artificial intelligence tools, including ChatGPT (version 5) and Gemini (version 2.5), to enhance sentence fluency and coherence. Grammarly was used to correct grammar issues, and Scispace was employed to review and improve the research background. The authors carefully reviewed and verified the manuscript\u0026apos;s accuracy and precision, ensuring it is both linguistically clear and scientifically sound.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll phases of data collection, analysis, and interpretation adhered to ethical and professional standards, fully respecting intellectual property rights. This study was reviewed and approved by the Ethics Committee of Kerman University of Medical Sciences, under the approval code IR.KMU.REC.1399.621.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the purpose and procedures of the study, and written informed consent was obtained prior to participation. Participation was voluntary, and confidentiality and anonymity were maintained throughout the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial, organizational, or personal conflicts of interest related to the topic, design, execution, or publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP. Mangolian Shahrbabaki designed and supervised the study. Z. Divdel and M. Moradi-Joo performed the data analysis and interpretation. A. Haghgoo and F. Nazari collected the data and drafted the manuscript. F. Nazari and M. Moradi-Joo served as the corresponding authors. All authors reviewed, revised, and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003cbr\u003e\u003c/strong\u003eThe authors sincerely thank the patients, as well as the medical and nursing staff of the Oncology Ward at Shahid Bahonar Hospital in Kerman, for their cooperation and support throughout the research process. Their help and collaboration were essential to the successful completion of this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSeif F, Bayatiani MR. Cancer and Radiotherapy. Journal of Arak University of Medical Sciences. 2018;21(4):1-5.\u003c/li\u003e\n\u003cli\u003eXia C, Dong X, Li H, Cao M, Sun D, He S, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. 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BMC nursing. 2025;24(1):239.\u003c/li\u003e\n\u003cli\u003eAlyami H, Alyami H, ALHindi E, Abdullah F, Alsaad S, Almahri S. Comprehensive review of personalized nursing care, technological integration, and workforce resilience in modern healthcare. J Ecohumanism. 2024;3(8):5098-107.\u003c/li\u003e\n\u003cli\u003eNguyen TVF, Anota A, Br\u0026eacute;dart A, Monnier A, Bosset J-F, Mercier M. A longitudinal analysis of patient satisfaction with care and quality of life in ambulatory oncology based on the OUT-PATSAT35 questionnaire. BMC cancer. 2014;14(1):42.\u003c/li\u003e\n\u003cli\u003eAkbulut G, Kant E, Ozmen S, Akpinar RB. Determining patients\u0026apos; satisfaction with the nursing services provided in an oncology clinic of Eastern Turkey. International Journal of Caring Sciences. 2017;10(3):1276-85.\u003c/li\u003e\n\u003cli\u003eGomez-Cano M, Lyratzopoulos G, Abel GA. 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Journal of Patient Experience. 2020;7(5):758-65.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Holistic Nursing Care, Patient Satisfaction, Cancer, Oncology Nursing","lastPublishedDoi":"10.21203/rs.3.rs-7944758/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7944758/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHolistic care plays a pivotal role in the treatment of patients with advanced cancer, with patient satisfaction serving as a key indicator of healthcare quality. This study aimed to examine the relationship between patients\u0026rsquo; perceptions of holistic nursing care and their overall satisfaction with the care received.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis cross-sectional study was conducted in 2022 among 98 patients with advanced cancer in the oncology department of Bahonar Hospital, Kerman. Participants were selected through convenience sampling. Data were collected using the standardized Holistic Caring Inventory (HCI) and the Patient Satisfaction Instrument (PSI). Analyses were performed with SPSS software, employing descriptive statistics, Pearson correlation, and linear regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe mean score for patients\u0026rsquo; perception of holistic care was 114.8\u0026thinsp;\u0026plusmn;\u0026thinsp;19.3, while the mean satisfaction score was 62.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.9. Correlation analysis revealed a significant positive relationship between perceptions of holistic care and patient satisfaction (r\u0026thinsp;=\u0026thinsp;0.22, p\u0026thinsp;=\u0026thinsp;0.02). Moreover, patients with a history of hospitalization and more frequent admissions reported significantly higher perceptions of holistic care (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In terms of satisfaction, significant differences were found based on gender\u0026mdash;with female patients reporting higher satisfaction (p\u0026thinsp;=\u0026thinsp;0.04)\u0026mdash;and marital status, with unmarried individuals reporting greater satisfaction (p\u0026thinsp;=\u0026thinsp;0.04). No other demographic variables were significantly associated with satisfaction. Multivariate regression analysis did not identify any variable as a significant predictor of patient satisfaction.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eAlthough patients with advanced cancer generally perceive holistic care positively, its impact on overall satisfaction is limited. This finding suggests that patient satisfaction is a multifaceted phenomenon shaped not only by the quality of direct care but also by systemic, organizational factors and the psychosocial burden of illness. To achieve substantial improvements in patient satisfaction, interventions should adopt a comprehensive and structural approach.\u003c/p\u003e","manuscriptTitle":"Mind–Body Connection and Satisfaction: The Correlation Between Holistic Nursing Care and Patient Satisfaction in Patients With Advanced Cancer","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-01 08:12:56","doi":"10.21203/rs.3.rs-7944758/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"044e0d36-2363-4a3c-a318-206f2c948699","owner":[],"postedDate":"December 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58844628,"name":"Biological sciences/Cancer"},{"id":58844629,"name":"Health sciences/Health care"},{"id":58844630,"name":"Health sciences/Oncology"},{"id":58844631,"name":"Biological sciences/Psychology"},{"id":58844632,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2025-12-09T10:39:12+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-01 08:12:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7944758","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7944758","identity":"rs-7944758","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}