Associations between gastrointestinal symptoms and coexisting symptoms amongst patients in a palliative care unit: a PCOC-based longitudinal study.
11 affiliations
- 1Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.
- 2Health Management Center, Taichung Veterans General Hospital, Taichung, Taiwan.
- 3Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
- 4Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, 1650 Taiwan Boulevard, Sect. 4, Taichung, 407219, Taiwan ROC.
- 5Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan.
- 6Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
- 7School of Public Health, China Medical University, Taichung, Taiwan.
- 8Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, 1650 Taiwan Boulevard, Sect. 4, Taichung, 407219, Taiwan ROC. [email protected].
- 9Geriatrics and Gerontology Research Center, College of Medicine, National Chung Hsing University, Taichung, Taiwan. [email protected].
- 10Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. [email protected].
- 11School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. [email protected].
Abstract
Background
Gastrointestinal (GI) symptoms are both common and distressing in patients receiving palliative care, however their relationships with coexisting symptoms and clinical factors, including functional status, clinician-rated problem severity, and palliative care phase, remain unclear in hospice ward settings. The Palliative Care Outcomes Collaboration (PCOC) framework enables for standardized daily symptom assessment and longitudinal evaluation. This study aimed to longitudinally investigate the associations between GI symptoms and related symptoms and clinical domains among patients admitted to a hospice ward.Methods
This retrospective cohort study included 1,008 unique adult patients admitted to the hospice ward of a tertiary medical center in central Taiwan between March 1, 2021 and September 30, 2023. Each patient contributed one hospice ward admission course and was followed from admission until death or transfer to home hospice care. Routine daily PCOC assessments collected throughout the admission course were analyzed longitudinally as repeated measurements within patients. Patients younger than 18 years, those with missing identification information, or those with incomplete PCOC data were excluded. Separate generalized estimating equation (GEE) models were constructed for the appetite, nausea, and bowel domains of the Symptom Assessment Scale (SAS), adjusting for demographic, clinical, functional, and symptom-related variables. Subgroup analyses were performed for cancer and non-cancer patients.Results
Amongst the 1,008 patients, the mean age was 68.0 years, with 59.1% being male, and 86.5% having cancer. At admission, mean SAS scores were 2.45 for appetite loss, 1.91 for bowel discomfort, and 0.69 for nausea, indicating that appetite loss was the most prominent GI symptom. Nausea was significantly associated with sleep disturbance, appetite loss, bowel discomfort, and pain, while older age was associated with lower nausea severity. Appetite loss was associated with sleep disturbance, nausea, bowel discomfort, fatigue, pain, greater clinician-rated "other" and family problems, as well as deteriorating phase; referral from the general ward was associated with lower appetite distress. Bowel discomfort was associated with appetite loss, nausea, breathlessness, fatigue, pain, higher clinician-rated "other" problems, and higher Australia-modified Karnofsky Performance Status (AKPS). Subgroup analyses showed that symptom associations were generally more extensive in cancer patients than in non-cancer patients, particularly for appetite loss and bowel discomfort.Conclusion
GI symptoms in hospice ward patients are closely linked to coexisting symptoms, functional status, clinician-rated problem severity, and palliative care phase, and should not be assessed in isolation. Daily standardized assessment using the PCOC framework may help support more individualized symptom management for palliative care patients.
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BibTeX
@article{lin2026associations,
title = {{Associations between gastrointestinal symptoms and coexisting symptoms amongst patients in a palliative care unit: a PCOC-based longitudinal study.}},
author = {Ching-Ju Lin and Cheng-Fu Lin and Chun-Li Wang and Ju-En Tsai and Lung-Chun Lee and Pi-Shan Hsu and Wei-Min Chu},
journal = {BMC palliative care},
year = {2026},
month = jul,
doi = {10.1186/s12904-026-02242-6},
url = {https://europepmc.org/article/MED/42897526},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Associations between gastrointestinal symptoms and coexisting symptoms amongst patients in a palliative care unit: a PCOC-based longitudinal study.
AU - Ching-Ju Lin
AU - Cheng-Fu Lin
AU - Chun-Li Wang
AU - Ju-En Tsai
AU - Lung-Chun Lee
AU - Pi-Shan Hsu
AU - Wei-Min Chu
PY - 2026
DA - 2026/07/01
JO - BMC palliative care
DO - 10.1186/s12904-026-02242-6
UR - https://europepmc.org/article/MED/42897526
AB - Background Gastrointestinal (GI) symptoms are both common and distressing in patients receiving palliative care, however their relationships with coexisting symptoms and clinical factors, including functional status, clinician-rated problem severity, and palliative care phase, remain unclear in hospice ward settings. The Palliative Care Outcomes Collaboration (PCOC) framework enables for standardized daily symptom assessment and longitudinal evaluation. This study aimed to longitudinally investigate the associations between GI symptoms and related symptoms and clinical domains among patients admitted to a hospice ward.Methods This retrospective cohort study included 1,008 unique adult patients admitted to the hospice ward of a tertiary medical center in central Taiwan between March 1, 2021 and September 30, 2023. Each patient contributed one hospice ward admission course and was followed from admission until death or transfer to home hospice care. Routine daily PCOC assessments collected throughout the admission course were analyzed longitudinally as repeated measurements within patients. Patients younger than 18 years, those with missing identification information, or those with incomplete PCOC data were excluded. Separate generalized estimating equation (GEE) models were constructed for the appetite, nausea, and bowel domains of the Symptom Assessment Scale (SAS), adjusting for demographic, clinical, functional, and symptom-related variables. Subgroup analyses were performed for cancer and non-cancer patients.Results Amongst the 1,008 patients, the mean age was 68.0 years, with 59.1% being male, and 86.5% having cancer. At admission, mean SAS scores were 2.45 for appetite loss, 1.91 for bowel discomfort, and 0.69 for nausea, indicating that appetite loss was the most prominent GI symptom. Nausea was significantly associated with sleep disturbance, appetite loss, bowel discomfort, and pain, while older age was associated with lower nausea severity. Appetite loss was associated with sleep disturbance, nausea, bowel discomfort, fatigue, pain, greater clinician-rated "other" and family problems, as well as deteriorating phase; referral from the general ward was associated with lower appetite distress. Bowel discomfort was associated with appetite loss, nausea, breathlessness, fatigue, pain, higher clinician-rated "other" problems, and higher Australia-modified Karnofsky Performance Status (AKPS). Subgroup analyses showed that symptom associations were generally more extensive in cancer patients than in non-cancer patients, particularly for appetite loss and bowel discomfort.Conclusion GI symptoms in hospice ward patients are closely linked to coexisting symptoms, functional status, clinician-rated problem severity, and palliative care phase, and should not be assessed in isolation. Daily standardized assessment using the PCOC framework may help support more individualized symptom management for palliative care patients.
SN - 1472-684X
ER -