Quality and influencing factors of hospice care outcomes in patients with advanced cancer: a cross-sectional study based on symptom management theory

Quality and influencing factors of hospice care outcomes in patients with advanced cancer: a cross-sectional study based on symptom management theory | 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 Quality and influencing factors of hospice care outcomes in patients with advanced cancer: a cross-sectional study based on symptom management theory Yan Huang, Xingling Liu, Junfeng Zhang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5728252/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Although the research and development of new drugs and the improvement of medical technology have made some progress in cancer treatment, the quality of life of cancer patients is still low, and the development of hospice care is still slow. At present, there are few studies on the quality of hospice care for patients themselves. Methods This cross-sectional study used convenience sampling to select 305 advanced cancer patients from hospitals, community health service centers and elderly care institutions related to the hospice care treatment pilot in Dongguan City, Guangdong Province between September 2023 and April 2024. The questionnaire was composed of seven parts: general information (including sociodemographic and disease-related information), palliative care outcome scale, numerical rating scale, brief illness perception questionnaire, 10-item Kessler psychological distress scale, family cohesion questionnaire, perceived social support scale. Data were analyzed using descriptive analysis, independent sample t -tests, one-way ANOVA, Pearson’s correlation, and multiple linear regression. Results A total of 305 advanced cancer patients were interviewed, most of them aged between 45 ~ 59 years. The average score of hospice care quality of cancer patients was 13.99 ± 5.98, which was at the lower average level compared with the median total score of the scale. The multiple linear regression results showed a linear correlation, between pain, disease perception, psychological distress, educational level, and financial stress on families and patient quality of hospice care. Conclusion The current quality of the hospice care outcomes in advanced cancer patients is at a moderate level. The results provide a reference for further construction of hospice care quality evaluation program and lay a foundation for improving the quality of the hospice care for advanced cancer patients. Hospice care hospice care outcomes quality cancer influencing factors symptom management theory Figures Figure 1 Figure 2 Figure 3 Figure 4 Background With an aging global population and a rising incidence of chronic disease, the global demand for hospice care is increasing and will likely continue to increase [1] . Cancer is one of the major diseases that seriously threaten people’s health, and it is also a major public health problem [2] . In recent years, more than 11,100 people are diagnosed with new cancer every day in China, and nearly 6,600 people die of cancer [3] . With the development of new drugs and the improvement of medical technology, the survival period of cancer patients has been relatively prolonged, and the number of cancer survivors has increased significantly [4] . However, in the face of heavy disease burden, patients with advanced cancer usually have poor quality care services and low quality of life [5] . Hospice care is a special type of care that provides medical, psychological and spiritual support are given to cancer patients and their loved ones when treatment no longer controls the disease. With hospice care, a team of healthcare professionals works with patients and families to provide the comfort and care they need at the end of their lives [6] . Quality of hospice care refers to the overall quality of hospice care services provided by the multidisciplinary team to the target [7] . The quality of hospice care is an important part of the outcomes indicators of hospice care [8] , which has a positive effect on improving the quality of life and psychological state of patients [9] . However, in an expert assessment of the quality of death in 81 countries in 2021, the quality of hospice care in mainland China was ranks 53rd, which is far behind the most advanced countries in the world [10] . In addition, influenced by traditional culture and ethics, because it is easy to misunderstand hospice care, most dying patients still want to treat diseases and prolong their lives in the last stage of life, and ignore the quality of life [11] , the quality of hospice care provided to patients in China is suboptimal [11, 12] . Sandsdalen et al. [13] show that it is crucial to pay attention to the patients’ subjective feelings of the quality of hospice care and timely identify the deficiencies of hospice care services to take effective measures to improve the quality of hospice care services. Therefore, in clinical practice and scientific research, we should not only actively promote the development of hospice care, but also strive to improve the quality of hospice care. The burden of cancer is increasing and the quality of life is low, hospice care can effectively improve the quality of life of patients by providing physical, mental and social integration services. Although the pilot project of hospice care has been carried out in China to meet the needs of patients with hospice care as much as possible, the related studies on hospice care mostly focus on caregivers and medical workers, and there is no research on the current situation of the quality of hospice care and related influencing factors for patients. Symptom management theory (SMT) was developed from the symptom management model (SMM) [14] . After that, in 2001, Dodd et al. [15] developed and improved the model. SMT indicates that patients’ symptom responses are influenced by individual, environmental, health, and disease conditions, and these factors also have effects on the patient’s symptom experience, symptom management strategies, and symptom management effects. There is currently no study applying SMT to the quality of outcomes in hospice care. The outcome quality of hospice care is an outcome indicator of symptom management effect. Therefore, this study analyzed the effects of human, environment, health and disease on the quality of hospice care based on SMT, with the quality of cancer patients as the dependent variable. The framework of this study is illustrated in Fig. 1 . The purpose of this study is based on SMT, cancer patients as the research object, with the quality of hospice care outcomes as the outcome index. By investigating the related factors that may affect the hospice care outcomes quality of cancer patients, analyze the status of hospice care quality, and lays the foundation for effectively improving the quality of life of cancer patients. Method Study design A cross-sectional study based on SMT was conducted to assess the current status of hospice care outcomes quality among patients with advance cancer and its influencing factors. Setting and sample From September 2023 to April 2024, convenience sampling method was used to select advanced cancer patients from tertiary hospitals, secondary hospitals, community health service centers and elderly care institutions in Dongguan City, Guangdong Province, which are pilot hospice care, as research objects. The inclusion criteria were: (1) age ≥ 18 years old, (2) Cancer was confirmed by histopathology and was not limited by the cancer type [16] , (3) receive hospice care for at least one month, (4) ability to complete questionnaires independently or with help, (5) patients know themselves condition, (6) patients volunteered to participate in the study. The exclusion criteria were: (1) patients with mental disorders, cognitive impairment and dementia, (2) patients with severe communication disorders. According to Kendall’s sample rough estimation method, the number of samples is at least 10 ~ 20 times the number of variables [17] , this study has 27 main items, and considering 10% of the invalid questionnaires, the final sample size is 305 cases. Variables and measures The general information questionnaire Based on the literature reading and clinical practice, the researcher designed the patient’s demographic data, including 13 items, such as the patient’s age, gender, religious belief, residence, marital status, education level, occupation, medical payment method, average monthly income of family members, and satisfaction with medical staff and hospitals. Disease-related information includes 4 items: hospice care place, tumor type, TNM clinical stage of tumor and duration of illness. The palliative care outcome scale (POS) Palliative care outcome scale (POS) by Hearn and Higginson [18] for cancer patients, is used to evaluate the quality of the hospice care outcomes for cancer patients. This scale includes 12 items divided into 2 dimensions: psychology and quality of life, and quality of care. Among them, the first l0 items are scored from 0 to 4 points according to the five-point Likert scale, 0 points indicates no problem, and 4 points indicates the most serious state of the problem. The total score was 0 to 40, and the higher the scores indicated the worse quality of care. The last two items were open-ended questions: (1) describe the main questions of the patient in the last three days; (2) whether the questionnaire was completed independently. The scale has good reliability and validity, with a Cronbach’s α coefficient of 0.734 [19] . In this study, the Cronbach’s α was 0.739. The numerical rating scale (NRS) Numerical Rating Scales (NRS) describe pain by a series of numbers on an 11 point scale from 0 to 10 with 0 being no pain, 10 being the worst pain possible, and the numbers in between representing intermediate intensities [20] . Where, 0 means no pain, 1 ~ 4 means mild pain, 5 ~ 6 means moderate pain, and 7 ~ 10 means severe pain [21] . The Cronbach’s α coefficient for this scale was reported to be 0.83, indicating moderate-to-good reliability [22] . The brief illness perception questionnaire (BIPQ) The Brief Illness Perception Questionnaire (BIPQ) is used to assess individual perception and perception of the disease [23] . consists of 9 items with 3dimensions: “perception of the disease(5 items)”, “emotion(2 items)”, and “understanding power(1 items)”, the 9th item is a causal question about the cause of the disease “Please list in order the 3 most important factors that you believe caused to your disease. The most important cause for me is...”. The scoring from 0 to 10 points, items 3, 4 and 7 are reverse scoring items. The total score was 0 to 80, the higher the scores indicated the more negative perception and the more serious the symptoms of the disease, and the worse quality of care. The Cronbach’s α reliability coefficient of the questionnaire was 0.77 [24] , and the Cronbach’s α in this study was 0.710. The 10-item Kessler psychological distress scale (Kesslerl0) The kessler psychological distress scale (Kesslerl0) is a scale used to investigate the mental health status of a population, which measures the frequency of non-specific mental health related symptoms such as anxiety and stress levels experienced in the past 4 weeks [25] . The Kesslerl0 consists of 10 items rated on a five-point Likert scale, with “almost never”, “occasionally”, “sometimes”, “most time” and “all of time” scoring from 1 to 5 points, respectively. The higher scores indicate greater psychological distress and worse mental health. Cronbach`s α coefficient for this scale was reported to be 0.80 [26] . The Cronbach’s α in this study was 0.845. The family cohesion questionnaire (FCQ) The family cohesion questionnaire (FCQ) is used to assess the emotional connections between family members, Fei Lipeng et al. [27] research team revised and translated the FCQ to form a Chinese version that consists of 16 items in the one dimension. The scale is scored on a five-point Likert scale, with “no”, “occasionally”, “sometimes”, “often”, “always” being worth 1 through 5 points, sequentially but with items 2, 5, 10, and items 15 being scored in reverse. The total score was 15 to 75, and the higher the scores indicated the closer emotional relationships among family members. The Cronbach’s α coefficient of the scale was 0.85 [27] , and in the present study the Cronbach’s α was 0.840. The perceived social support scale (PSSS) The Perceived Social Support Scale (PSSS) is a tool to measure an individual’s self-perceived multi-level social support [28] . The PSSS consists of 12 items in 3 dimensions, including items 3, 4, 8,11 in the “family support” dimension, items 6,7,9,12 in the “friends support” dimension and items 1,2,5,10 in the “other support”. The scale is scored on a seven-point Likert scale, with “highly disagree”, “very disagree”, “slightly disagree”, “neutral”, “slightly