Effectiveness of Palliative Care Program on Psychosocial and Spiritual Wellness among Philippine Heart Center Clients Undergoing Hemodialysis

Tuesday, 8 July 2008: 1:15 PM
Lee B. Banguilan, RN , Division of Nursing Education and Research, Philippine Heart Center, Quezon City, Philippines
Felissisma A. Romero , Division of Medical-Surgical Care, Philippine Heart Center, Quezon City, Philippines

Learning Objective 1: discuss the importance of having a pallative care program and the result of the study, particularly for patients with end-stage renal disease.

Learning Objective 2: create/revise their own pallative care program specifically for patients with chronic kidney disease.

Background. Hemodialysis, the most widely used form of renal replacement therapy (Philippine Renal registry, 2003), compels physiological, psychosocial, and emotional burden both for the patients and their significant others. Although physically, the patients are satisfied as their metabolic condition improves every session, the psychosocial and spiritual wellness are often neglected. The researchers aimed in determining if there are any significant differences in the behavioral aspect of health of these patients after the implementation of the palliative care program.

Methods. The study used a nonrandomized comparative design which was composed of the intervention (N=29) group and the control (N=16) group. All samples are CKD diagnosed patients who's undergone dialysis for more than 1 year. Subject selection was done using the inclusion criteria, and dialysis decking schedule taken from the PHC OPD renal registry. Psychosocial and spiritual wellness were measured using the KDQOL and MGQOL questionnaires which used a non-parametric type of scoring. To statistically test any significant findings, the Wilcoxon paired ranks (fir the difference between the groups) and Mann Witney U test (the difference between the questionnaires administered). For significant pretest p values, the analysis of Univariate of Covariance was taken to determine the sample homogeneity.

Results. The psychological and social issues included in the KDQOL and MGQOL included are perception of general health now an compared to a year ago, the amount of productivity and efficiency in performing work or regular activities in conjunction with emotional problems met, the effect of the disease and subsequent emotional problems on the social activities, feelings of cheerfulness and ability to concentrate, and the patient's ability to interact effectively with other persons. Among the aforementioned concerns, the interference of emotional problem to social health, feeling of nervousness, and feeling of happiness were noted to have a significant difference even during the pretest (p <0.05). Moreover, the palliative care program was able to attend to the psychosocial concerns of the patients as issues including: feeling pep, nervousness, peacefulness, energy, interference in social participation, and time spent in dealing with disease remarkably improved for the intervention group. However, no significant difference or change happened on the patients' productivity and efficiency in work, ability to concentrate, and dependence on health care providers like doctors even after the program was implemented (p>0.05).

Conclusion. The study demonstrates that there was a significant difference in the psychosocial and spiritual wellness of clients who underwent palliative care program. Moreover, there was a significant difference between the group who attended the program compared to those who did not.

Keywords: Chronic Kidney Disease, Quality of Life, Psychosocial, Spiritual, Palliative Care