“We Just Want to Feel at Peace”: A Qualitative Exploration of Comfort Care Needs in Geriatric Palliative Patients

“We Just Want to Feel at Peace”: A Qualitative Exploration of Comfort Care Needs in Geriatric Palliative Patients | 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 Research Article “We Just Want to Feel at Peace”: A Qualitative Exploration of Comfort Care Needs in Geriatric Palliative Patients Na Li, Xinru Liu, Ronghui Wang, Longhui Xu, Yanbo Ji, cuiping xu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8241914/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 Aim： An in-depth exploration of the comfort care needs, experiences, and influencing factors of Chinese elderly patients during hospice care with a view to optimizing clinical practice. Design： A qualitative descriptive study Methods： Audio-recorded, face-to-face, semi-structured, individual interviews were conducted from May 2025 to June 2025 with nurses, elderly patients, and family members in a tertiary care hospital and four health care facilities in China. Coding was conducted using NVivo 12 software and themes were distilled based on Colaizzi's seven-step phenomenological analysis. Result： Four themes and 14 sub-themes were identified. The main themes are somatic comfort, psychological and emotional comfort, environmental comfort and sociocultural and spiritual comfort. Conclusion： This study reveals multiple dimensions of comfort needs and their influencing factors, including physical, psychological, emotional, sociocultural and spiritual, in geriatric hospice care, to provide a basis for healthcare teams to more accurately identify unmet needs and develop individualized care plans. Impact： This study provides insight into patients' and families' true perceptions of comfort, providing a richer, more contextualized understanding of comfort care in geriatric hospice, which will help healthcare teams more accurately identify unmet needs and develop more personalized and humanized care plans, thereby improving the quality of geriatric hospice care. Patient or Public Contribution： There was no patient or public contribution. Palliative care elderly comfort qualitative research 1 INTRODUCTION Data from the World Health Organization (WHO) indicates that the proportion of the global population aged 65 and above is projected to increase significantly from 9% in 2019 to 16% by 2050[1]。As the world's most populous country, China is facing immense pressure due to accelerating population agingFrom 2020 to 2050, the population aged 65 and above in China is estimated to increase from 172 million to 366 million[2].This demographic trend presents complex challenges for China's healthcare system, economy, and society.Older adults are more susceptible to chronic and comorbid diseases, which significantly increases the burden on healthcare infrastructure[3],As a result, there is a need to move from a focus on acute, disease-specific treatment to a model of care that is long-term, holistic and patient-centered. One of the key models is hospice, which is able to manage complex chronic diseases and continuously improve quality of life throughout the course of a patient's illness, not just at the end of life.[4].With the increasing trend of global population aging, the number of elderly terminally ill patients continues to grow[1]，其对以人为本的临终照护需求日益突出[5],The core goal of comfort care is to help patients maintain dignity and peace of mind at the end of their lives.[6].The purpose of this study is to explore in depth the comfort care needs, experiences and influencing factors of elderly patients during hospice care through qualitative research methods, so as to provide theoretical basis and practical guidance for optimizing clinical practice and improving the quality of end-of-life care. 2 BACKGROUND In geriatric hospice care, the primary goals of comfort care as a patient-centered philosophy include relieving pain and other distressing symptoms, improving communication between the patient, family, and healthcare providers, supporting the patient's ability to make autonomous decisions, addressing emotional, social, and spiritual concerns, and ultimately improving the patient's quality of life[7],Thus, comfort occupies an irreplaceable central place in geriatric hospice care and is a key indicator of quality of care[8-10].Despite the growing importance of geriatric hospice and comfort care, there are still many challenges and unmet needs in its development globally, especially in China. Many elderly patients perceive it as a treatment limited to the terminal phase and do not accept hospice services, a misconception that often leads to hesitation on the part of patients and their families, resulting in missed opportunities to improve their quality of life[11].Second, the shortage of human resources and lack of professional capacity are notable constraints. China faces the bottleneck of nursing personnel shortage, and the existing personnel in service consciousness[12],professional ethics[13],Professional knowledge and skills training[14]still need to be upgraded.This has led to variable quality of services to meet the needs of a wide range of patients. Inadequate training and education of healthcare professionals about hospice care[15 16],lack of enthusiasm for their work [17]and insufficient material fulfillment[18 19]and other factors all contribute to the inability of domestic hospice practitioners to meet the demand in both quantity and quality of service. Finally, there is the hindrance of socio-cultural perceptions.In the context of traditional Chinese culture, discussions about death and dying have traditionally been considered taboo[20].This “talk of death” mentality prevents people from facing the topic of death head-on, much less accepting it openly[21],thus hindering the popularization of hospice care. Together, these challenges have led to a large unmet need in geriatric hospice care. In the field of comfort care in geriatric hospice, qualitative research methods offer irreplaceable advantages, especially in gaining a deeper understanding of patients' subjective experiences and complex social phenomena. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research collects non-numerical data and aims to delve into meanings, perceptions, and subjective experiences.[22].Qualitative research, through methods such as interviews, focus groups and open-ended questionnaires[22], can provide rich descriptions and explanations of processes in identifiable localized situations.In hospice, the patient's “suffering” is not only physical pain, but also psychological, social, and spiritual suffering, i.e., “all-encompassing pain.”[23]Qualitative research can go beyond the numbers and dig deeper into the nature of these subjective afflictions and the coping mechanisms of patients to provide a more comprehensive understanding[24].Second, qualitative research is often not linear like quantitative designs[25],so researchers can dynamically adapt data collection methods based on participant responses and emerging themes. In the complex context of geriatric hospice care, where patients' comfort needs and experiences are dynamic and changing, the flexibility of qualitative research allows it to better capture these nuances and individual differences.Furthermore, qualitative research is able to explore the context of complex issues. By examining behaviors and practices in natural settings, qualitative research can reveal social dynamics and cultural factors that enrich the understanding of the topic[26].In geriatric hospice care, the patient's experience of comfort is influenced by a variety of situational factors such as physical symptoms, environmental conditions, and social support[27].Qualitative research can provide insights into how these factors interact and work together to shape patients' perceptions of comfort. While quantitative research has provided important insights in assessing the effectiveness and outcomes of hospice care, such as by measuring pain reduction [28], depression and anxiety symptom reduction[29], and quality of life improvement[30], quantitative studies often only reveal a quantifiable portion of the problem and cannot fully explain the complexity in real-world contexts. Despite the growing importance of hospice and comfort care and its widely recognized positive role in improving patients' quality of life[31 32], there are still significant research gaps in the field of qualitative research on comfort care in geriatric hospice, especially in the Chinese context. The existing literature is still deficient in defining the concept of “unmet comfort needs” in geriatric hospice care and lacks high-quality standardized identification methods[33]. Although some studies have identified the physical and psychological unmet needs of elderly patients[34], these are mostly quantitative and fail to delve deeper into the deeper causes of these needs and the subjective experiences of patients. Second, there is a relative scarcity of qualitative research on the specific experiences and perceptions of comfort care among older patients and their families. Although some studies have explored the service experiences of hospice volunteers[35]or the needs assessment of family caregivers of terminally ill cancer patients[36]there is a lack of qualitative research that addresses the real feelings of older patients themselves during the process of receiving comfort care, how they define “comfort”, and what factors really influence their comfort experience are still insufficiently explored qualitatively in depth, which limits our comprehensive understanding of patients' individualized needs, especially in the context of Chinese culture, where the implicit nature of emotional expression between patients and their families may result in the true feelings not being adequately communicated[37]. In summary, this study aims to explore in-depth the practice of comfort care in geriatric hospice care through qualitative research methods, and to reveal the definition, experience, needs, and expectations of comfort care from the perspectives of geriatric patients and their family caregivers, so as to provide valuable patient-centered perspectives on comfort care in geriatric hospice care, and to lay a solid foundation for improving the quality of life at the end of life and promoting the healthy development of the hospice care industry. This will provide a valuable, patient-centered perspective for the field of geriatric hospice comfort care, laying a solid foundation for improving the quality of life at the end of life for elderly patients and promoting the healthy development of the hospice industry. 3 THE STUDY 3.1 | Aim This study delves into the comfort care needs, experiences, and influencing factors of elderly palliative care patients in China, examining these from multiple perspectives—including those of patients, family members, and healthcare providers—to identify the core elements of comfort care and unmet needs. The findings aim to provide theoretical foundations and practical guidance for optimizing clinical practices and developing personalized care plans. 3.2 | Design A phenomenological research methodology was used to conduct semi-structured in-depth interviews on a one-to-one basis. The 32-item checklist of the Uniform Standards for Reporting Qualitative Research (CONDITION) was used to guide this study[38]. 3.3 | Participants This study used purposive sampling method to select a total of 24 nurses, elderly patients and family members in a tertiary-level hospital and four health care institutions in Jinan City from May 2025 to June 2025 as the study subjects. Inclusion criteria for health care workers and social workers: ① working in hospice care; ③ informed consent to this study and voluntary participation in this study. Exclusion criteria: (1) internship, further study or training; (2) sick leave, maternity leave, personal leave. Inclusion criteria for elderly patients: ① the age of elderly patients ≥ 60 years old; ② clear language expression; ③ informed consent to the study and voluntary participation in the study. Exclusion criteria: (1) critical condition, may occur at any time the condition of the person; (2) the speech expression is not clear. Inclusion criteria for family members of elderly patients: ① family members of elderly patients are the immediate family members of patients, such as spouses, children, etc.; ② the main companion of the patient ≥ 12 h per day; ③ clear speech; ④ informed consent to the study and voluntary participation in the study. Exclusion criteria: ① suffering from serious mental disorders and physical diseases; ② unwilling to participate in this study. The sample size was based on the criterion that the respondents' data were repeated and no new themes emerged. 