Development of Palliative Care Model in Terminal Cancer Patients in Surin Hospital

Abstract

Background: Patients with terminal cancer face life-threatening illness issues and spend a long time in nursing care. When symptoms worsen, patients experience physical, psychological, and emotional distress, pain, and other discomforts, requiring increased hospitalization. A key issue in patient care is proactive care planning, which requires caregivers at home to be adequately prepared according to defined criteria, along with diverse nursing practices that affect service quality.
Objective: To develop a model of palliative care for terminal cancer patients and study the effects of implementing a palliative care model for terminal cancer patients.
Study Design: Research and Development
Methods: This research conducted between March 2023 and December 2023 consisted of four stages:1) problem study, 2) model development, 3) model implementation, and 4) evaluation. The sample group included 75 medical personnel, 60 patients, and 60 caregivers. Research tools included structured interviews, care model assessment forms, caregiver and recipient knowledge assessment forms, compliance assessment forms, model usage opinion surveys, satisfaction surveys, outcome measurement forms, and service quality assessment forms. Data were analyzed qualitatively and quantitatively using content analysis, percentages, means, standard deviations, chi-square tests, and t-tests.
Results: 1. Study findings on terminal cancer patient care issues: 1) Policy and structural issues revealed not enough medical personnel 2) Equipment damage due to incorrect usage at home and budget constraints on purchases were identified. 3) Process issues included delayed physician consultations, leading to inadequate timely assessments and knowledge dissemination to patients and relatives without post-knowledge assessment. 2. The model of palliative care for terminal cancer patients is in a structured and comprehensive format, consisting of 1) nursing management, including patient care policies, clinical practice guidelines (CPG, CNPG, Standing order), with nurses managing individual cases, 2) care aspects based on the 7 Aspects of care 3) professional nurse capacity development, providing knowledge, guidance on end-of-life cancer patient care practices, and expert assessment finding that the care model is highly suitable (mean=4.9, SD=0.1).3. Professional nurse competency development included knowledge provision and guidance on terminal cancer patient care practices, resulting in expert evaluation of the palliative care model, which was found highly suitable (mean = 4.9, SD = 0.1). Implementation of the palliative care model showed increased knowledge (p<0.01), highest satisfaction with the model (mean = 4.6, SD = 0.5), and 98.7% compliance. Patient groups showed knowledge improvement (p<0.01), highest satisfaction (mean = 4.9, SD = 0.2), and better outcomes on the Palliative outcome scale than the control group (mean = 3.8, SD = 0.5) (p<0.01). Readmission rates within 28 days were 6.7%, emergency department readmission rates were 10%, home continuous care was 80%, strong opioid pain management and advance planning was 100%.
Conclusion: The palliative care model for terminal cancer patients facilitated proactive planning for patients and families, and professional nurses had standardized practices for terminal cancer patient care.