A Qualitative Study On The Referral Experience Of Palliative Care From General Hospital To Community Hospital For Cancer Patients

Objective The purpose of the study is to explore the referral experience of palliative care for cancer patients from general hospital to community hospital in Nanjing Area,enhancing the understanding of referral rules of palliative care for medical staff by analyzing the subjective evaluation contents palliative care from cancer patients,and analyzing the influencing factors on accepting the palliative care referral and the feelings and needs after they had been referred to the community hospital,which was used to provide a reference for the promotion of palliative care referral from general hospital to community hospital later in Nanjing area.Methods Purposive sampling was used to recruit patients who just accept referral of palliative care from the general hospital to the community hospital in Nanjing area.Semi-structured in-depth interviews were conducted for each cancer patient to get the material and the interpretive phenomenological approach was used to analyse all the materials.The purpose and the meaning of the study were explained to the patients before the interview,including signing the informed consent form with the patient to be allowed to record live by the researcher.The interviews for each patient were conducted for two times:before the patient were referred and after one week of the referral,and data integration was performed after the two interviews.During the interview,the researcher paid attention to get the information including language,tone,movement and demeanor of the patient.The interview wasn't stopped until no new theme generated.About 30-45 minutes were spent on each interview,and the Colaizzi phenomenological seven-step analysis method was used to analyze the data.Result:10 cancer patients were selected according to the principle of data saturation in the study,and all the 10 patients participated in the interviews in the whole process.The age of patients ranked from 42 to 72 years old;six male and four female were included;and their marital status were that two in ten patients lost their spouses;the category of the work of patients were retired worker,peasantry,teacher and civil servant;and the education background of patients are five patients in primary school or below,two patients graduated from high school,one patient graduated from senior school,one patient held a master's degree,one patient held a Ph.D's degree;the course of disease ranked from 2 to 6 years;there were two patients who were christian believers and two patients were buddhist believers and six patients had no religious belief;six patients had worker medical insurance,three patients had new rural cooperative medical insurance(abbreviated as the new rural cooperative medical system).The researcher integrated and analysed all the data,and three themes along with twelve sub-themes were summarized.Theme one:Reasons of accepting the referral of palliative care for cancer patientsTheme one were divided into six sub-themes as follows:(1)disease status:the disease status were mainly reflected in the continuous decline of physical function,the side effects of drug treatment on the body and mind,and the long course of disease;(2)social support:social support were mainly reflected in the support from the medical staff,the support from family,the need of being accompanied with and the need of being supported economically;(3)the concept of life and death:The main factors affecting the concept of life and death of cancer patients were:correct understanding of death,the realization of the value of life,no concern on their relatives,age,belief,loss of spouse and negative attitude;(4)the medical level of community hospital:(5)the environment of the community hospital;(6)the distance between the community hospital and patient's home.Theme two:Hospitalization experience and needs of patients after referral to the community hospital.Theme two were divided into four sub-themes as follows:(1)The environment of community hospital was comfortable and quiet;(2)being satisfied psychologically:the main influencing factors were the harmonious relationship between nurses and patients,the increase of family companionship and professional psychological guidance.(3)being satisfied spiritually;the main manifestation is the relative satisfaction of religious belief needs and the meaning of life is sublimated.(4)pressure on economy were relieved relatively:the main influencing factors were the decrease of active treatment and the relatively low charge of community hospital;Theme three were divided into two sub-themes as follows:(1)The level of technical nursing operation need to be improved:the main manifestations were the relative lack of nursing technology and nurses were not skilled enough;(2)The medical staff were relatively lacked of;the main manifestations were the lack of senior medical staff and non-professional support staff.Conclusion:This study gained an understanding of the experience of receiving the referral of palliative care for cancer patients from general hospital to community hospital.The palliative care focuses on the physical,psychological,social and spiritual care and humanistic care for the advanced patients,reflecting the progress of the social concept.Here are two conclusions as follows:(1)Patients who received referrals of palliative care were highly satisfied with the community hospital,whose body was protected from the suffering from inefficient anti-tumor treatment.The hospitalization expenses were reduced to a certain degree after being referred to the community hospital.At the same time,the patients were accompanied with relatives or nurses more,which make the need of patients met psychologically and spiritually,thus the patients were more comfortable physically and psychologically.However,the level of nursing technology of nurses in community hospital remained to be improved,.(2)To promote the development of palliative care,the first main step is to improve their ability to provide palliative care,and to improve the level of palliative care of community hospitals through the training courses about nursing technology,and to promote the homogenization management of the upper and lower hospitals by improving the construction of Medical union.;after that,professional and multi-form health education should be given to patients,including the concept of tranquillity care and the cognition of life and death to promote the development of palliative care.