Effect of integrating personalized psychological nursing with humanistic care on treatment outcomes in patients with advanced cancers

Abstract

BACKGROUND

Patients with advanced cancer frequently experience significant psychological distress, which is often inadequately addressed by standard palliative care. Although humanistic care, an approach emphasizing respect for patient values, dignity, and individualized emotional support, is widely endorsed, its benefits, especially for those diagnosed with advanced cancer, remain unclear.

AIM

To assess whether integrating personalized psychological nursing with humanistic care improves quality of life (QoL) and satisfaction with end-of-life care.

METHODS

This retrospective single-center study included data from 110 patients undergoing first-line chemotherapy, divided into 2 groups: Control [conventional palliative care, June 2022 to November 2023 (n = 42)] and intervention [combined psychological-humanistic support, December 2023 to June 2025 (n = 68)]. The distress thermometer (DT), State Anxiety Inventory (SAI), State Self-Esteem Scale, and World Health Organization QoL Measure Short Form were used at baseline (T0) and 4 weeks (T1). Family members completed satisfaction surveys after discharge or death.

RESULTS

After the intervention, both groups exhibited reduced mean DT and SAI scores (all P < 0.001), with greater mean reductions in the intervention group [DT, 2.8 ± 1.1 vs 4.9 ± 1.4; SAI, 38.5 ± 5.2 vs 47.8 ± 6.1 (P < 0.001)]. The intervention group exhibited a more notable improvement in the mean State Self-Esteem Scale score (82.4 ± 6.8 vs 71.6 ± 7.5; P < 0.001). Significant enhancements in the psychological and social aspects of QoL were observed (P < 0.001), along with increased satisfaction with hospice care (93.5 vs 84.2; P < 0.001).

CONCLUSION

Integrated psychological and humanistic care is more effective in easing distress, enhancing self-esteem and psychosocial QoL, and increasing family satisfaction with care; thus representing a promising advance in psycho-oncological care.

Key Words: Advanced cancer; Negative emotions; Quality of life; Hospice care satisfaction; Humanistic care; Personalized psychological care

Core Tip: This single-center retrospective cohort study included data from 110 patients with advanced cancer undergoing first-line chemotherapy in a hospice ward between June 2022 and June 2025, divided into 2 groups: Control (standard palliative care) and intervention (standard care plus a four-week personalized psychological-humanistic intervention, which included psychological assessment, dignity therapy, family care conferences, and comfort care). Outcomes according to various scales revealed significantly reduced psychological distress and anxiety, increased self-esteem, improved quality of life, and higher family satisfaction in the observation group. These results support the effectiveness of a personalized psychological-humanistic care model in enhancing hospice care outcomes.

INTRODUCTION

Patients diagnosed with advanced cancer experience significant physical pain owing to disease progression and chemotherapy-related adverse effects, including chronic pain, nausea, and vomiting[1]. Additionally, they often experience profound fear regarding the unknown aspects of death. These factors contribute to pervasive anxiety about pain and mortality, regret over unfinished personal matters, self-blame for dependency on others, and a pronounced sense of shame[2,3]. Collectively, these experiences result in a high prevalence of negative emotions, including anxiety and depression, which severely compromise the quality of life (QoL) during the terminal stages of the disease[4]. Studies have indicated that approximately 50% of patients with terminal cancer(s) report moderate-to-severe pain. Although 97% of patients receive opioid therapy, a significant number continue to experience unresolved pain during the final week of life[5]. Furthermore, cancer-related nutritional impact symptoms are also closely associated with depression. Research has shown that patients scoring ≥ 4 points on ≥ 4 nutritional impact symptoms items are more prone to developing depression[6]. Second, the fear of death and uncertainty experienced by patients with advanced cancer also contribute significantly to anxiety and depression. Anxiety over impending death is prevalent among patients with late-stage cancer, with approximately 37% of patients and 75% of family caregivers reporting significant anxiety levels[7]. This anxiety not only affects the patients’ psychological state but may also lead to decreased treatment adherence and a decline in the QoL[3]. Traditional care models that prioritize symptom management and life support are essential. However, they frequently overlook the psychological, social, and spiritual dimensions of treating the patient as a “whole person”. Notably, the spiritual needs of terminally ill patients, such as their quest for meaning in life and acceptance of mortality, are often neglected in clinical settings, with only 23% of hospice care institutions incorporating spiritual care into their standard practices[2]. While the conventional palliative care model effectively addresses specific physiological symptoms, such as pain and nausea, it falls short in addressing spiritual needs[8,9].

