Factors predicting the effectiveness of palliative care in patients with advanced cancer.

ABSTRACTObjective: The purpose of this study was to assess the factors that predict the effectiveness ofpalliative care in patients with advanced cancer.Method: Cross-sectional data were collected from 240 patients recruited from three tertiarycare hospitals in Bangkok and suburban Thailand aged 18 years or older who were willing toparticipate;abletospeak,read,andwriteThai;werenotreceivingaggressivecancertreatment;and had been diagnosed with advanced-stage cancer. Participants were asked to complete aPersonalInformationQuestionnaire(PIQ),aPalliativeCareAssessmentForm(PCAF),andtheSpiritual Well-Being Scale (SWBS).Results: The significant predictors of the effectiveness of palliative care in patients withadvancedcancerwerefoundtobespiritualwell-being(p ¼ 0.000)andpalliativecarestrategies:acombinationofpharmacologicalandpsychosocialcare,mind–bodyintervention,andspiritualcare; physical management; and traditional medicine, herbal treatment, and diet management(p ¼ 0.027).Thelikelihoodofeffectivenessforpatientswhosespiritualwell-beingandpalliativecare strategies scores increased by an average of one point increased by factors of 1.058 and2.271, respectively.SignificanceofResults:Thesefindingssuggestthatpatientswhoexperiencedbetterspiritualwell-being and who employed a variety of palliative care strategies also experienced enhancedeffectiveness of palliative care.KEYWORDS: Effectiveness, Palliative care, Advanced cancerINTRODUCTIONCancer was a major cause of death during 2011,accounting for some 113 fatalities per 100,000 popu-lation worldwide and 67 per 100,000 in SoutheastAsia.TheWorld HealthOrganization(2012)predictsthat the worldwide numbers will rise to 120 and 152per 100,000 population by 2015 and 2030, respect-ively. Cancer patients suffer from a wide variety ofphysical and psychological symptoms (Gilbertson-White, 2011), especially during the advanced stagesof the disease. Chaiviboontham and her colleagues(2011) reported that pain is the most distressingsymptom for these patients and identified fourmain symptom clusters: (1) pain, sickness-behavior,and psychological; (2) anorexia/cachexia; (3) gastro-intestinal and elimination; and (4) dermatological.In addition, patients confronted with advanced can-cer may experience a state of imbalance and dishar-mony. They often experience a sense of loss, fear,uncertainty, and anxiety. All these symptoms impactthe quality of life (QoL), functional status, and per-formance of the activities of daily life for patientsand their family members (Suwisith et al., 2008;Phligbua et al., 2013).The goal of advanced cancercare isto delivercom-prehensive symptom management as well as psycho-logical, educational, social, and spiritual support topatients. Palliative care is a process of active total