A study to assess the effect of interventional package on acute symptoms experienced by terminally ill patients with head and neck cancer receiving palliative homecare, its management by the primary caregivers and their holistic wellbeing at selected hospital in Kanyakumari District

Sheeba, C (2018) A study to assess the effect of interventional package on acute symptoms experienced by terminally ill patients with head and neck cancer receiving palliative homecare, its management by the primary caregivers and their holistic wellbeing at selected hospital in Kanyakumari District. Doctoral thesis, Christian College of Nursing, Neyyoor.

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Abstract

INTRODUCTION: In developing world, cancer is the leading cause of death, and cancer patients pass through various phases of experience throughout illness. When cancer patients reach the point at which treatment is no longer effective, they are considered as terminally ill. Palliative care is a bridge to enable the patient to cross over without pain and suffering and at peace with oneself, with the man and God. In the developing countries like India, home services are the primary focus of palliative care. If the terminally ill patients are cared for at home, it gives them an opportunity to continue family life with dignity. Family caregivers play a crucial role in the home care including administration of medications. The family members are willing to care for their relatives at home, but they need training in various aspects of care including symptom management. The conceptual framework for the present study was adapted from Ernestine Widenbach’s prescriptive theory. OBJECTIVE: The study was undertaken with the aim of assessing the effect of interventional package on acute symptoms experienced by terminally ill patients with head and neck cancer receiving palliative home-care, its management by the primary caregivers and their holistic well-being at selected hospital in Kanyakumari District. METHODS: The study used a quasi-experimental pretest-post-test control group research design. A total of 200 TIP with H&N cancer and their primary caregivers (100 in control group and 100 in interventional group) fulfilled the inclusion criteria were selected using purposive sampling. Demographic and clinical data were gathered from both TIP with H&N cancer and primary caregivers by means of structured questionnaires administered in face to face interview after getting written consent. Pretest was done with acute symptoms assessment scale, acute symptom management questionnaire and holistic wellbeing tool I and II. Control group was taking the routine treatment which was already practiced in the department. Along with routine treatment, the interventional group received interventional package. The interventional package consisted of three components: education, skill training and counseling. Post test was done on 30th, 60th and 90th day of data collection. The collected data were analyzed using both descriptive and inferential statistics on the basis of objective and hypotheses of the study. RESULTS: Most of TIP with H&N cancer (81% in control group and 76% in the interventional group) were men, all were married in both groups, majority of them (86% in control group and 82% in the interventional group) were unskilled laborers. In terms of diagnosis, 30% of the TIP with H&N cancer in control group and 32% in the interventional group had Ca. Buccal mucosa. • Most of the primary caregivers (80% in control group and 71% interventional group) were females and the majority of them (74% in control group and 69% in the interventional group) were spouse. • After the administration of IP, the mean difference in pain score among control group and interventional group on post-test I was (6.4-4.4) 2.0, post-test II was (6.8-2.8) 3.9 and post-test III was (7.0-2.9) 4.2. The computed student ’t’ test values (between groups) of post-test I, II & III (11.457, 27.435 & 26.115) were higher than the table value at 0.05 level of significance. • After the administration of IP, the mean difference in nausea and vomiting score among control group and interventional group on post-test I was (1.3-0.9) 0.4, posttest II was (1.7-0.8) 0.9 and post-test III was (1.7-1.0) 0.7. The computed student ’t’ test values (between groups) of post-test I, II & III (3.563, 7.927&10.353) were higher than the table value at 0.05 level of significance. • After the administration of IP, the mean difference in dyspnea score among control group and interventional group on post-test I was (2.7-2.1) 0.6, post-test II was (2.9-1.8) 1.1 and post-test III was (3.3-2.0) 1.3. The computed student ’t’ test values (between groups) of post-test I, II & III (3.243, 7.321& 9.396) were higher than the table value at 0.05 level of