Volume 34, Issue 130 (July 2021)
IJN 2021, 34(130): 59-72 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Farzadnia F, Bastani F, Haghani H. The Quality of Palliative Care from the Perspectives of the Elderly with Cancer at Firoozgar Hospital in 2019: A Cross-sectional Study. IJN 2021; 34 (130) :59-72
URL: http://ijn.iums.ac.ir/article-1-3438-en.html
URL: http://ijn.iums.ac.ir/article-1-3438-en.html
1- MS Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. (Corresponding author) Tel: 02143651820 Email: bastani.f@iums.ac.ir
3- Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
2- Department of Community Health Nursing and Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran. (Corresponding author) Tel: 02143651820 Email: bastani.f@iums.ac.ir
3- Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
Abstract: (2037 Views)
Background & Aims: Along with the growth of the aging population, there are several challenges for this population group as well as for caregivers and health policymakers. One of the most important challenges is the increase in care needs due to the increased suffering of the elderly from chronic and malignant diseases and disabilities. Therefore, due to the high prevalence of cancer and also the growth of the aging population, palliative care appears to be one of the important priorities of the health system. Palliative care has been identified as an important and ongoing part of cancer care. Palliative care is an approach that improves the quality of life of the patient and his family in the face of problems related to life-limiting diseases by preventing the patient's suffering and improving the patient's symptoms and other physical, mental, spiritual, and social problems. In fact, palliative care alleviates the disease-related pain and its effects on the patient and her family from the diagnosis of the disease to the control of pain and other symptoms. Studies have shown that there is a significant relationship between palliative care received and the quality of life in patients with chronic diseases such as cancer. Quality of life is also a multidimensional concept and nurses have an important role in improving the quality of services and care by considering the physical, mental, spiritual, religious, cultural, and social aspects of the patients. Therefore, it is necessary to first investigate the existing conditions and the quality of palliative care in the health centers and then take effective measures to improve them. Therefore, this study was conducted to determine the quality of palliative care from the perspectives of the elderly with cancer admitted to Firoozgar Educational and Medical Center in 2019.
Materials & Methods: This was a cross-sectional study. A total of 123 elderly patients with cancer admitted to Firoozgar Hospital in 2019 (November to January 2019) were selected through continuous sampling procedure. Inclusion criteria were informed consent to participate in the study, no cognitive impairment (a minimum score of 7 out of 10 based on AMT test) in the elderly, the ability to communicate and answer the items of the questionnaire, no known mental illness (based on the patient's medical record), confirmed cancer (according to the medical diagnosis and medical record). The exclusion criteria were no consent to participate in the study, non-cooperation in each stage of completing the questionnaire (AMT, demographic form, palliative care quality tools). Data collection tools included the short-form anxiety management training (AMT) to analyze the elderlies' mental health status and cognitive system, demographic form, and quality end of life questionnaire (QEOLC-10) which were completed through face-to-face interviews with the samples. The palliative care quality questionnaire assesses the quality of palliative care provided from the perspectives of patients with chronic diseases. This questionnaire includes 10 items with different dimensions of staff communication skills, patient-centered care system, symptom reduction management, staff emotional skills, and care based on patient values which are rated on an 11-point scale (range: 0-10). Data were analyzed using descriptive and inferential statistics such as independent t-test and ANOVA using SPSS Software version 16 at the significance level of P≤0.05.
Results: The mean age of the elderlies was 65.55 ± 4.12 years. The highest frequency was related to the age group of 60-64 years, which shows that the subjects were classified as young-old. Among them, 76 (61.8%) cases were male and 47 (38.2%) were female. Almost all samples in these studies were married (95.9%), retired and unemployed elderly had the highest frequency with (47.2%) and (41.5%), respectively. More than half of the study samples, about (56.9%), had a history of hospitalization, among which (47.1%) declared that they were hospitalized for one to two weeks and (48%) of the elderly were suffering from gastrointestinal cancer, which was more common than other types of cancer. In this study, the quality of palliative care in various dimensions (patient-centered care system, personnel communication skills, symptom reduction management, personnel emotional skills, patient values) was at the desired level. (54.5%) of the elderly reported the quality of palliative care to be desirable. The mean and standard deviation of palliative care quality was 65.55 ± 4.12. In all dimensions of quality of care, the two variables of the current hospitalization period (P=0.012) and nursing skills (P<0.001) had the most statistically significant relationship with the quality of palliative care. The quality of palliative care in pain management had a statistically significant relationship with gender (p = 0.047), current hospitalization period (P=0.015), and nurses' skills (P<0.001), which was significantly higher in men than women, and had the highest frequency during 3-4 days of hospitalization, and nursing skills had a significant role in all the aspects.
