Development of Palliative Care System for Terminally Ill Patients, Phra Phrom District Health Service Network, Nakhon Si Thammarat Province

Abstract

This study is a research and development project with the objective of developing a system for palliative care for terminally ill patients. The research was conducted in three phases as follows: 1) Study the situation, problems, and needs 2) Develop the care system and 3) Evaluate the effectiveness of the system. The sample group consisted of professional nurses, multidisciplinary team members, and caregivers of terminally ill patients. The instruments used included questionnaires, focus group discussion questions, the 2S-PH Center system, and secondary documents. The questionnaire was validated by three experts, yielding an IOC (Index of Item-Objective Congruence) ranging from 0.67 to 1.00. The satisfaction questionnaire and outcome evaluation form had reliability coefficients of 0.90 and 0.81, respectively. The statistical methods used included descriptive statistics, One-sample t-test, and Wilcoxon Signed Ranks Test.

          The research findings revealed that: 1) From 2022 to 2024 (B.E. 2565–2567), the number of terminally ill patients receiving palliative care increased by approximately half each year. The implementation of palliative care for terminal patients still faces several unclear issues, such as: the roles of nurses responsible for patient assessment in hospitals are not well-defined; personnel within the network lack sufficient knowledge regarding palliative care; and there is a lack of coordination within the care network. 2) The developed system is the 2S-PH Center Model. And 3) After the development of the care system, the average outcome score was 84.52, which is higher than the set benchmark (80.00%). The caregiver burden score was significantly lower than before the system was developed. Multidisciplinary team members reported satisfaction levels above the 80% threshold, and professional nurses who followed the system scored higher in performance than the benchmark score (80%). The research also found that caregivers experienced anxiety. Therefore, hospitals and primary care units (PCUs) within the network should develop programs to reduce caregiver anxiety in caring for patients. For professional nurses, it was found that the initial and discharge POS (Palliative care Outcome Scale) assessments were not conducted correctly. Hence, responsible personnel should conduct regular workshops to improve this practice.