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The intervention of palliative love among terminal cancer patients

The intervention of palliative love among terminal cancer patients

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Problem Description: 

Facing death, anyone have experience. Family members of patients with advanced cancer in the face of loved ones dying stages of the lack of response capabilities.

The latest data show that in 2012 in Shanghai, Shanghai, 5.1 million new cancer patients each year; 3.2 million people died of cancer patients each year, a mortality rate of 238/10 million, or hospital beds open but can not meet the needs of patients with advanced cancer, so some the final stage of dying patients with advanced cancer can only be spent at home, and family members of patients and lack of care skills, the ability to soothe the mind, but powerless to face the death of their loved ones. The same year, the Shanghai government practical projects proposed in the city's districts and counties to select pilot community health service centers set soothing palliative care (hospice) Division, provides a combination of home and institutional palliative care services to relieve advanced cancer patients and their families.

The center as a soothing palliative care pilot units, began in October 2012 to provide palliative care services to relieve advanced cancer patients, while the death of the patient's family to provide education, training psychological support, human love, life care skills. Our team of 12 people through the formation, establishment soothing loving homes, provides a series of interventions for 60 cases of family members of patients with advanced cancer.

Solution: 

PSBH use of concepts and methods "to solve problems, promote health", the development of solutions to this problem.

Through the establishment of soothing loving homes, the research group of the check-Ying Bo community health centers to relieve families of patients with advanced cancer palliative care ward for a period from March to June of intervention, provide death education, training, psychological support, human love, life care skills, implement specific measures are as follows:

1, the group training, a clear division of labor

2, literature, interviews with family members, family members of patients to collect the most puzzling questions, questionnaire design disease-related knowledge. Including families in general, mental state, the concept of palliative care to relieve awareness, life care skills, physical symptoms care.

3. Subjects: Choose from January to November 2013 Check the Center soothing palliative care ward of advanced cancer families (primary caregiver) of 60 patients.

4. Inclusion criteria: ① cancer patients Karnofsky score (Karnofsky, KPS) score ≤70 points; their survival is expected within three months [3]; ② voluntarily with their families in this study; ③ families in junior high school education and above; ④ acceptance of the concept of palliative care to relieve their families.

5. Methods: soothing loving homes, family members of patients stay soothing palliative care wards caring homes with advanced cancer are soothing members. The families included in the study signed informed consent, a family information file on the spot to accept the baseline questionnaire. Use the survey results to develop a soothing loving home care program plan, provides a series of interventions, intervention time for six months.

(1) to carry out various forms of health education activities ○ 1 series of health education seminars held once a week, every 30 minutes. Content includes: soothing palliative care philosophy, gifted education dead tumor disease-related knowledge, skills and other life care. ○ 2 issued a brochure covers four areas of body, mind, social, spiritual, including palliative care ward soothing introduction, hospital procedures, soothing palliative care knowledge, inform the disease, daily care articles, symptom care articles and other content. ○ 3 soothing philosophy billboards show had Xinlingyizhan, human caring, excellent idea dead.

(2) life skills training to teach and care skills demonstration combining elements: prevention of pressure sores, mouth, skin cleansing, turning handling skills, feeding skills, such as effective expectoration.

(3) to provide personalized psychological counseling include: one to one, then talk, relaxation therapy, grief counseling.

(4) a caring home activities birthday wishes, golden wedding celebration, the Dragon Boat Festival to send warm smell scholarly month,

"Love and Respect" life education, a pro-joy parties, communities and other soothing auditorium.

(5) social support to build "a soothing love home" network platform, launched the site, QQ group, Sina microblogging column; cooperation with non-profit organizations, volunteers play advantage, interaction with domestic and foreign workers in life; to provide information support for family members of patients and emotional catharsis platform.

6, after the intervention of training questionnaire again.

7, collect data compilation and statistical analysis, writing papers.

Achievement: 

Family members of patients with advanced cancer disease related knowledge before and after the intervention in the families of patients with advanced cancer disease-related knowledge awareness of the four dimensions were significant differences (P <0.05) before and after 1. intervention. Table 1.

Table 1 family members of patients with advanced cancer disease-related knowledge before and after the intervention (n = 60)

维度             干预前       干预后         t                 P

Score                    Before              After   

舒缓疗护理念  26.73±3.51    47.95±4.12    -8.25      <0.01

Soothing palliative care attitudes

生活照顾技能  18.22±1.14    22.35±1.98    -6.85      <0.01

Daily care skills

躯体症状护理  20.76±1.34    27.24±1.21    -7.71      <0.01

Somatic symptoms care

心理状态      9.90±0.66     11.79±0.57    -2.35      <0.05

Psychological conndition

2. SAS scores before and after the intervention compared to patients with advanced cancer families before the intervention SAS positive 27 (45.0%), SAS positive rate of 16 (26.7%), there was a significant difference (p <0.01), Table 2 after the intervention.

Table 2 SAS scores before and after the intervention (n = 60, patients)

表2  干预前后SAS评分比较(n=60,例)

SAS

评分 Score

干预前 Before

47.78±7.31

干预后 After

41.35±6.08

t

-7.53

P

<0.01

 

SCSQ scores between families of patients with positive coping around 3. intervention to improve before the intervention by 21.32 ± 5.06 to 23.58 ± 4.21 after the intervention, negative coping decreased from 9.52 ± 3.76 before the intervention to 8.0l ± 4.04 after the intervention. Table 3

Table 3 SCSQ scores before and after the intervention (n = 60, patients)

应对方式

Way of Response

积极应对

Positive attitude

消极应对

Negative attitude

干预前 Before

21.32±5.06

9.52±3.76

干预后 After

23.58±4.21

8.0l±4.04

t

-8.91

9.37

P

<0.05

<0.05

4. "Love soothing home - home hospice services building goodwill of the community" project, won the 2013 Federation of Trade Unions, Pudong New Area, technological innovations "advanced operation of law" Finalist.

5. I have a teaching mentor, train, Pudong New Area community a suitable talent.

6. Write the subject related papers 4

1) published two. (1) to relieve a caring home for families of patients with advanced cancer community capacity to respond to the intervention, the magazine of the PLA care; (2) to relieve progress and thinking, Shanghai care of Medicine study.

2) soothing palliative care (hospice) International Bioethics Conference papers exchange one: the narrative perspective of exploring hospice medical ethical dilemmas, won the best paper award.

3) Shanghai Community Health Service Forum Congress exchange papers 1: Narrative Medicine Perspective Community Hospice Nurse Training explore new paths.

7. produced a series of health education soothing palliative care Handbook "dying patients at home - hospitalized Guide to Life," "Body Care" chapter, the "heart" chapter two, family members of patients to disseminate knowledge played a good role.

8. Shanghai television news channel integrated 1/7, Pudong TV, ICS Television, News, Pudong Times, the New People's Daily, Liberation Daily, public health reporting and many other news media coverage, more than 30 times, in Shanghai, the county leadership and palliative care to relieve fellow repeatedly visited the exchange of experiences to share.

9. soothing palliative care stems from the love and dedication, May 2014 Shanghai was "left England Care Award" nomination.

 

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