Conclusion: In general, the results of this study showed that relief from physical, psychosocial, social, and spiritual problems through palliative care is possible for more than 90% of patients at the advanced stages of cancer. Palliative care to treat and alleviate the cancer-related symptoms and improve the quality of life of patients and their families can help people live more comfortably. It is especially true in places where there is a large number of patients with advanced cancer and there is little chance of treatment. In this study, the quality of palliative care from the perspective of the studied elderly was rated as desired, which is one of the reasons for providing such services in the special palliative care ward of Firoozgar Medical Center with experienced and trained caregivers. However, the main problem of the nursing system in Iran regarding palliative care for patients with cancer is that this type of care does not have a specific framework for nurses and is not seriously included in the formal curriculum.
Materials & Methods: This was a cross-sectional study. A total of 123 elderly patients with cancer admitted to Firoozgar Hospital in 2019 (November to January 2019) were selected through continuous sampling procedure. Inclusion criteria were informed consent to participate in the study, no cognitive impairment (a minimum score of 7 out of 10 based on AMT test) in the elderly, the ability to communicate and answer the items of the questionnaire, no known mental illness (based on the patient's medical record), confirmed cancer (according to the medical diagnosis and medical record). The exclusion criteria were no consent to participate in the study, non-cooperation in each stage of completing the questionnaire (AMT, demographic form, palliative care quality tools). Data collection tools included the short-form anxiety management training (AMT) to analyze the elderlies' mental health status and cognitive system, demographic form, and quality end of life questionnaire (QEOLC-10) which were completed through face-to-face interviews with the samples. The palliative care quality questionnaire assesses the quality of palliative care provided from the perspectives of patients with chronic diseases. This questionnaire includes 10 items with different dimensions of staff communication skills, patient-centered care system, symptom reduction management, staff emotional skills, and care based on patient values which are rated on an 11-point scale (range: 0-10). Data were analyzed using descriptive and inferential statistics such as independent t-test and ANOVA using SPSS Software version 16 at the significance level of P≤0.05.
Results: The mean age of the elderlies was 65.55 ± 4.12 years. The highest frequency was related to the age group of 60-64 years, which shows that the subjects were classified as young-old. Among them, 76 (61.8%) cases were male and 47 (38.2%) were female. Almost all samples in these studies were married (95.9%), retired and unemployed elderly had the highest frequency with (47.2%) and (41.5%), respectively. More than half of the study samples, about (56.9%), had a history of hospitalization, among which (47.1%) declared that they were hospitalized for one to two weeks and (48%) of the elderly were suffering from gastrointestinal cancer, which was more common than other types of cancer. In this study, the quality of palliative care in various dimensions (patient-centered care system, personnel communication skills, symptom reduction management, personnel emotional skills, patient values) was at the desired level. (54.5%) of the elderly reported the quality of palliative care to be desirable. The mean and standard deviation of palliative care quality was 65.55 ± 4.12. In all dimensions of quality of care, the two variables of the current hospitalization period (P=0.012) and nursing skills (P<0.001) had the most statistically significant relationship with the quality of palliative care. The quality of palliative care in pain management had a statistically significant relationship with gender (p = 0.047), current hospitalization period (P=0.015), and nurses' skills (P<0.001), which was significantly higher in men than women, and had the highest frequency during 3-4 days of hospitalization, and nursing skills had a significant role in all the aspects.
Conclusion: In general, the results of this study showed that relief from physical, psychosocial, social, and spiritual problems through palliative care is possible for more than 90% of patients at the advanced stages of cancer. Palliative care to treat and alleviate the cancer-related symptoms and improve the quality of life of patients and their families can help people live more comfortably. It is especially true in places where there is a large number of patients with advanced cancer and there is little chance of treatment. In this study, the quality of palliative care from the perspective of the studied elderly was rated as desired, which is one of the reasons for providing such services in the special palliative care ward of Firoozgar Medical Center with experienced and trained caregivers. However, the main problem of the nursing system in Iran regarding palliative care for patients with cancer is that this type of care does not have a specific framework for nurses and is not seriously included in the formal curriculum.
