Patel Dhriti, Patel Parimalkumar, Ramani Monal, Makadia Khushbu
Department of Internal Medicine, B.J. Medical College and Civil Hospital, Gujarat, India.
Department of Community Medicine, B.J. Medical College and Civil Hospital, Gujarat, India.
Indian J Palliat Care. 2023 Jan-Mar;29(1):57-63. doi: 10.25259/IJPC_92_2021. Epub 2023 Jan 12.
The objectives of the study were to evaluate the perceptions and performance of terminally ill cancer patients regarding the quality of palliative care at different settings and to measure their quality of life (QOL) at the end of life.
This comparative, parallel and mixed method study was conducted at the Community Oncology Centre, Ahmedabad, among 68 terminally ill cancer patients as per inclusion criteria; who were receiving hospice (HSbased and home (HO)-based palliative care under 2 months permitted by the Indian Council of Medical Research. In this parallel and mixed method study, qualitative findings were supplemented by quantitative data with both components executed simultaneously. Interview data were recorded by taking extensive notes during interviews along with an audio recording. Interviews were transcribed verbatim and a thematic approach was adopted. QoL questionnaire ('FACIT© System') was used for the assessment of QOL in terms of four dimensions. Data were analysed using the appropriate statistical test on Microsoft Excel.
The qualitative data (primary component) analysed under five themes - staff behaviour, comfort and peace, enough and consistent care, nutrition and moral support, in the present study favours a HS-based setting more than a HO-based setting. Among all four subscale scores, physical well-being and emotional well-being subscale scores were statistically significantly associated with the place of palliative care. Functional Assessment of Cancer Therapy-General (FACT-G) total score was high among patients getting HO-based palliative (mean = 67.64) care than HS-based palliative care (mean = 56.56) and the difference between total FACT-G scores was statistically significant (unpaired -test = 2.20, = 0.03).
Overall, with the primary component favouring HS care and higher scores obtained in HO-based patients, the present study advocates the necessity for palliative services to expand their coverage regardless of whether they are provided at HS or HO, as it has improved the QOL of cancer patients significantly.
本研究的目的是评估晚期癌症患者对不同环境下姑息治疗质量的认知和表现，并衡量他们临终时的生活质量（QOL）。
本比较性、平行性和混合方法研究在艾哈迈达巴德的社区肿瘤中心进行，根据纳入标准选取了68例晚期癌症患者；这些患者在印度医学研究理事会允许的2个月内接受临终关怀（HS）和居家（HO）姑息治疗。在这个平行性和混合方法研究中，定性研究结果由定量数据补充，两个部分同时进行。访谈数据通过访谈期间做详细笔记以及录音来记录。访谈逐字转录并采用主题分析法。使用生活质量问卷（“FACIT©系统”）从四个维度评估生活质量。数据在Microsoft Excel上使用适当的统计检验进行分析。
本研究中，定性数据（主要部分）在五个主题下进行分析——工作人员行为、舒适与安宁、充足且持续的护理、营养与精神支持，结果表明与居家环境相比，基于临终关怀机构的环境更受青睐。在所有四个子量表得分中，身体幸福感和情绪幸福感子量表得分与姑息治疗地点在统计学上有显著关联。接受居家姑息治疗的患者的癌症治疗通用功能评估（FACT-G）总分（均值 = 67.64）高于接受临终关怀机构姑息治疗的患者（均值 = 56.56），FACT-G总分之间的差异具有统计学意义（非配对t检验 = 2.20，P = 0.03）。
总体而言，主要部分支持临终关怀机构护理，而居家患者得分更高，本研究主张姑息治疗服务有必要扩大其覆盖范围，无论服务是在临终关怀机构还是居家提供，因为这显著提高了癌症患者的生活质量。
