The Quality of Palliative Care from the Perspectives of the Elderly with Cancer at Firoozgar Hospital in 2019: A Cross-sectional Study

Abstract

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, noncooperation 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 . MS Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran . 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 . Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran D ow nl oa de d fr om ij n. iu m s. ac .ir a t 2 :2 8 IR S T o n S un da y N ov em be r 28 th 2 02 1 ناریا یراتسرپ هیرشن هرود 4 3 هرامش / 30 1 / ریت هام 400 1 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 (patientcentered 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.