Developing Kano’s model of customer satisfaction-driven intensive care unit end-of-life care strategies for gastrointestinal cancer patients

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.

Keywords: Kano model; End-of-life care in intensive care unit; Gastrointestinal cancer; Construction of nursing strategies; Quality of death

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.