significance. • After the administration of IP, the mean difference in restlessness score among control group and interventional group on post-test I was (1.9-1.3) 0.6, post-test II was (2.2-1.2) 1.0 and post-test III was (2.6-1.3) 1.3. The computed student ’t’ test values (between groups) of post-test I, II & III (5.445, 8.414 & 13.644) were higher than the table value at 0.05 level of significance. • After the administration of IP, the mean difference in cough score among control group and interventional group on post-test I was (1.9-1.2) 0.7, post-test II was (2.1- 1.1) 1.0 and post-test III was (2.5-1.1) 1.4. The computed student ’t’ test values (between groups) of post-test I, II & III (5.222, 9.647&14.8) were higher than the table value at 0.05 level of significance. • The calculated Hotelling’s T2 p-value (sig) is 0.000 for pain, nausea / vomiting, dyspnea, restlessness and cough of TIP with H&N cancer receiving PH. Hence the research hypothesis was accepted at 0.05 level of significance. It means the interventional package was effective in reducing acute symptoms experienced by the TIP with H&N cancer receiving PH. • After the administration of IP, the mean difference in holistic well-being score of TIP with H&N Cancer among control group and interventional group on post-test I was (42.2-80.0) -37.8, post-test II was (48.3-94.3) -46.0 and post-test III was (47.8-101.1) -54.1. The computed student ’t’ test values (between groups) of post-test I, II and III (-11.391, -17.992 & -20.610) were higher than the table value at 0.05 level of significance. • The calculated Hotelling’s T2 p-value is 0.000 for physical, psychological, social, financial, spiritual and holistic well-being of TIP with H&N cancer receiving PH. Hence the research hypothesis was accepted at 0.05 level of significance. • After the administration of IP, the mean difference in expense per unscheduled hospital visit among control group and interventional group on post- test I was (455.9-177.0) Rs.278.9, post-test II was (457.1-83.8) Rs.373.3 and post-test III was (533.6-156.5) Rs.377.7. The computed student ’t’ test values (between groups) of post-test I, II and III (-11.391, -17.992 & -20.610) were higher than the table value at 0.05 level of significance. • The calculated Hotelling’s T2 p-value is 0.000 for expense/ unscheduled hospital visit to manage acute symptoms among control group and interventional group. Hence the research hypothesis was accepted at 0.05 level of significance and concludes that the interventional package was effective in reducing the expense/ unscheduled hospital visit to manage acute symptom. • After the administration of IP, the mean difference in holistic well-being score of primary caregivers among control group and interventional group on post- test I was (56.8-105.8) –49.0, post-test II was (57.4-125.3) -67.9 and post-test III was (56.6- 135.1) -78.5. The computed student ’t’ test values (between groups) of post-test I, II and III (-20.734, -31.889 & -35.887) were higher than the table value at 0.05 level of significance. • The calculated Hotelling’s T2 p-value for physical, psychological, social, financial, spiritual and holistic well-being of primary caregivers among control group and the interventional group was 0.000. Hence the research hypothesis was accepted at 0.05 level of significance and concludes that the interventional package was effective in improving physical, psychological, social, financial, spiritual and holistic well-being of primary caregivers of TIP with H&N cancer receiving PH. CONCLUSION: This study has revealed that the pain, restlessness, nausea and vomiting and dyspnea were the common acute symptoms experienced by the cancer patients receiving palliative home care. The study result has concluded that the interventional package was effective in reducing the acute symptoms experienced by TIP with H&N cancer, improving their holistic well-being and reducing the expense of managing acute symptoms. Health-care professionals can train caregivers during outpatient/inpatient hospital visits, empowering them to manage breakthrough symptoms and provide simple home nursing care. This is probably important for the majority of cancer and other palliative patients receiving home care, but particularly so in settings where resources are limited and palliative care facilities scarce.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: interventional package, acute symptoms, terminally ill patients, head and neck cancer, palliative homecare, primary caregivers, holistic wellbeing, selected hospital, Kanyakumari District.
Subjects: NURSING > Psychiatric Nursing
Depositing User: Subramani R
Date Deposited: 12 Nov 2019 03:31
Last Modified: 15 Jan 2020 02:58
URI: http://repository-tnmgrmu.ac.in/id/eprint/11623

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