agree”, “very agree”, “highly agree” being worth 1 through 7 points. The scale has good reliability and validity [29] , and the Cronbach’s α in this study was 0.809. Data collection procedure Data were collected from September 2023 to March 2024. After obtaining the consent of the hospital ethics committee, the purpose and significance of this study were explained to the respondents in detail, and the questionnaires were distributed after obtaining their informed consent. The questionnaire was filled in on the spot, and the researcher checked the integrity and recovered it. In this study, a total of 310 questionnaires were issued, and 305 valid questionnaires were collected (1 case withdrew, and 4 questionnaires were checked regularly), and the effective recovery rate of questionnaires was 98.39%. Ethical considerations This study adhered to the guidelines of the Declaration of Helsinki. The Ethics Committee of Dongguan Songshan Lake Central Hospital issued the ethical approval for this study, and the ethical batch number was No.72,2023. All participants were informed about the study and volunteered to participate in the study. In addition, the researchers obtained informed consent from all participants to indicate their consent before recruitment. Data analysis Data were analyzed using SPSS 25.0 software. Descriptive statistics were used to analyze the participants’ demographic characteristics and POS scores. A linear regression analysis was performed to explore associated factors influencing patients hospice care outcomes quality, using POS scores as the dependent variable and factors that were statistically significant ( P < 0.05) in the univariate analysis as independent variables. A positive standardized regression coefficient ( β ) was used to indicate a protective factor and negative one to indicate a risk factor. A difference was considered statistically significant at P < 0.05. RESULTS General information and demographic characteristics A total of 305 terminal cancer patients provided a valid questionnaire in this study. Most of the patients aged between 45 and 59 years (37.7%). The proportion of male patients (50.8%) was slightly higher than that of female patients (49.2%). Of them, married cancer patients accounted for the majority (82.0%), and the vast majority of the patients reported no religious beliefs (88.9%). Most patients acquired monthly income 1001 ~ 3000 CNY (47.5%). Of the 305 patients, the occupations cover farmers, workers, teachers, self-employed, etc. Most of patients’ medical expenses payment was the rural cooperative medical insurance (46.9%) and the employee medical insurance (39.0%). Besides, thought the economic pressure brought by illness to the family was very heavy (34.4%), received relevant nursing information (45.6%). They were satisfied with the communication and satisfaction of medical staff about the illness, accounting for 43.3%. Most of the hospice care places were tertiary hospitals (89.2%), digestive system (39.0%) and respiratory system (30.5%). The majority of the disease is less than 1 year (37.0%). The characteristics of the participants and the relationship of the demographic variables are detailed in Table 1 . Table 1 Demographic characteristics of participants (N = 305) Variables category N(%) POS (Mean ± SD) t / F P Age 18 ~ 44 54(17.7) 12.72 ± 6.26 1.502 0.214 45 ~ 59 115(37.7) 14.02 ± 5.58 60 ~ 74 113(37.0) 14.73 ± 6.18 ≥ 75 23(7.5) 13.26 ± 6.02 Gender Male 155(50.8) 13.63 ± 5.73 1.110 0.293 Female 150(49.2) 14.36 ± 6.22 Religious beliefs No 271(88.9) 13.97 ± 5.95 0.048 0.826 Yes 34(11.1) 14.21 ± 6.30 Long term residence Rural 83(27.2) 13.84 ± 5.97 0.994 0.371 Town 133(43.6) 14.50 ± 5.69 Urban 89(29.2) 13.37 ± 6.39 Marital status Unmarried 9(3.0) 12.00 ± 6.48 2.163 0.092 Married 250(82.0) 14.12 ± 5.89 Divorce 10(3.3) 9.90 ± 4.56 Widowed 36(11.8) 14.78 ± 6.47 Educational status Primary school or below 78(25.8) 15.81 ± 5.95 3.819 0.010 Junior high school 116(38.0) 13.83 ± 5.86 High school or vocational school 64(21.0) 13.05 ± 5.55 College degree or above 47(15.4) 12.68 ± 6.32 Occupation Farmer 71(23.3) 13.86 ± 5.74 1.840 0.079 Worker 94(30.8) 13.09 ± 5.63 Teacher 13(4.3) 12.92 ± 7.25 Medical related 3(1.0) 16.00 ± 10.00 Liberal professions 10(3.3) 12.60 ± 5.66 Unemployed 50(16.4) 16.52 ± 6.73 Individual household 20(6.6) 13.40 ± 6.10 Other 44(14.4) 14.05 ± 5.07 Medical expenses payment Rural cooperative medical insurance 143(46.9) 14.50 ± 6.00 3.804 0.011 Employee medical insurance 119(39.0) 12.93 ± 5.89 Self-expense 4(1.3) 21.25 ± 6.13 Social insurance 39(12.8) 14.61 ± 5.49 Continuing Table 1 Demographic characteristics of participants (N = 305) Variables category N(%) POS (Mean ± SD) t / F P Monthly income (CNY) ≤ 1000 44(14.4) 16.75 ± 5.47 7.835 5001 55(18.0) 11.53 ± 5.72 The financial strain of the illness on your family Very heavy 104(34.1) 15.79 ± 5.95 7.375 < 0.001 Heavier 105(34.4) 14.37 ± 5.63 Average 68(22.3) 12.22 ± 5.88 Lighter 11(3.6) 10.91 ± 5.09 None 17(5.6) 9.76 ± 4.80 Medical-related care information received Very full 43(14.1) 11.58 ± 5.52 5.521 < 0.001 Sufficient 139(45.6) 13.27 ± 5.90 Average 97(31.8) 15.29 ± 5.59 Less sufficient 21(6.9) 17.48 ± 5.84 Not at all 5(1.6) 15.00 ± 9.46 Satisfaction with medical staff’s discussion and communication of the condition Very satisfied 89(29.2) 11.91 ± 5.89 8.912 < 0.001 More satisfied 132(43.3) 13.90 ± 5.80 Average 74(24.3) 15.78 ± 5.09 Less satisfied 8(2.6) 22.13 ± 5.25 Very dissatisfied 2(0.7) 14.00 ± 12.73 Satisfaction degree of holistic nursing service Very satisfied 84(27.5) 11.61 ± 5.81 13.266 < 0.001 More satisfied 147(48.2) 13.78 ± 5.53 Average 72(23.6) 16.97 ± 5.73 Less satisfied 2(0.7) 22.50 ± 0.71 Receiving hospice care facilities Tertiary hospital 272(89.2) 14.02 ± 5.83 2.429 0.065 Secondary hospital 9(3.0) 11.11 ± 7.47 Community 18(5.9) 16.28 ± 6.94 Elderly care institutions 6(2.0) 10.17 ± 4.83 Cancer type* Respiratory system 93(30.5) 15.03 ± 5.37 5.196 < 0.001 Digestive system 119(39.0) 12.88 ± 5.91 Gynecological malignant 50(16.4) 16.40 ± 5.98 Head and neck 20(6.6) 12.00 ± 6.59 Other 23(7.5) 12.04 ± 6.05 Clinical stages Stage III 72(23.6) 13.19 ± 6.08 1.688 0.195 Stage IV 233(76.4) 14.24 ± 5.94 Continuing Table 1 Demographic characteristics of participants (N = 305) Variables category N(%) POS (Mean ± SD) t / F P Time of illness(year) 3 69(22.6) 13.96 ± 6.34 Notes: Among cancer types, respiratory system include lung cancer; digestive system include liver cancer, stomach cancer, esophageal cancer, pancreatic cancer, colorectal cancer; gynecological malignant include breast cancer, cervical cancer, ovarian cancer; head and neck include nasopharyngeal cancer, thyroid cancer, tongue cancer, and others include ureteral cancer, peritoneal cancer, bladder cancer, prostate cancer. Current status of hospice care outcomes The mean score of hospice care outcomes quality was (13.99 ± 5.98), with a mean item score of (1.39 ± 0.60). See Table 2 the score of each dimension for details. The three highest scoring hospice care outcomes quality were “Have you felt good about yourself in the last three days? (1.90 ± 1.10)”, “Have your family or friends ever been anxious or worried about you in the past three days? (1.76 ± 0.96)”, and “Can you have shared your feelings with your family or friends in the past three days? (1.72 ± 1.18)”. The two lowest-scoring hospice care outcomes quality were “Have you been affected / troubled by the pain in the last three days? (0.96 ± 0.94)” and “In the past three days, how much time do you think has been wasted on medical appointments? For example: road round-trip or repeated tests? (1.04 ± 1.41) ”(Table 3 ) . Table 2 Score of all dimensions of hospice care outcomes quality Items Number of items Total score (Mean ± SD) Dimension equally score POS 10 13.99 ± 5.98 1.39 ± 0.60 Psychology and the quality of life 6 8.60 ± 3.85 1.43 ± 0.64 Care quality 4 5.40 ± 3.25 1.35 ± 0.82 Notes: POS is Palliative care outcome scale. Table 3 Score and sequencing of each item in hospice care outcomes quality Items Mean ± SD Sequence 1.Have you been affected / troubled by the pain in the last three days? 0.96 ± 0.94 10 2.Are there any other symptoms that have affected your feelings in the past three days? For example, experience nausea, cough, or constipation? 1.23 ± 0.80 7 Continuing Table 3 Score and sequencing of each item in hospice care outcomes quality Items Mean ± SD Sequence 3.Have you been anxious or worried about your condition or treatment for the last three days? 1.41 ± 0.96 5 4.Have your family or friends ever been anxious or worried about you in the past three days? 1.76 ± 0.96 2 5.How much information have you or your family and friends been told in the past three days? 1.05 ± 1.05 8 6.Can you have shared your feelings with your family or friends in the past three days? 1.72 ± 1.18 3 7.Have you ever felt depressed in the past three days? 1.34 ± 0.94 6 8.Have you felt good about yourself in the last three days? 1.90 ± 1.10 1 9.In the past three days, how much time do you think has been wasted on medical appointments? For example, road round-trip or repeated tests? 1.04 ± 1.41 9 10.Whether any practical problems (whether financial or personal) caused by your illness have been solved in the last three days? 1.58 ± 1.69 4 Correlation between key variables The results of Pearson correlation analysis showed that the quality of the hospice care outcomes was positively correlated with pain ( r = 0.479)and illness perception( r = 0.552, P < 0.01). Quality of hospice care outcomes was also positively correlated with psychological distress ( r = 0.639, P < 0.01). See Table 4 for details. Table 4 Pearson correlation coefficients between key study variables(N = 305) Entries 1 2 3 4 5 6 1.POS 1 2.NRS 0.479** 1 3.Illness perception 0.552** 0.354** 1 4.Psychological distress 0.639** 0.394** 0.563** 1 5.Family cohesion -0.216** -0.076 0.005 -0.175* 1 6.Perceived social support -0.278** -0.082 -0.022* -0.237** 0.546** 1 Note:* P < 0.05, ** P < 0.01 Test for normality of the residuals, homogeneity of variance test As seen from the normalized residual histogram, the normalized residuals fit a normal distribution, see Fig. 2 . Furthermore, the P-P plot model is well arranged along the diagonal, suggesting that the data satisfy a normal distribution, see Fig. 3 . Figure 4 shows the scatter plot of the regression standardized residual and standardized predicted values. The data points are evenly distributed and basically within plus or minus 3 standard deviations, indicating that the overall effect is good. In summary, the tests show that the data in this study met three conditions: independence, homogeneity of variance and normality. Multiple linear regression In Table 5 , the equation had an R 2 of 0.600 and an adjusted R 2 of 0.583, indicating that the seven variables described above explained 58.3% of the variance in hospice care outcomes quality. The results showed that pain ( β = 0.194, P < 0.01), illness perception ( β = 0.220, P < 0.01), psychological distress ( β = 0.376, P < 0.01), education level ( β =−0.092, P = 0.023), and the financial strain of the illness on the family ( β =-0.118, P = 0.011) were independently associated with hospice care outcomes quality. Table 5 The results of the Multiple Linear regression analysis of the influencing factors of hospice care outcomes quality Variables B SE β t P VIF Constant 0.374 2.647 0.141 0.888 NRS 0.470 0.101 0.194 4.639 0.000 1.272 BIPQ 0.127 0.028 0.220 4.596 0.000 1.662 Kesslerl0 0.347 0.045 0.376 7.691 0.000 1.742 Education -0.543 0.238 -0.092 -2.283 0.023 1.171 The financial strain of the illness on your family -0.643 0.251 -0.118 -2.563 0.011 1.538 Note: 95%CI, R 2 = 0.600, adjusted R 2 = 0.583; F = 33.640, P < 0.001 DISCUSSION The total score of the POS scale was 40 points, and the higher the score, the worse the quality of hospice care was. The results of this study showed that the total POS scale of patients with advanced cancer was (13.99 ± 5.98), 20 points below the middle value of the scale and at a moderate level. Compared with the results of foreign studies, the score is higher than that of Higginson (8.20 ± 4.40) [30] and Waldemar [31] (12.1 ± 6.3). The comparison shows that influenced by the traditional “ filial piety (Tao) culture” in China, hospice care is not recognized by most people, which leads to the poor development of hospice care in China and unsatisfactory quality of hospice care. However, the results of this study are lower than the results of Chinese scholars [32] 2020 (22.57 ± 7.43), indicating that with the promotion of hospice care, the pilot program of hospice care has achieved remarkable results, which improves the quality of advanced hospice care for cancer patients. The results of this study showed that the score of quality of care dimension (6.49 ± 3.90) was lower than the score of psychological and quality of life dimension (9.18 ± 3.94), indicating that cancer patients had a better quality of care and less psychological