Type of Study: Research |
Subject:
nursing
Received: 2021/03/15 | Accepted: 2021/06/16 | Published: 2021/06/16
Received: 2021/03/15 | Accepted: 2021/06/16 | Published: 2021/06/16
References
1. World Health Organization. Latest global cancer data: Cancer burden rises to 18.1 million new cases and 9.6 million cancer deaths in 2018. International Agency for Research on Cancer. Geneva: World Health Organization. 2018 Sep 12.
2. Sharifzadeh G, Moodi M, Akhbari H. Investigating health status of older people supported by Imam. Iranian journal of ageing. 2010;5(3):52-9.
3. Mirzaei M, Shams Ghahfarokhi M. Demography of elder population in Iran over the period 1956 To 2006. Iranian Journal of Ageing. 2007;2(3):326-31.
4. DiIorio CK. Measurement in health behavior: methods for research and evaluation. John Wiley & Sons; 2006 Mar 6.
5. World Health Organization. Cancer WHO; 2021 [updated 3 March 2021- 2021.
6. Weinberger MI, Bruce ML, Roth AJ, Breitbart W, Nelson CJ. Depression and barriers to mental health care in older cancer patients. Int J Geriat Psych. 2011;26(1):21-6. [DOI:10.1002/gps.2497] [PMID] [PMCID]
7. Cinar D, Tas D. Cancer in the elderly. Northern clinics of Istanbul. 2015;2(1):73. [DOI:10.14744/nci.2015.72691] [PMID] [PMCID]
8. De Martel C, Ferlay J, Franceschi S, Vignat J, Bray F, Forman D, Plummer M. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. The lancet oncology. 2012;13(6):607-15. [DOI:10.1016/S1470-2045(12)70137-7]
9. Barbera L, Paszat L, Charter C. Indicators of poor quality end-of-life cancer care in Ontario. J Palliat Care. 2006;22(1):12-7. [DOI:10.1177/082585970602200103] [PMID]
10. Agar M, Currow DC, Shelby-James TM, Plummer J, Sanderson C, Abernethy AP. Preference for place of care and place of death in palliative care: are these different questions?. Palliative medicine. 2008;22(7):787-95. [DOI:10.1177/0269216308092287] [PMID]
11. Graphic PC. Dying in America: Improving quality and honoring individual preferences near the end of life. 2014.
12. Twycross RG. Introducing palliative care. Radcliffe Publishing; 2003.
13. World Health Organization. Ageing and health: WHO; 2018.
14. Nouhi E, Jahani Y. The study of palliative care and its relationship with quality of life in patients with chronic heart failure. in 2014-2015. Journal of Clinical Nursing and Midwifery. 2017;5(4):35-46.
15. Kartika IR, Hariyati TS. Nelwati. Nurses-patients interaction model and outpatients' satisfaction on nursing care. Nurse Care Open Acces J. 2018;5(2):70-6. [DOI:10.15406/ncoaj.2018.05.00123]
16. Engelberg RA, Downey L, Wenrich MD, Carline JD, Silvestri GA, Dotolo D, Nielsen EL, Curtis JR. Measuring the quality of end-of-life care. J Pain Symptom Manage. 2010;39(6):951-71. [DOI:10.1016/j.jpainsymman.2009.11.313] [PMID]
17. Gholjeh M, Dastoorpour M, Ghasemi A. The relationship between nursing care quality and patients satisfaction among hospitals affiliated to Zahedan University of medical sciences in 2014. Jorjani Biomedicine Journal. 2015;3(1):68-81.
18. Nazari B, Bakhshi S, Kaboudi M, Dehghan F, Ziapour A, Montazeri N. A comparison of quality of life, anxiety and depression in children with cancer and healthy children, Kermanshah-Iran. International Journal of Pediatrics. 2017;5(7):5305-14.
19. Abdel Maqsood AS, Oweis AI, Hasna FS. Differences between patients' expectations and satisfaction with nursing care in a private hospital in Jordan. Int J Nurs Pract. 2012;18(2):140-6. [DOI:10.1111/j.1440-172X.2012.02008.x] [PMID]
20. Al-Awamreh K, Suliman M. Patients' satisfaction with the quality of nursing care in thalassemia units. Appl Nurs Res. 2019;47:46-51. [DOI:10.1016/j.apnr.2019.05.007] [PMID]
21. Schroeder K, Lorenz K. Nursing and the future of palliative care. Asia-Pacific J Oncol Nurs. 2018;5(1):4-8
22. Altaker KW, Howie-Esquivel J, Cataldo JK. Relationships among palliative care, ethical climate, empowerment, and moral distress in intensive care unit nurses. Am J Crit Care. 2018;27(4):295-302. [DOI:10.4037/ajcc2018252] [PMID]
23. Arnold EC, Boggs KU. Interpersonal relationships e-book: professional communication skills for nurses. Elsevier Health Sciences; 2019 Feb 2.