3.4 | Data collection The interview outline was divided into a healthcare worker, social worker version, patient version, and family member version with open-ended questions. See Appendix. Prior to the interview, respondents were introduced to their identity, the purpose of the study, and the time of the interview, and the content and purpose of the interview were explained, informed consent was obtained, and the location of the interview was chosen to be in a quiet and private doctor-patient communication room. During the interview process, we need to ensure that the interviewees feel comfortable and are able to freely express their views and experiences; conduct in-depth exploration and ask questions based on the interviewees' answers to encourage the interviewees to express their true feelings; carefully observe and record the interviewees' body language, facial expressions and emotional reactions in a timely manner, to ensure that we collect useful information; and adjust the order of the questioning as appropriate according to the actual situation. The duration of the interview was 10-20 min. 3.5 | Data analysis NVivo 12 software was used for coding, and themes were extracted according to Colaizz's seven-step phenomenological analysis, which proceeded as follows: (1) read the original interview materials carefully and repeatedly; (2) identify and extract meaningful materials; (3) code recurring ideas; (4) gather and cluster the coded ideas into a prototype theme; (5) describe the theme in detail; (6) identify similar ideas to form a theme; (7) return the resulting theme to the respondent for validation; and (8) return the resulting theme to the respondent for validation. themes; and (vii) returning the resulting themes to the respondents for validation. 3.6 | Rigour Interviewees were recruited in strict accordance with the inclusion criteria to ensure that the participants were representative, patients were informed of the purpose and significance of the study before the interviews, and one-on-one interviews were conducted with them, in which the interviewer positioned himself/herself as the researcher to maintain the scientific nature of the study, and in the data coding stage, two researchers coded independently to ensure consistency, and in case of disagreement, the final coding would be determined by a third researcher. Interviews and data analysis were conducted in Chinese and translated into English when the results were reported. The credibility of this study was enhanced through audio-recorded interviews, verbatim translation and cross-checking. 3.7 | Ethical considerations The study followed the ethical principles of the Declaration of Helsinki, which emphasizes respect for participants, doing no harm, and the voluntary nature of participation. The study was approved by the regional ethical review body YXLL-KY-2025(035). 4 RESULTS A total of 24 individuals participated in the interviews and further details of the characteristics of the interviewees are presented in Table 1.The analysis revealed that four themes and 14 sub-themes were identified. The main themes were somatic comfort, psychological and emotional comfort, environmental comfort and socio-cultural and spiritual comfort. The results are displayed in Table 2. TABLE 1 Characteristics of participates Patients(P) Minders(M) Nurses(N) No. Gender Age Diagnosis No. Relationship Age Length of Care No. Gender Education Job Years of Work P1 Female 61 Breast Cancer M1 Mother and Daughter 29 3days N1 Female Specialty Nurse 3years P2 Female 64 Lung Cancer M2 Mother and Daughter 34 2years N2 Female Specialty Nurse 2years P3 Male 87 Stroke M3 Father and Daughter 45 1years N3 Female Undergraduate Director of Nursing 3years P4 Female 78 Bowel Cancer M4 Couple 64 2years N4 Female Undergraduate Nurse 3years P5 Male 72 Prostate Cancer M5 Granddaughter 30 1week N5 Female Specialist Nurse 15years P6 Female 74 Lung Cancer M6 Granddaughter 26 3days N6 Female Undergraduate Nurse 3years P7 Male 78 Rectal Cancer M7 Father and Son 46 2years N7 Female Undergraduate Nursing Director 11years P8 Male 88 Lung Cancer M8 Father and Daughter 40 1years N8 Female Undergraduate Nurse 10years TABLE 2 Theme and categories Theme Category Physical comfort •Pain and discomfort management •Basic physiological needs met; •Personal hygiene and physical care •Activity and rehabilitation support Psychological and emotional comfort •Disease awareness and psychological adjustment •Emotional support and effective communication •Family ties and social integration •Maintaining dignity and autonomous choice Comfortable environment •Comfortable physical environment •Safety and convenience •Personalization and wa Social culture and spiritual comfort •Concepts of death and the end of life •Religious beliefs and spiritual solace •Unfulfilled wishes and emotional attachments 4.1 | Theme 1 ： Physical comfort 4.1.1 | Pain and discomfort management Patients generally regard “no pain” as the primary criterion for comfort. Pain management is not only an immediate need for the patient, but also at the center of the family's concerns. “No pain, being able to eat and pass stools is comfort.” P1. “The most important thing for him is to be in less pain and to relieve it through treatment.” M1. In addition to pain, other physical discomforts such as gastrointestinal problems like nausea, insomnia, and constipation significantly affected patient comfort. “Not sleeping very well either, have insomnia, can't eat, stomach is bad, little tummy is bad, weakness.” P2. “Elderly people have a little bit low immunity, constipation, if you have constipation, use some medicine like Keflex for constipation, and give attention to eating.” M2. Cancer pain is difficult to relieve completely, even with painkillers the pain may return after a period of time, and painkillers may have side effects such as constipation or mental effects. While pain relief is critical, its management is often complicated by medication side effects and disease progression, leading to a cyclical challenge where one intervention may bring on new discomfort. “In patients with cancer pain, instant pain medication is unlikely to work, it may still hurt after a while, and the medications all have side effects that can lead to constipation or have a mental impact as well.” N1. 4.1.2 | Basic physiological needs met An adequate and tasty diet, as well as a good-quality diet for sleep, are important components of comfort. However, this variability in satisfaction with diet and sleep, even within the same institution, suggests that the satisfaction of “basic physiological needs” is highly individualized. A standardized, one-size-fits-all approach to care is not sufficient to achieve optimal comfort. True comfort requires a careful assessment of individual preferences and sensitivities, based on which flexible adjustments can be made. This means that in addition to providing basic eating and sleeping conditions, care teams need to pay attention to details such as patients' taste preferences and sensitivity to ambient noise, and try to provide personalized solutions, such as adjusting the type of meal according to the patient's appetite or providing earplugs to improve the sleeping environment, to truly enhance the patient's comfort experience. “The meals are not repeated three times a day, and you can even eat four buns.” P3. “Feeling that the food is average, average in terms of quality, not eating meat when it's time to eat meat, not comparable to home.” P4. “Sleeping at night is definitely not as good as at home, everyone's habits are also different, in the morning there are room checks or blood draws and whatnot, and the ward can be very noisy, and sleep is not very good, and it also affects the sleep of the accompanying nurses, and the environment, I guess, some people snore, and that affects some of the sleep as well.” M1. 4.1.3 | Personal hygiene and physical care Keeping the body clean and preventing complications are important aspects of somatic comfort. For the disabled or bedridden elderly, timely turning is critical. The continued emphasis by patients and healthcare professionals on timely and thorough personal hygiene and turning reveals the fundamental role of these seemingly routine tasks in the prevention of conditions such as pressure ulcers and the maintenance of patient dignity, which in turn has a profound impact on the patient's psychological well-being. The caregiver's “don't mind getting dirty” attitude goes beyond mere duty and reflects a deeper humanistic concern that significantly enhances the patient's sense of being valued and cared for, and has an impact far beyond the physical needs themselves. This suggests that high-quality basic physical care is a key cornerstone to achieving overall comfort. When these basic needs are met with diligence and respect, patients develop a sense of security and dignity, which reduces psychological distress. Therefore, training for caregivers should not only focus on operational skills, but also emphasize their role in maintaining patients' dignity and psychological well-being by fostering empathy and professionalism. “Some pee in their pants and change it right away, take a shower, and don't mind being dirty when they poop and pee.” P5. “I think I should do a good job with the cleaning aspect, like today is bath day, bathing once or twice a week, going to turn every 2 to 3 hours, changing a new one, making sure the elderly person doesn't smell.” N2. 4.1.4 | Activity and rehabilitation support Despite the limited mobility of many terminally ill patients, moderate mobility and rehabilitation support are still considered part of their comfort. For the disabled elderly, the need for assistive devices and rehabilitation equipment is obvious. Even for those at the end of life, the desire for activity and mobility persists, a phenomenon that suggests that even minor mobility in hospice care can significantly enhance a patient's quality of life and sense of autonomy. Therefore, there is a need for innovation in hospice equipment and protocols, particularly in developing solutions that provide gentle, passive mobility and comfort to bedridden patients to meet their unique rehabilitation needs, thereby enhancing their overall comfort at the end of life. “I'm not well enough to sit and talk, I can't lift my head up, I don't want to get out and about, but it's better to get out and about.” P6. “Rehabilitation techniques, I look at some of the armrests, the equipment is pretty good, but it would be nice to have rehabilitation equipment that is better for lying in bed.” N3. 4.2 | Theme 2: Psychological and emotional comfort 4.2.1 | Disease awareness and psychological adjustment Patients' perceptions of their disease vary widely, which directly affects their psychological state. Patients with end-stage illnesses present a complex range of psychological responses from acceptance to denial, anxiety and depression. The family's choice to conceal the diagnosis or the patient's initial denial highlights the complex interplay between family protection, the patient's coping mechanisms, and the delay or exacerbation of potential psychological distress. “Psychological changes are quite big, at the beginning of the time will feel that the hospital is not diagnosed incorrectly, it was transferred to the hospital to see , and then confirmed that it is indeed this disease, and then but he was extremely denied at the beginning, and then come over to slowly he was a little bit grumpy.” M1. “Now the old man is not aware that he is this disease, just tell her is nodules, afraid to tell her after she can not accept” M3. 4.2.2 | Emotional support and effective communication The companionship and communication of healthcare professionals is crucial to the psychological comfort of patients, and the combination of their approachability and professionalism can bring psychological comfort to patients. The role of healthcare professionals in emotional support and communication goes far beyond technical operations, and their affinity, timely response and empathy can significantly reduce the patient's psychological burden, build a sense of trust, and make them feel understood and valued. For patients with cognitive impairment, healthcare professionals need to be more patient. “I am more interested in the caregiver's attitude towards the elderly, to be enthusiastic, to take the initiative to greet the elderly, not to be all classy and not passionate anymore, this is what the caregiver needs to improve, in terms of communication, enthusiasm.” N4. “There is a grandmother, always said to go home to take care of her old mother, in fact, her old mother has passed away, the memory stays at that time, to appease her emotions will work for a while, a while and then forget, more think artificially to appease them, for this kind of old people, the first time to appease his emotions, stand in her point of view to think, take her downstairs to go for a walk, to do other things, do activities, or talk to family members on the phone, stay in one place for a long time, there will be some depression, we can only be more companion, as their own elderly to care for a little.” N4. 