Research On The Service Status And Shared Care Mode Of Tumor Palliative Care

[Objective]At present,China is in the environment of high incidence and mortality of tumor,there is huge demand in palliative care from Chinese tumor patients with end-stage,but the existing resources in palliative care are scarce and the limited resources are not used in a standard rule.It results in low service quality of palliative care,and many patients do not receive good care at the end of life.This study aims to investigate the service status of different medical institutions,clarify the obstacles and influencing factors existing in the development of palliative care,and to put forward suggestions and countermeasures to promote the palliative care service of tumor patients in the medical alliance.This study can improve palliative care services in Nanjing and improve the quality of life of palliative care patients with cancer,we will provide reference for other medical institutions to standardize the development of palliative care services,and provide reference for the future exploration of palliative care service model in Nanjing.[Methods]First,we used the method of qualitative research,through the phenomenological interviewing to interviewed 32 doctors,nurses,medical and nursing managers in 27 medical institutions in Nanjing.We used content analysis method to summarize the status quo,the practice content,and the influencing factors of palliative care;Second,we used the method of quantitative research,based on the qualitative research and expert advice,we designed a questionnaire and analyzed the reliability of the questionnaire.Through the questionnaire survey method to understand the cognition of the assessment and management of the palliative care symptoms of 220 medical staffs from 27 medical institutions in Nanjing.[Result]1.Through the phenomenological interviewing,we summarized and extracted 3 first grade themes,including 12 second grade themes:(1)The status of palliative care:Status of the tumor palliative treatment beds;Status of tumor palliative care team;Status of the admission and exit of patients with tumor palliative care;(2)The contents of tumor palliative care services:Provide basic supportive symptom management services;Focus on psychological support and spiritual needs;Provide free home palliative care and community nurse traing sevices.(3)The deficiencies and obstacles in palliative care:Doctors had insufficient knowledge of palliative care;There were limited human resources and limited energies in nurses;Patients and their families lacked life and death education and the concept of palliative care;The beds in the department were tight and the utilization rate was high;The medical facilities were lacked,and the analgesic drugs were insufficient;There exist a problem of charging for palliative care,and there were no policy and institutional guarantee.2.Through questionnaire survey,we understood the cognition of the medical staff in the assessment and remission of symptoms of palliative care,it is concluded that:(1)55%of the medical staff have received theoretical training in palliative care,31.4%of medical staff have received practical training in palliative care;93.6%of the medical staff understood the pain assessment tools,64.5%of the medical staff understood the dyspnea assessment tools.(2)The medical staff can well master the evaluation and management of the symptoms in palliative care;The highest score of the questionnaire is 40,the lowest score is 9,and the average score is 34.7±6.09.(3)In terms of the evaluation of symptoms,more than 80%of the medical staff can evaluate the symptoms,but only 61.8%medical staff can evaluate the occurrence time,the onset and remission,and medication of dyspnea,and only 69.1%medical staff can evaluate the drug and environmental factors of delirium.(4)In terms of the management of symptoms,more than 80%medical staff can find the causes of symptoms and conduct targeted management,but there are still deficiencies in the management of symptoms such as delirium,dry mouth,hemoptysis,abdominal distension,hematemesis and hematochezia.(5)There was no significant difference in the self-assessment scores between medical staff who received and did not receive palliative care training;There was no significant difference in the self-assessment scores between the medical staff of tertiary hospitals and those of hospitals below tertiary level;There was no significant difference in the self-assessment scores between the medical staff of secondary hospitals and those of hospitals below secondary level.[Conclusion]At present,the palliative care was still in the exploratory stage in Nanjing area,there were still many shortcomings and obstacles,including standardized training of tumor palliative care should to be strengthened,resources of tumor palliative care should to be rational allocated and the symptom management of tumor palliative care should be attentioned and so on.But the overall cognition of palliative care symptoms assessment and remission of medical staff is good,and there is no significant difference between hospitals of different grades,to explore the shared care of tumor palliative care is helpful to alleviate the problems of poor palliative care resources,unreasonable resource allocation and low quality of palliative care.In the future,we can improve policies and regulations,and increasing system security;Improving the value of nursing and multi-disciplinary teams;Defining the division of responsibilities,and exploring the referral mechanism;Actively carrying out training,strengthen medical education;Strengthening life education,and enhancing the awareness of palliative care;Improving payment mechanisms,strengthening financial support and other aspects to enhance the palliative care services,in order to promote the healthy development of hospice care industry and improve the quality of tumor palliative care patients’life.