Title : Development of a seamless integrated palliative cancer care nursing system within the Maharat Nakhon Ratchasima hospital network in Nakhon Ratchasima province
Abstract:
Palliative care for terminal cancer patients in Thailand continues to face challenges due to fragmented service delivery across healthcare settings. The key problems identified are resource allocation and disparities in service accessibility. This study aimed to 1) develop a seamless nursing care system, 2) examine the outcomes of the seamless nursing care system, and 3) synthesize policy recommendations. This action research was conducted from September 2024 to August 2025, divided into three phases: 1) situational analysis, 2) development of the seamless nursing care system, and 3) outcome evaluation with 46 end-stage cancer patients and 46 caregivers, divided into experimental and control groups of 23 participants each. Data were collected through in-depth interviews, focus group discussions, natural conversations, observations, document analysis, palliative care outcome evaluation forms, quality of life assessment forms, caregiver perception assessments of patients' peaceful end-of-life, and caregiver satisfaction questionnaires regarding palliative care. Descriptive statistics, two-way repeated ANOVA, t-tests, and content analysis were applied. The research findings revealed that the seamless nursing care system comprised three main components: 1) Input factors including patient factors, nursing factors, and service system factors; 2) Process components consisting of a 5-phase care plan driven by the peaceful end-of-life theory concept, case management, primary nursing, nursing process, and telenursing; 3) Outcomes of nursing system implementation revealed statistically significant differences between experimental and control groups in palliative care outcomes, quality of life, caregivers' perception of patients' peaceful end-of-life, and satisfaction at significance levels of .017, .001, <.001, and <.001, respectively. The proposed system can serve as a prototype for developing nursing care systems and has led to significant policy recommendations: 1) consideration of curriculum revision for Bachelor of Nursing Science and advanced specialty nursing programs; 2) identification of case manager roles in health service plans; 3) support for telenursing information technology, and 4) adjustment of indicators to reflect good death through peaceful end-of-life.
