Abstract: Bridging Patient and Caregiver Distress in Hospice Care: A Network Analysis of Psychosocial and Spiritual Connections (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, Associate Professor, Renmin University of China, Beijing, Beijing, China

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

Shuang Guo, Senior social worker, Beijing Sereniturn Palliative Care Development Centre, Beijing, China

Yingying Shi, social worker, Beijing Sereniturn Palliative Care Development Centre, Beijing, China

Lu Bai, MD, Attending physician, Beijing Haidian Hospital, Beijing, China

Background/Purpose: Hospice patients and their caregivers often experience interconnected psychosocial and spiritual distress, yet dyadic interactions in end-of-life care remain understudied. This study employs network analysis to (1) identify central psychosocial/spiritual issues within hospice patient and caregiver networks and (2) uncover bridging factors linking these networks to inform targeted interventions.

Methods: Data were drawn from standardized intake assessments of 358 hospice patient-caregiver dyads (patients: life expectancy ≤6 months; physician-confirmed) admitted to a palliative care ward in Beijing, China, between February 2022 and June 2024. Psychosocial and spiritual issues of patients and caregivers were assessed using the Social Work Assessment Tool (SWAT) developed by the National Hospice and Palliative Care Organization’s National Council of Hospice and Palliative Professionals. Eleven items were evaluated for both patients and their primary caregivers.

Network analysis were conducted using R package bootnet. A Gaussian graphical model was conducted to estimate the network structures. Node centrality (strength, closeness, betweenness, expected influence) and network stability (95% bootstrapped confidence intervals) were analyzed. Bridge strength between patient and caregiver networks was quantified using R package networktools.

Results: Hospice patients (mean age=73.92, SD=12.17) were mostly female (54.47%), identified as Han ethnicity (96.93%), and had cancer diagnoses (77.93%). In patient networks, complicated anticipatory grief (strength=1.60; EI=1.58) and religion/culture-informed end-of-life decisions (strength=1.10; EI=1.11) emerged as central nodes. Among caregivers, awareness of prognosis (strength=1.64; EI=1.51) and preference about care environment (strength=1.10; EI=1.05) were most influential. Key bridging nods between patients and caregivers’ networks are caregivers’ thoughts of hastened death” (0.95), patients’ financial concerns” (0.91), patients’ safety concerns (0.83), patients’ preference about environment” (0.77), caregivers’ concerns of patients’ spiritual issues (0.72), and “caregivers’ concerns of patents’ comfort issues” (0.70).

Conclusions and Implications: Bridging nodes highlight critical interdependencies between patient and caregiver distress. Caregivers’ existential struggles (e.g., hastened death thoughts) and patients’ financial stressors are pivotal connectors, underscoring the need for dyad-centered interventions. Patients’ preference about environment and safety reflects broader issues of dignity and control for patients. Social workers should prioritize communication frameworks addressing existential distress and integrate financial resource planning into care plans.