คุณภาพการดูแลแบบประคับประคองตามรูปแบบการจัดการรายกรณี ในผู้ป่วยมะเร็ง

Abstract

Palliative care for patients with cancer who face physio-psycho-social-spiritual distress should be holistic care delivered by a multidisciplinary health care team. The case management model is based on the concept of efficient care in order to gain great patient care outcomes. This outcome research aimed to describe palliative care quality based on the case management model among patients. Participants were recruited using purposive sampling. They consisted of 60 cancer patients receiving palliative care at a provincial hospital and 60 of their family caregivers from May 2019 to July 2019. Additionally, seven palliative health care providers and three hospital administrators participated in this study. Research instruments were; 1) the semi-structured interview guidelines for health care providers related to coordination in palliative care based on a case management model for cancer patients, 2) the semi-structured interview guidelines for case manager based on case management practices and activities in palliative care in a case management model for cancer patients. 3) the semi-structured interview guidelines for executives related to palliative care structure based on the case management model, 4) the patient's outcome record, 5) the patient satisfaction questionnaire towards palliative care based on a case management model for cancer patients, 6) the caregivers' family satisfaction questionnaire towards palliative care based on a case management model for cancer patients, and 7) the observation checklist regarding nurse case managers providing palliative care. Data were analyzed using descriptive statistics and point-based classification. The results revealed that: 1. For structure, it was found that this hospital had a policy on organizing an outpatient and inpatient service system, allocating human resources following the Ministry of Public Health standards, budgets for palliative care, and supporting pain relief. Additionally, the hospital provided adequate essential equipment for patient care and appropriate establishments/services for palliative care and the healthcare systems' interconnection. A palliative care system also collaborates with the various levels of network service. 2. For processes, it was found that the hospital has a nurse who is a case manager. The case manager's roles include selecting patients for care, evaluating and identifying problems, coordination of planned care, continued evaluation, and monitoring until termination of care. Nevertheless, coordinating with the network service to link data about treatment plans before discharging and forwarding patients' data to a health care service network or community, and providing assistance in various fields enables patients to receive continuing palliative care. 3. For outcomes, in terms of patient outcomes, it was found that all patients received symptoms management and died on-demand, and 92.3 1 %o received care consistent with their advance care planning. Only 70.00 % had advanced care planning and had decision-making at the end of life stage. Satisfaction with physical symptoms relief management, psychological suffering relief management, family well-being assistance, and an enhancing moral care were at high level of 95.00, 98.33, 88.33, and 95.00 %, respectively, at a high level. For family caregivers' outcomes, it was found that satisfaction towards caring for family members and assistance in managing family well-being problems was 81.67 and 86.67 %, respectively. For the organization's outcomes were found that the patients and family caregivers were highly satisfied with the overall quality of care under this model at 86.67 and 70.00 %, respectively. Implementing this palliative care based on case management model can reduce costs by reflecting on the length of stay in hospital and lower hospital re-admission rate and enhance multidisciplinary teamwork in efficient palliative care. This study's results can be applied as preliminary data for supporting the development and improvement of palliative care in other hospitals. The institution should determine the case manager's scope of duties and systemically evaluate their practices' outcomes. Further study should develop a competency development model of nurse case managers for palliative care and examine that model's effects.