4.2.3 | Family ties and social integration Family companionship is an important source of psychological comfort for elderly terminal patients. Healthcare professionals have also repeatedly emphasized the importance of family companionship, and family members are well aware of the importance of companionship to the elderly and strive to meet their emotional needs. In addition to affection, social interaction also has a positive impact on psychological comfort. However, the reality is that the lack of affectionate companionship is a common challenge. This lack of affectionate companionship not only makes the elderly feel lonely and abandoned, but also increases the psychological burden on healthcare professionals. “Being by the side of the elderly during this last time is the most important thing for them.” M13. “Exercise is done twice a day, and there are recreational activities such as playing cards, and some of the elderly enjoy going out for a stroll.” N7. “Children are cruel to send the elderly here, basically there are many family members who don't come to visit the elderly.” N8. 4.2.4 | Maintaining dignity and autonomous choice At the end of life, preserving the patient's dignity and autonomy of choice is essential to psychological comfort; however, some elderly people may feel unfree or even find it troublesome to rely on others for care, reflecting the impact of the loss of autonomy on their sense of self-worth. This contradiction between the desire for dignity and autonomy and the dependence on others due to physical deterioration is a deep-seated challenge to the psychological comfort of elderly terminal patients. When patients feel “trapped” or “dragged down by their families,” their sense of self-worth is severely eroded, leading to psychological distress. “Feeling not free, trapped, need to take care of is urination and defecation, help me to get out of bed bed, do not help a little is not able to get up, in here to come have fallen over several times, some people sometimes too busy to pass, their own want to get up when they fall, psychological hard to say, rely on people to take care of always trouble, not as good as themselves.” P7. “The old man's psychology is that he has been in just remembering that this disease is very serious, dragging down the family, feeling quite guilty about us.” M4. 4.3 | Theme 3: Comfortable environment 4.3.1 | Comfortable physical environment Quietness, cleanliness, appropriate temperature and humidity, and good lighting are elements of the physical environment that patients generally seek. However, noise problems are prevalent and temperature and humidity problems vary among elderly people. While facilities strive to maintain clean, odor-free environments and provide central air conditioning to control temperature and humidity, the noise and temperature regulation challenges inherent in multiple rooms make it difficult to meet the individual preferences of all patients. “Some people are good-tempered and tolerate each other, and some people just can't understand and think you're noisy.” M7. “At night like so many people live in a room, turn off the lights sometimes earlier and later everyone is not unified, the environment is also more noisy. It's too hot that we are still kind of hard to coordinate with the crowd, it's a little bit cold and a little bit hot, mainly in the summer nowadays some people may want to turn on the air conditioner, some people don't want to turn it on.”M6. 4.3.2 | Safety and convenience Safety is the cornerstone of care for elderly patients, and accessibility of the examination process is also an important factor affecting comfort. Institutions have invested in the safety of the physical environment (e.g., barrier-free facilities and non-slip floors), but the design of medical processes still fails to adequately take into account the mobility limitations of elderly patients. “We in this toilet I think there should be some of those handles, that is, he pay attention to his safety, to prevent the elderly from falling” M7. “The most unacceptable to me is the examination, pouring out to go to the outpatient clinic to go to where it is not very convenient to need to go to the elevator, there is no staircase, would not have wanted to wait and want to go to the staircase, but after walking After the stairs and found that you can not get out, the inspection is not convenient, if the inspection is not timely it is easy because of the delay will have a certain hidden danger, if because you can not find the elevator or wait for the elevator there are still emergencies, resulting in delayed conditions. I hope the inspection integration.”M5. 4.3.3 | Personalization and warmth Creating a warm and personalized environment helps to enhance patients' psychological comfort. The contradiction between patients' desire for a homey atmosphere and personalized décor and the reality of the lack of family connection and the monotony of the environment for some seniors reveals the challenge of creating a welcoming environment. Despite efforts to create a sense of “home” through group activities and encouraging decorations, this feeling of “home” is greatly diminished when patients do not have photos of family members or access to abundant natural elements. “A lot of greenery in the corridor, sometimes we and the patients say you take good care of the greenery at the door ah, patients are old patients, get along for a long time are familiar with, some patients take their own flowers to decorate a little bit, people are beautiful, but also very much in demand.”N5. “There are not a lot of greenery patterns, there are few old people's rooms will put family photos.”N3. 4.4 | Theme 4: Social culture and spiritual comfort 4.4.1 | Concepts of death and the end of life Patients and their families generally take a “let's-go”approach to death, and healthcare professionals express similar views that death is a relief, or even that it is not necessarily a good thing to be alive. This “natural” and “relieved”view of death reflects the increasing importance that society and the medical field are placing on the quality of the end of life. When patients and families are able to accept death with equanimity and want to live without regrets or suffering at the end of life, this provides an important psychological foundation for hospice care. This philosophy is further reinforced by healthcare professionals' emphasis on “death with dignity”and their understanding of the suffering of patients who live without dignity. “It's normal for people to die, I have no worries.”P8. “I feel like it's a relief that they're gone, and it's psychologically painful to see them lying there in that state.”N8. 4.4.2 | Religious beliefs and spiritual solace Religious beliefs play an important role of spiritual solace in end-of-life care for some patients and their families. This need for religious belief and spiritual solace reveals a deeper need that transcends the material and physical dimensions in the face of death. For patients with faith, religious rituals and beliefs can provide psychological peace, hope for the afterlife, and acceptance of death, thus alleviating their fears and anxieties. Healthcare professionals respect and support patients' beliefs, and by providing appropriate spiritual services, they not only meet patients' individual needs, but also embody hospice's philosophy of whole-person care. “What's more special is that we have Buddhism here, and also a lot of faith, to give you the supernatural, you can end up not going to hell and go to heaven, this recognition is still better.”N6. 4.4.3 | Unfulfilled wishes and emotional attachments At the end of life, many patients still have unfulfilled wishes and attachments to their loved ones. These unfulfilled wishes and emotional attachments are an important source of psychological burden for patients at the end of life. When patients still have regrets near the end of life, this can negatively affect their psychological peace. Healthcare professionals and families recognize the importance of fulfilling these wishes; however, they are often difficult to achieve due to physical conditions, financial conditions, and time constraints. “Attachment is their own children, do not want us to spend so much money, children are not married, the elderly also want to go out, travel travel, meet old friends.”M8. 5 DISCUSSION 5.1 | Building a multifaceted care support system that focuses on the complex comfort needs of elderly patients The importance of physiologic comfort as a cornerstone of geriatric hospice care was well documented in this study, particularly in the two core areas of pain management and primary care. The findings suggest that inadequate pain control significantly affects patients' treatment adherence and quality of life, a finding consistent with the Amsalu et al. [39]study. Some patients even developed significant treatment resistance due to the persistence of pain. In clinical practice, healthcare professionals should strictly implement the principle of three-step analgesia recommended by the World Health Organization (WHO), and rationally use non-opioid, weak opioid, and strong opioid medications based on the patient's pain level. At the same time, it is crucial to establish a dynamic assessment mechanism, and tools such as numerical scoring method or facial expression scale can be used to assess the pain level of patients on a regular basis. In addition, healthcare professionals need to be particularly vigilant against the behavior of patients privately adjusting their medication dosage, and effectively prevent such situations by conducting medication education and close monitoring. In terms of non-pharmacological interventions, emphasis should be placed on the integrated application of postural therapy, physical therapy (e.g., hot and cold compresses), and complementary therapies (e.g., music therapy, massage) to further alleviate patients' pain perception. One study noted that up to 42% of patients in community and nursing facility settings are at risk for malnutrition [40]. This may be because at the end of life, the patient's craving for food may have diminished. At this point, good palliative care, rather than simply trying to feed the patient, may become a more appropriate intervention[41], and therefore nutritional support needs to be personalized to the individual patient's needs, with dietary regimens tailored to the different disease states, and with full respect for the patient's dietary culture and habits [42] and in the area of excretory care, research findings have shown that when caregivers display unprofessional attitudes when dealing with patients' personal care needs, including arbitrary judgments of incontinence conditions, delayed responses to requests for help, or the use of inappropriate language during assistance with toileting, this can lead directly to strong feelings of dignity impairment and self-worth depreciation. sense of compromised dignity and devalued self-worth[43]. This is similar to the findings of this study and highlights the importance of defecation care in maintaining patients' human dignity. Healthcare professionals should strictly implement standardized practices such as regular turning and perineal care, and may use deodorizing products, such as herbal fumigation, to improve the ward environment and enhance patients' comfort. In addition, sleep disturbance is a common problem among patients with advanced, life-limiting illnesses, which is not only debilitating, but also leads to increased morbidity and decreased quality of life, while potentially exacerbating the suffering of patients and their caregivers [44]. Therefore, sleep management needs to start with optimizing the physical environment of the ward, such as reducing noise and rationalizing night care activities to improve patients' sleep quality. These measures need to be flexibly adjusted by nursing staff based on following standardized operations and taking into account the individual differences of patients in order to truly meet the physical comfort needs of elderly patients. 5.2 | Focusing on the two sides of the psychological needs of elderly patients and resolving the conflict between dependence and dignity of elderly patients In geriatric hospice care, patients' psychological needs present a complex duality, a conflict between the desire for dependence on others and the need to preserve their dignity. This conflict is evident in the patient's psychological state and behavioral manifestations and challenges nursing practice. With the multiple effects of declining physical functioning, disease distress, and medical and family issues, psychological problems in elderly patients are becoming more prominent. Studies have shown that more than 90% of cancer patients have varying degrees of psychological problems, such as anxiety, depression, and despair[45], and elderly patients gradually shift from being able to take care of themselves to losing their autonomy [46], and therefore become dependent on family members, healthcare professionals, and others in terms of life care, emotional support, and so on . However, they also have a strong desire to maintain their dignity and to be respected and recognized. Terminally ill patients are most often troubled not by physical symptoms, but by existential and dignity-related concerns, such as pain associated with the illness, loss of autonomy and control, and loss of meaning in their lives or the feeling of being a burden[47]. This is consistent with the findings of this study. Patient's patience and respect for healthcare professionals are extremely valued by patients.Ragan et al.