The concept of “humanistic care” is gaining recognition in the field of palliative care. This approach fundamentally emphasizes respect for patients’ individual values, preferences, and beliefs, and underscores the importance of empathy, communication, and preservation of dignity[10,11]. In this study, humanistic care was operationally defined as a structured approach that integrates psychological support, dignity preservation, family engagement, and individualized comfort measures; this aimed to address the holistic needs of patients beyond physical symptoms. In practical applications, humanistic care is often formalized or fragmented, and there is a notable absence of systematic psychological intervention technologies to support it, complicating efforts to quantify and validate its effectiveness[9]. Concurrently, personalized psychological nursing, which has its roots in the practice of psycho-oncology, necessitates that healthcare professionals customize psychological intervention strategies - such as cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), or narrative therapy - based on precise psychosocial assessments[12,13]. The organic integration of these 2 concepts, aimed at developing a structured and operational “psycho-humanistic” integrated intervention model, has emerged as a significant direction for the advancement of contemporary clinical practice.

Although numerous studies have independently investigated the positive effects of psychological interventions and humanistic care, few studies have systematically integrated these approaches and applied them to patients with advanced cancer. Furthermore, existing studies often lack rigorous designs to evaluate their effects on multidimensional outcomes such as negative mood, self-esteem, QoL, and satisfaction with hospice care, particularly in retrospective analyses based on real-world clinical data. As such, the present single-center retrospective cohort analysis aimed to systematically assess the multifaceted impact of an intervention program, “Personalized Psychological Nursing into Humanistic Care”, on patients with advanced cancers. Furthermore, this study aimed to provide robust evidence-based insights to optimize clinical palliative care practices and enhance the QoL of patients undergoing end-of-life care.

MATERIALS AND METHODS

Research design and participants

The present investigation adopted a retrospective single-center cohort study design conducted within the hospice ward of the authors’ hospital, which consistently offers integrated holistic care addressing the physical, psychological, and spiritual dimensions of patient care. The medical records used in this study were sourced from the hospital’s electronic medical record system and a specialized hospice care nursing record system. During the initial screening phase, 156 patients with advanced cancer who underwent first-line chemotherapy at the authors’ hospital between June 2022 and June 2025 were evaluated based on the predefined inclusion and exclusion criteria. Ultimately, 110 patients who met these criteria were included in this study. Using the implementation of nursing quality improvement in the hospital as a temporal demarcation, the patients were categorized into 2 groups. The control group comprised 42 patients admitted between June 2022 and November 2023, who received the “routine palliative support nursing” program. In contrast, the intervention group consisted of 68 patients admitted between December 2023 and June 2025, who were provided with a “usual care + personalized psycho-humanistic integration intervention” program. Both groups were treated in the same ward by the same medical team, ensuring that the only variable was the nursing intervention regimen, thereby minimizing the influence of confounding factors on study outcomes.

Ethics approval

All the participants provided informed consent. This study was approved by the Ethics Committee of The First People's Hospital of Chun’an County, approval No. 2025-03-09-13 in accordance with the Declaration of Helsinki.

Inclusion and exclusion criteria

Inclusion criteria: Histopathological or cytological diagnosis of malignant tumor(s), including but not limited to, lung, gastric, colorectal, and breast cancers, with a clinical stage of III.B to IV, as classified based on the 8^th Edition of the Tumor-Node-Metastasis Staging Criteria of Malignant Tumors, and receiving first-line chemotherapy[14]; expected survival > 3 months, as assessed by the attending physician based on Performance Status score and other relevant factors; clear consciousness and basic communication and reading comprehension skills, as supported by a Mini-Mental State Examination score ≥ 24; and complete clinical nursing data.

