Construction and validation of palliative care nursing theory guidelines for patients with advanced cancer

Abstract

Background: Globally, there are many patients suffering from advanced cancers. There is a limited structured theoretical framework available for providing palliative care to these patients.Objectives: We aimed to construct and validate palliative care nursing theory guidelines to provide better palliative services to patients with advanced cancer.Materials and Methods: This study was conducted in Departments of Surgery and Radiation Oncology at the All India Institute of Medical Sciences, Rishikesh. In the present study, we used mixed-method design in which both qualitative and quantitative methods were used. In the qualitative study, exploratory surveys were used to derive themes using directed content analysis. We used the prospective cohort methods in the quantitative study. We tested the palliative care nursing theory on 80 patients with advanced gallbladder cancer and their caregivers for 6 months using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QOL) scale and assessed the survival outcomes.Results: Between July 2019 and Dec 2019, we enrolled 25 patients in the qualitative study. Four concepts of palliative care nursing theory were derived, that is, symptomatic management, problem-solving counseling, yoga and meditation, and family or caregiver involvement. Out of these, we developed a conceptual framework and palliative care nursing theory. In the subsequent quantitative study, we then tested this palliative care nursing theory on 80 patients (40 in the interventional group and 40 in the control group) with advanced cancer who were receiving palliative treatment. We provided care according to the palliative care nursing theory guidelines to the patients in the interventional group and found that this resulted in a significant benefit for both overall survival and quality of life (P = 0.0001; 95% confidence interval [CI], 5.97–87.82).Conclusion: Our validated palliative care nursing theory is a structured and well-designed tool to provide comprehensive palliative care to patients with cancer. This can guide palliative care teams to provide better palliative care to patients and their families.