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The Quality of Palliative Care to Advanced Cancer Patient and Associated Factors:a Cross-sectional Study in Shanghai

Author: ZuoMin
Tutor: XuYan
School: Second Military Medical University
Course: Nursing
Keywords: Advanced cancer patient the qualiy of palliative care scale Status quo influencing factors
CLC: R473.73
Type: Master's thesis
Year: 2013
Downloads: 63
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Abstract


Objectives:Introduced Chinese version of scale of Palliative Care Outcome Scale (POS). Convenient sampling and cross-sectional survey methods were applied to evaluate the qualiy of palliative care for advanced cancer patients in shanghai. The target patient population were investigated by semi-structure interviews for comprehensive analyze and discussion on the possible influencing factors, aiming to promote design to make pertinence intervention strategies for ascending advanced cancer patients at the level of the qualiy of palliative care in clinical practice. Thus improve the quality of survival in patients with adanced cancer.Methods:1. By using literature content analysis systematically reviewed palliative care assessment tools in oncology care field. Introduced the qualiy of palliative care scale (Palliative Care Outcome Scale, POS) into China, completed cultured adaption, reliability and validity test of Chinese version scale and get the localized cancer palliative care outcome assessment tools.2. by using convenient sampling,389advanced cancer patients from8hospitals which contain Tertiary hospitals, Secondary level hospitals, first-class hospital in Shanghai were investigated to evaluate the level of qualiy of palliative care. The questionnaire including General demographic information, Chinese-version POS, EROTC-QLQ-C30(European Organization for Research and treatment) and the self-developed questions with possible related factors which affected the quality of palliative care.3. Purposive sampling method and Semi-structured were adoptted to interview10nursing management, from oncology department and TCM oncology, Palliative care unit of first, second and tertiary hospitals in Shanghai.4. Data processing:descriptive analysis were used to analysis the general data, quality of life (QLQ-C30) and the quality of care (POS) results; Mann-Whitney U test, Kruskal-Wallis H test, Spearman rank correlation analysis (p＜0.01)were performed used for univariate analysis; stepwise multiple regression analysis (p＜0.05) was used for multivariate analysis. Results:1. Culture debugging and semantic analysis on the scale to ensure its face validity, content validity. Reliability and Validity were tested,100questionnaires were granted, and95questionnaires were returned, the response rate was95%. Of which80were valid questionnaires, the effective rate was84.2%. Cronbach’s alpha is0.734, and the correlation coefficient of total score of POS and EROTC, QLQ-C30was0.574(P＜0.01), Each factor of the scale and EROTC QLQ-C30total score criterion-related coefficients are0.595(P＜0.01),0.236(P＜0.05), implied the scale had good reliability and validity. Showed that POS criterion-related validity is better; exploratory factor analysis two common factors, consistent with the original scale, the cumulative contribution rate of47.07%, indicating that the Chinese version POS has good construct validity.2. The care quality status and influencing factors of patients with advanced cancer.(1) three hundred and eighty nine questionnaires were released and346were returned, with a resultant a response rate of88.9%. The number of valid questionnaires is300, which acconts to86.7%of the released questionnaires.The status of quality palliative care for patients with advanced cancer:All patient samples POS score as well as scores of each dimension (Mean±SD) as follows:(16.55±6.47) points,(13.03±5.50) points,(3.52±1.85) points. Quality of life in patients with advanced cancer:QLQ-C30highest score57points, the lowest16points and overall quality of life was37.71±19.75minutes.(2) Influencing factors of quality of care in patients with advanced cancer①One-way analysis of variance found that marital status,the attitude of the doctors involved with the care of patients during hospitalization,the degree of compliance with doctors’ orders, ordered because of the degree of compliance during hospitalization,whether there are complications, satisfaction with medical care, disease duration (months), whether the patient informed,stage of disease, where the hospital level, per capita household income,disease,economic pressure, the main source of health care costs, the accepted psychological care situation during hospitalizations,medical care and information received during hospitalization, education level were positively correlated (p＜0.05) in patients with advanced cancer palliative care quality.②Multiple regression analysis showed that the variables of whether informed,the degree of compliance with doctors’ orders, the course, the per capita monthly income, economic pressure, psychological care,the location of care level were the main factor to affect the quality of palliative care in advanced cancer.3. Qualitative research results:Interviews collected data were analyzed, The results showed that factors were from policy management, the nurse’s own terms. Specifically, respectively:the lack of clear palliative care patients with advanced cancer access standards; lack of standardized operational policies and service guide; lack of palliative care for cancer quality assessment tools as well as standard; does not establish nurse suffering from advanced cancer palliative care knowledge and skills standardized training system; nurse shortage of human resources; professional with advanced cancer palliative care nursing service concept related to inadequate.Conclusion:Chinese version of the POS scale suitable for domestic cultural background level of quality cancer palliative care assessment, provide effective assessment tools for palliative care of cancer patients.The quality of life for patients with advanced cancer in test sites was poor, the overall quality of palliative care at the middle level.Thus it is imperative toenhance palliative care quality in patients with advanced cancer; to identified the main factors affecting the palliative care quality of patients with advanced cancer will help the clinical staff and associated policy departments develop targeted intervention measures to improve the quality of care for patients with advanced cancer levels, thereby enhancing their quality of life.

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