Exclusion criteria: Concurrent diagnosis of severe mental illness, such as schizophrenia, bipolar disorder, or a major depressive episode confirmed by a psychiatrist, or cognitive dysfunction indicated by an Mini-Mental State Examination score < 24; severe organ failure, including heart, liver, or kidney failure, such as Child-Pugh grade C cirrhosis or stage 5 chronic kidney disease; serious complications during chemotherapy, such as septic shock or upper gastrointestinal bleeding, require treatment interruption for ≥ 7 days; and follow-up < 4 weeks.

Nursing intervention

The intervention cycle for both groups was designed for 4 weeks, spanning the initiation of the first chemotherapy cycle (T0) until the end of the fourth week (T1). The following measures were implemented.

Control group: Participants received standard palliative care, including symptom management were as follows: (1) Pain management[15]: The following protocol was used in accordance with the three-step analgesic ladder of the World Health Organization. For mild pain [numerical rating scale (NRS) score, 1-3], patients received 500 mg of acetaminophen orally 3 times daily. For moderate pain (NRS score 4-6), 1 tablet of hydrocodone/acetaminophen was administered orally every 6 hours. For severe pain (NRS score, 7-10), extended-release morphine tablets (10-20 mg) were administered orally every 12 hours. Pain assessments were performed daily at 08:00 am and 20:00 pm to monitor and adjust treatment as necessary; (2) Management of nausea and vomiting: Ondansetron 8 mg was administered intravenously 30 minutes before chemotherapy. If vomiting occurred within 24 hours post-chemotherapy (≥ 1 episode per day), an additional dose of intravenous ondansetron (4 mg) was administered; (3) Management of other symptoms (e.g., fatigue and constipation): To provide nutritional support through enteral nutrition supplementation and the administration of laxatives such as lactulose, 15 mL was administered orally once daily; (4) Health education: One day before chemotherapy, patients were informed about the chemotherapy regimen and strategies for managing adverse reactions; and (5) Basic psychological support: The designated nurse engaged in 10 minutes to 15 minutes of bedside communication at 14: 00 pm daily, primarily addressing treatment-related inquiries (e.g., “What should I do if my white blood cell count decreases after chemotherapy?”) and offering emotional reassurance using standardized phrases (e.g., “Adherence to treatment will yield positive results”). No specialized psychological assessments or interventions were performed.

Intervention group[16,17]: In addition to standard care, participants in the intervention group received a structured “personalized psycho-humanistic integration intervention” over a four-week period, consisting of weekly sessions delivered by the multidisciplinary team (MDT). The psychological nurse, a registered nurse with specialized training in psycho-oncology, was primarily responsible for conducting psychological assessments and delivering structured interventions, such as CBT and ACT. These interventions were tailored to address maladaptive thoughts and promote value-based living despite illness. This protocol was collaboratively executed by an MDT, comprising 1 palliative care nurse, 1 psychological nurse, 1 spiritual caregiver, 1 oncologist, and a family member of the patient. The specific components of the intervention were as follows: (1) Personalized psychological assessment and program development (week 1). Within 48 hours of admission, a trained specialist nurse used the psychological distress thermometer (DT) in conjunction with self-authored semi-structured interviews to conduct an initial assessment. This assessment aimed to comprehensively identify the psychosocial issues faced by patients, such as fear of death, financial pressures, familial relationship tensions, alterations in self-image, and spiritual needs. The MDT convened once weekly to deliberate on cases and formulate individualized psychological care plans for each patient. These strategies focus on incorporating CBT methods (core principles: Identifying and challenging negative automatic thoughts, developing coping skills for stress and anxiety, and restructuring maladaptive cognitive patterns) to correct negative automatic thoughts, while using ACT principles (core principles: Accepting unavoidable symptoms and negative emotions, clarifying personal values, and committing to value-consistent behaviors rather than avoiding distress) to help patients live with their symptoms and clarify their values; (2) Dignity therapy and narrative care (ongoing): Using Chochinov’s Dignity Therapy framework[8], trained nurses or counselors conducted weekly 45-60 minutes one-on-one recorded conversations with patients to guide them to reflect on their lives, share meaningful moments, and express love and wishes. These sessions result in a “life inheritance document” or audio recording for the family, strongly affirming the patient’s sense of worth and meaning; (3) Family system meetings and advance care planning (ACP): A weekly 50-minute family meeting was held to help relatives recognize emotional cues (e.g., silence or loss of appetite as signs of anxiety) and teach supportive communication (e.g., saying “I’ll face it with you” instead of “don’t worry”). Counseling techniques such as “emotional journaling” were introduced to reduce caregiver stress. The discussions included prognosis, end-of-life preferences, and medical decisions. Nurses served as facilitators and informants, assisting families in achieving consensus and respecting patients’ autonomy in decision-making, including the completion of ACP documentation when necessary; and (4) Humanized environment and comfort care: Care extends beyond basic needs to include personalized comfort measures. This includes arranging the patient’s room according to their preferences, such as displaying family photos and religious symbols, and offering twice-weekly 20-minute music therapy, aromatherapy, or massage sessions (based on patient preference). Visitation policies were made flexible to allow pet visits, and the patients’ dietary preferences and religious practices were respected.

