The Development of Discharge Planning Model for End-Stage Cancer Patient
Keywords:discharge planning, Orem’s self-care theory, palliative care, end-stage cancer patient
Introduction: End-stage cancer patients require complex care. Based on the literature review, no studies related to a discharge planning model focusing on capacity development in patients and caregivers’ self-care were found. It is important to promote quality of life in the end-stage of patients. Research Objectives: To develop and examine the effects of using the discharge planning model for end-stage cancer patients on nursing outcomes. Research Methodology: This study was a research and development conducted at Maharat Nakhon Ratchasima Hospital during August 2019 and February 2021. It comprised three phases: 1) studying the situation, 2) developing the discharge planning model for end-stage cancer patients with a multidisciplinary team applying Orem’s self-care theory, and 3) examining the effects of using the developed model on nursing outcomes. The samples were a nine-health care provider multidisciplinary team that developed this model, 25 end-stage cancer patients each for intervention and control groups, and 25 caregivers each for intervention and control groups. Data were collected using the nursing outcomes evaluation form, and observational form. Next, data were analyzed using descriptive statistics, t-test, fisher’s exact test, and content analysis. Results: The discharge planning model comprises specialized nursing competencies, discharge planning guidelines, and nursing supervision. The results of using this model found that the patient’s self-care agency, quality of life, and success in managing symptom disturbances, as well as caregiver’s dependent care agency of intervention groups were statistically significantly higher than control groups at <.001, .002, .011, and <.001, respectively. However, complication and re-admission occurrences between intervention and control groups were not different. Conclusion: This discharge planning model can promote the patient’s self-care agency, symptom disturbance management, and quality of life, as well as the caregiver’s dependent care agency. Implications: Nurses should apply this developed discharge planning model to promote their continuing care and good nursing outcomes.
WHO. Cancer [Internet]. 2018 [cited 2019 Feb10]. Available from: https://www.who.int/cancer/PRGlobocanFin al.pdf
Stewart B, Chistopher PW. Rising burden of cancer: World cancer report [Internet]. 2014 [cited 2019 December 15]. Available from: http://www.ias.org.uk/
Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, et al. Global cancer observatory: cancer today. Lyon, France: International Agency for Research on Cancer [Internet]. 2020 [cited 2021 April 4].Available from: https://gco.iarc.fr/today
Strategy and Planning Division, Ministry of Public Health. Public health statistics A.D. [Internet]. 2019 [cited 2021 April 4]. Available from: https://bps.moph.go.th/new_bps/sites/default/files/statistic62.pdf. (in Thai)
Pasri P, Isaramalai S, Hattakit U. Family caregivers’ support needs in caring for end-stage cancer patients. Songklanagarind Journal of Nursing 2015;35(2):79-92.
Cheewasakulyong B, Sapinun L. Palliative Performance Scale for adult Suandok (PPS adult Suandok). In: Cheewasakulyong B, Somwangprasert A, Chiraniramai S, Maneetorn B, Leehapun T, Mahaprom C, et al., editors. Palliative care. Chiang Mai: Klangweang; 2013. P.35-45. (in Thai)
The discharge planning and palliative care center, Maharat Nakhon Ratchasima Hospital. Palliative care report 2017-2019. Nakhon Ratchasima; 2020. (in Thai)
Casotto V, Rolfini M, Ferroni E, Savioli V, Gennaro N, Avossa F, et al. End-of-life place of care, health care settings, and health care transitions among cancer patients: impact of an integrated cancer palliative care plan. J Pain Symptom Manage 2017;54(2):167-75.
Bužgová R, Jarošová D, Hajnová E. Assessing anxiety and depression with respect to the quality of life in cancer in patients receiving palliative care. Eur J Oncol Nurs 2015;19(6):667-72.
Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 2013;18(4):381-90.
