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Palliative care aims to support people with life-limiting illnesses by addressing their physical, emotional, social, and spiritual needs. This research focuses on the development and use of the Utrecht Symptom Diary–4 Dimensional (USD-4D)—a tool that helps patients share how they’re feeling and what they need in these four areas. The goal is to improve communication between patients and healthcare professionals, making care more personal and meaningful.

The first part of the study explored how people experience social and spiritual needs at the end of life. Although these are often treated separately in healthcare, patients describe them in overlapping ways. This calls for an integrated approach—one that sees the person as a whole, rather than dividing their needs into categories.

Next, the USD-4D was tested with patients and healthcare professionals to see if it made sense, covered what mattered, and helped guide care. Results showed that the tool is clear, relevant, and useful for starting important conversations about what really matters to patients.

Finally, the study looked at what is needed to use the USD-4D successfully in daily care. Patients want to feel invited—not forced—to use it, and they need to see that their input makes a difference. Professionals appreciate the tool, but face challenges like time pressure and discomfort discussing spiritual topics.

Overall, the USD-4D helps bring truly holistic care within reach, empowering patients and guiding healthcare professionals toward compassionate, tailored support.