[48]showed that sound communication at the end of life not only relieves stress, but also improves the well-being of the dying individual, promotes meaningful interactions, and facilitates patient-centered care, leading to a more satisfying outcome for all involved. In contrast, when healthcare professionals display indifference or impatience, patients feel belittled and their dignity is compromised. At the same time, the patients' quest for dignity is also reflected in their continued affirmation of their family roles, and their desire for more visits from family members, not only out of a simple need for companionship, but also a desire to confirm that they are still of value and significance within the family, rather than being abandoned or forgotten. In response to this conflict, caregiving responses should focus on balance. First, comprehensive life care and emotional support should be provided to fulfill the patient's dependency needs and make the patient feel cared for and looked after. Second, the individual differences and autonomy of patients should be respected and their dignity should be maintained. In recent years, there are more and more studies on dignity therapy in hospice care. Dignity therapy is a simple and easy to implement individualized psychotherapeutic intervention that has been shown to have many benefits. Research has shown that dignity therapy can reduce anxiety and depression and improve the sense of dignity, creativity, self-integrity, hope, and overall quality of life of terminally ill patients[49], In addition, research has shown that dignity therapy has great potential for family members of terminally ill patients as well, by decreasing distress, aiding in bereavement, and alleviating grief[50]Therefore, dignity therapy is recommended for elderly hospice patients to better meet their psychological needs and enhance their quality of life at the end of life. 5.3 | Emphasizing the social and cultural comfort and spiritual needs of elderly patients and improving the elderly hospice service system In geriatric hospice care, meeting the socio-cultural and spiritual needs of patients plays a crucial role in enhancing their psychological comfort and quality of life. With regard to sociocultural needs, family support, respect for cultural practices, and social connectedness form the core of patients' emotional attachment. Family relationships play a central role in shaping an individual's well-being over the life course[51], providing patients with the comfort of affection and, more importantly, affirmation of the value of their lives. However, family caregivers are often challenged by both emotional responsibilities and real-world stressors[52], and the question of how to balance family support with caregiver stress becomes critical. Research has shown that sociocultural has a significant impact on end-of-life care[53]. Cultural practices have deep emotional roots in the patient's mind and provide a familiar rhythm of life and emotional connection. However, some patients choose social avoidance due to “stigmatization” concerns, reflecting the need to respect patients' cultural practices while paying attention to their psychological status and avoiding social isolation due to cultural factors. Therefore, nursing practice should focus on cultural sensitivity, understanding the cultural background and customary needs of patients and their families through communication, while providing psychological support to help patients overcome social barriers and enhance their social connections. In terms of spiritual needs, a qualitative study by Jadidi et al.[54]proposed that caregivers of older adults should recognize the spiritual needs of older adults and attempt to maintain and promote their spiritual health. This is similar to the findings of this study. Therefore, social workers provide training to the staff of organizations that provide integrated health and care services on comprehensive assessment of the characteristics of the terminally ill elderly, analysis of the elderly's family relationships, and awareness of the elderly's mindfulness. This training can foster the concept of integrated care among geriatric healthcare workers and improve the quality of life of the terminally ill elderly[55]. Geriatric hospice care should consider patients' socio-cultural and spiritual needs in an integrated manner, and enhance patients' psychological comfort and quality of life through multidimensional interventions of family support, respect for cultural practices, social connection, and spiritual care. This requires not only the professional skills of healthcare professionals, but also the joint efforts of society and families to provide comprehensive support and care for elderly patients. 6 LIMITATIONS Due to the limited time available for recruitment, we did not fully realize our purposeful sampling strategy. For example, the sample did not include patients from different ethnic groups, with more female than male participants. The perspectives and experiences of patients from these groups may differ from those of the patients who participated in this study. 7 CONCLUSION This study will provide a valuable, patient-centered perspective in the field of geriatric hospice comfort care, which is expected to guide clinical practice, facilitate policy development, and promote societal perceptions of hospice care, ultimately laying a solid foundation for enhancing the end-of-life quality of life of elderly patients and promoting the healthy development of hospice care. Declarations Ethics approval and consent to participate ： This study obtained approval from the Ethics Committee of Shangdong Provincial Qianfoshan Hospital (YXLL-KY-2025(035)).Our research adhered strictly to the ethical principles outlined in the Declaration of Helsinki, ensuring compliance with all pertinent guidelines and regulations. Prior to their participation, all individuals involved in the study provided their informed consent. Consent for publication ： Not applicable. Availability of data and materials ： Not applicable. Competing interests ： No conflict of interest has been declared by the authors. Funding ： This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions ： All authors conceived the study and were responsible for designing the study, acquisition of data and analysis of data. 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03:10:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":982750,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8241914/v1/25f86b68-bfe7-4f19-8d06-2fc600fa5b97.pdf"},{"id":100032149,"identity":"1dce6011-46de-4ea1-8ee1-be608bdfc80b","added_by":"auto","created_at":"2026-01-12 09:42:00","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":15847,"visible":true,"origin":"","legend":"","description":"","filename":"InterviewOutline.docx","url":"https://assets-eu.researchsquare.com/files/rs-8241914/v1/c5679cdb02fac50fcddc10f1.docx"},{"id":100032154,"identity":"c81040d3-5076-4b20-849d-f2073f1e806f","added_by":"auto","created_at":"2026-01-12 09:42:03","extension":"zip","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":99211321,"visible":true,"origin":"","legend":"","description":"","filename":"rawdata.zip","url":"https://assets-eu.researchsquare.com/files/rs-8241914/v1/49d5b3da5419c7c1da9d88d4.zip"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e\u003cstrong\u003e“We Just Want to Feel at Peace”: A Qualitative Exploration of Comfort Care Needs in Geriatric Palliative Patients\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"1 INTRODUCTION","content":"\u003cp\u003eData from the World Health Organization (WHO) indicates that the proportion of the global population aged 65 and above is projected to increase significantly from 9% in 2019 to 16% by 2050[1]。As the world's most populous country, China is facing immense pressure due to accelerating population agingFrom 2020 to 2050, the population aged 65 and above in China is estimated to increase from 172 million to 366 million[2].This demographic trend presents complex challenges for China's healthcare system, economy, and society.Older adults are more susceptible to chronic and comorbid diseases, which\u003c/p\u003e\n\u003cp\u003esignificantly increases the burden on healthcare infrastructure[3],As a result, there is a need to move from a focus on acute, disease-specific treatment to a model of care that is long-term, holistic and patient-centered. One of the key models is hospice, which is able to manage complex chronic diseases and continuously improve quality of life throughout the course of a patient's illness, not just at the end of life.[4].With the increasing trend of global population aging, the number of elderly terminally ill patients continues to grow[1]，其对以人为本的临终照护需求日益突出[5],The core goal of comfort care is to help patients maintain dignity and peace of mind at the end of their lives.[6].The purpose of this study is to explore in depth the comfort care needs, experiences and influencing factors of elderly patients during hospice care through qualitative research methods, so as to provide theoretical basis and practical guidance for optimizing clinical practice and improving the quality of end-of-life care.\u003c/p\u003e"},{"header":"2 BACKGROUND","content":"\u003cp\u003eIn geriatric hospice care, the primary goals of comfort care as a patient-centered philosophy include relieving pain and other distressing symptoms, improving communication between the patient, family, and healthcare providers, supporting the patient's ability to make autonomous decisions, addressing emotional, social, and spiritual concerns, and ultimately improving the patient's quality of life[7],Thus, comfort occupies an irreplaceable central place in geriatric hospice care and is a key indicator of quality of care[8-10].Despite the growing importance of geriatric hospice and comfort care, there are still many challenges and unmet needs in its development globally, especially in China. Many elderly patients perceive it as a treatment limited to the terminal phase and do not accept hospice services, a misconception that often leads to hesitation on the part of patients and their families, resulting in missed opportunities to improve their quality of life[11].Second, the shortage of human resources and lack of professional capacity are notable constraints. China faces the bottleneck of nursing personnel shortage, and the existing personnel in service consciousness[12],professional ethics[13],Professional knowledge and skills training[14]still need to be upgraded.This has led to variable quality of services to meet the needs of a wide range of patients. Inadequate training and education of healthcare professionals about hospice care[15 16],lack of enthusiasm for their work [17]and insufficient material fulfillment[18 19]and other factors all contribute to the inability of domestic hospice practitioners to meet the demand in both quantity and quality of service. Finally, there is the hindrance of socio-cultural perceptions.In the context of traditional Chinese culture, discussions about death and dying have traditionally been considered taboo[20].This “talk of death” mentality prevents people from facing the topic of death head-on, much less accepting it openly[21],thus hindering the popularization of hospice care. Together, these challenges have led to a large unmet need in geriatric hospice care.\u003c/p\u003e\n\u003cp\u003eIn the field of comfort care in geriatric hospice, qualitative research methods offer irreplaceable advantages, especially in gaining a deeper understanding of patients' subjective experiences and complex social phenomena. Unlike quantitative research, which focuses on numerical data and statistical analysis, qualitative research collects non-numerical data and aims to delve into meanings, perceptions, and subjective experiences.[22].Qualitative research, through methods such as interviews, focus groups and open-ended questionnaires[22], can provide rich descriptions and explanations of processes in identifiable localized situations.In hospice, the patient's “suffering” is not only physical pain, but also psychological, social, and spiritual suffering, i.e., “all-encompassing pain.”