ประสิทธิผลของการใช้แนวปฏิบัติทางคลินิกในการส่งเสริมการวางแผน ดูแลล่วงหน้าสำหรับผู้ป่วยโรคมะเร็งที่ได้รับการดูแลแบบประคับประคอง

Abstract

An advanced care plan is a process of giving information about the diagnosis, prognosis, treatment goals, and choices of treatment to patients and their families. This process aims to help patients to receive care as their needed and maintain their good quality of life until the end of life stage. The purpose of this implementation research was to examine the effectiveness of implementing clinical practice guidelines (CPGs) in promoting advanced care planning for cancer patients receiving palliative care. The study was conducted following the clinical practice guidelines of the National Health and Medical Research Council framework, Australia (NHMRC, 1999, 2000). Participants consisted of two groups; group 1 was 52 cancer patients receiving palliative care before CPGs implementation and 33 cancer patients receiving palliative care during CPGs implementation. Group 2 were fourteen health care personal who utilized CPGs. The research instruments composed of: (1) the Clinical Practice Guidelines in Promoting Advanced Care Planning for Cancer Patient developed by Surasree et al. (2013),(2) the Palliative Performance scale for Adult Suandok (PPS Adult Suandok), (3) the Hospital Anxiety and Depression Scale: Thai Version (Thai HADS), (4) the Advanced Care Planning for Cancer Patient Assessment, and (5) the User Satisfaction of Implementing Clinical Practice Guidelines in Promoting Advanced Care Planning for Cancer Patients Receiving Palliative Care survey form. All instruments were tested for psychometric properties before use to collect data. The data were analyzed using descriptive statistics. The result revealed that: 1. The desire, expectation, needs, and choices of treatment were indicated by 11.54% of participants before the CPGs implementation, while during the implementation 81.82% indicated their need for these domain. Before the implementation, 23.08% of participants mentioned their need for a care plan related to reliving unpleasant symptoms, while during the CPGs implementation, 90.91% needed the advanced care planning for this specific domain. Twenty point eight percent of participants before CPGs implementation and 66.6 7% of participants during the CPGs implementation indicated their need of care plan for an emergency condition. Regarding the need for discharge planning, 7.69% of participants before CPGs implementation reported the need for this domain, whereas 51.52% of those during CPGs implementation reported their need for discharge planning during the guideline implementation. 2. Most healthcare personnel (85.71%) had a high level of overall satisfaction regarding utilizing CGPs for constipation management. The result indicated that implementing CPGs in promoting advanced care planning for cancer patients receiving palliative care could promote their advanced care planning. Furthermore, health care providers who utilized this guideline expressed their satisfaction for CPGs implementation at a high level. Thus, this study's results should be proposed to the administration hospital to further implement CPGs in caring for cancer patients.