Study On Eligible Conditions Of Palliative Home Care For Advanced Cancer Patients In Shanghai

Nowadays, cancer has become the leading cause of death in China. However, palliative care is an effective approach to improve quality of life of advanced cancer patients. Palliative home care, as one of the most important types of palliative care service, not only could satisfy the desire of advanced cancer patients for receiving care and passing away at home, and ensure their families to get through the grief period, but also could ease the tension of relatively less hospital beds, maintain continuity of care, reduce national health expenditure and achieve a more efficient allocation of medical resources. Therefore, to develop palliative home care in China has important practical significance and far-reaching effects. This study is aimed to explore the basic, feasible and necessary conditions, namely the eligible conditions, with which palliative home care could be developed rapidly and reasonably. Furthermore, these eligible conditions would provide guidance for enhancing and improving palliative home care.There are two parts in this study.The first part is an investigation of palliative home care for advanced cancer patients.Objectives: To explore the current situation of the development of community-based palliative home care and its influencing factors, and to find out the health & function status and the utilization of health service among residential advanced cancer patients, and the quality of family care for them, all of which would provide base and information for initial proposition of the eligible conditions of palliative home care for advanced cancer patients Methods: Palliative home care service was explored by field studies in 5 community health service centers, 15 palliative home care providers were interviewed by semi-structure interviews, and 201 pairs of advanced cancer patients and their family care givers were surveyed by questionnaires. Results:①Palliative home care services including regular follow-up, hospital bed at home and temporary visit were provided for residential advanced cancer patients by community health service centers.②The influencing factors of developing community-based palliative home care included three aspects such as policy, service provider and receiver.③The results of questionnair survey were as follows: Firstly, fatigue was the most sever symptom among residential advanced cancer patients with the highest mean score of 4.19, and the mean score of quality of life was 62.24±16.80. In addition, KPS (B=6.82,P=0.00) , site of cancer (B=-10.47,P=0.00) and hygienic conditions(B=2.33,P=0.03) were the influencing factors of quality of life. Secondly, as to most follow-up services, the number of patients who needed them was more than that who accepted them(P=0.00). Although 70.15% of the patients needed hospital bed at home, actually 36.82% knew it and only 10.45% had used it. Lastly, 67.66% of the family care givers thought that they could meet all or most of the care needs of the patients. however, 60.20% of those suffered some or great stress, of which economic conditions accounted for 77.11%, psychological factors 65.17%, lack of knowledge about disease and care 59.20%, physical factors 48.76% and social factors 32.34%.The second part is proposition and amendment of the eligible conditions of palliative home care for advanced cancer patients in shanghai. Objectives: To amend and constitute the eligible conditions of palliative home care for advanced cancer patients in shanghai, which would provide sound guidance for strengthening and improving palliative home care service in the future. Methods: The eligible conditions based on the first-part study were amended and modified by Delphi method (two rounds and 15 experts). Results:①The coefficient of authoritative (Ca) of the experts was 0.81.②The response rates (RR) of the experts in the two rounds were both 100%.③The eligible conditions of palliative home care for advanced cancer patients in shanghai included 3 main connotations and 14 sub-conditions: health policies that provide guarantee and support for the development of palliative home care( 4 sub-conditions), community health service that is able to provide palliative home care (8 sub- conditions), and advanced cancer patients that are appropriate for palliative home care (2 sub-conditions).Conclusions:①Palliative home care provided by community health service center ought to be improved and enhanced.②Residential advanced cancer patients often have a variety of symptoms, of which fatigue is the most sever one, and their quality of life was poor. Therefore, they should receive comprehensive and holistic nursing care.③The eligible conditions of palliative home care for advanced cancer patients that are constituted from the results of the theoretical and empirical researches are in accordance with the situation of community health service in Shanghai, and thus have a certain feasibility.④Palliative home care service could be improved through enhancing such four aspects as government input, scientific research, professional training and organization & management.