Development of Home based Palliative Care Program for Patients with Cancer: A Action Research Study

Abstract

Abstract Introduction: Cancer is perceived as one of the greatest global health challenges in the 21st century. To overcome this challenge, it is necessary to employ comprehensive care. It should be noted that, the World Health Organization (WHO) has identified palliative care as a way to improve quality of life of patients with incurable diseases and their relatives.

Methods: The current survey was carried out by using participatory action research (PAR) approach and also according to O'Leary's model (observation, rethinking, planning, and action). First, in the data observation stage, the data were collected by taking advantage of two quantitative methods (the measurement of attitude and knowledge of home-based palliative care) using a special questionnaire for home care nurses as well as a qualitative approach (individual interview with 23 nurses about barriers to home-based palliative care and care needs of home-based patients receiving treatment for cancer). Quantitative data analysis determined the level of both knowledge of and attitude toward palliative care at home. It is worth mentioning that qualitative data were analyzed by conventional content analysis method. Moreover, barriers to home‐based care and needs for cancer patients were identified according to the analysis of qualitative data and in the end, these data were used to develop a palliative care program at home. Following that, in the rethinking phase, the data were analyzed and an evaluation was carried out to develop a palliative care. Next, in the planning stage, the way the nurses were going to be trained to develop a palliative care program at home was determined. Training was conducted through face-to-face interviews and a Telegram channel for six months. After that, evaluation was performed following the interventions in a quantitative manner (surveying nurses' attitudes and knowledge and patients' quality of life through a questionnaire) and finally, nurses' opinions were collected through the Telegram channel to determine the level of the achievement of aims and objectives.

Results: quantitative findings before the implementation of strategies (action) revealed that nurses have a moderate to low knowledge of as well as a poor attitude toward home-based palliative care. Attitude score and knowledge score in home-based end-of-life care both were lower than those in other areas. Analysis of qualitative findings of barriers to palliative care led to the extraction of three main categories of barriers, namely instructional deficiencies, family desperation, and the lack of professional caregivers. Analysis of home care needs data led to the extraction of four major categories including physical, psychological, educational and financial needs. In the planning stage, the home-based palliative care program was prepared according to quantitative and qualitative findings, and in the action phase, the nurses were provided with palliative care training for patients with cancer. Quantitative findings after the action phase (evaluation or reflection) showed that the mean scores of attitude and knowledge have enhanced significantly compared with those before implementing the program.

Conclusion: The results showed that in order to develop a palliative care program at home, identifying barriers to palliative care at home and patients 'care needs is helpful, and in this regard, nurses can be educated about familiarity with patients' care needs. In the field of management, to remove barriers to palliative care, Made the necessary plans.