Monitoring patients’ symptom improvement in palliative care units using patient-reported outcomes: a multicenter prospective observational study

The use of patient-reported outcomes (PROs) can facilitate the reduction of the severity of patient symptoms. Several countries have implemented projects that routinely use PROs in palliative care settings, resulting in increased patient symptom improvement rates. In Japan, a pilot study of hospital-based palliative care teams was conducted in 2021; however, no study has been conducted in palliative care units (PCUs). This study assessed patient symptom improvement rates using PROs and evaluated the feasibility of routine PRO assessment and data collection in PCUs in Japan. We conducted a multicenter, prospective, observational study in eight PCUs. Patients newly admitted to PCUs between June and September 2024 were included in this study. Based on the analysis requirement of 369 PRO responders and an assumed 60% response rate, 615 participants were targeted for enrollment (369/0.60). Data on four symptoms (pain, shortness of breath, nausea, and worries or concerns) were collected weekly using the Integrated Palliative Outcome Scale (IPOS) from admission to week 4. A total of 550 patients were admitted to the PCUs; 388 self-reported patients were included in the analysis. The PRO response rate was > 70% at all timepoints. The IPOS score decreased statistically only between admission and week 1 (pain, p < 0.001; shortness of breath, p < 0.001; nausea, p = 0.001; worries or concerns, p < 0.001). A 1-point decrease in IPOS scores was observed for pain (from 2 to 1), shortness of breath (from 2 to 1), worries or concerns (from 2 to 1) from admission to week 1, and shortness of breath from week 3 to week 4 (from 1 to 0). In the “severe/moderate to absent/mild” and “keep absent/mild” categories, benchmark improvement rates were achieved only for nausea (70.7%; 90.0%). A 1-week regular evaluation using PROs may be feasible in PCUs in Japan. The greatest improvement in symptom scores occurred within the first week following PCU admission, with an observed plateau in subsequent weeks, suggesting that the first week may be important for assessing the quality of care in PCUs.