Research On End Of Life Care Pathway For The Dying Cancer Patients

Objective:Cancer is disease of high incidence and high mortality and characteristic of low quality of life of cancer patients.Especially in the dying stage,the symptoms can not be effectively controlled and patients always under great physical and psychological suffering.The evidence of supporting the care of patient dying and standardized and unified operation flow are lacked.This study formed End of life care pathway for the dying cancer patient on basis of literature research,learn from foreign experience in developmentment contry of end of life care for the dying,with a view to alleviate the symptoms of dying patients,improve the quality of life of patients and their families and provide evidence of care for dying patients on the basis of clinical diagnosis and care for the clinical staffs.Methods:1.Qualitative research method was used to explore how the medical staff determined the cancer patients were dying,thus it can be regarded as a reference in recruiting patients for cancer patients dying phase care pathway.2.Literature content analysis was used to select the care pathway.The draft of care pathway for the dying cancer patient was formed through translation and cultural debugging.Expert group meeting was convened to revise the draft and then made the ?End of life care pathway for the dying cancer patient,ECP-D?3.A non-parallel controlled trial was carried on to verify the clinical effects of ECP-D.Before the implementation of care pathway,forty patients meeting the criteria were treated with routine care and without any intervention of the researcher.After the training for the medical staffs who will participate in the clinical trial,forty patients meeting the standards of dying were managed with ?End of life care pathway for the dying cancer patient?.The incidence and every four hours recorded incidence of pain,dyspnea,nausea&vomiting,secretion obstruction,irritability were noted and family members were invited to fill the homemade hospice care satisfaction survey after the patients' death.Medical staffs involved in the implementation of the pathway and some family members were interviewed to understand the effect of the implementation of nursing pathway for the dying patients of cancer.Results:1.Medical workers assess the cancer patients whether is dying often through the following symptoms,including pain,"supernatural",consciousness,the breathing frequency,blood circulation,intake and output,functional status and the mode of administration on eight aspects and medical workers' intuition or experience.2.?End of life care pathway for the dying cancer patient?was formed and revised through literature content analysis,translation and cultural debugging and expert meeting There are 7 pages of the text,including the initial assessment of a single,continuous assessment alone,died instantly record sheet(after funeral care),a total of 23 care goals,covering various aspects of the patient and family's physical,psychological,social and spiritual support.3.Cancer patients dying phase care pathway was verified in hospice care ward.The incidence of the above five symptoms calculated by the number of patients in pathway group was lower than control group,while only the incidence of pain and difficulty breathing calculated by the number of patients and the incidence of pain,difficulty breathing and obstructive secretions calculated by the time recorded every 4 hours had statistically difference(P<0.05).Hospice care satisfaction survey showed that the satisfaction of family members of patients in care pathway group on health care,management and control of the patient's symptoms,medical staffs' support of families were higher than control group,and there was a statistically significant difference(P<0.05).The results of Medical workers involved in the pathway of the interview showed that using the pathway affected the doctor's philosophy and they can observe and record through the care pathway clearly and easily.The results of families in the interviews showed that the application of care pathway can timely deal with the symptoms occurred or potential and they extricate the fear of death in patients and reduce their guilt.Conclusions:1.The results of medical staffs in the judgment of dying cancer patient can be regarded as reference in determining patients in dying phase through qualitative research.2.Cancer patients dying phase care pathway exerts a certain effect on the controlling symptoms of dying cancer patients.It can improve the quality of life of dying patients with advanced cancer and improve the overall quality of care.Medical workers and patients' families gave their recognition.Cancer patients dying phase care pathway has certain clinical Value.