and poor quality of life. The mood of family members affects the quality of hospice care [33] . Studies have shown that psychological adjustment and grief counseling for the families of patients with advanced cancer can improve the level of psychological grief and disease coping, and at the same time, the quality of care for patients has also been significantly improved. Advanced cancer patients was unable to receive conventional anti-tumor treatments such as surgery, radiotherapy, chemotherapy and molecular targeting, and often face various symptoms and psychological problems, and their quality of life is seriously damaged [31] . However, hospice care with comfortable nursing and psychological comfort for patients with advanced cancer can significantly improve their quality of life and help them die with dignity [34] . Therefore, when providing hospice care for patients, medical staff should pay close attention to cancer patients to meet their psychological and spiritual needs, so as to improve the quality of hospice care outcome. Also, pay attention to the emotions of family members. Pain is a manifestation associated with the actual or possible presence of tissue damage, including painful experiences of feeling, emotion, and cognition [35] . It is one of the common symptoms of cancer patients, and it is also an important influencing factor that directly affects the quality of hospice care outcomes of cancer patients. In this study, the more severe the pain of the patients, the worse the quality of hospice care outcome, which may be related to the more severe the pain, and the daily life, activities and sleep of the patient are affected. Studies have shown [36] that the prevalence of pain in patients with advanced and metastatic cancer reaches 54.6%, and about one third of patients with cancer pain may even have psychological disorders. Therefore, if the pain is not effectively controlled in time, the patient’s comfort will be reduced, and the symptoms such as anxiety and depression will be aggravated, which will ultimately affect the quality of hospice care outcomes. Relevant research shows [37] that accurate dynamic pain assessment and management of patients based on the concept of hospice care can effectively relieve patients’ pain, improve their quality of life and treatment compliance. Therefore, pain control is one of the important tasks to improve the quality of hospice care for cancer patients. In clinic practice, medical staff should master the necessary analgesic measures, and pay continuous attention to and dynamically manage the pain of cancer patients. In addition to drug therapy, psychological support and non-drug therapy, including meditation, hypnosis, Tai Chi , music therapy, can be used to treat patients with comprehensive pain management, to relieve the pain and improve the quality of hospice care outcomes for advanced patients. Disease perception is the process by which an individual analyzes their current symptoms or disease based on known information and personal experience [38] . The results of this study showed that illness perception was positively correlated with the total score of POS ( P < 0.05), and the higher the patient’s illness perception, the higher the score of hospice care quality, that is, the worse the quality of hospice care, which is consistent with the research conclusions of Norwegian scholar Sandsdalen et al. [13] . It indicates that patients’ understanding, awareness, attention and sense of control over their disease treatment may affect the quality of the hospice care outcomes. Cancer patients have limited access to disease-related information, relatively low level of health literacy, and weak ability to obtain information, so they often fail to correctly understand the possible complications and prognosis caused by disease treatment, which further aggravates disease perception [39] . Improper cognition of the disease will lead to the increase of patients’ psychological pressure and negative pessimism, and eventually affect the quality of life [40] . Therefore, medical staff should actively promote hospice care services, timely identify patients’ negative emotions, provide them with disease-related information, form correct disease cognition, and make them face the disease and receive treatment with a positive attitude, so as to indirectly improve the quality of hospice care outcomes. Psychological distress refers to the adverse emotional states experienced by individuals experience in a variety of stressful states, including cognitive, behavioral, emotional, social behavior, mental and physical distress, which can develop into anxiety and depression [41] . In this study, the degree of patient psychological distress was positively associated with the quality of hospice care outcomes. When patients have psychological distress problems, its accepts the hospice care quality will be affected [42] . A survey of 1880 hospice patients in Australia showed that 66% of them had depression, 20% had serious anxiety and 45% had serious family anxiety [43] . Moreover, Roch et al. [44] investigated the quality of the hospice care outcomes of 100 patients with heart failure, and identified that patients widely had a high burden of both physical and psycho-emotional symptoms. Therefore, medical staff should not only focus on diagnosing and treating physical symptoms in cancer patients, but also prioritize their mental health status. Particular attention should be given to the emotional and psychological well-being of vulnerable patients susceptible to cancer-related psychological distress, with comprehensive interventions implemented to safeguard their mental health through systematic psychological support and monitoring. The results of this study show that education is one of the factors influencing the quality of hospice care outcomes in cancer patients. Consistent with the findings of Bi Jieying’s study [45] , in terms of educational level, the results of this study indicated that the higher the quality score of hospice care outcomes, the lower the quality of hospice care. The reasons behind may be that patients with low education level have relatively low learning ability and thirst for knowledge, are not good at using the knowledge to improve their own health level, and have difficulties in understanding the illness, treatment plan and the purpose and process of hospice care as explained by medical staff. Furthermore, the education level also an impact on patients’ levels of self-management and treatment compliance [46] . Patients with low education level may not abide medical advice, have poor treatment compliance, limited self-management skills, unable to better control the course of their disease, and the disease is prone to recurrent attacks, so the quality of hospice care for patients is low. It is suggested that medical staff should design corresponding hospice care services according to the characteristics of different groups of people when carrying out health education activities. For patients with relatively low educational level, targeted explanation and guidance can be used in understandable language and images, and guidance to enhance patients’ self-expression and disease awareness. The results of this study showed that economic pressure is one of the influencing factors of the quality of the hospice care outcomes in advanced cancer patients. The more severe the economic pressure, the higher the score of hospice care outcome, and the lower the quality of hospice care ( P < 0.05). The reason is that the patients receive long-term treatment of cancer, and the cost of hospice care is high, while the corresponding service does not meet the personal needs of the patients, and the family income is small, which increases the economic burden of the family. Some patients say that they have asked their friends and relatives for help for many times to pay the medical expenses, which led to the poor quality of hospice care outcomes. Studies show that up to 18.3% of patients with advanced cancer over 70 years have a severe financial burden, and that the economic burden is associated with poorer health-related quality of life [47] . In China, the growth rate of medical expenses has exceeded the growth rate of residents’ income. Due to the high medical expenses, low-income families often unbearable and heavy a economic burden, which leads to their even interruption of treatment, thus affecting the quality of hospice care outcomes. It is suggested that it is necessary for medical staff to guide cancer patients to apply for chronic and special diseases in hospital-related outpatient clinics, so as to reduce the economic burden of low-income groups and ensure that patients can get necessary support and services. In addition, the hospital strengthens cooperation with social work organizations to relieve the appropriate economic pressure for cancer patients through charitable fund projects. The results of multiple linear regression in this study indicated that age, occupation, medical payment method and per capita monthly income of family are not factors affecting the quality of hospice care outcomes, which is different from previous studies [45, 48] , but health care workers still take these factors seriously. Moreover, in this study, the different patients receiving hospice care sites was not show statistically significant differences in the quality of the hospice care outcomes in patients with advanced cancer.The reason may be that this study did not include enough samples of other secondary hospitals, community service centers, and nursing homes to identify differences. In future studies, researchers could recruit more patients receiving hospice care service outside of tertiary hospitals. Limitations Our results should be considered in light of several limitations. Firstly, this was a descriptive cross-sectional study that only dealt in correlation rather than causation between quality of hospice care outcomes and influencing factors, not causality. We therefore suggested that a longitudinal study be conducted in the future to explore the causality of personal and environmental factors on the quality of hospice care outcomes. Secondly, the convenience sampling method used in this study may cause selection bias, thus limiting the extrapolation of the results. Future studies should be conducted in more venues to improve the reliability and generalizability of the results. Finally, although the results were valid, there may be other factors influencing participants’ quality of hospice care outcomes. Further research is needed to explore these issues, and take targeted measures to intervene in hospice care quality in patients with advanced cancer. Conclusion In conclusion, the quality of hospice care outcomes in cancer patients is moderate and needs to be further improved. The quality of hospice care outcomes in cancer patients is influenced by pain, disease perception, psychological distress, different educational levels, and economic stress factors. Among them, the more serious the pain, the worse the quality of hospice care outcomes; the worse the disease perception, the worse the quality of hospice care outcomes; the worse the psychological distress, the worse the quality of hospice care outcomes. It suggests that clinical medical workers should pay attention to the control of patients’ pain, guide patients to form correct disease cognition, provide necessary psychological counseling for patients, relieve patients’ psychological distress, so as to promote the quality of patients’ hospice care outcomes. Abbreviations BIPQ Brief Illness Perception Questionnaire FCQ Family Cohesion Questionnaire Kesslerl0 10-item Kessler Psychological Distress Scale NRS Numerical Rating Scale POS Palliative Care Outcome Scale PSSS Perceived Social Support Scale Declarations Acknowledgements Firstly, The authors would like to express sincere gratitude to all the patients who participated in this study and generously shared their time and insights, and also gratefully acknowledge the participation of all healthcare institutions. Their contribution was essential in providing valuable data for this research. Author contributions YH and JZ conceived of and designed the study. YH carried out the data collection. XL provided guidance for data analysis. All authors read and approved the final manuscript. Funding This work was supported by the Science and Technology Development Key Project of Dongguan City(grant number20221800906222). Data availability All data generated or analyzed during this study will be made available upon request from the corresponding author. Ethics approval and consent to participate The Ethics Committee of Dongguan Songshan Lake Central Hospital issued the ethical approval to the researchers with the ethical batch number (No.72,2023). All participants were informed about the study and volunteered to participate in the study. In addition, the researchers obtained informed consent from all participants to indicate their consent before recruitment. All methods were performed by relevant guidelines and regulations. Consent to participate Informed consent was obtained from all participants included in the study prior to the interview process. Participation in this study was voluntary and confidential. Transcript interviews were anonymized using codes. No names or establishments are mentioned in the article to ensure confidentiality. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 School of Nursing, Guangdong Pharmaceutical University, Located on No.283 Jianghai Avenue, Haizhu Distric, Guangzhou, Guangdong province 510006, China 2 Department of Nursing, Dongguan Songshan Lake Central Hospital, No.1, Xianglong Road, Donggua, Guangdong Province 523000, China References Sleeman K E, de Brito M, Etkind S, et al. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions[J]. Lancet Glob Health, 2019,7(7):e883-e892. Crosby D, Bhatia S, Brindle K M, et al. Early detection of cancer[J]. Science, 2022,375(6586):eaay9040. Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants[J]. Chin Med J (Engl), 2022,135(5):584-590. Ramasamy V M, Sirala J N, Elavally S, et al. Public, patient and carers' views on palliative and end-of-life care in India[J]. 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Cultural factors affecting the self-care of cancer survivors: An integrative review[J]. Eur J Oncol Nurs, 2022,59:102165. Arastu A, Patel A, Mohile S G, et al. Assessment of Financial Toxicity Among Older Adults With Advanced Cancer[J]. JAMA Netw Open, 2020,3(12):e2025810. Arenas O L, Gonzalez-Jaramillo V, Saldarriaga C, et al. Prevalence and characteristics of patients with heart failure needing palliative care[J]. BMC Palliat Care, 2021,20(1):184. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5728252","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":436104038,"identity":"c84e5b1c-243f-446f-97e3-c8d6bea26d25","order_by":0,"name":"Yan Huang","email":"","orcid":"","institution":"Guangdong Pharmaceutical University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Huang","suffix":""},{"id":436104039,"identity":"1ba6f1d2-a168-46af-961f-61170da1e46b","order_by":1,"name":"Xingling Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAz0lEQVRIie3RsQqCUBSA4QOB06HWG4o+QXBBKATRV7kSNPkAjUKQS72BbxE4HxFssd2hIQmcXBxbJNtq8rYF3X//OOdwAFSqH0yzzkRi26Mf70iOTBkGdCvJ4FgIOWIysLN6Ty5nIZdcTI8ECe2KKwi7qgXPXERjxMiGW7BBJ7qcnATW9pLGCIhhCpsgZMdUR6AglSCcBB9Ijo0kYS8icuQFapIEy2Ex2uD8oNlOwiVuseI47x6968+se121W88cJR8xlHzNO/lWqFQq1V/0BEtwRhUMQr4+AAAAAElFTkSuQmCC","orcid":"","institution":"Guangdong Pharmaceutical University","correspondingAuthor":true,"prefix":"","firstName":"Xingling","middleName":"","lastName":"Liu","suffix":""},{"id":436104040,"identity":"593979ee-e233-496d-a020-6b17d5d9b267","order_by":2,"name":"Junfeng Zhang","email":"","orcid":"","institution":"Dongguan Songshan Lake Central Hospital","correspondingAuthor":false,"prefix":"","firstName":"Junfeng","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-12-29 03:38:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5728252/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5728252/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79746915,"identity":"685aa42d-18af-438b-8733-91cb5ead0607","added_by":"auto","created_at":"2025-04-02 08:54:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":250475,"visible":true,"origin":"","legend":"\u003cp\u003eConceptual framework\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5728252/v1/340bb244abdb72e6ce845fb2.png"},{"id":79746920,"identity":"f8726d04-1b67-4057-8ad2-33728771fc4a","added_by":"auto","created_at":"2025-04-02 08:54:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":122030,"visible":true,"origin":"","legend":"\u003cp\u003eNormalized Residual Histogram\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5728252/v1/14f8e128281d03ea77173a48.png"},{"id":79746919,"identity":"2cc64dfb-1906-43bb-9915-698f21f3efa9","added_by":"auto","created_at":"2025-04-02 08:54:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":153926,"visible":true,"origin":"","legend":"\u003cp\u003eP-P Diagram\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5728252/v1/c47b18e5c9583f7f06ed67eb.png"},{"id":79747538,"identity":"d55a208b-722b-421a-8d75-f8a1a93ca1f4","added_by":"auto","created_at":"2025-04-02 09:02:09","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":195122,"visible":true,"origin":"","legend":"\u003cp\u003eScatter Diagram of Normalized Residual and Normalized Predicted Values\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5728252/v1/baaccee025af3d625eb4a236.png"},{"id":81970053,"identity":"9ce325e4-0a87-4a75-8d28-83f58b7f0946","added_by":"auto","created_at":"2025-05-05 12:16:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2018097,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5728252/v1/0b6479bd-413b-4f97-8ec5-597904bc7422.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality and influencing factors of hospice care outcomes in patients with advanced cancer: a cross-sectional study based on symptom management theory","fulltext":[{"header":"Background","content":"\u003cp\u003eWith an aging global population and a rising incidence of chronic disease, the global demand for hospice care is increasing and will likely continue to increase\u003csup\u003e[1]\u003c/sup\u003e. Cancer is one of the major diseases that seriously threaten people\u0026rsquo;s health, and it is also a major public health problem\u003csup\u003e[2]\u003c/sup\u003e. In recent years, more than 11,100 people are diagnosed with new cancer every day in China, and nearly 6,600 people die of cancer\u003csup\u003e[3]\u003c/sup\u003e. With the development of new drugs and the improvement of medical technology, the survival period of cancer patients has been relatively prolonged, and the number of cancer survivors has increased significantly\u003csup\u003e[4]\u003c/sup\u003e. However, in the face of heavy disease burden, patients with advanced cancer usually have poor quality care services and low quality of life\u003csup\u003e[5]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHospice care is a special type of care that provides medical, psychological and spiritual support are given to cancer patients and their loved ones when treatment no longer controls the disease. With hospice care, a team of healthcare professionals works with patients and families to provide the comfort and care they need at the end of their lives\u003csup\u003e[6]\u003c/sup\u003e. Quality of hospice care refers to the overall quality of hospice care services provided by the multidisciplinary team to the target\u003csup\u003e[7]\u003c/sup\u003e. The quality of hospice care is an important part of the outcomes indicators of hospice care\u003csup\u003e[8]\u003c/sup\u003e, which has a positive effect on improving the quality of life and psychological state of patients\u003csup\u003e[9]\u003c/sup\u003e. However, in an expert assessment of the quality of death in 81 countries in 2021, the quality of hospice care in mainland China was ranks 53rd, which is far behind the most advanced countries in the world\u003csup\u003e[10]\u003c/sup\u003e. In addition, influenced by traditional culture and ethics, because it is easy to misunderstand hospice care, most dying patients still want to treat diseases and prolong their lives in the last stage of life, and ignore the quality of life\u003csup\u003e[11]\u003c/sup\u003e, the quality of hospice care provided to patients in China is suboptimal\u003csup\u003e[11, 12]\u003c/sup\u003e. Sandsdalen et al.\u003csup\u003e[13]\u003c/sup\u003e show that it is crucial to pay attention to the patients\u0026rsquo; subjective feelings of the quality of hospice care and timely identify the deficiencies of hospice care services to take effective measures to improve the quality of hospice care services. Therefore, in clinical practice and scientific research, we should not only actively promote the development of hospice care, but also strive to improve the quality of hospice care.\u003c/p\u003e \u003cp\u003eThe burden of cancer is increasing and the quality of life is low, hospice care can effectively improve the quality of life of patients by providing physical, mental and social integration services. Although the pilot project of hospice care has been carried out in China to meet the needs of patients with hospice care as much as possible, the related studies on hospice care mostly focus on caregivers and medical workers, and there is no research on the current situation of the quality of hospice care and related influencing factors for patients. Symptom management theory (SMT) was developed from the symptom management model (SMM)\u003csup\u003e[14]\u003c/sup\u003e. After that, in 2001, Dodd et al.\u003csup\u003e[15]\u003c/sup\u003edeveloped and improved the model. SMT indicates that patients\u0026rsquo; symptom responses are influenced by individual, environmental, health, and disease conditions, and these factors also have effects on the patient\u0026rsquo;s symptom experience, symptom management strategies, and symptom management effects. There is currently no study applying SMT to the quality of outcomes in hospice care. The outcome quality of hospice care is an outcome indicator of symptom management effect. Therefore, this study analyzed the effects of human, environment, health and disease on the quality of hospice care based on SMT, with the quality of cancer patients as the dependent variable. The framework of this study is illustrated in \u003cb\u003eFig.\u0026nbsp;1\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eThe purpose of this study is based on SMT, cancer patients as the research object, with the quality of hospice care outcomes as the outcome index. By investigating the related factors that may affect the hospice care outcomes quality of cancer patients, analyze the status of hospice care quality, and lays the foundation for effectively improving the quality of life of cancer patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA cross-sectional study based on SMT was conducted to assess the current status of hospice care outcomes quality among patients with advance cancer and its influencing factors.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSetting and sample\u003c/h2\u003e \u003cp\u003eFrom September 2023 to April 2024, convenience sampling method was used to select advanced cancer patients from tertiary hospitals, secondary hospitals, community health service centers and elderly care institutions in Dongguan City, Guangdong Province, which are pilot hospice care, as research objects. The inclusion criteria were: (1) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years old, (2) Cancer was confirmed by histopathology and was not limited by the cancer type\u003csup\u003e[16]\u003c/sup\u003e, (3) receive hospice care for at least one month, (4) ability to complete questionnaires independently or with help, (5) patients know themselves condition, (6) patients volunteered to participate in the study. The exclusion criteria were: (1) patients with mental disorders, cognitive impairment and dementia, (2) patients with severe communication disorders. According to Kendall\u0026rsquo;s sample rough estimation method, the number of samples is at least 10\u0026thinsp;~\u0026thinsp;20 times the number of variables\u003csup\u003e[17]\u003c/sup\u003e, this study has 27 main items, and considering 10% of the invalid questionnaires, the final sample size is 305 cases.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eVariables and measures\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eThe general information questionnaire\u003c/h2\u003e \u003cp\u003eBased on the literature reading and clinical practice, the researcher designed the patient\u0026rsquo;s demographic data, including 13 items, such as the patient\u0026rsquo;s age, gender, religious belief, residence, marital status, education level, occupation, medical payment method, average monthly income of family members, and satisfaction with medical staff and hospitals. Disease-related information includes 4 items: hospice care place, tumor type, TNM clinical stage of tumor and duration of illness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eThe palliative care outcome scale (POS)\u003c/h2\u003e \u003cp\u003ePalliative care outcome scale (POS) by Hearn and Higginson\u003csup\u003e[18]\u003c/sup\u003efor cancer patients, is used to evaluate the quality of the hospice care outcomes for cancer patients. This scale includes 12 items divided into 2 dimensions: psychology and quality of life, and quality of care. Among them, the first l0 items are scored from 0 to 4 points according to the five-point Likert scale, 0 points indicates no problem, and 4 points indicates the most serious state of the problem. The total score was 0 to 40, and the higher the scores indicated the worse quality of care. The last two items were open-ended questions: (1) describe the main questions of the patient in the last three days; (2) whether the questionnaire was completed independently. The scale has good reliability and validity, with a Cronbach\u0026rsquo;s α coefficient of 0.734\u003csup\u003e[19]\u003c/sup\u003e. In this study, the Cronbach\u0026rsquo;s α was 0.739.