Evaluation indicators

This study used existing clinical and nursing records. Assessments were routinely administered as part of standard care at admission (T0) and after 4 weeks (T1) by nursing staff who were not involved in the intervention design. Data were retrospectively extracted and analyzed. Satisfaction levels were evaluated by primary family members within 72 hours of patient discharge or death.

Negative emotions: Psychological distress was measured using the Psychological DT[18,19], a self-report scale ranging from 0 to 10, where higher scores indicate greater distress. A score of 0 denotes no distress, a score of 10 indicates extreme distress, and scores ≥ 4 suggest the presence of clinically significant psychological distress. The Chinese version of this scale demonstrates a Cronbach’s α of 0.78 and a test-retest reliability of r = 0.82 in patients with advanced cancer.

State anxiety: The State Anxiety Inventory (SAI) of the State-Trait Anxiety Inventory[20,21] comprises 20 items, each rated on a scale from 1 to 4 (1 = not at all, 4 = very much so), yielding a total score ranging from 20 to 80. Higher scores indicated more severe anxiety. The Chinese version demonstrates a Cronbach’s α of 0.83, with a structural validity root mean square error of approximation of 0.06.

Self-esteem level: Self-esteem was assessed using the revised German version of the State Self-Esteem Scale (SSES)[22]. This 15-item scale measures self-esteem across three dimensions: Performance, social, and appearance. Participants rated their agreement with statements such as “I feel good about myself” on a 5-point Likert scale (1 = not at all, 5 = extremely), with higher scores indicating greater self-esteem. The subscales demonstrated good internal consistency (performance, α = 0.80; social, α = 0.83; and appearance, α = 0.83).

QoL: The Chinese version of the World Health Organization QoL Measurement-Brief Version was used[23]. This instrument comprises 26 items distributed across four dimensions: Physiological (seven items), psychological (six items), social relations (three items), and environmental domains (eight items). Each item is rated on a scale of 1-5, with scores subsequently converted to a percentage scale ranging from 0 point to 100 points using a specified formula. Higher scores indicate a superior QoL. The Chinese version demonstrated a Cronbach’s α of 0.88, with Cronbach’s α values ranging from 0.80 to 0.86 for each dimension.

Satisfaction with hospice care: The scale encompasses four structural components: Nursing services (5 items; e.g., “whether the nurse is gentle towards the patient”), psychological support (4 items; e.g., “whether the nurse attends to the family’s care-related stress”), humanistic care (3 items; e.g., “whether the nurse respects the patient’s end-of-life wishes”), and overall satisfaction (2 items’ e.g., “your overall evaluation of this hospice care service”), totaling 14 items. Each item is rated on a scale of 1 to 10, where 1 indicates “very dissatisfied” and 10 indicates “very satisfied.” The cumulative score ranged from 14 points to 140 points and was subsequently converted to a percentage using the following formula: (total score/14) × 100. Higher scores indicated greater satisfaction. In terms of reliability and validity, the preliminary trial (n = 30) demonstrated a Cronbach’s alpha of 0.89, content validity index of 0.93, and test-retest reliability coefficient (r) of 0.87, based on repeated assessments of 15 family members within a one-week interval. These results indicate good content validity.