[23]Qualitative research can go beyond the numbers and dig deeper into the nature of these subjective afflictions and the coping mechanisms of patients to provide a more comprehensive understanding[24].Second, qualitative research is often not linear like quantitative designs[25],so researchers can dynamically adapt data collection methods based on participant responses and emerging themes. In the complex context of geriatric hospice care, where patients' comfort needs and experiences are dynamic and changing, the flexibility of qualitative research allows it to better capture these nuances and individual differences.Furthermore, qualitative research is able to explore the context of complex issues. By examining behaviors and practices in natural settings, qualitative research can reveal social dynamics and cultural factors that enrich the understanding of the topic[26].In geriatric hospice care, the patient's experience of comfort is influenced by a variety of situational factors such as physical symptoms, environmental conditions, and social support[27].Qualitative research can provide insights into how these factors interact and work together to shape patients' perceptions of comfort. While quantitative research has provided important insights in assessing the effectiveness and outcomes of hospice care, such as by measuring pain reduction [28], depression and anxiety symptom reduction[29], and quality of life improvement[30], quantitative studies often only reveal a quantifiable portion of the problem and cannot fully explain the complexity in real-world contexts.\u003c/p\u003e\n\u003cp\u003eDespite the growing importance of hospice and comfort care and its widely recognized positive role in improving patients' quality of life[31 32], there are still significant research gaps in the field of qualitative research on comfort care in geriatric hospice, especially in the Chinese context. The existing literature is still deficient in defining the concept of “unmet comfort needs” in geriatric hospice care and lacks high-quality standardized identification methods[33]. Although some studies have identified the physical and psychological unmet needs of elderly patients[34], these are mostly quantitative and fail to delve deeper into the deeper causes of these needs and the subjective experiences of patients. Second, there is a relative scarcity of qualitative research on the specific experiences and perceptions of comfort care among older patients and their families. Although some studies have explored the service experiences of hospice volunteers[35]or the needs assessment of family caregivers of terminally ill cancer patients[36]there is a lack of qualitative research that addresses the real feelings of older patients themselves during the process of receiving comfort care, how they define “comfort”, and what factors really influence their comfort experience are still insufficiently explored qualitatively in depth, which limits our comprehensive understanding of patients' individualized needs, especially in the context of Chinese culture, where the implicit nature of emotional expression between patients and their families may result in the true feelings not being adequately communicated[37].\u003c/p\u003e\n\u003cp\u003eIn summary, this study aims to explore in-depth the practice of comfort care in geriatric hospice care through qualitative research methods, and to reveal the definition, experience, needs, and expectations of comfort care from the perspectives of geriatric patients and their family caregivers, so as to provide valuable patient-centered perspectives on comfort care in geriatric hospice care, and to lay a solid foundation for improving the quality of life at the end of life and promoting the healthy development of the hospice care industry. This will provide a valuable, patient-centered perspective for the field of geriatric hospice comfort care, laying a solid foundation for improving the quality of life at the end of life for elderly patients and promoting the healthy development of the hospice industry.\u003c/p\u003e"},{"header":"3 THE STUDY","content":"\u003cp\u003e3.1 \u0026nbsp;| \u0026nbsp;Aim\u003c/p\u003e\n\u003cp\u003eThis study delves into the comfort care needs, experiences, and influencing factors of elderly palliative care patients in China, examining these from multiple perspectives—including those of patients, family members, and healthcare providers—to identify the core elements of comfort care and unmet needs. The findings aim to provide theoretical foundations and practical guidance for optimizing clinical practices and developing personalized care plans.\u003c/p\u003e\n\u003cp\u003e3.2 | Design\u003c/p\u003e\n\u003cp\u003eA phenomenological research methodology was used to conduct semi-structured in-depth interviews on a one-to-one basis. The 32-item checklist of the Uniform Standards for Reporting Qualitative Research (CONDITION) was used to guide this study[38].\u003c/p\u003e\n\u003cp\u003e3.3 | Participants\u003c/p\u003e\n\u003cp\u003eThis study used purposive sampling method to select a total of 24 nurses, elderly patients and family members in a tertiary-level hospital and four health care institutions in Jinan City from May 2025 to June 2025 as the study subjects.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for health care workers and social workers: ① working in hospice care; ③ informed consent to this study and voluntary participation in this study. Exclusion criteria: (1) internship, further study or training; (2) sick leave, maternity leave, personal leave.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for elderly patients: ① the age of elderly patients ≥ 60 years old; ② clear language expression; ③ informed consent to the study and voluntary participation in the study. Exclusion criteria: (1) critical condition, may occur at any time the condition of the person; (2) the speech expression is not clear.\u003c/p\u003e\n\u003cp\u003eInclusion criteria for family members of elderly patients: ① family members of elderly patients are the immediate family members of patients, such as spouses, children, etc.; ② the main companion of the patient ≥ 12 h per day; ③ clear speech; ④ informed consent to the study and voluntary participation in the study. Exclusion criteria: ① suffering from serious mental disorders and physical diseases; ② unwilling to participate in this study.\u003c/p\u003e\n\u003cp\u003eThe sample size was based on the criterion that the respondents' data were repeated and no new themes emerged.\u003c/p\u003e\n\u003cp\u003e3.4 \u0026nbsp;| \u0026nbsp;Data collection\u003c/p\u003e\n\u003cp\u003eThe interview outline was divided into a healthcare worker, social worker version, patient version, and family member version with open-ended questions. See Appendix. Prior to the interview, respondents were introduced to their identity, the purpose of the study, and the time of the interview, and the content and purpose of the interview were explained, informed consent was obtained, and the location of the interview was chosen to be in a quiet and private doctor-patient communication room. During the interview process, we need to ensure that the interviewees feel comfortable and are able to freely express their views and experiences; conduct in-depth exploration and ask questions based on the interviewees' answers to encourage the interviewees to express their true feelings; carefully observe and record the interviewees' body language, facial expressions and emotional reactions in a timely manner, to ensure that we collect useful information; and adjust the order of the questioning as appropriate according to the actual situation. The duration of the interview was 10-20 min.\u003c/p\u003e\n\u003cp\u003e3.5 \u0026nbsp;| \u0026nbsp;Data analysis\u003c/p\u003e\n\u003cp\u003eNVivo 12 software was used for coding, and themes were extracted according to Colaizz's seven-step phenomenological analysis, which proceeded as follows: (1) read the original interview materials carefully and repeatedly; (2) identify and extract meaningful materials; (3) code recurring ideas; (4) gather and cluster the coded ideas into a prototype theme; (5) describe the theme in detail; (6) identify similar ideas to form a theme; (7) return the resulting theme to the respondent for validation; and (8) return the resulting theme to the respondent for validation. themes; and (vii) returning the resulting themes to the respondents for validation.\u003c/p\u003e\n\u003cp\u003e3.6 \u0026nbsp;| \u0026nbsp;Rigour\u003c/p\u003e\n\u003cp\u003eInterviewees were recruited in strict accordance with the inclusion criteria to ensure that the participants were representative, patients were informed of the purpose and significance of the study before the interviews, and one-on-one interviews were conducted with them, in which the interviewer positioned himself/herself as the researcher to maintain the scientific nature of the study, and in the data coding stage, two researchers coded independently to ensure consistency, and in case of disagreement, the final coding would be determined by a third researcher. Interviews and data analysis were conducted in Chinese and translated into English when the results were reported. The credibility of this study was enhanced through audio-recorded interviews, verbatim translation and cross-checking.\u003c/p\u003e\n\u003cp\u003e3.7 \u0026nbsp;| \u0026nbsp;Ethical considerations\u003c/p\u003e\n\u003cp\u003eThe study followed the ethical principles of the Declaration of Helsinki, which emphasizes respect for participants, doing no harm, and the voluntary nature of participation. The study was approved by the regional ethical review body YXLL-KY-2025(035).\u003c/p\u003e"},{"header":"4 RESULTS","content":"\u003cp\u003eA total of 24 individuals participated in the interviews and further details of the characteristics of the interviewees are presented in Table 1.The analysis revealed that four themes and 14 sub-themes were identified. The main themes were somatic comfort, psychological and emotional comfort, environmental comfort and socio-cultural and spiritual comfort. The results are displayed in Table 2.\u003c/p\u003e\n\u003cp\u003eTABLE 1 Characteristics of participates\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"718\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd colspan=\"4\" valign=\"top\" style=\"width: 219px;\"\u003e\n \u003cp\u003ePatients(P)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"4\" valign=\"top\" style=\"width: 234px;\"\u003e\n \u003cp\u003eMinders(M)\u003c/p\u003e\n \u003c/td\u003e\u003ctd colspan=\"5\" valign=\"top\" style=\"width: 265px;\"\u003e\n \u003cp\u003eNurses(N)\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eDiagnosis\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eRelationship\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eLength of Care\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eJob\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eYears of Work\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eBreast Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMother and Daughter\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3days\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN1\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eSpecialty\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP2\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eLung Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM2\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eMother and Daughter\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2years\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN2\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eSpecialty\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP3\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eStroke\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM3\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFather and Daughter\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1years\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eDirector of Nursing \u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP4\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eBowel Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM4\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCouple\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2years\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN4\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP5\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eProstate Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM5\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eGranddaughter\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1week\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN5\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eSpecialist\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e15years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP6\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eLung Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM6\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eGranddaughter\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3days\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN6\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e3years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP7\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eRectal Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM7\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFather and Son\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e2years\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN7\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNursing Director\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e11years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 41px;\"\u003e\n \u003cp\u003eP8\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 36px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eLung Cancer\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eM8\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFather and\u003c/p\u003e\n \u003cp\u003eDaughter \u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 40px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1years\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003eN8\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 60px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003eNurse\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e10years\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003eTABLE 2 Theme and categories\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"590\"\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eTheme\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePhysical comfort\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\n \u003cp\u003e•Pain and discomfort management\u003c/p\u003e\n \u003cp\u003e•Basic physiological needs met;\u003c/p\u003e\n \u003cp\u003e•Personal hygiene and physical care\u003c/p\u003e\n \u003cp\u003e•Activity and rehabilitation support\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePsychological and emotional comfort\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\n \u003cp\u003e•Disease awareness and psychological adjustment\u003c/p\u003e\n \u003cp\u003e•Emotional support and effective communication\u003c/p\u003e\n \u003cp\u003e•Family ties and social integration\u003c/p\u003e\n \u003cp\u003e•Maintaining dignity and autonomous choice\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eComfortable environment\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\n \u003cp\u003e•Comfortable physical environment\u003c/p\u003e\n \u003cp\u003e•Safety and convenience\u003c/p\u003e\n \u003cp\u003e•Personalization and wa\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eSocial culture and spiritual comfort\u003c/p\u003e\n \u003c/td\u003e\u003ctd valign=\"top\" style=\"width: 400px;\"\u003e\n \u003cp\u003e•Concepts of death and the end of life\u003c/p\u003e\n \u003cp\u003e•Religious beliefs and spiritual solace\u003c/p\u003e\n \u003cp\u003e•Unfulfilled wishes and emotional attachments\u003c/p\u003e\n \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e4.1 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eTheme 1\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003cstrong\u003ePhysical comfort\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.1 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003ePain and discomfort management\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients generally regard “no pain” as the primary criterion for comfort. Pain management is not only an immediate need for the patient, but also at the center of the family's concerns. \u003c/p\u003e\n\u003cp\u003e“No pain, being able to eat and pass stools is comfort.” P1. \u003c/p\u003e\n\u003cp\u003e“The most important thing for him is to be in less pain and to relieve it through treatment.” M1. \u003c/p\u003e\n\u003cp\u003eIn addition to pain, other physical discomforts such as gastrointestinal problems like nausea, insomnia, and constipation significantly affected patient comfort.\u003c/p\u003e\n\u003cp\u003e“Not sleeping very well either, have insomnia, can't eat, stomach is bad, little tummy is bad, weakness.” P2. \u003c/p\u003e\n\u003cp\u003e“Elderly people have a little bit low immunity, constipation, if you have constipation, use some medicine like Keflex for constipation, and give attention to eating.” M2. \u003c/p\u003e\n\u003cp\u003eCancer pain is difficult to relieve completely, even with painkillers the pain may return after a period of time, and painkillers may have side effects such as constipation or mental effects. While pain relief is critical, its management is often complicated by medication side effects and disease progression, leading to a cyclical challenge where one intervention may bring on new discomfort.\u003c/p\u003e\n\u003cp\u003e“In patients with cancer pain, instant pain medication is unlikely to work, it may still hurt after a while, and the medications all have side effects that can lead to constipation or have a mental impact as well.” N1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.2 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eBasic physiological needs met\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn adequate and tasty diet, as well as a good-quality diet for sleep, are important components of comfort. However, this variability in satisfaction with diet and sleep, even within the same institution, suggests that the satisfaction of “basic physiological needs” is highly individualized. A standardized, one-size-fits-all approach to care is not sufficient to achieve optimal comfort. True comfort requires a careful assessment of individual preferences and sensitivities, based on which flexible adjustments can be made. This means that in addition to providing basic eating and sleeping conditions, care teams need to pay attention to details such as patients' taste preferences and sensitivity to ambient noise, and try to provide personalized solutions, such as adjusting the type of meal according to the patient's appetite or providing earplugs to improve the sleeping environment, to truly enhance the patient's comfort experience. \u003c/p\u003e\n\u003cp\u003e“The meals are not repeated three times a day, and you can even eat four buns.” P3. \u003c/p\u003e\n\u003cp\u003e“Feeling that the food is average, average in terms of quality, not eating meat when it's time to eat meat, not comparable to home.” P4. \u003c/p\u003e\n\u003cp\u003e“Sleeping at night is definitely not as good as at home, everyone's habits are also different, in the morning there are room checks or blood draws and whatnot, and the ward can be very noisy, and sleep is not very good, and it also affects the sleep of the accompanying nurses, and the environment, I guess, some people snore, and that affects some of the sleep as well.” M1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.3 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003ePersonal hygiene and physical care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKeeping the body clean and preventing complications are important aspects of somatic comfort. For the disabled or bedridden elderly, timely turning is critical. The continued emphasis by patients and healthcare professionals on timely and thorough personal hygiene and turning reveals the fundamental role of these seemingly routine tasks in the prevention of conditions such as pressure ulcers and the maintenance of patient dignity, which in turn has a profound impact on the patient's psychological well-being. The caregiver's “don't mind getting dirty” attitude goes beyond mere duty and reflects a deeper humanistic concern that significantly enhances the patient's sense of being valued and cared for, and has an impact far beyond the physical needs themselves. This suggests that high-quality basic physical care is a key cornerstone to achieving overall comfort. When these basic needs are met with diligence and respect, patients develop a sense of security and dignity, which reduces psychological distress. Therefore, training for caregivers should not only focus on operational skills, but also emphasize their role in maintaining patients' dignity and psychological well-being by fostering empathy and professionalism. \u003c/p\u003e\n\u003cp\u003e“Some pee in their pants and change it right away, take a shower, and don't mind being dirty when they poop and pee.” P5. \u003c/p\u003e\n\u003cp\u003e“I think I should do a good job with the cleaning aspect, like today is bath day, bathing once or twice a week, going to turn every 2 to 3 hours, changing a new one, making sure the elderly person doesn't smell.” N2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.1.4 \u003c/strong\u003e\u003cstrong\u003e | \u003c/strong\u003e\u003cstrong\u003eActivity and rehabilitation support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the limited mobility of many terminally ill patients, moderate mobility and rehabilitation support are still considered part of their comfort. For the disabled elderly, the need for assistive devices and rehabilitation equipment is obvious. Even for those at the end of life, the desire for activity and mobility persists, a phenomenon that suggests that even minor mobility in hospice care can significantly enhance a patient's quality of life and sense of autonomy. Therefore, there is a need for innovation in hospice equipment and protocols, particularly in developing solutions that provide gentle, passive mobility and comfort to bedridden patients to meet their unique rehabilitation needs, thereby enhancing their overall comfort at the end of life. \u003c/p\u003e\n\u003cp\u003e“I'm not well enough to sit and talk, I can't lift my head up, I don't want to get out and about, but it's better to get out and about.” P6. \u003c/p\u003e\n\u003cp\u003e“Rehabilitation techniques, I look at some of the armrests, the equipment is pretty good, but it would be nice to have rehabilitation equipment that is better for lying in bed.” N3.\u003c/p\u003e\n\u003cp\u003e4.2 | Theme 2: Psychological and emotional comfort\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.1 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eDisease awareness and psychological adjustment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients' perceptions of their disease vary widely, which directly affects their psychological state. Patients with end-stage illnesses present a complex range of psychological responses from acceptance to denial, anxiety and depression. The family's choice to conceal the diagnosis or the patient's initial denial highlights the complex interplay between family protection, the patient's coping mechanisms, and the delay or exacerbation of potential psychological distress.\u003c/p\u003e\n\u003cp\u003e“Psychological changes are quite big, at the beginning of the time will feel that the hospital is not diagnosed incorrectly, it was transferred to the hospital to see , and then confirmed that it is indeed this disease, and then but he was extremely denied at the beginning, and then come over to slowly he was a little bit grumpy.” M1. \u003c/p\u003e\n\u003cp\u003e“Now the old man is not aware that he is this disease, just tell her is nodules, afraid to tell her after she can not accept” M3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.2 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eEmotional support and effective communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe companionship and communication of healthcare professionals is crucial to the psychological comfort of patients, and the combination of their approachability and professionalism can bring psychological comfort to patients. The role of healthcare professionals in emotional support and communication goes far beyond technical operations, and their affinity, timely response and empathy can significantly reduce the patient's psychological burden, build a sense of trust, and make them feel understood and valued. For patients with cognitive impairment, healthcare professionals need to be more patient.\u003c/p\u003e\n\u003cp\u003e“I am more interested in the caregiver's attitude towards the elderly, to be enthusiastic, to take the initiative to greet the elderly, not to be all classy and not passionate anymore, this is what the caregiver needs to improve, in terms of communication, enthusiasm.” N4. \u003c/p\u003e\n\u003cp\u003e“There is a grandmother, always said to go home to take care of her old mother, in fact, her old mother has passed away, the memory stays at that time, to appease her emotions will work for a while, a while and then forget, more think artificially to appease them, for this kind of old people, the first time to appease his emotions, stand in her point of view to think, take her downstairs to go for a walk, to do other things, do activities, or talk to family members on the phone, stay in one place for a long time, there will be some depression, we can only be more companion, as their own elderly to care for a little.” N4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.3 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eFamily ties and social integration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFamily companionship is an important source of psychological comfort for elderly terminal patients. Healthcare professionals have also repeatedly emphasized the importance of family companionship, and family members are well aware of the importance of companionship to the elderly and strive to meet their emotional needs. In addition to affection, social interaction also has a positive impact on psychological comfort. However, the reality is that the lack of affectionate companionship is a common challenge. This lack of affectionate companionship not only makes the elderly feel lonely and abandoned, but also increases the psychological burden on healthcare professionals.