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eThe numerical rating scale (NRS)\u003c/h2\u003e \u003cp\u003eNumerical Rating Scales (NRS) describe pain by a series of numbers on an 11 point scale from 0 to 10 with 0 being no pain, 10 being the worst pain possible, and the numbers in between representing intermediate intensities\u003csup\u003e[20]\u003c/sup\u003e. Where, 0 means no pain, 1\u0026thinsp;~\u0026thinsp;4 means mild pain, 5\u0026thinsp;~\u0026thinsp;6 means moderate pain, and 7\u0026thinsp;~\u0026thinsp;10 means severe pain\u003csup\u003e[21]\u003c/sup\u003e. The Cronbach\u0026rsquo;s α coefficient for this scale was reported to be 0.83, indicating moderate-to-good reliability\u003csup\u003e[22]\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eThe brief illness perception questionnaire (BIPQ)\u003c/h2\u003e \u003cp\u003eThe Brief Illness Perception Questionnaire (BIPQ) is used to assess individual perception and perception of the disease\u003csup\u003e[23]\u003c/sup\u003e. consists of 9 items with 3dimensions: \u0026ldquo;perception of the disease(5 items)\u0026rdquo;, \u0026ldquo;emotion(2 items)\u0026rdquo;, and \u0026ldquo;understanding power(1 items)\u0026rdquo;, the 9th item is a causal question about the cause of the disease \u0026ldquo;Please list in order the 3 most important factors that you believe caused to your disease. The most important cause for me is...\u0026rdquo;. The scoring from 0 to 10 points, items 3, 4 and 7 are reverse scoring items. The total score was 0 to 80, the higher the scores indicated the more negative perception and the more serious the symptoms of the disease, and the worse quality of care. The Cronbach\u0026rsquo;s α reliability coefficient of the questionnaire was 0.77\u003csup\u003e[24]\u003c/sup\u003e, and the Cronbach\u0026rsquo;s α in this study was 0.710.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eThe 10-item Kessler psychological distress scale (Kesslerl0)\u003c/h2\u003e \u003cp\u003eThe kessler psychological distress scale (Kesslerl0) is a scale used to investigate the mental health status of a population, which measures the frequency of non-specific mental health related symptoms such as anxiety and stress levels experienced in the past 4 weeks\u003csup\u003e[25]\u003c/sup\u003e. The Kesslerl0 consists of 10 items rated on a five-point Likert scale, with \u0026ldquo;almost never\u0026rdquo;, \u0026ldquo;occasionally\u0026rdquo;, \u0026ldquo;sometimes\u0026rdquo;, \u0026ldquo;most time\u0026rdquo; and \u0026ldquo;all of time\u0026rdquo; scoring from 1 to 5 points, respectively. The higher scores indicate greater psychological distress and worse mental health. Cronbach`s α coefficient for this scale was reported to be 0.80\u003csup\u003e[26]\u003c/sup\u003e. The Cronbach\u0026rsquo;s α in this study was 0.845.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eThe family cohesion questionnaire (FCQ)\u003c/h2\u003e \u003cp\u003eThe family cohesion questionnaire (FCQ) is used to assess the emotional connections between family members, Fei Lipeng et al.\u003csup\u003e[27]\u003c/sup\u003e research team revised and translated the FCQ to form a Chinese version that consists of 16 items in the one dimension. The scale is scored on a five-point Likert scale, with \u0026ldquo;no\u0026rdquo;, \u0026ldquo;occasionally\u0026rdquo;, \u0026ldquo;sometimes\u0026rdquo;, \u0026ldquo;often\u0026rdquo;, \u0026ldquo;always\u0026rdquo; being worth 1 through 5 points, sequentially but with items 2, 5, 10, and items 15 being scored in reverse. The total score was 15 to 75, and the higher the scores indicated the closer emotional relationships among family members. The Cronbach\u0026rsquo;s α coefficient of the scale was 0.85\u003csup\u003e[27]\u003c/sup\u003e, and in the present study the Cronbach\u0026rsquo;s α was 0.840.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eThe perceived social support scale (PSSS)\u003c/h2\u003e \u003cp\u003eThe Perceived Social Support Scale (PSSS) is a tool to measure an individual\u0026rsquo;s self-perceived multi-level social support\u003csup\u003e[28]\u003c/sup\u003e. The PSSS consists of 12 items in 3 dimensions, including items 3, 4, 8,11 in the \u0026ldquo;family support\u0026rdquo; dimension, items 6,7,9,12 in the \u0026ldquo;friends support\u0026rdquo; dimension and items 1,2,5,10 in the \u0026ldquo;other support\u0026rdquo;. The scale is scored on a seven-point Likert scale, with \u0026ldquo;highly disagree\u0026rdquo;, \u0026ldquo;very disagree\u0026rdquo;, \u0026ldquo;slightly disagree\u0026rdquo;, \u0026ldquo;neutral\u0026rdquo;, \u0026ldquo;slightly agree\u0026rdquo;, \u0026ldquo;very agree\u0026rdquo;, \u0026ldquo;highly agree\u0026rdquo; being worth 1 through 7 points. The scale has good reliability and validity\u003csup\u003e[29]\u003c/sup\u003e, and the Cronbach\u0026rsquo;s α in this study was 0.809.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eData were collected from September 2023 to March 2024. After obtaining the consent of the hospital ethics committee, the purpose and significance of this study were explained to the respondents in detail, and the questionnaires were distributed after obtaining their informed consent. The questionnaire was filled in on the spot, and the researcher checked the integrity and recovered it. In this study, a total of 310 questionnaires were issued, and 305 valid questionnaires were collected (1 case withdrew, and 4 questionnaires were checked regularly), and the effective recovery rate of questionnaires was 98.39%.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e This study adhered to the guidelines of the Declaration of Helsinki. The Ethics Committee of Dongguan Songshan Lake Central Hospital issued the ethical approval for this study, and the ethical batch number was No.72,2023. All participants were informed about the study and volunteered to participate in the study. In addition, the researchers obtained informed consent from all participants to indicate their consent before recruitment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using \u003cem\u003eSPSS 25.0\u003c/em\u003e software. Descriptive statistics were used to analyze the participants\u0026rsquo; demographic characteristics and POS scores. A linear regression analysis was performed to explore associated factors influencing patients hospice care outcomes quality, using POS scores as the dependent variable and factors that were statistically significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) in the univariate analysis as independent variables. A positive standardized regression coefficient (\u003cem\u003eβ\u003c/em\u003e) was used to indicate a protective factor and negative one to indicate a risk factor. A difference was considered statistically significant at \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eGeneral information and demographic characteristics\u003c/h2\u003e \u003cp\u003eA total of 305 terminal cancer patients provided a valid questionnaire in this study. Most of the patients aged between 45 and 59 years (37.7%). The proportion of male patients (50.8%) was slightly higher than that of female patients (49.2%). Of them, married cancer patients accounted for the majority (82.0%), and the vast majority of the patients reported no religious beliefs (88.9%). Most patients acquired monthly income 1001\u0026thinsp;~\u0026thinsp;3000\u003cem\u003eCNY\u003c/em\u003e (47.5%). Of the 305 patients, the occupations cover farmers, workers, teachers, self-employed, etc. Most of patients\u0026rsquo; medical expenses payment was the rural cooperative medical insurance (46.9%) and the employee medical insurance (39.0%). Besides, thought the economic pressure brought by illness to the family was very heavy (34.4%), received relevant nursing information (45.6%). They were satisfied with the communication and satisfaction of medical staff about the illness, accounting for 43.3%. Most of the hospice care places were tertiary hospitals (89.2%), digestive system (39.0%) and respiratory system (30.5%). The majority of the disease is less than 1 year (37.0%). The characteristics of the participants and the relationship of the demographic variables are detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of participants (N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePOS\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;~\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54(17.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026thinsp;~\u0026thinsp;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e115(37.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026thinsp;~\u0026thinsp;74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113(37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.26\u0026thinsp;\u0026plusmn;\u0026thinsp;6.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e155(50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.63\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.293\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e150(49.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e271(88.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.826\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34(11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.21\u0026thinsp;\u0026plusmn;\u0026thinsp;6.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLong term residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.84\u0026thinsp;\u0026plusmn;\u0026thinsp;5.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.994\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133(43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnmarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e250(82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.12\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.90\u0026thinsp;\u0026plusmn;\u0026thinsp;4.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36(11.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.78\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary school or below\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78(25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.81\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e116(38.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.83\u0026thinsp;\u0026plusmn;\u0026thinsp;5.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school or vocational school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64(21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege degree or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47(15.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71(23.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.86\u0026thinsp;\u0026plusmn;\u0026thinsp;5.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.840\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.079\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWorker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94(30.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.09\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.92\u0026thinsp;\u0026plusmn;\u0026thinsp;7.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedical related\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.00\u0026thinsp;\u0026plusmn;\u0026thinsp;10.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLiberal professions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.60\u0026thinsp;\u0026plusmn;\u0026thinsp;5.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.52\u0026thinsp;\u0026plusmn;\u0026thinsp;6.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIndividual household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.40\u0026thinsp;\u0026plusmn;\u0026thinsp;6.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.05\u0026thinsp;\u0026plusmn;\u0026thinsp;5.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedical expenses payment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural cooperative medical insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143(46.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.50\u0026thinsp;\u0026plusmn;\u0026thinsp;6.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.804\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployee medical insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119(39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.93\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-expense\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(1.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e21.25\u0026thinsp;\u0026plusmn;\u0026thinsp;6.