Statistical analysis

Data analyses were performed using SPSS version 26.0 (IBM Corporation, Armonk, NY, United States). Continuous data are expressed as mean ± SD. For comparisons of baseline data, the independent sample t-test was used when continuous data exhibited a normal distribution and homogeneity of variance; otherwise, the Mann-Whitney U test was used. Categorical data were analyzed using the χ² test. A paired t-test was used for within-group comparisons of pre- and post-intervention data. To compare post-intervention scores between the groups, an analysis of covariance was performed with pre-intervention scores as covariates, and independent sample t-tests were used. Pre-intervention scores were used as covariates in the analysis of covariance to control for baseline differences and enhance the accuracy of between-group comparisons, despite the lack of significant baseline differences. Differences with P < 0.05 were considered to be statistically significant.

RESULTS

Comparison of baseline data between the 2 groups

As shown in Table 1, there were no significant differences in the general data, such as age, sex, tumor type, or education level, between the 2 groups (P > 0.05). Before the intervention, there were no significant differences in the DT and SAI scores between the 2 groups (P > 0.05), indicating that the baseline characteristics between the 2 groups were balanced and comparable.

Table 1 Comparison of baseline data between the two groups, n (%).

Index	Control group (n = 42)	Observation group (n = 68)	P value
Age (years), mean ± SD	58.6 ± 7.2 (range: 42-75)	57.8 ± 6.9 (range: 40-74)	0.602
Sex	Male 25 (59.5)	Male 39 (57.4)	0.77
	Female 17 (40.5)	Female 29 (42.6)
Tumor type	Lung cancer 26 (61.9)	Lung cancer 42 (61.8)	0.999
	Gastric cancer 8 (19.0)	Gastric cancer 13 (19.1)
	Colorectal cancer 6 (14.3)	Colorectal cancer 10 (14.7)	0.994
	Others 2 (4.8)	Others 3 (4.4)
Clinical stage	Stage IIIB 22 (52.4)	Stage IIIB 36 (52.9)	0.928
	Stage IV 20 (47.6)	Stage IV 32 (47.1)
Baseline DT score (points), mean ± SD	6.8 ± 1.4	6.7 ± 1.3	0.704
Baseline SAI score (points), mean ± SD	58.6 ± 7.4	57.9 ± 6.8	0.652
Educational level	Junior high school or below 23 (54.8)	Junior high school or below 37 (54.4)	0.951
	Senior high school/technical secondary school 12 (28.6)	Senior high school/technical secondary school 19 (27.9)	0.971
	College degree or above 7 (16.7)	College degree or above 12 (17.6)

P < 0.05 was considered statistically significant. DT: Distress thermometer; SAI: State Anxiety Inventory.

Comparison of DT scores between before and after intervention

Before the intervention, there was no significant difference in the DT scores between the 2 groups (P > 0.05). After the intervention, The DT scores of both groups were significantly lower than those before the intervention (both P < 0.001), and the decrease was even greater in the intervention group [3.9-point (58.2%) decrease in the intervention group]. The mean DT score of the observation group (2.8 ± 1.1) was significantly lower than that of the control group (4.9 ± 1.4) (P < 0.001) (Table 2).

Table 2 Comparison of distress thermometer between the two groups before and after intervention, mean ± SD.

Index	Control group (n = 42)	Observation group (n = 68)
Before intervention (T0, points)	6.8 ± 1.4	6.7 ± 1.3
After intervention (T1, points)	4.9 ± 1.4	2.8 ± 1.1
Intra-group comparison (P value)	< 0.001	< 0.001
Inter-group comparison at T1 (P value)	< 0.001

P < 0.05 was considered statistically significant.

Comparison of SAI scores before and after intervention

Before the intervention, there was no significant difference in the SAI scores between the 2 groups (P > 0.05). After the intervention, however, SAI scores of both groups were significantly lower than those before the intervention (both P < 0.001), the intervention group decreased by 19.4 points (a decrease of 33.5%), the control group decreased by 10.8 points (a decrease of 18.4%), and the mean SAI score of the intervention group (38.5 ± 5.2) was significantly lower than that of the control group (47.8 ± 6.1) (P < 0.001) (Table 3).

Table 3 Comparison of State Anxiety Inventory between the two groups before and after intervention, mean ± SD.

