Effects of a Palliative Performance Scale–Based Home Palliative Care Model on Clinical Outcomes and Quality of Life among Patients with Advanced Cancer at Nakhon Phanom Hospital

Abstract

Palliative care at home or in the community is care aimed at alleviating disruptive symptoms (ESAS) such as pain, fatigue, and shortness of breath, increasing access to services, and enabling patients and their families to have the best possible quality of life.

Objective:

To compare clinical outcomes (PS, ESAS, and MO access), survival, and mortality between the new care model and the conventional care model.

Materials and Methods: This is a quasi-experimental research study using a two-group, non-random sampling design, comparing retrospective and prospective data  among 42 registered cancer palliative care patients receiving home visits under the Department of Community Nursing, Nakhon Phanom Hospital. Participants were divided into two groups: the standard care group (n = 21) with data collected retrospectively from July to December 2024, and the intervention group (n = 21) with data collected prospectively from January to June 2025. Outcome variables included Palliative Performance Scale (PPS), Pain Score (PS), and Edmonton Symptom Assessment System (ESAS) scores. General information was analyzed using descriptive statistics, including percentages, means, standard deviations/medians. Comparisons of care outcomes were analyzed using inferential statistics such as the t-test and Fisher's exact test. Potential confounders were adjusted using multivariable regression. Repeated monthly measures of PS, PPS, and ESAS were analyzed using multilevel regression, while patient survival days were analyzed using survival analysis.

Results: Baseline characteristics between the two groups showed no significant differences. The new home-visit model demonstrated improved quality of follow-up and symptom management, resulting in significantly reduced PS and ESAS scores, increased access to MO, longer survival days, and higher patient satisfaction. Mean PS scores were significantly lower in the intervention group (3.03 ± 1.52) than in the standard care group (3.87 ± 1.99; p = 0.009). Mean ESAS scores were also significantly lower (3.15 ± 2.04 vs. 4.00 ± 2.20; p=0.017). The mean number of morphine doses was higher in the intervention group (261 ± 239.50) than in standard care (151.82 ± 107.72), though not statistically significant (p = 0.098). Average survival days were significantly longer in the intervention group (123.53 ± 57.95) compared to standard care (79.05 ± 58.47; p < 0.001). Patient satisfaction scores significantly increased between the first and second follow-up (46.86 ± 1.80 vs. 48.81 ± 1.37; p < 0.001). Overall quality of life remained high but showed no significant difference between the two assessments (96.19 ± 7.81 vs. 94.95 ± 7.97; p = 0.437). Team satisfaction with the new home-visit model (n = 35) was also at the highest level (mean = 23.63 ± 2.06). Mortality rates were reduced in the intervention group when stratified by PPS levels, compared to the standard care model. The mortality rate for the new home visit group was 4.6/1,000 person-days, compared to the traditional home visit group's 10.2/1,000 person-days. The new home visit method reduced mortality by 0.44, or a 56% reduction, a statistically significant difference (p-value 0.030).

Conclusion: The study findings suggest that PPS-based home palliative care can  symptom management, significantly reduce PS and ESAS scores, increase access to morphine, prolong survival time, and lower mortality rates compared with the conventional home-visit model.