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial insurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39(12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eContinuing\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Demographic characteristics of participants (N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePOS\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMonthly income (CNY)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;1000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44(14.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.835\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1001\u0026ndash;3000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145(47.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.55\u0026thinsp;\u0026plusmn;\u0026thinsp;5.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3001\u0026ndash;5000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55(18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.53\u0026thinsp;\u0026plusmn;\u0026thinsp;5.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eThe financial strain of the illness on your family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery heavy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104(34.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.79\u0026thinsp;\u0026plusmn;\u0026thinsp;5.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHeavier\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105(34.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.37\u0026thinsp;\u0026plusmn;\u0026thinsp;5.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68(22.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.22\u0026thinsp;\u0026plusmn;\u0026thinsp;5.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLighter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17(5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e9.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMedical-related care information received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery full\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43(14.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.521\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e139(45.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97(31.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.29\u0026thinsp;\u0026plusmn;\u0026thinsp;5.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess sufficient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e17.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNot at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5(1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.00\u0026thinsp;\u0026plusmn;\u0026thinsp;9.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eSatisfaction with medical staff\u0026rsquo;s discussion and communication of the condition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89(29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.91\u0026thinsp;\u0026plusmn;\u0026thinsp;5.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132(43.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.90\u0026thinsp;\u0026plusmn;\u0026thinsp;5.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74(24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8(2.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.13\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery dissatisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.00\u0026thinsp;\u0026plusmn;\u0026thinsp;12.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eSatisfaction degree of holistic nursing service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVery satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84(27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.61\u0026thinsp;\u0026plusmn;\u0026thinsp;5.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147(48.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.78\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72(23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.97\u0026thinsp;\u0026plusmn;\u0026thinsp;5.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e22.50\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReceiving hospice care facilities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272(89.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.02\u0026thinsp;\u0026plusmn;\u0026thinsp;5.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e11.11\u0026thinsp;\u0026plusmn;\u0026thinsp;7.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCommunity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18(5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.28\u0026thinsp;\u0026plusmn;\u0026thinsp;6.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eElderly care institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e10.17\u0026thinsp;\u0026plusmn;\u0026thinsp;4.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer type*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespiratory system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93(30.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.03\u0026thinsp;\u0026plusmn;\u0026thinsp;5.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDigestive system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119(39.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.88\u0026thinsp;\u0026plusmn;\u0026thinsp;5.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGynecological malignant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50(16.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e16.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead and neck\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(6.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.00\u0026thinsp;\u0026plusmn;\u0026thinsp;6.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.04\u0026thinsp;\u0026plusmn;\u0026thinsp;6.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical stages\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72(23.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.19\u0026thinsp;\u0026plusmn;\u0026thinsp;6.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e233(76.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.24\u0026thinsp;\u0026plusmn;\u0026thinsp;5.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003cb\u003eContinuing\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e Demographic characteristics of participants (N\u0026thinsp;=\u0026thinsp;305)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePOS\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e/\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTime of illness(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e113(37.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e12.96\u0026thinsp;\u0026plusmn;\u0026thinsp;5.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;~\u0026thinsp;2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83(27.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e14.72\u0026thinsp;\u0026plusmn;\u0026thinsp;6.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026thinsp;~\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40(13.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e15.48\u0026thinsp;\u0026plusmn;\u0026thinsp;5.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69(22.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e13.96\u0026thinsp;\u0026plusmn;\u0026thinsp;6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNotes: Among cancer types, respiratory system include lung cancer; digestive system include liver cancer, stomach cancer, esophageal cancer, pancreatic cancer, colorectal cancer; gynecological malignant include breast cancer, cervical cancer, ovarian cancer; head and neck include nasopharyngeal cancer, thyroid cancer, tongue cancer, and others include ureteral cancer, peritoneal cancer, bladder cancer, prostate cancer.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eCurrent status of hospice care outcomes\u003c/h2\u003e \u003cp\u003e The mean score of hospice care outcomes quality was (13.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98), with a mean item score of (1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60). See Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e the score of each dimension for details.\u003c/p\u003e \u003cp\u003eThe three highest scoring hospice care outcomes quality were \u0026ldquo;Have you felt good about yourself in the last three days? (1.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10)\u0026rdquo;, \u0026ldquo;Have your family or friends ever been anxious or worried about you in the past three days? (1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96)\u0026rdquo;, and \u0026ldquo;Can you have shared your feelings with your family or friends in the past three days? (1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18)\u0026rdquo;. The two lowest-scoring hospice care outcomes quality were \u0026ldquo;Have you been affected / troubled by the pain in the last three days? (0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94)\u0026rdquo; and \u0026ldquo;In the past three days, how much time do you think has been wasted on medical appointments? For example: road round-trip or repeated tests? (1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41) \u0026rdquo;(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScore of all dimensions of hospice care outcomes quality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of items\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTotal score\u003c/p\u003e \u003cp\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDimension equally\u003c/p\u003e \u003cp\u003escore\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e13.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychology and the quality of life\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e8.60\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.43\u0026thinsp;\u0026plusmn;\u0026thinsp;0.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCare quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e5.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e \u003cp\u003e1.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNotes: POS is Palliative care outcome scale.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eScore and sequencing of each item in hospice care outcomes quality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSequence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.Have you been affected / troubled by the pain in the last three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e0.96\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.Are there any other symptoms that have affected your feelings in the past three days? For example, experience nausea, cough, or constipation?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eContinuing\u003c/b\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e Score and sequencing of each item in hospice care outcomes quality\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItems\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSequence\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.Have you been anxious or worried about your condition or treatment for the last three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.41\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.Have your family or friends ever been anxious or worried about you in the past three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.How much information have you or your family and friends been told in the past three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.Can you have shared your feelings with your family or friends in the past three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.Have you ever felt depressed in the past three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.Have you felt good about yourself in the last three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.90\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9.In the past three days, how much time do you think has been wasted on medical appointments? For example, road round-trip or repeated tests?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10.Whether any practical problems (whether financial or personal) caused by your illness have been solved in the last three days?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e1.58\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eCorrelation between key variables\u003c/h2\u003e \u003cp\u003eThe results of Pearson correlation analysis showed that the quality of the hospice care outcomes was positively correlated with pain (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.479)and illness perception(\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.552, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Quality of hospice care outcomes was also positively correlated with psychological distress (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.639, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01). See Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e for details.