\u003c/p\u003e\n\u003cp\u003e“Being by the side of the elderly during this last time is the most important thing for them.” M13. \u003c/p\u003e\n\u003cp\u003e“Exercise is done twice a day, and there are recreational activities such as playing cards, and some of the elderly enjoy going out for a stroll.” N7. \u003c/p\u003e\n\u003cp\u003e“Children are cruel to send the elderly here, basically there are many family members who don't come to visit the elderly.” N8.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.2.4 \u003c/strong\u003e\u003cstrong\u003e| \u003c/strong\u003e\u003cstrong\u003eMaintaining dignity and autonomous choice\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the end of life, preserving the patient's dignity and autonomy of choice is essential to psychological comfort; however, some elderly people may feel unfree or even find it troublesome to rely on others for care, reflecting the impact of the loss of autonomy on their sense of self-worth. This contradiction between the desire for dignity and autonomy and the dependence on others due to physical deterioration is a deep-seated challenge to the psychological comfort of elderly terminal patients. When patients feel “trapped” or “dragged down by their families,” their sense of self-worth is severely eroded, leading to psychological distress.\u003c/p\u003e\n\u003cp\u003e“Feeling not free, trapped, need to take care of is urination and defecation, help me to get out of bed bed, do not help a little is not able to get up, in here to come have fallen over several times, some people sometimes too busy to pass, their own want to get up when they fall, psychological hard to say, rely on people to take care of always trouble, not as good as themselves.” P7. \u003c/p\u003e\n\u003cp\u003e“The old man's psychology is that he has been in just remembering that this disease is very serious, dragging down the family, feeling quite guilty about us.” M4.\u003c/p\u003e\n\u003cp\u003e4.3 | Theme 3: Comfortable environment\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3.1\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e Comfortable physical environment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuietness, cleanliness, appropriate temperature and humidity, and good lighting are elements of the physical environment that patients generally seek. However, noise problems are prevalent and temperature and humidity problems vary among elderly people. While facilities strive to maintain clean, odor-free environments and provide central air conditioning to control temperature and humidity, the noise and temperature regulation challenges inherent in multiple rooms make it difficult to meet the individual preferences of all patients.\u003c/p\u003e\n\u003cp\u003e“Some people are good-tempered and tolerate each other, and some people just can't understand and think you're noisy.” M7. \u003c/p\u003e\n\u003cp\u003e“At night like so many people live in a room, turn off the lights sometimes earlier and later everyone is not unified, the environment is also more noisy. It's too hot that we are still kind of hard to coordinate with the crowd, it's a little bit cold and a little bit hot, mainly in the summer nowadays some people may want to turn on the air conditioner, some people don't want to turn it on.”M6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3.2 \u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eSafety and convenience\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSafety is the cornerstone of care for elderly patients, and accessibility of the examination process is also an important factor affecting comfort. Institutions have invested in the safety of the physical environment (e.g., barrier-free facilities and non-slip floors), but the design of medical processes still fails to adequately take into account the mobility limitations of elderly patients.\u003c/p\u003e\n\u003cp\u003e“We in this toilet I think there should be some of those handles, that is, he pay attention to his safety, to prevent the elderly from falling” M7. \u003c/p\u003e\n\u003cp\u003e“The most unacceptable to me is the examination, pouring out to go to the outpatient clinic to go to where it is not very convenient to need to go to the elevator, there is no staircase, would not have wanted to wait and want to go to the staircase, but after walking After the stairs and found that you can not get out, the inspection is not convenient, if the inspection is not timely it is easy because of the delay will have a certain hidden danger, if because you can not find the elevator or wait for the elevator there are still emergencies, resulting in delayed conditions. I hope the inspection integration.”M5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.3.3\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e Personalization and warmth\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCreating a warm and personalized environment helps to enhance patients' psychological comfort. The contradiction between patients' desire for a homey atmosphere and personalized décor and the reality of the lack of family connection and the monotony of the environment for some seniors reveals the challenge of creating a welcoming environment. Despite efforts to create a sense of “home” through group activities and encouraging decorations, this feeling of “home” is greatly diminished when patients do not have photos of family members or access to abundant natural elements.\u003c/p\u003e\n\u003cp\u003e“A lot of greenery in the corridor, sometimes we and the patients say you take good care of the greenery at the door ah, patients are old patients, get along for a long time are familiar with, some patients take their own flowers to decorate a little bit, people are beautiful, but also very much in demand.”N5. \u003c/p\u003e\n\u003cp\u003e“There are not a lot of greenery patterns, there are few old people's rooms will put family photos.”N3.\u003c/p\u003e\n\u003cp\u003e4.4 | Theme 4: Social culture and spiritual comfort\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4.1\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e Concepts of death and the end of life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients and their families generally take a “let's-go”approach to death, and healthcare professionals express similar views that death is a relief, or even that it is not necessarily a good thing to be alive. This “natural” and “relieved”view of death reflects the increasing importance that society and the medical field are placing on the quality of the end of life. When patients and families are able to accept death with equanimity and want to live without regrets or suffering at the end of life, this provides an important psychological foundation for hospice care. This philosophy is further reinforced by healthcare professionals' emphasis on “death with dignity”and their understanding of the suffering of patients who live without dignity.\u003c/p\u003e\n\u003cp\u003e“It's normal for people to die, I have no worries.”P8. \u003c/p\u003e\n\u003cp\u003e“I feel like it's a relief that they're gone, and it's psychologically painful to see them lying there in that state.”N8.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4.2\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e Religious beliefs and spiritual solace\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReligious beliefs play an important role of spiritual solace in end-of-life care for some patients and their families. This need for religious belief and spiritual solace reveals a deeper need that transcends the material and physical dimensions in the face of death. For patients with faith, religious rituals and beliefs can provide psychological peace, hope for the afterlife, and acceptance of death, thus alleviating their fears and anxieties. Healthcare professionals respect and support patients' beliefs, and by providing appropriate spiritual services, they not only meet patients' individual needs, but also embody hospice's philosophy of whole-person care.\u003c/p\u003e\n\u003cp\u003e“What's more special is that we have Buddhism here, and also a lot of faith, to give you the supernatural, you can end up not going to hell and go to heaven, this recognition is still better.”N6.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.4.3\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e Unfulfilled wishes and emotional attachments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the end of life, many patients still have unfulfilled wishes and attachments to their loved ones. These unfulfilled wishes and emotional attachments are an important source of psychological burden for patients at the end of life. When patients still have regrets near the end of life, this can negatively affect their psychological peace. Healthcare professionals and families recognize the importance of fulfilling these wishes; however, they are often difficult to achieve due to physical conditions, financial conditions, and time constraints.\u003c/p\u003e\n\u003cp\u003e“Attachment is their own children, do not want us to spend so much money, children are not married, the elderly also want to go out, travel travel, meet old friends.”M8.\u003c/p\u003e\n\n\n\n\n\n\n"},{"header":"5 DISCUSSION","content":"\u003cp\u003e\u003cstrong\u003e5.1 \u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eBuilding a multifaceted care support system that focuses on the complex comfort needs of elderly patients\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eThe importance of physiologic comfort as a cornerstone of geriatric hospice care was well documented in this study, particularly in the two core areas of pain management and primary care. The findings suggest that inadequate pain control significantly affects patients' treatment adherence and quality of life, a finding consistent with the Amsalu et al. [39]study. Some patients even developed significant treatment resistance due to the persistence of pain. In clinical practice, healthcare professionals should strictly implement the principle of three-step analgesia recommended by the World Health Organization (WHO), and rationally use non-opioid, weak opioid, and strong opioid medications based on the patient's pain level. At the same time, it is crucial to establish a dynamic assessment mechanism, and tools such as numerical scoring method or facial expression scale can be used to assess the pain level of patients on a regular basis. In addition, healthcare professionals need to be particularly vigilant against the behavior of patients privately adjusting their medication dosage, and effectively prevent such situations by conducting medication education and close monitoring. In terms of non-pharmacological interventions, emphasis should be placed on the integrated application of postural therapy, physical therapy (e.g., hot and cold compresses), and complementary therapies (e.g., music therapy, massage) to further alleviate patients' pain perception. One study noted that up to 42% of patients in community and nursing facility settings are at risk for malnutrition [40]. This may be because at the end of life, the patient's craving for food may have diminished. At this point, good palliative care, rather than simply trying to feed the patient, may become a more appropriate intervention[41], and therefore nutritional support needs to be personalized to the individual patient's needs, with dietary regimens tailored to the different disease states, and with full respect for the patient's dietary culture and habits [42] and in the area of excretory care, research findings have shown that when caregivers display unprofessional attitudes when dealing with patients' personal care needs, including arbitrary judgments of incontinence conditions, delayed responses to requests for help, or the use of inappropriate language during assistance with toileting, this can lead directly to strong feelings of dignity impairment and self-worth depreciation. sense of compromised dignity and devalued self-worth[43]. This is similar to the findings of this study and highlights the importance of defecation care in maintaining patients' human dignity. Healthcare professionals should strictly implement standardized practices such as regular turning and perineal care, and may use deodorizing products, such as herbal fumigation, to improve the ward environment and enhance patients' comfort. In addition, sleep disturbance is a common problem among patients with advanced, life-limiting illnesses, which is not only debilitating, but also leads to increased morbidity and decreased quality of life, while potentially exacerbating the suffering of patients and their caregivers [44]. Therefore, sleep management needs to start with optimizing the physical environment of the ward, such as reducing noise and rationalizing night care activities to improve patients' sleep quality. These measures need to be flexibly adjusted by nursing staff based on following standardized operations and taking into account the individual differences of patients in order to truly meet the physical comfort needs of elderly patients.