Introduction
The modern world is being faced with many challenges in the provision of quality health care to patients. For an efficient health care system, the consumers of the services must be well satisfied. This means that they transit through the illness period with minimal pain and suffering. However, many diseases have been known to be lifelong or chronic and care is needed throughout the patient’s life. There is a need to provide rehabilitative services to the patients so that they can live a life of normalcy as healthy people. In the 21st century, there has been a rise in cases of diseases that are chronic like cancers and others. This can be attributed to the changes in lifestyles as modernization is embraced, environmental changes as a result of increased urbanization among others. This has resulted in changes in the disease trends as disease burden increases and more deaths are recorded in our hospitals and homes. Therefore, there is a need for taking care of these patients and in efforts to achieve this objective palliative care centers and hospice, homes have been set up which take care of terminally ill patients especially those suffering from cancer. This essay discusses palliative care for cancer patients at palliative care centers as opposed to caring at homes.
Palliative care
When a patient is facing a serious illness like cancer, there is associated pain and suffering and therefore prompt and efficient relief is highly required. The patient undergoes a stressful period that often requires professional handling or else psychological problems may arise (Hill, 2007, p.807). There is a willingness by the patient to have a clear understanding of what they are going through and the associated changes in their bodies as a result of their ailments. Also, they need to know the available medical choices for their care to reduce the symptoms and therefore reduce their suffering. In total, this will enable them to carry on with their normal life by feeling better. As a result, palliative care comes in handy to offer the patient much-needed assistance. Palliative care refers to any mode of medical care or offering of treatment regimens that aims at minimizing the disease symptoms’ severity. According to the World Health Organisation (WHO, 2010, para.1), palliative care is an approach that aims at enhancing a patient’s quality of life and also those of their families. It does this through the prevention of suffering by early diagnosis and treatment of pain or any other associated problems. Unlike other medical care, it does not intend to stop, delay the symptoms or otherwise turn around disease progression; neither does it provide the much-needed cure for the diseases. Palliative care intends to prevent and alleviate suffering the patients undergo as a result of their illnesses. It provides relief to the terminally ill and the patient is able to enjoy the highest quality of life in their lifetime. Efficient palliative care does not only focus on physical health but also considers the patient’s need for mental wellness as well as spiritual comfort. Palliative care also provides affirmation for life and the patient is shown to consider the act of dying as a normal process for every human being. It gives support to the patients to be able to live an active life as much as possible while at the same time assisting the families of the sick to come to terms with their patient’s sickness (Becker, 2009, p.95). Hygiene is of utmost importance to prevent the occurrence of some opportunistic infections in the patient. Good nutritional practices are important in the patient’s recovery and should be maintained at all times. Palliative care utilizes a multidisciplinary approach with many health specialists like physicians, nurses, counselors and psychologists, occupational therapists among others. The family works in tandem with all these specialists to ensure good care and facilitate by providing the resources required.
Cancer
Cancer is a type of disease in which some abnormal cell types divide uncontrollably and therefore invade other tissues of the healthy body. This intrusion causes the destruction of the cells which are near to the cancerous ones. They spread throughout the body via either the lymph or the blood (Kinzler and Vogelstein, 2002, p.12). Cancerous cells display three main properties which are; rapid growth which cannot be controlled, the ability to invade other healthy cells which are adjacent to them and spread to other body parts through the process of metastasis. There are over 100 different types of cancer known to affect humans. The different forms of cancer come about following an abnormal mutation of cells. This leads to loss of programmed cell death and therefore the cells accumulate forming tumors in the area of occurrence. The naming of the various types of cancer depends on the particular part of the body that is affected. An example is lung cancer and bone cancer. Another classification is by the type of cell which they affect and is generalized to the tissue where the tumor is present. General categories of the cancers include the following; carcinoma which is the malignant tumor affecting the epithelial cells of the skin and represents the highest number of cancers affecting many people (English et al., 1997, p.272). There are sarcomas which are malignant tumors that affect the connective tissue in the body or the mesenchymal cells in the skin. The other type is lymphoma and leukemia which originate from blood-forming cells. Cancer presents with many symptoms of which include the following; symptoms may appear locally in the area of infection and presents as either swellings or bleeding accompanied by pain and often ulceration. The others are enlargement of the lymph nodes, liver and bone pains. In addition, loss of weight, feeling fatigued and lack of appetite are also exhibited. Normal human cells can mutate into carcinogenic ones when exposed to chemical carcinogens, ionizing radiations or disease invasion by certain viruses like the Human Papilloma Virus (Croce, 2008, p.503).
Literature review
In a study to determine the preferred place of death by patients suffering from cancer, most of the patients preferred dying at home instead of the palliative care centers. The main purpose of this study was to evaluate the time that is spent at home, the place of death and differences in the socio-demographic and medical characteristics of patients. All the patients had cancer in the palliative stage and were receiving hospital-based advanced home care while the rest just received the usual hospital care. Ahlner-Elmqvist et al. assigned the patients to either of the care procedures according to what each of them preferred. After full consent was sought, the patients were ready to participate in the study. Eligibility criteria were for those patients with malignant disease and were adults whose survival expectancy was estimated to be between 2-12 months. The study found out that with a total of 297 patients who were sampled, 280 patients faced their death during the study period. Also, it was noted that 117 of the respondents were in advanced home care while 163 were in conventional care at various places. It was noted that more patients died at home representing a percentage of 45% while those who got conventional care showed 10% deaths in the conventional group. Socio-demographic factors had no relation with preference. The study concludes that advanced hospital-based home care that targets cancer patients who are seriously ill and who wish to remain at home has enabled many patients to face their death in their preferred places.
