The Effects of a Case Management Model in Palliative Care Transitioning from Hospital to Home on Pain and Suffering in Terminal Cancer Patients

Abstract

Introduction In 2015, the Ministry of Public Health established a national policy requiring hospitals nationwide to establish palliative care units for terminally ill patients, with the aim of providing comprehensive care that addresses physical, psychological, and quality-of-life needs. Between 2020 and 2022, statistics indicated a continuous increase in the number of terminal cancer patients requiring palliative care. In response to this policy, the Warinrak Center at Warinchamrap Hospital developed a case management model for palliative care of terminal cancer patients, transitioning care from hospital to home beginning in 2016 and refining it through 2022. This model integrates the nursing process framework with case management, including problem assessment, nursing diagnosis, individualized care planning, nursing interventions, and outcome evaluation, with particular emphasis on pain management as a common and critical symptom. Although this care model has been implemented in patient care, systematic evaluation of its outcomes remains limited.

Objectives This study aimed to 1) compare pain, distress, and functional performance and self-care ability among terminal cancer patients before and after receiving the case management model of palliative care from hospital to home; and 2) describe patient and family satisfaction with the case management model.

Design This study employed a quasi-experimental design using a one-group pretest–posttest approach. The study was conducted at the Warinrak Center, including the medical and surgical wards of Warinchamrab Hospital, Ubon Ratchathani Province, Thailand. Following hospital discharge, continuity of care during the transition from hospital to home was provided through telephone follow-up and consultation via the Warinrak Center’s LINE Official Account. Methodology The study sample comprised 16 terminal cancer patients experiencing pain who were admitted to the inpatient wards of Warinchamrap Hospital, Ubon Ratchathani Province. Participants were purposively selected according to the inclusion criteria. The sample size was determined using power analysis, with an effect size of 0.80, a statistical power of .80, and a significance level of .05. Data collection instruments included: a personal information record form, the Brief Pain Inventory–Short Form (BPI-SF), the Distress Thermometer, the Palliative Performance Scale (PPS) for assessing self-care ability in terminal cancer patients receiving palliative care, and a satisfaction questionnaire. The intervention was the case management model of palliative care for terminal cancer patients transitioning from hospital to home, developed by integrating the nursing process framework with case management principles. Each participant was enrolled in the study for 21 days. Data were collected between November 2023 and January 2024 and analyzed using descriptive statistics and Wilcoxon Signed-Rank test.

Results The majority of participants were female (56.3%) and aged 60 years or older (87.5%). Equal proportions (12.5% each) were diagnosed with colorectal cancer, lung cancer, and cervical cancer. The most frequently reported discomfort was pain (87.5%), followed by fatigue (68.8%) and insomnia (43.8%). After the intervention, pain scores were significantly lower than before the intervention across all dimensions: worst pain (Z = -2.783, p = .005), least pain (Z = -2.834, p = .005), average pain (Z = -2.939, p = .003), and current pain (Z = -2.956, p = .003). The impact of pain on daily activities across seven domains also decreased significantly, as did psychological distress levels (Z = -3.256, p = .001). However, no statistically significant difference was observed in functional performance and self-care ability, as measured by the Palliative Performance Scale (PPS), before and after the intervention (Z = -1.000, p = .317). Patient and family satisfaction with case management after the intervention was high, particularly regarding the healthcare team’s responsiveness to patient needs (81.3%), followed by the provision of information on symptom management and family involvement in care-related decision-making, both rated at 75.0%.

Recommendations The case management model of palliative care was found to significantly reduce pain and distress among patients, thereby alleviating the impact on the quality of life of terminal cancer patients. In addition, patients and their families expressed high levels of satisfaction, particularly with the quality of care and their involvement in decision-making. The application of this hospital-to-home case management model of palliative care should be considered in the development of service systems for terminal cancer patients, as it can effectively relieve pain and distress, enhance nurses’ competencies in symptom management, and strengthen continuity of care between hospital and home.