Index	Control group (n = 42)	Observation group (n = 68)
Before intervention (T0, points)	58.6 ± 7.4	57.9 ± 6.8
After intervention (T1, points)	47.8 ± 6.1	38.5 ± 5.2
Intra-group comparison (P value)	< 0.001	< 0.001
Inter-group comparison at T1 (P value)	< 0.001

P < 0.05 was considered statistically significant.

Comparison of SSES

After the intervention, the total SSES and dimensional scores of the 2 groups were significantly higher than those before the intervention (P < 0.001). Comparison between the groups revealed that total SSES and dimension scores of patients in the intervention group were significantly higher than those in the control group after the intervention, and the difference was highly and statistically significant (P < 0.001) (Figure 1).

Figure 1 Comparison of State Self-Esteem Scale between the two groups before and after intervention. ^aP < 0.001 vs control. A: Total score; B: Appearance self-esteem; C: Behavioral self-esteem; D: Social self-esteem. SSES: State Self-Esteem Scale.

Comparison of World Health Organization QoL measurement-Brief Version

After the intervention, the scores of the 2 groups in the physiological, psychological, and social relationship domains significantly improved (P < 0.05), whereas the environmental domain scores did not (P > 0.05). Comparison of the groups revealed that after the intervention, improvement in the scores of the patients in the psychological and social relationship domains was significantly better in the intervention group than in the control group, and the difference was highly significant (P < 0.001). There were no significant differences between the 2 groups in the physiological or environmental domains (P > 0.05) (Figure 2).

Figure 2 Comparison of World Health Organization Quality of Life-Brief Version between the two groups. ^aP < 0.001 vs control. A: Physical domain; B: Psychological domain; C: Social relationships domain; D: Environmental domain. A and D: P > 0.05 vs control, there is no statistically significant difference.

Comparison of satisfaction with hospice care

The mean satisfaction score for hospice care reported by family members in the intervention group was significantly higher than that in the control group (93.5 ± 3.8 vs 84.2 ± 5.1; P < 0.001). In the intervention group, 48 (70.6%) patients were very satisfied, 18 (26.5%) were satisfied, and 2 (2.9%) were dissatisfied, with a total satisfaction rate of 97.1%. In the control group, 22 (52.4%) patients were very satisfied, 14 (33.3%) were satisfied, and 6 (14.3%) were dissatisfied, with a total satisfaction rate of 85.7%; the difference in total satisfaction between the 2 groups was statistically significant (P = 0.007) (Table 4).

Table 4 Comparison of family members’ satisfaction with hospice care between the two groups, n (%).

Satisfaction grade	Control group (n = 42)	Observation group (n = 68)	P value
Very satisfied (≥ 90 points)	22 (52.4)	48 (70.6)	0.007
Satisfied (80-89 points)	14 (33.3)	18 (26.5)
Dissatisfied (< 80 points)	6 (14.3)	2 (2.9)
Total satisfaction (very satisfied + satisfied)	36 (85.7)	66 (97.1)

Total satisfaction rate = (number of very satisfied cases + number of satisfied cases)/total number of cases × 100%; P < 0.05 was considered statistically significant.

DISCUSSION

Advances in medical technology have led to significant improvements in cancer treatment. However, the physical and mental health challenges faced by patients undergoing chemotherapy for advanced cancer remain significant. Chemotherapy is a particularly demanding treatment approach characterized by numerous pronounced side effects[24]. Patients undergoing chemotherapy often experience poor physical health and psychological distress. Failure to cope effectively with chemotherapy-related stress and anxiety may severely affect patients’ physical and mental health, potentially reducing treatment efficacy and survival rates[4]. Therefore, psychological nursing care is essential for patients with advanced cancer undergoing chemotherapy. The results of this single-center retrospective cohort study revealed that after a four-week intervention, patients in the intervention group exhibited greater improvements in DT, SAI, and SSES scores and QoL than those receiving routine care. Family satisfaction with care was also significantly higher in the intervention group.

