Family-Based Palliative Care Model for Advanced Cancer Patients in Community Settings in the Northeast, Thailand

Abstract

Background: Advanced cancer patients (ACPs) need complex care and appropriate support from the family to relieve suffering and stress during the life-threatening course of the disease until the end of life. Objective: To examine the current situation of family cancer care and to develop a family-based palliative care model for ACPs in community settings in the Northeast, Thailand. Materials and Methods: The present study was a participatory action research study comprised four phases, situation analysis, model development and planning, model implementation and assessment, and follow-up assessment and model remodification. The participants included 12 dyads of ACPs-family caregivers (FCGs), 44 community network committee members (CNCs), comprising 28 community network volunteers-CNVs such as local leaders, teachers, Buddhist monks, nurses, and village health volunteers (VHVs), 11 health personnel, and five other local leaders. Data collection used interview schedules, in-depth-interview guide, focus group discussion guidelines, and observation checklists. Data analyses used descriptive and analytical statistics for quantitative data, and content analysis for qualitative data. Results: The results showed that the participatory model developed was called “the integrated family-based palliative care for ACPs in community or IFPC-ACPC model”. It was composed of 1) the CNCs for ACPs and families, 2) the roles of the CNC in providing social support to the ACPs and families, 3) the palliative care guidelines for ACPS, FCGs, and CNCs, 4) the three-workshop training on palliative care for ACPs, FCGs, and CNCs, and 5) the home visits and the home environmental modification. This eight-week model was applied to all patient-caregiver dyads after the CNCs agreed upon its potential for implementation at a high level. The satisfaction of the FCGs and CNCs changed, and the ACPs’ symptoms were significantly changed at the end of the implementation at post-test and follow-up. The clinical outcomes revealed that the ACPs had PPS duration of 70 to 90 reflected by multidimensional adverse symptoms of the ACPs. The ESAS were improved significantly at post-test and follow-up (p<0.05). The ACPs’ knowledge, perceptions, palliative care behavior, and social support were improved significantly at post-test and at follow-up (p<0.05). The received symptom management from his/her FCGs were also at a higher level. Conclusion: The developed IFPC-ACPC model can be implemented in semi-urban communities in the Northeast, Thailand with adjustments based on local problems and needs. However, outcome evaluation for the model effectiveness in the long term needs further study. Keywords: Advanced cancer patient; Family-based care; Integrated palliative care model; Family caregiver; Community network