In yet another study but this time in an Irish setting, patients who were referred to a Hospice Home Care Team were requested to state their preferred places to face their death. They were then followed in order to establish the actual places where they met their death and the associated factors for their preference. Many patients, that is over 80% of them expressed a wish to die at home. Among this category, nearly 50% were able to meet their wishes and die at home. The reason for taking patients to the hospital or the hospices to face their death was included development for symptoms that could not be controlled and the inability of many families to cope and adapt to caring for the patients. There is a need to acquire adequate resources at home to be able to take care of these patients (Tiernan et al., 2003, p.120).
Finally, Fainsinger et al. carried out a survey to find out the factors that aided and barred home discharge for 100 consecutive patients. All these patients never required advanced specialist palliative or acute care. Data on functional ability were collected by using Palliative Performance Scale [PPS], demographics and Karnofsky Performance Scale [KPS]). In addition, knowledge the patients had during the time of discharge, the circumstances prevailing for home support, and what the patient and his or her family preferred for discharge. A total of 59 patients were observed to have been discharged home while 41 were moved to a hospice for professional care. It was noted that patients who were young and with caregivers who were also young were discharged home more often than the rest who were older. The section of the sample that preferred going home had increased chances of being married. More than two-thirds of the patients (76 percent) and nearly 90 percent of families that were involved in this particular research study opted for discharge at the site. The patients who had lost their cognitive ability and who were dependent for motility did not return home (Fainsinger et al., 2000, p.29).
Research statement
Patients in need of palliative care prefer dying at their homes to dying at the palliative care centers or hospices. This can be attributed to the moral support they are accorded when at home by the family members.
Definition of variables
Study method
Quantitative study approach will be utilized in this study. This approach clearly spells out both the independent and dependent variables under investigation in a study by following firmly the original set of research goals. This guides the researcher in coming up with objective conclusions, determining the issues of causality and testing of hypothesis. A sample of 150 patients who meet the selection criteria will be randomly picked and evaluated on the variables mentioned above. Their carers will also qualify for the study and will be interviewed to express their opinions on the satisfaction they receive and how the disease burden is influencing their lives together with that of their patients. Finally, a team of health care professionals that makes up the palliative care team will be assessed.
Design
The study will employ a quantitative survey study to get the required sample size. The study intends to get data from a large sample of respondents which will then be used for the generalization of the whole population.
Data collection tools
In obtaining the much-needed data for our study, three tools will be employed. The first involves interviews where the selected sample will be interviewed to determine the variables set. The second method is the use of questionnaires that seeks to find the personal opinions of the patients, caregivers and a section of the professionals. Finally, Focussed Group Discussions will be undertaken to discuss common issues in the patients and to seek their opinions as a group.
Sampling criteria
Convenience sampling will first be employed to select the palliative care centers to visit and the different homes that the research intended to visit in order to gather the sample needed. This will help reduce the costs of the research since resources are limited. Next, after the selection of institutions, random sampling will be used to select the respondents who meet the criteria for the study. This will ensure the minimization of selection bias since each patient will have an equal chance of participating in the study.
Ethical consideration
First the study will be approved by the Ethics and Research board of the university before being carried out. Next, consent will be sought from the patients before participating in the research. Finally, the respondent’s details will be confidential and will not be used anywhere outside this study or their names used.
Study limitations
The research expects to encounter uncooperative respondents during the study. These are patients with long-term illness and pain and may be unwilling to discuss or disclose their information. The resources available may also hinder the research process due to the many details needed.
Conclusion
Cancer and other terminal illnesses pose a big burden to both the patients as well as their caregivers. There is suffering and much pain for the patients. However, palliative care has given hope to the sick. Many patients are of the opinion that they would rather die in their homes than at the palliative care centers. Whichever approach is employed proper care should always be maintained to increase the patient’s quality of life.
Reference List
Ahlner-Elmqvist, M. Et al., 2004. Place of Death: Hospital-Based Advanced Home Care Versus Conventional Care. A Prospective Study in Palliative Cancer Care. Palliative Medicine, Vol.18, No. 7, pp. 583-93.
Becker, R., 2009. Online Courses for Nurses Working in Palliative Care. European Journal of Palliative Care, Vol. 16, No. 2, pp. 94-97.
Croce, C., 2008. Oncogenes and Cancer. The New England Journal of Medicine, Vol. 358, No. 5, pp. 502–11.
English, D. et al.,1997. Sunlight and Cancer. Cancer Causes & Control: CCC, Vol. 8, No. 3, pp. 271–83.
Fainsinger, R., 2000. Home Versus Hospice Inpatient Care: Discharge Characteristics of Palliative Care Patients in an Acute Care Hospital. Journal of Palliative Care, Vol. 16, No. 1, pp. 29-34.
Finlay, I., 1997. Palliative Care in Hospital, Hospice, at Home: Results From a Systematic Review. Web.
Hill, R., 2007. Clinical Pharmacy Services in a Home-Based Palliative Care Program. American Journal of Health Systems Pharmacy, Vol. 64, No. 8, pp. 806-810.
Kinzler, K., & Vogelstein, B., 2002. Introduction. The Genetic Basis of Human Cancer (2nd, illustrated, revised Ed.). New York: McGraw-Hill.
Tiernan, E., 2002. A Prospective Study of Preferred Versus Actual Place of Death Among Patients Referred to A Palliative Care Home Care Service. Irish Medical Journal, Vol. 96, No. 4, pp.120-1.
WHO., 1998. WHO Definition of Palliative Care. Web.