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation coefficients between key study variables(N\u0026thinsp;=\u0026thinsp;305)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEntries\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.POS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.NRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.479**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3.Illness perception\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.552**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.354**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.Psychological distress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.639**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.394**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.563**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5.Family cohesion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.216**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.175*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6.Perceived social support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.278**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.022*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.237**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.546**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote:*\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eTest for normality of the residuals, homogeneity of variance test\u003c/h2\u003e \u003cp\u003eAs seen from the normalized residual histogram, the normalized residuals fit a normal distribution, see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Furthermore, the P-P plot model is well arranged along the diagonal, suggesting that the data satisfy a normal distribution, see Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows the scatter plot of the regression standardized residual and standardized predicted values. The data points are evenly distributed and basically within plus or minus 3 standard deviations, indicating that the overall effect is good. In summary, the tests show that the data in this study met three conditions: independence, homogeneity of variance and normality.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eMultiple linear regression\u003c/h2\u003e \u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the equation had an R\u003csup\u003e2\u003c/sup\u003e of 0.600 and an adjusted R\u003csup\u003e2\u003c/sup\u003e of 0.583, indicating that the seven variables described above explained 58.3% of the variance in hospice care outcomes quality. The results showed that pain (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.194, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), illness perception (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.220, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), psychological distress (\u003cem\u003eβ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.376, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), education level (\u003cem\u003eβ\u003c/em\u003e=\u0026minus;0.092, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.023), and the financial strain of the illness on the family (\u003cem\u003eβ\u003c/em\u003e=-0.118, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011) were independently associated with hospice care outcomes quality.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of the Multiple Linear regression analysis of the influencing factors of hospice care outcomes quality\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eβ\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003et\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003eVIF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.639\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBIPQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.662\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKesslerl0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.347\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7.691\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.742\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe financial strain of the illness on your family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.643\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.251\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e-2.563\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.538\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eNote: 95%CI, R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.600, adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.583; \u003cem\u003eF\u003c/em\u003e\u0026thinsp;=\u0026thinsp;33.640, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe total score of the POS scale was 40 points, and the higher the score, the worse the quality of hospice care was. The results of this study showed that the total POS scale of patients with advanced cancer was (13.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98), 20 points below the middle value of the scale and at a moderate level. Compared with the results of foreign studies, the score is higher than that of Higginson (8.20\u0026thinsp;\u0026plusmn;\u0026thinsp;4.40)\u003csup\u003e[30]\u003c/sup\u003e and Waldemar\u003csup\u003e[31]\u003c/sup\u003e (12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3). The comparison shows that influenced by the traditional \u0026ldquo;\u003cem\u003efilial piety (Tao)\u003c/em\u003e culture\u0026rdquo; in China, hospice care is not recognized by most people, which leads to the poor development of hospice care in China and unsatisfactory quality of hospice care. However, the results of this study are lower than the results of Chinese scholars\u003csup\u003e[32]\u003c/sup\u003e2020 (22.57\u0026thinsp;\u0026plusmn;\u0026thinsp;7.43), indicating that with the promotion of hospice care, the pilot program of hospice care has achieved remarkable results, which improves the quality of advanced hospice care for cancer patients. The results of this study showed that the score of quality of care dimension (6.49\u0026thinsp;\u0026plusmn;\u0026thinsp;3.90) was lower than the score of psychological and quality of life dimension (9.18\u0026thinsp;\u0026plusmn;\u0026thinsp;3.94), indicating that cancer patients had a better quality of care and less psychological and poor quality of life. The mood of family members affects the quality of hospice care\u003csup\u003e[33]\u003c/sup\u003e. Studies have shown that psychological adjustment and grief counseling for the families of patients with advanced cancer can improve the level of psychological grief and disease coping, and at the same time, the quality of care for patients has also been significantly improved. Advanced cancer patients was unable to receive conventional anti-tumor treatments such as surgery, radiotherapy, chemotherapy and molecular targeting, and often face various symptoms and psychological problems, and their quality of life is seriously damaged\u003csup\u003e[31]\u003c/sup\u003e. However, hospice care with comfortable nursing and psychological comfort for patients with advanced cancer can significantly improve their quality of life and help them die with dignity\u003csup\u003e[34]\u003c/sup\u003e. Therefore, when providing hospice care for patients, medical staff should pay close attention to cancer patients to meet their psychological and spiritual needs, so as to improve the quality of hospice care outcome. Also, pay attention to the emotions of family members.\u003c/p\u003e \u003cp\u003ePain is a manifestation associated with the actual or possible presence of tissue damage, including painful experiences of feeling, emotion, and cognition\u003csup\u003e[35]\u003c/sup\u003e. It is one of the common symptoms of cancer patients, and it is also an important influencing factor that directly affects the quality of hospice care outcomes of cancer patients. In this study, the more severe the pain of the patients, the worse the quality of hospice care outcome, which may be related to the more severe the pain, and the daily life, activities and sleep of the patient are affected. Studies have shown\u003csup\u003e[36]\u003c/sup\u003e that the prevalence of pain in patients with advanced and metastatic cancer reaches 54.6%, and about one third of patients with cancer pain may even have psychological disorders. Therefore, if the pain is not effectively controlled in time, the patient\u0026rsquo;s comfort will be reduced, and the symptoms such as anxiety and depression will be aggravated, which will ultimately affect the quality of hospice care outcomes. Relevant research shows\u003csup\u003e[37]\u003c/sup\u003e that accurate dynamic pain assessment and management of patients based on the concept of hospice care can effectively relieve patients\u0026rsquo; pain, improve their quality of life and treatment compliance. Therefore, pain control is one of the important tasks to improve the quality of hospice care for cancer patients. In clinic practice, medical staff should master the necessary analgesic measures, and pay continuous attention to and dynamically manage the pain of cancer patients. In addition to drug therapy, psychological support and non-drug therapy, including meditation, hypnosis, \u003cem\u003eTai Chi\u003c/em\u003e, music therapy, can be used to treat patients with comprehensive pain management, to relieve the pain and improve the quality of hospice care outcomes for advanced patients.\u003c/p\u003e \u003cp\u003eDisease perception is the process by which an individual analyzes their current symptoms or disease based on known information and personal experience\u003csup\u003e[38]\u003c/sup\u003e. The results of this study showed that illness perception was positively correlated with the total score of POS (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the higher the patient\u0026rsquo;s illness perception, the higher the score of hospice care quality, that is, the worse the quality of hospice care, which is consistent with the research conclusions of Norwegian scholar Sandsdalen et al.\u003csup\u003e[13]\u003c/sup\u003e. It indicates that patients\u0026rsquo; understanding, awareness, attention and sense of control over their disease treatment may affect the quality of the hospice care outcomes. Cancer patients have limited access to disease-related information, relatively low level of health literacy, and weak ability to obtain information, so they often fail to correctly understand the possible complications and prognosis caused by disease treatment, which further aggravates disease perception\u003csup\u003e[39]\u003c/sup\u003e. Improper cognition of the disease will lead to the increase of patients\u0026rsquo; psychological pressure and negative pessimism, and eventually affect the quality of life\u003csup\u003e[40]\u003c/sup\u003e. Therefore, medical staff should actively promote hospice care services, timely identify patients\u0026rsquo; negative emotions, provide them with disease-related information, form correct disease cognition, and make them face the disease and receive treatment with a positive attitude, so as to indirectly improve the quality of hospice care outcomes.\u003c/p\u003e \u003cp\u003ePsychological distress refers to the adverse emotional states experienced by individuals experience in a variety of stressful states, including cognitive, behavioral, emotional, social behavior, mental and physical distress, which can develop into anxiety and depression\u003csup\u003e[41]\u003c/sup\u003e. In this study, the degree of patient psychological distress was positively associated with the quality of hospice care outcomes. When patients have psychological distress problems, its accepts the hospice care quality will be affected\u003csup\u003e[42]\u003c/sup\u003e. A survey of 1880 hospice patients in Australia showed that 66% of them had depression, 20% had serious anxiety and 45% had serious family anxiety\u003csup\u003e[43]\u003c/sup\u003e. Moreover, Roch et al.\u003csup\u003e[44]\u003c/sup\u003e investigated the quality of the hospice care outcomes of 100 patients with heart failure, and identified that patients widely had a high burden of both physical and psycho-emotional symptoms. Therefore, medical staff should not only focus on diagnosing and treating physical symptoms in cancer patients, but also prioritize their mental health status. Particular attention should be given to the emotional and psychological well-being of vulnerable patients susceptible to cancer-related psychological distress, with comprehensive interventions implemented to safeguard their mental health through systematic psychological support and monitoring.