Development of Palliative care system in the health community network, Cheunchom hospital

Abstract

Abstract

            Background : Palliative care plays a vital role in enhancing the quality of life for patients in the terminal stage and their families. Continuity of care at home after hospital discharge is essential to ensure comfort and dignity in the final stages of life. However, gaps in access to appropriate and contextually relevant services still exist, particularly at the community level. Therefore, it is necessary to develop an effective home-based palliative care system that ensures continuity of care and aligns with the local context and community needs.

            Material and method : This study employed an action research design, conducted through a four-phase cycle: planning, acting, observing, and reflecting. The target group consisted of 72 terminally ill patients receiving care at the Palliative Care Clinic of Chuenchom Hospital, Maha Sarakham Province. The research instruments included: (1) the Edmonton Symptom Assessment Scale (ESAS), (2) an advance care planning questionnaire for end-of-life care, and (3) a follow-up form for palliative care outcomes. Data collection was conducted between April and September 2024. The data were analyzed using frequency, percentage, mean, standard deviation, and paired t-test.

            Results : Following the implementation of palliative care, patients showed a statistically significant reduction in the severity of all nine symptoms assessed using the Edmonton Symptom Assessment Scale (p-value < 0.001). All patients participated in structured family meetings and advance care planning. In addition, patients received spiritual care, which helped them achieve greater emotional and psychological relief compared to their condition prior to receiving palliative care.

            Conclusion : The developed home-based palliative care system proved to be effective in ensuring appropriate and continuous care for terminally ill patients. It significantly reduced the severity of symptoms, enhanced patients' quality of life, and holistically addressed the physical, psychological, social, and spiritual needs of both patients and their families in a systematic manner.

Keywords : Palliative care, Symptom severity, Terminally ill patients