Construction Of Palliative Care Program Based On The Needs Of Elderly Patients With Advanced Cancer And Their Caregivers

ObjectivesThis study aimed to build a systematic and scientific palliative care program based on the needs of elderly patients with advanced cancer and their caregivers,which provided a theoretical basis for improving the quality of life of elderly patients with advanced cancer and their caregivers.Methods1.Meta-integration of qualitative researches was used to summarize the coping illness experiences and needs of elderly patients with advanced cancer.Qualitative interview was used to summarize the care experiences and needs of caregivers by Colaizzi seven-step analysis.These contents provided the basis for the construction of palliative care program.2.We systematically searched the literatures related to palliative care,through content analysis method analyzed the literatures to obtain the elements and contents.Representative and authoritative experts were invited to conduct Delphi expert consultation on the initially constructed palliative care program,and the program contents were continuously optimized and improved based on experts’ opinions to finally establish a palliative care program based on the needs of elderly patients with advanced cancer and their caregivers.Results1.A total of 26 qualitative studies on the experiences and needs of elderly patients with advanced cancer were included for Meta-integration.14 categories were summarized with six integrated outcomes:symptoms control needs(physical symptoms,psychological symptoms);information needs(correct disease perception,access to disease-related information);social support needs(alleviating the current situation of difficulty in seeking medical care,reducing financial burden,support from family,friends and medical personnel);humanistic care needs(maintaining autonomy,preserving dignity,emotional expression);spiritual care needs(respecting religious beliefs;pursuing hope,meaning and love);and death education needs(accepting death calmly,accomplishing the wishes).2.A qualitative interview about the experiences and demands of caregivers in caring advanced cancer patients,a total of extracting two themes of 10 sub-themes:caregivers beared huge pressure and experienced complex care(lack of care knowledge and skills,challenges of condition disclosure,different stages of psychological change,role conflict,promote self-care);various needs of palliative care(physical needs,psychological needs,spiritual needs,social support needs,popularization and education needs).3.A total of 16 palliative care literatures were included for content analysis,and 68 items were summarized,including 5 aspects,such as knowledge popularization,symptoms management,emotions relief,death education,and quality of life evaluation.4.A total of 14 experts participated in two rounds of Delphi expert consultation.The experts showed a high degree of positivity(the recovery rate of both rounds was 93.33%,and the proportion of experts who put forward opinions was 64.29%and 42.86%,respectively),the authority coefficient of both rounds was 0.947,the kendal harmony coefficient of contents ranged from 0.097 to 0.240(P<0.05),experts’ opinions tended to be consistent.After two rounds of expert consultation,the palliative care program was formed,including 4 first-level items,22 second-level items and 70 third-level items:health education,symptoms management,psychological care and life education.Conclusions1.Elderly patients with advanced cancer and their caregivers had physiological,psychological,social,spiritual and other unmet needs.The quality of life of patients and caregivers needed to be improved.2.Based on the needs of elderly patients with advanced cancer and caregivers,we constructed an evidence-based palliative care program with rigorous scientific content and high feasibility through content analysis and expert consultation.