Abstract: Heterogeneity in Psychological Distress Among Hospice Patients: A Latent Profile Analysis of Screening Tools (Society for Social Work and Research 30th Annual Conference Anniversary)

Schedule:

Thursday, January 15, 2026

Liberty BR I, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Shuo Xu, PhD, Associated researcher, Renmin University of China, Beijing, China

Zhiqi Yi, MSW, PhD Student, Graduate Research Assistant, University of Kansas, Lawrence, KS

Jie Yang, MS, Executive director, Beijing Sereniturn Palliative Care Development Centre, Beijing, China

Ning Zhang, Senior social worker, Beijing Sereniturn Palliative Care Development Centre, Beijing, China

Changhong Li, MD, Deputy head of department, Beijing Haidian Hospital, Beijing, China

Background/Purpose: Hospice patients with a life expectancy of ≤6 months often experience significant psychosocial distress. While social workers play a critical role in screening for these risks, systematic use of validated screening tools for screening remains limited. This study aims to (1) identify distinct psychosocial risk profiles among hospice patients using currently used screening tools: the Social Work Assessment Tool (SWAT), Distress Thermometer (DT), and eight high-risk indicators for psychosocial issues (HRIPI), and (2) evaluate the effectiveness of these tools in screening for psychological distress.

Methods: A retrospective analysis included 228 hospice patients (life expectancy ≤6 months per physician diagnosis) admitted to a palliative care ward in Beijing, China, between February 2022 and June 2024. From an initial cohort of 558 patients, exclusions were applied for incomplete assessments or survival exceeding six months per clinical records. Data was drawn from standardized social worker intake assessments. Psychological distress was measured via the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7). Latent profile analysis (LPA) identified distinct psychosocial risk profiles using SWAT, DT, and HRIPI scores. Logistic regression examined socio-demographic predictors of profile membership, and equality tests assessed between-profile differences in PHQ-9 and GAD-7 scores.

Results: Participants (mean age=74.74, SD=11.24) were predominantly female (54.8%), married (67.1%), and had high school or lower education (48.2%). Most identified as Han ethnicity (96.9%), reported no religious affiliation (88.6%), had cancer diagnoses (74.6%), and perceived adequate family support (73.2%). LPA supported a two-profile model: a low-risk profile (n=179; HRIPI=0, DT=3.4, SWAT=39.81) and a high-risk profile (n=49; HRIPI=1, DT=4.6, SWAT=39.04). Cancer diagnoses and religious affiliation are significant in predicting profile memberships. Moreover, the high-risk group demonstrated significantly elevated PHQ-9 and GAD-7 scores compared to the low-risk group (p<0.001).

Conclusions and Implications:

DT and HRIPI effectively differentiated high-risk patients with elevated psychological distress, supporting their utility as rapid screening tools for social workers. However, SWAT scores showed negligible between-profile differences, suggesting limited value in predicting psychological risk. These findings highlight the importance of integrating brief, validated tools like DT and HRIPI into routine hospice assessments to prioritize patients for psychosocial interventions. Future research should explore cultural and contextual factors influencing SWAT’s applicability in end-of-life care.