Phadungsri P, Ladla A. Development of care model for patients with end stage of cancer: from hospital to home Ubonrat hospital, Khon-Kaen province. Journal of Nursing and Healthcare 2019;37(2):199-207. (in Thai)
Wisesrith W, Soonthornchaiya R, Sukcharoen P. Development and preliminary testing of the spiritual care need assessment scale for end of life patients in Thai cultural context. Journal of Boromarajonani College of Nursing, Bangkok 2019;35(1):163-74. (in Thai)
Jullapan P, Manastachakun P, Sudsa S. Relatives’ lived experience of caring for the terminal stage of older patients to achieve a peaceful death. Journal of Health and Nursing Research 2020;36(3):33-44. (in Thai)
Phengjard J. Nurse’s role in palliative care. Journal of Boromarajonani College of Nursing, Bangkok 2014;30(1):100-9. (in Thai)
Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end of life care in cancer patients. Cancer 2014;120(11):1743-49.
Global atlas of palliative care at the end of life. Worldwide Palliative Care Alliance [Internet]. 2014 [cited 2020 January 15]. Available from: https://www. who.int/nmh/Global_ Atlas_of_ Palliative_Care.pdf
Panich N. Lean with discharge planning model and discharge plan [Internet]. 2014 [cited 2020 January 10]. Available from: http://220.127.116.11/km/admin/new/070919_133635.pdf. (in Thai)
Fabie J, Walker K, Pharm D, Kearney C. The power of a plan: the impact of palliative care decisions at hospital discharge on readmission rates (S730) JPSM 2016;51(2):e 423.
Bond A, Teubner A, Taylor M, Willbraham M, Gillespie L, Farrer K, et al. A novel discharge pathway for patients with advanced cancer requiring home parenteral nutrition. J Hum Nutr Diet 2019;32(4):492-500.
Orem DE. Nursing concepts of practice. 6th ed. St. Louis: Mosby; 2001.
Kemmis S, McTaggart R. The action research planner. 3rd ed. Geelong, Australia: Deakin University Press; 1988.
Chirawatkul A. Statistics for health science research. Bangkok: Withayapat; 2010. (in Thai)
Evers GCM, et al. The appraisal of self-care agency scale. Assen/ Maastricht: Van Gorcum & Comp; 1985.
Denyes MJ. Development of an instrument to measure self-care agency in adolescents [doctoral's dissertation]. Michigan: The University of Michigan; 1980.
Ratanatharathorn V, Sirilerttrakul S, Jirajarus M, Silpakit C, Maneechavakajom J, Sailamai P, et al. Quality of life, functional assessment of cancer therapy- general. Journal of Medical Association of Thailand 2001;84(10):1430-42.
Sansom N, Thanasil S. Selected factors related to terminal cancer patients. Journal of Nursing Science Chulalongkorn University 2010;22(Sup 2):42-53. (in Thai).
Yawichaipong R. Let’s go home [Internet]. 2020 [cited 2020 January 10]. Available from: https://www.rama.mahidol.ac.th/km/sites/default/files/public/qc/pdf/52.Let%E2%80%99s%20go%20 home.pdf. (in Thai)
Rongmuang D, Nakchattree C, Thongphet P. Palliative and end-of-life care competencies among registered nurses in regional health 11. Journal of The Royal Thai Army Nurses 2018;19(Supplement): 412-22. (in Thai)
Hökkä M, Pereira SM, Pölkki T, Kyngäs H, Hernández-Marrero P. Nursing competencies across different levels of palliative care provision: a systematic integrative review with thematic synthesis. Palliat Med 2020;34(7):851-70.
DiMartino LD, Weiner BJ, Hanson LC, Weinberger M, Birken SA, Reeder-Hayes K, et al. Inpatient palliative care consultation and 30-day readmissions in oncology. J Palliat Med 2018;21(1):62-8.
How to Cite
Article published Is the copyright of the Journal of Health and Nursing Research (Boromarajonani College of Nursing, Bangkok) Cannot be republished in other journals