Intervention group intervention measures
terminal cancer, death, anxiety, Pain, pain, depression
TUMOURS, DISEASE, TERMINAL CANCER
The patients in the intervention group received multidisciplinary collaborative team care combined with palliative care as follows:(1) Establish the multidisciplinary team. Team members were from multiple disciplines, mainly composed of clinicians, head nurses, and specialists in tumours, nutrition, rehabilitation, psychology and other areas. The whole team was led by case managers. Team division was as follows: The attending physician was mainly responsible for palliative treatment and symptom control of patients. The head nurse mainly managed the whole nursing team, supervised the implementation of the programme and was responsible for the nursing quality of the whole team. The case manager was mainly responsible for team coordination and arranging meetings to evaluate nursing work. The nurse team developed detailed programmes according to the arrangements of the head nurse, participated in meetings in a timely manner and guided clinical nursing work. Psychologists provided training on psychological counselling to nurses and supervised and guided nurses to carry out psychological support interventions once a week. The doctors and nurses participating in this study received training from nutrition experts, medical experts and psychologists to improve the implementation quality of the intervention measures.(2) Evaluate the condition and make nursing plans. The medical experts evaluated the patients’ expected survival period and determined that the patients could enter the stage of palliative care. The case manager conducted a comprehensive assessment of the patients. After the assessments were completed, the results were sent to other team members. The other members of the team completed the specialist assessment within 24 h, and the first multidisciplinary consultation was conducted within 48 h to jointly develop the diagnosis and treatment plan. The medical experts provided guidance and consultation for the implementation of the nursing plan and inspected the ward once a week to find and correct the errors.(3) Specific measures of the nursing programme.① Health education: After teamwork to develop personalised education programmes, doctors and nurses carried out specific operations to strengthen patients’ cognition in a way and frequency that patients could accept. Doctors carried out health education for patients to avoid patients giving up their lives, encouraged them to actively cooperate with medical staff, and instructed patients on how to face the disease with a brave and strong attitude and actively fight the disease. Nurses conducted daily psychological counselling for patients, learnt their inner thoughts through communication with patients, and provided timely comfort and encouragement. An attention-shifting method can be used to alleviate the patient’s attention to the disease, effectively improving internal depression and avoiding depression. For patients with anxiety and loneliness, family members were instructed to accompany and care.② Comfort care: For patients with terminal cancer in the ward for a long time, nurses should do their ward nursing work to ensure that patients are in a comfortable state. Reasonable control of indoor temperature and humidity is necessary to ensure that warm, light conditions permit properly dressed patients to feel warm. Nurses need to ensure that patients are kept clean and tidy in personal hygiene. They would regularly assist patients in turning over while giving patients sufficient respect.③ Pain care: Physical pain will directly affect the patient’s physical and mental state. In order to alleviate the patient’s physical pain, it is necessary to give patients pain care. Clinicians should regularly evaluate the patient’s physical pain and give reasonable analgesic drugs to patients. Nurses should closely observe the medication response of patients. At the same time, it is necessary to observe and record patients’ physical pain daily and take effective pain control measures according to the actual situation to lay the foundation for improving patients’ comfort [④ Dietary care: The clinical nutritionist formulated appropriate nutritional diets according to the nutritional status and personal preferences of patients, provided nutritional support for patients, and followed up with patients once a week after discharge to improve their nutritional status.⑤ Psychological and social support care: Two nurses with psychological counselling qualifications in the team used the anxiety and depression scale to evaluate the psychological and emotional status of patients and referred to “The Questionnaire Survey on Awareness of Palliative Care” by the Department of Elderly Section of the union medical college hospital. The content mainly included the patient’s medical history and general situation, the needs and awareness of patients and their families for palliative care, the choice of patients and their families for the final treatment plan, and the needs of families for grief counselling. This was done to educate the patients and their families on the acceptance of death, coping ability, the assessment of patients on dying, and any future concerns. Timely professional counselling and intervention were undertaken to alleviate the patient’s adverse emotions. Family members were encouraged to involve themselves in the whole process, appreciate the good things and the most desirable people in the group, provide strong social support, comply with the wishes of the patients in the whole process, and strive to help the patients with their unfinished wishes so they could spend their final journey in peace. Patients were provided with goodbyes, thanks, apologies, and love opportunities to meet the emotional needs of patients and their families and comfort them.⑥ Effect evaluation: The executors of the above care measures should do thorough periodic evaluations and feedback, and the case managers should pay attention to the problems in the care process and how to resolve them. The intervention of this study was from the patient’s admission to the hospital until the patient’s death. During this period, data collection (scale score) was conducted every other month, and the final data included in the analysis was the last score before the death of the patient. After the death of the patient, the family members were given psychological counselling for half a year.