Study On What Palliative Home Care Services Should Community Health Service Centers Delivery For Advanced Cancer Patients And Their Informal Caregivers In Shanghai

Objective: To investigate the status of the needs and service utilization wills of advanced cancer patients and their informal caregivers and service contents of some community health service centers delivery in Shanghai.Methods: In-depth interviews was used to investigate the community health service utilization will of patient and their informal caregivers, What they need and what community health service providers think should be delivered were investigated by self-designed questionnaires based on the Supportive Care Model. Integrating the survey outcomes and the related health care service theories and the Supportive Care Model the Home Palliative Care Services framework was constructed, and which was revised by Delphi specialist consult.Result: (1) Residential advanced cancer patients and their informal caregivers in Shanghai exist more needs and unitily wills,especially in the psychical support field. (2)The prime needs of patients focus on the psychical field ,which is followed by physical care and social support. The prime needs of the informal caregivers focus on the psychical field ,which is followed by social support and education and instruction.(3)Never joined any anti-cancer parties is the risk factor of more psychical and physical needs of patients.Lower KPS scores and continuing medication in home are the risk factors of more psychical needs of patients.The divorced or single patients or having received over 2 therpies or never joined any anti-cancer parties or with lower KPS scores have more social support needs. (4)The psychical needs of the informal caregivers correlate negatively with literacy of caregiver and age of patients but with subjective psychical stress positively .The social supportive needs of the informal caregivers correlate positively with their literacy ,career, mean care time daily, subjective psychical stress and physical burden, but with patient' s age negatively. In education and instruction field, the needs of the informal caregivers correlate negatively with the caregiver's age, but with patient' s age, subjective psychical stress and the relation between caregivers and patient positively. The total needs correlate positively with the caregiver's age , the relation between caregivers and patient, caregiver numbers and subjective psychical stress, but with patient' s age negatively.(5) Parts of community health service centers in Shanghai have developed and deliveried some services for residential cancer families more or less,and community health professional workers have realized the importance of developing palliative care in communities. (6)Community health professional workers and oncology physicians and nurses in the tertiary hospitals in Shanghai think it is necessary and support positively developing palliative home care service,but related knowledge and skills need to be improved and the human resources should be enhanced.(7)The Palliative Home Care Services Content Framework was builded up by psychical support(4items), physical care(21 items) ,consult and instruction (15items) and social support (3items) with 43 items.Conclusion: (1) The Palliative Home Care Services Content Framework was builded up by psychical support(4items), physical care(21 items) ,consult and instruction (15items) and social support (3items) with 43 items. (2)Community health service supervision sections should establish relate guideline and regulation and policy in detail, and more continuing education and training about pain and symptom control knowledge and communication skills, what is more, some special workers such as social worker must be included in the primary health care team as soon as possible. (3)There are some gaps between the service content framework and actual conditions of some community health service centers., so the framework need to be modified and improved in further research.