\u003c/p\u003e \u003cp\u003eThe results of this study show that education is one of the factors influencing the quality of hospice care outcomes in cancer patients. Consistent with the findings of Bi Jieying\u0026rsquo;s study\u003csup\u003e[45]\u003c/sup\u003e, in terms of educational level, the results of this study indicated that the higher the quality score of hospice care outcomes, the lower the quality of hospice care. The reasons behind may be that patients with low education level have relatively low learning ability and thirst for knowledge, are not good at using the knowledge to improve their own health level, and have difficulties in understanding the illness, treatment plan and the purpose and process of hospice care as explained by medical staff. Furthermore, the education level also an impact on patients\u0026rsquo; levels of self-management and treatment compliance\u003csup\u003e[46]\u003c/sup\u003e. Patients with low education level may not abide medical advice, have poor treatment compliance, limited self-management skills, unable to better control the course of their disease, and the disease is prone to recurrent attacks, so the quality of hospice care for patients is low. It is suggested that medical staff should design corresponding hospice care services according to the characteristics of different groups of people when carrying out health education activities. For patients with relatively low educational level, targeted explanation and guidance can be used in understandable language and images, and guidance to enhance patients\u0026rsquo; self-expression and disease awareness.\u003c/p\u003e \u003cp\u003eThe results of this study showed that economic pressure is one of the influencing factors of the quality of the hospice care outcomes in advanced cancer patients. The more severe the economic pressure, the higher the score of hospice care outcome, and the lower the quality of hospice care (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The reason is that the patients receive long-term treatment of cancer, and the cost of hospice care is high, while the corresponding service does not meet the personal needs of the patients, and the family income is small, which increases the economic burden of the family. Some patients say that they have asked their friends and relatives for help for many times to pay the medical expenses, which led to the poor quality of hospice care outcomes. Studies show that up to 18.3% of patients with advanced cancer over 70 years have a severe financial burden, and that the economic burden is associated with poorer health-related quality of life\u003csup\u003e[47]\u003c/sup\u003e. In China, the growth rate of medical expenses has exceeded the growth rate of residents\u0026rsquo; income. Due to the high medical expenses, low-income families often unbearable and heavy a economic burden, which leads to their even interruption of treatment, thus affecting the quality of hospice care outcomes. It is suggested that it is necessary for medical staff to guide cancer patients to apply for chronic and special diseases in hospital-related outpatient clinics, so as to reduce the economic burden of low-income groups and ensure that patients can get necessary support and services. In addition, the hospital strengthens cooperation with social work organizations to relieve the appropriate economic pressure for cancer patients through charitable fund projects.\u003c/p\u003e \u003cp\u003eThe results of multiple linear regression in this study indicated that age, occupation, medical payment method and per capita monthly income of family are not factors affecting the quality of hospice care outcomes, which is different from previous studies\u003csup\u003e[45, 48]\u003c/sup\u003e, but health care workers still take these factors seriously. Moreover, in this study, the different patients receiving hospice care sites was not show statistically significant differences in the quality of the hospice care outcomes in patients with advanced cancer.The reason may be that this study did not include enough samples of other secondary hospitals, community service centers, and nursing homes to identify differences. In future studies, researchers could recruit more patients receiving hospice care service outside of tertiary hospitals.\u003c/p\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eOur results should be considered in light of several limitations. Firstly, this was a descriptive cross-sectional study that only dealt in correlation rather than causation between quality of hospice care outcomes and influencing factors, not causality. We therefore suggested that a longitudinal study be conducted in the future to explore the causality of personal and environmental factors on the quality of hospice care outcomes. Secondly, the convenience sampling method used in this study may cause selection bias, thus limiting the extrapolation of the results. Future studies should be conducted in more venues to improve the reliability and generalizability of the results. Finally, although the results were valid, there may be other factors influencing participants\u0026rsquo; quality of hospice care outcomes. Further research is needed to explore these issues, and take targeted measures to intervene in hospice care quality in patients with advanced cancer.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the quality of hospice care outcomes in cancer patients is moderate and needs to be further improved. The quality of hospice care outcomes in cancer patients is influenced by pain, disease perception, psychological distress, different educational levels, and economic stress factors. Among them, the more serious the pain, the worse the quality of hospice care outcomes; the worse the disease perception, the worse the quality of hospice care outcomes; the worse the psychological distress, the worse the quality of hospice care outcomes. It suggests that clinical medical workers should pay attention to the control of patients\u0026rsquo; pain, guide patients to form correct disease cognition, provide necessary psychological counseling for patients, relieve patients\u0026rsquo; psychological distress, so as to promote the quality of patients\u0026rsquo; hospice care outcomes.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eBIPQ \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Brief Illness Perception Questionnaire\u003c/p\u003e\n\u003cp\u003eFCQ \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Family Cohesion Questionnaire\u003c/p\u003e\n\u003cp\u003eKesslerl0 \u0026nbsp; \u0026nbsp; 10-item Kessler Psychological Distress Scale\u003c/p\u003e\n\u003cp\u003eNRS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Numerical Rating Scale\u003c/p\u003e\n\u003cp\u003ePOS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Palliative Care Outcome Scale\u003c/p\u003e\n\u003cp\u003ePSSS \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Perceived Social Support Scale\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFirstly, The authors would like to express sincere gratitude to all the patients who participated in this study and generously shared their time and insights, and also gratefully acknowledge the participation of all healthcare institutions. Their contribution was essential in providing valuable data for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYH and JZ conceived of and designed the study. YH carried out the data collection. XL provided guidance for data analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the Science and Technology Development Key Project of Dongguan City(grant number20221800906222).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data generated or analyzed during this study will be made available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of Dongguan Songshan Lake Central Hospital issued the ethical approval to the researchers with the ethical batch number (No.72,2023). All participants were informed about the study and volunteered to participate in the study. In addition, the researchers obtained informed consent from all participants to indicate their consent before recruitment. All methods were performed by relevant guidelines and regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants included in the study prior to the interview process. Participation in this study was voluntary and confidential. Transcript interviews were anonymized using codes. No names or establishments are mentioned in the article to ensure confidentiality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eSchool of Nursing, Guangdong Pharmaceutical University, Located on No.283 Jianghai Avenue, Haizhu Distric, Guangzhou, Guangdong province 510006, China\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003eDepartment of Nursing, Dongguan Songshan Lake Central Hospital, No.1, Xianglong Road, Donggua, Guangdong Province 523000, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSleeman K E, de Brito M, Etkind S, et al. 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BMJ Support Palliat Care, 2016,6(3):315-322.\u003c/li\u003e\n\u003cli\u003eRoch C, Palzer J, Zetzl T, et al. Utility of the integrated palliative care outcome scale (IPOS): a cross-sectional study in hospitalised patients with heart failure[J]. Eur J Cardiovasc Nurs, 2020,19(8):702-710.\u003c/li\u003e\n\u003cli\u003e毕洁莹. 延边地区慢性心力衰竭患者安宁疗护需求及影响因素分析[D]. 延边大学, 2022.\u003c/li\u003e\n\u003cli\u003eYeom J W, Yeom I S, Park H Y, et al. Cultural factors affecting the self-care of cancer survivors: An integrative review[J]. Eur J Oncol Nurs, 2022,59:102165.\u003c/li\u003e\n\u003cli\u003eArastu A, Patel A, Mohile S G, et al. Assessment of Financial Toxicity Among Older Adults With Advanced Cancer[J]. JAMA Netw Open, 2020,3(12):e2025810.\u003c/li\u003e\n\u003cli\u003eArenas O L, Gonzalez-Jaramillo V, Saldarriaga C, et al. Prevalence and characteristics of patients with heart failure needing palliative care[J]. BMC Palliat Care, 2021,20(1):184.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hospice care, hospice care outcomes quality, cancer, influencing factors, symptom management theory","lastPublishedDoi":"10.21203/rs.3.rs-5728252/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5728252/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cb\u003eBackground\u003c/b\u003e Although the research and development of new drugs and the improvement of medical technology have made some progress in cancer treatment, the quality of life of cancer patients is still low, and the development of hospice care is still slow. At present, there are few studies on the quality of hospice care for patients themselves.\u003c/p\u003e \u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e This cross-sectional study used convenience sampling to select 305 advanced cancer patients from hospitals, community health service centers and elderly care institutions related to the hospice care treatment pilot in Dongguan City, Guangdong Province between September 2023 and April 2024. The questionnaire was composed of seven parts: general information (including sociodemographic and disease-related information), palliative care outcome scale, numerical rating scale, brief illness perception questionnaire, 10-item Kessler psychological distress scale, family cohesion questionnaire, perceived social support scale. Data were analyzed using descriptive analysis, independent sample \u003cem\u003et\u003c/em\u003e-tests, one-way ANOVA, Pearson\u0026rsquo;s correlation, and multiple linear regression.\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e A total of 305 advanced cancer patients were interviewed, most of them aged between 45\u0026thinsp;~\u0026thinsp;59 years. The average score of hospice care quality of cancer patients was 13.99\u0026thinsp;\u0026plusmn;\u0026thinsp;5.98, which was at the lower average level compared with the median total score of the scale. The multiple linear regression results showed a linear correlation, between pain, disease perception, psychological distress, educational level, and financial stress on families and patient quality of hospice care.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e The current quality of the hospice care outcomes in advanced cancer patients is at a moderate level. The results provide a reference for further construction of hospice care quality evaluation program and lay a foundation for improving the quality of the hospice care for advanced cancer patients.\u003c/p\u003e","manuscriptTitle":"Quality and influencing factors of hospice care outcomes in patients with advanced cancer: a cross-sectional study based on symptom management theory","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-02 08:54:04","doi":"10.21203/rs.3.rs-5728252/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":"04827400-b58f-425e-ba86-37c87913811d","owner":[],"postedDate":"April 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-05T12:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-02 08:54:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5728252","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5728252","identity":"rs-5728252","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}