This integrated intervention model significantly reduced the psychological distress and anxiety in patients with advanced cancer. In the intervention group, the DT score decreased by 3.9 points (a 58.2% reduction), which was significantly greater than the 1.9-point decrease (a 27.9% reduction) observed in the control group. Similarly, the SAI decreased by 33.5% in the intervention group, far exceeding the 18.4% reduction in the control group. These results highlighted the essential role of structured psychosocial support in advanced cancer care[25]. Although conventional care provides basic symptom control and emotional support, it often fails to meet patients’ deeper psychosocial needs[26]. An integrated approach, including dignity therapy, cognitive restructuring, and family sessions, helps patients better understand and accept their illness, offering a safe outlet for expressing fears and concerns, thereby reducing overall distress and anxiety[27]. Importantly, fewer patients in the intervention group met the cut-off for “significant distress” or “overt anxiety” after treatment, demonstrating the potential of this model in preventing clinical mood disorders.

The intervention also markedly improved patients’ self-esteem. Advanced illnesses often lead to reduced physical function, loss of social roles, and reduced self-worth. Our integrated approach included dignity therapy, which directly targets these issues by guiding patients to review their lives, affirm their values, and create a legacy document[28,29]. After the intervention, the total SSES score of the intervention group increased by > 20 points, with the greatest gains in “behavioral self-esteem” and “appearance self-esteem.” These results indicate that the intervention not only reduced negative emotions but also helped rebuild a positive self-image. These findings support personality integrity and psychological adjustment in advanced illness[30].

The integrated intervention significantly improved the QoL in the psychological and social domains, although no statistically significant differences were found in the physical or environmental areas compared with controls. This aligns with the known focus of psychosocial interventions, which target emotional and relational well-being rather than physical symptoms or surroundings[31,32]. Gains in psychological well-being were correlated with reduced anxiety and improved self-esteem, while better social relationships likely resulted from family meetings and ACP, which enhanced family support and communication[33]. These results support the use of a combination of psychosocial and symptom management strategies in providing holistic palliative care.

Furthermore, the families of the patients in the intervention group reported significantly higher satisfaction with hospice care. This is especially important because family members act as caregivers and key evaluators of the quality of care provided. The integrated intervention markedly enhanced the professional trust and perceived support among family members by fostering effective communication, respecting patients’ wishes, and addressing family needs[34,35]. Elevated satisfaction levels not only indicate an improvement in the quality of care but may also positively influence the family’s subsequent grief adjustment.

Ultimately, these positive developments culminate in increased satisfaction with hospices. Families experience not only professional competence but also a care environment characterized by warmth, respect, and deep understanding. Satisfaction serves as a critical indicator of hospice care quality and exemplifies the successful implementation of the core principle of “patient-centered care”.

Limitations

The present study had several limitations. The first was its retrospective design, which inherently presents challenges, including the inability to fully control for all confounding variables. Second, grouping was based on temporal nodes, and despite comparable baselines, there remains the potential for historical bias. Third, the satisfaction measure used was a scale developed at our center. Although the scale has demonstrated good reliability and validity, its generalizability requires further validation. Fourth, the sample size was not based on formal power calculations, which may have limited the statistical robustness of our findings. Future studies should include a power analysis to determine appropriate sample sizes. Finally, because this was a single-center study with a limited sample size, caution should be exercised when attempting to generalize our findings. Future research should involve prospective multicenter randomized controlled trials to provide more robust evidence. Additionally, extending the follow-up period could facilitate the exploration of the long-term effects of the intervention on the mental health of family members during the bereavement period. Using qualitative research methods enables a deeper understanding of patients’ experiences and emotions.

Clinical implementation considerations

Although the integrated intervention demonstrated positive outcomes, its complexity and resource intensity may pose challenges for routine implementation. To enhance feasibility, we propose a stepped-care model in which core components (e.g., dignity therapy and family meetings) are prioritized with adjustments based on local resource availability. Training the nursing staff in basic psychological support and humanistic communication could also reduce their reliance on specialized personnel, thereby improving cost-effectiveness and scalability.

CONCLUSION

The findings of the present study indicate that compared with conventional palliative care, the integrated intervention model, which systematically incorporates personalized psychological care into humanistic care, more effectively alleviates negative emotions, enhances self-esteem, and improves both psychological and social QoL. Ultimately, this approach leads to greater satisfaction with end-of-life care. The model exemplifies the modern hospice nursing concept of holistic care, addressing the “body, mind, social, and spiritual” dimensions, and represents a successful application of psycho-oncology within nursing practice. Therefore, it merits broader implementation and application in clinical settings.