Exploring Multidimensional Symptoms of Hospice Patients With Different Lengths of Survival

ContextHospice care is intended for the final phase of life, but trajectories after admission vary widely. Some patients die within days, whereas others stabilize and live longer than expected. Very short stays may limit comprehensive care, while prolonged stays may involve socio-existential concerns and practical challenges. Early symptom profiles may reveal differences between trajectories.ObjectivesTo describe multidimensional symptom profiles at admission and during the first month of hospice care among patients with short, average, and prolonged survival.MethodsPatient-completed Utrecht Symptom Diary-4 Dimensional (USD-4D) data from 15 Dutch hospices (2017-2025) were analyzed. Survival was grouped as short (0-3 days), average (4-93 days), or prolonged (≥94 days). Physical/psychological prevalence (>0) and clinically relevant prevalence (>3) were calculated, and intensity (0-10) was summarized for all items at admission and across five predefined 3-day windows during the first month.ResultsAmong 2112 patients, 82 had short survival, 1825 had average survival, and 205 had prolonged survival. Physical and psychological burden were highest in short survival, intermediate in average survival, and lowest in prolonged survival; in prolonged survival, physical symptoms improved within two weeks and then stabilized. Socio-existential concerns were more prominent in the short and prolonged survival groups than in the average-survival group.ConclusionMultidimensional symptom and concern profiles differed across survival groups, with differences visible at admission and more pronounced within two weeks. Routine multidimensional evaluation within two weeks may help identify emerging prolonged trajectories and align care with changing physical and socio-existential needs.