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e5.2 \u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eFocusing on the two sides of the psychological needs of elderly patients and resolving the conflict between dependence and dignity of elderly patients\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIn geriatric hospice care, patients' psychological needs present a complex duality, a conflict between the desire for dependence on others and the need to preserve their dignity. This conflict is evident in the patient's psychological state and behavioral manifestations and challenges nursing practice. With the multiple effects of declining physical functioning, disease distress, and medical and family issues, psychological problems in elderly patients are becoming more prominent. Studies have shown that more than 90% of cancer patients have varying degrees of psychological problems, such as anxiety, depression, and despair[45], and elderly patients gradually shift from being able to take care of themselves to losing their autonomy [46], and therefore become dependent on family members, healthcare professionals, and others in terms of life care, emotional support, and so on . However, they also have a strong desire to maintain their dignity and to be respected and recognized. Terminally ill patients are most often troubled not by physical symptoms, but by existential and dignity-related concerns, such as pain associated with the illness, loss of autonomy and control, and loss of meaning in their lives or the feeling of being a burden[47]. This is consistent with the findings of this study. Patient's patience and respect for healthcare professionals are extremely valued by patients.Ragan et al.[48]showed that sound communication at the end of life not only relieves stress, but also improves the well-being of the dying individual, promotes meaningful interactions, and facilitates patient-centered care, leading to a more satisfying outcome for all involved. In contrast, when healthcare professionals display indifference or impatience, patients feel belittled and their dignity is compromised. At the same time, the patients' quest for dignity is also reflected in their continued affirmation of their family roles, and their desire for more visits from family members, not only out of a simple need for companionship, but also a desire to confirm that they are still of value and significance within the family, rather than being abandoned or forgotten. In response to this conflict, caregiving responses should focus on balance. First, comprehensive life care and emotional support should be provided to fulfill the patient's dependency needs and make the patient feel cared for and looked after. Second, the individual differences and autonomy of patients should be respected and their dignity should be maintained. In recent years, there are more and more studies on dignity therapy in hospice care. Dignity therapy is a simple and easy to implement individualized psychotherapeutic intervention that has been shown to have many benefits. Research has shown that dignity therapy can reduce anxiety and depression and improve the sense of dignity, creativity, self-integrity, hope, and overall quality of life of terminally ill patients[49], In addition, research has shown that dignity therapy has great potential for family members of terminally ill patients as well, by decreasing distress, aiding in bereavement, and alleviating grief[50]Therefore, dignity therapy is recommended for elderly hospice patients to better meet their psychological needs and enhance their quality of life at the end of life.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e5.3 \u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003e |\u003c/strong\u003e\u003cstrong\u003e \u003c/strong\u003e\u003cstrong\u003eEmphasizing the social and cultural comfort and spiritual needs of elderly patients and improving the elderly hospice service system\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eIn geriatric hospice care, meeting the socio-cultural and spiritual needs of patients plays a crucial role in enhancing their psychological comfort and quality of life. With regard to sociocultural needs, family support, respect for cultural practices, and social connectedness form the core of patients' emotional attachment. Family relationships play a central role in shaping an individual's well-being over the life course[51], providing patients with the comfort of affection and, more importantly, affirmation of the value of their lives. However, family caregivers are often challenged by both emotional responsibilities and real-world stressors[52], and the question of how to balance family support with caregiver stress becomes critical. Research has shown that sociocultural has a significant impact on end-of-life care[53]. Cultural practices have deep emotional roots in the patient's mind and provide a familiar rhythm of life and emotional connection. However, some patients choose social avoidance due to “stigmatization” concerns, reflecting the need to respect patients' cultural practices while paying attention to their psychological status and avoiding social isolation due to cultural factors. Therefore, nursing practice should focus on cultural sensitivity, understanding the cultural background and customary needs of patients and their families through communication, while providing psychological support to help patients overcome social barriers and enhance their social connections. In terms of spiritual needs, a qualitative study by Jadidi et al.[54]proposed that caregivers of older adults should recognize the spiritual needs of older adults and attempt to maintain and promote their spiritual health. This is similar to the findings of this study. Therefore, social workers provide training to the staff of organizations that provide integrated health and care services on comprehensive assessment of the characteristics of the terminally ill elderly, analysis of the elderly's family relationships, and awareness of the elderly's mindfulness. This training can foster the concept of integrated care among geriatric healthcare workers and improve the quality of life of the terminally ill elderly[55]. Geriatric hospice care should consider patients' socio-cultural and spiritual needs in an integrated manner, and enhance patients' psychological comfort and quality of life through multidimensional interventions of family support, respect for cultural practices, social connection, and spiritual care. This requires not only the professional skills of healthcare professionals, but also the joint efforts of society and families to provide comprehensive support and care for elderly patients.\u003c/p\u003e"},{"header":"6 LIMITATIONS","content":"\u003cp\u003eDue to the limited time available for recruitment, we did not fully realize our purposeful sampling strategy. For example, the sample did not include patients from different ethnic groups, with more female than male participants. The perspectives and experiences of patients from these groups may differ from those of the patients who participated in this study.\u003c/p\u003e"},{"header":"7 CONCLUSION","content":"\u003cp\u003eThis study will provide a valuable, patient-centered perspective in the field of geriatric hospice comfort care, which is expected to guide clinical practice, facilitate policy development, and promote societal perceptions of hospice care, ultimately laying a solid foundation for enhancing the end-of-life quality of life of elderly patients and promoting the healthy development of hospice care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis study obtained approval from the Ethics Committee of Shangdong Provincial Qianfoshan Hospital (YXLL-KY-2025(035)).Our research adhered strictly to the ethical principles outlined in the Declaration of Helsinki, ensuring compliance with all pertinent guidelines and regulations. Prior to their participation, all individuals involved in the study provided their informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eNo conflict of interest has been declared by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eAll authors conceived the study and were responsible for designing the study, acquisition of data and analysis of data. Na Li wrote the first draft of the paper;Cuiping Xu and Yanbo Ji have contributed to the conception and design of the study;Xinru Liu,Ronghui Wang and Longhui Xu made substantial contributions to analysis and interpretation of data;Xiaoting Wang,Yan Li,Mei Yu and Yuanjie Liu made substantial contributions to acquisition of data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eThe research team would like to thank all participates.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePadeiro M, Santana P, Grant M. In: Oliveira PJ, Malva JO, editors. Chapter 1 - Global aging and health determinants in a changing world. Aging: Academic; 2023. pp. 3\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLobanov-Rostovsky S, He Q, Chen Y, et al. 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[published Online First: Epub Date]|.\u003c/span\u003e\u003c/li\u003e\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":"Palliative care, elderly, comfort, qualitative research","lastPublishedDoi":"10.21203/rs.3.rs-8241914/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8241914/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eAim：\u003c/strong\u003eAn in-depth exploration of the comfort care needs, experiences, and influencing factors of Chinese elderly patients during hospice care with a view to optimizing clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDesign：\u003c/strong\u003eA qualitative descriptive study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods：\u003c/strong\u003eAudio-recorded, face-to-face, semi-structured, individual interviews were conducted from May 2025 to June 2025 with nurses, elderly patients, and family members in a tertiary care hospital and four health care facilities in China. Coding was conducted using NVivo 12 software and themes were distilled based on Colaizzi's seven-step phenomenological analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult：\u003c/strong\u003eFour themes and 14 sub-themes were identified. The main themes are somatic comfort, psychological and emotional comfort, environmental comfort and sociocultural and spiritual comfort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion：\u003c/strong\u003eThis study reveals multiple dimensions of comfort needs and their influencing factors, including physical, psychological, emotional, sociocultural and spiritual, in geriatric hospice care, to provide a basis for healthcare teams to more accurately identify unmet needs and develop individualized care plans.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImpact：\u003c/strong\u003eThis study provides insight into patients' and families' true perceptions of comfort, providing a richer, more contextualized understanding of comfort care in geriatric hospice, which will help healthcare teams more accurately identify unmet needs and develop more personalized and humanized care plans, thereby improving the quality of geriatric hospice care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatient or Public Contribution：\u003c/strong\u003e There was no patient or public contribution.\u003c/p\u003e","manuscriptTitle":"“We Just Want to Feel at Peace”: A Qualitative Exploration of Comfort Care Needs in Geriatric Palliative Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 09:41:55","doi":"10.21203/rs.3.rs-8241914/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":"60d491ec-0756-49aa-a4aa-a47ce7dde6fd","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-26T03:10:11+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-12 09:41:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8241914","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8241914","identity":"rs-8241914","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}