24. Evangelista LS, Lombardo D, Malik S, Ballard-Hernandez J, Motie M, Liao S. Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure. J Cardiac Failure. 2012;18(12):894-9. [DOI:10.1016/j.cardfail.2012.10.019] [PMID] [PMCID]
25. Van Lancker A, Velghe A, Van Hecke A, Verbrugghe M, Van Den Noortgate N, Grypdonck M, Verhaeghe S, Bekkering G, Beeckman D. Prevalence of symptoms in older cancer patients receiving palliative care: a systematic review and meta-analysis. J pain symptom manag. 2014;47(1):90-104. [DOI:10.1016/j.jpainsymman.2013.02.016] [PMID]
26. Rassouli M, Sajjadi M. Palliative care in the Islamic Republic of Iran. Palliative care to the cancer patient: The Middle East as a model for emerging countries. New York: Nova Scientific Publisher. 2014:39.
27. Ghazimirsaeed SJ, Moghimkhan F. Information Behavior of Patients with Cancer in Palliative Care in Tehran City, Iran. Health Information Management. 2018;15(3):120-5.
28. Valizadeh L, Zamanzadeh V, Rahmani A, Howard F, Nikanfar AR, Ferguson C. Cancer disclosure: Experiences of Iranian cancer patients. Nursing & health sciences. 2012;14(2):250-6. [DOI:10.1111/j.1442-2018.2012.00686.x] [PMID]
29. Jacobsen R, Møldrup C, Christrup L, Sjøgren P, Hansen OB. Psychological and behavioural predictors of pain management outcomes in patients with cancer. Scand J Caring Sci. 2010;24(4):781-90. [DOI:10.1111/j.1471-6712.2010.00776.x] [PMID]
30. Money S, Garber B. Management of cancer pain. Curr Emerg Hospital Medic Reports. 2018;6(4):141-6. [DOI:10.1007/s40138-018-0170-9]
31. Jones R, Regan M, Ristevski E, Breen S. Patients' perception of communication with clinicians during screening and discussion of cancer supportive care needs. Patient education and counseling. 2011;85(3):e209-15. [DOI:10.1016/j.pec.2010.12.006] [PMID]
32. Ferrell BR, Twaddle ML, Melnick A, Meier DE. National consensus project clinical practice guidelines for quality palliative care guidelines. J Palliat Medic. 2018;21(12):1684-9. [DOI:10.1089/jpm.2018.0431] [PMID]
33. Wachterman MW, Pilver C, Smith D, Ersek M, Lipsitz SR, Keating NL. Quality of end-of-life care provided to patients with different serious illnesses. JAMA internal medicine. 2016;176(8):1095-102. [DOI:10.1001/jamainternmed.2016.1200] [PMID] [PMCID]
34. Kartika IR, Hariyati TS. Nelwati. Nurses-patients interaction model and outpatients' satisfaction on nursing care. Nurse Care Open Acces J. 2018;5(2):70-6. [DOI:10.15406/ncoaj.2018.05.00123]
35. da Silva Soares D, Nunes CM, Gomes B. Effectiveness of emergency department based palliative Care for Adults with advanced disease: a systematic review. J Palliat Medic. 2016;19(6):601-9. [DOI:10.1089/jpm.2015.0369] [PMID] [PMCID]
36. Sanford MT, Greene KL, Carroll PR. The argument for palliative care in prostate cancer. Translational andrology and urology. 2013;2(4):278-80.
37. Huynh L, Moore J. Palliative and end-of-life care for the older adult with cancer. Current Opinion in Supportive and Palliative Care. 2021;15(1):23-8. [DOI:10.1097/SPC.0000000000000541] [PMID]
38. Taghdisi MH, Doshmangir P, Dehdari T, Doshmangir L. Influencing Factors on Healthy Lifestyle From Viewpoint of Ederly People: Qualitative Study. Iranian Journal of Ageing. 2013;7(4):47-58.
| Rights and permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
Copyright © The Author(s);
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
Contact Information
