Zhao P, Miao L, Fu GJ, Feng JY, Deng W, Li HY. Developing Kano’s model of customer satisfaction-driven intensive care unit end-of-life care strategies for gastrointestinal cancer patients. World J Gastrointest Surg 2025; 17(12): 111704 [DOI: 10.4240/wjgs.v17.i12.111704]
Corresponding Author of This Article
Hua-Ying Li, Head Nurse, Intensive Care Unit, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou 215000, Jiangsu Province, China. 15306216185@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 27, 2025 (publication date) through Dec 25, 2025
Times Cited of This Article
Times Cited (0)
Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Zhao P, Miao L, Fu GJ, Feng JY, Deng W, Li HY. Developing Kano’s model of customer satisfaction-driven intensive care unit end-of-life care strategies for gastrointestinal cancer patients. World J Gastrointest Surg 2025; 17(12): 111704 [DOI: 10.4240/wjgs.v17.i12.111704]
World J Gastrointest Surg. Dec 27, 2025; 17(12): 111704 Published online Dec 27, 2025. doi: 10.4240/wjgs.v17.i12.111704
Developing Kano’s model of customer satisfaction-driven intensive care unit end-of-life care strategies for gastrointestinal cancer patients
Peng Zhao, Li Miao, Guang-Jing Fu, Jia-Yuan Feng, Wei Deng, Hua-Ying Li
Peng Zhao, Li Miao, Guang-Jing Fu, Jia-Yuan Feng, Wei Deng, Hua-Ying Li, Intensive Care Unit, The Second Affiliated Hospital of Soochow University, Suzhou 215000, Jiangsu Province, China
Co-first authors: Peng Zhao and Li Miao.
Author contributions: Zhao P and Miao L contributed to the manuscript writing, data collection and analysis as co-first authors; Zhao P, Miao L, Fu GJ, Feng JY and Deng W collected data; Li HY was involved in the conceptualization and supervision of this manuscript; all authors approved the final manuscript.
Institutional review board statement: This study was approved by Ethic Committee of the Second Affiliated Hospital of Soochow University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Ying Li, Head Nurse, Intensive Care Unit, The Second Affiliated Hospital of Soochow University, No. 1055 Sanxiang Road, Gusu District, Suzhou 215000, Jiangsu Province, China. 15306216185@163.com
Received: August 8, 2025 Revised: September 18, 2025 Accepted: November 10, 2025 Published online: December 27, 2025 Processing time: 138 Days and 18.2 Hours
Abstract
BACKGROUND
In the intensive care unit (ICU) setting, patients with end-stage gastrointestinal cancer (GIC) frequently bear a heavier symptom burden, see faster functional regression, and struggle with eating impairments. These further increase the demands and complexities of nursing care.
AIM
To discuss the development of Kano model-driven ICU end-of-life care (ICU-EOLC) strategies for patients with GIC and its implications for quality of death (QoD).
METHODS
This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024. A Kano model-driven ICU-EOLC protocol was applied to the observation group (n = 65), contrasting with routine care in the control group (n = 50). Pre-intervention and post-intervention comparisons were made in terms of psychological well-being [Hospital Anxiety and Depression Scale (HADS)], quality of life (QoL) [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version (EORTC QLQ-C15-PAL)], QoD (Chinese version of the Quality of Dying and Death in the ICU Scale), death-related attitudes [Revised Death Attitude Profile (DAP-R)], and nursing care satisfaction.
RESULTS
Compared with controls, patients in the observation group scored markedly lower on HADS (all domains), EORTC QLQ-C15-PAL (symptom domain), and DAP-R (escape acceptance, fear of death, and death avoidance), while achieving statistically higher scores on EORTC QLQ-C15-PAL (physical function and overall QoL dimensions), C-QDD-ICU, DAP-R (natural and approaching acceptance), and nursing care satisfaction measures.
CONCLUSION
Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with end-stage GIC, and patients’ quality of life, QoD, death-related attitudes, and nursing satisfaction were improved.
Core Tip: Focused on end-stage gastrointestinal cancer patients in intensive care unit (ICU), this research centers on constructing a Kano model-driven ICU end-of-life care model and examining how it influences patients’ quality of death. Involving 115 patients, our multi-faceted analysis, which incorporated metrics on psychological wellbeing, life and death quality, death attitudes, and care satisfaction, demonstrated that the Kano model-driven nursing intervention is clinically more advantageous than standard nursing methods for this patient population.
