الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Background: Hepatocellular Carcinoma is a common cancer and patients often present at late stages. Patients with HCC report several symptoms which are severe enough to affect the QoL like, sleep disorders, sexual dysfunction, ascites, gynecomastia, pruritis, fatigue, muscle cramps. The HQoL indicators that have been used in trials thus far are based on these symptoms. Available HCC’s treatment modality requires expertise on the part of nurses and other health care providers. Nurses must assess risks and benefits of therapy specific to the patient’s quality of life, support services, health education, lifestyle, psychosocial status, and symptoms. Aim: This study was carried out to evaluate the effect of implementing early palliative care on hepatocellular carcinoma patients’ outcomes. • Research hypothesis: Patients with hepatocellular carcinoma who exposed to early palliative care will exhibit better quality of life, improvement and reduction in intensity of symptoms as well as improvement in their mood than those who are exposed to usual care. Study design: The quasi experimental research design was used to achieve the aim of the current study. Setting of the study: This study was conducted in Mahalla Hepatology Educational Hospital, El Mahalla AlKoubra in the inpatient department as well as outpatient clinics for patients follow up. The subjects of the study: A proposed Sample of 114 adult patients aged 20 - 60 years old of both sexes who admitted to the previously mentioned setting with the diagnosis of hepatocellular carcinoma were recruited for the participation in the current study. The total study sample was randomly assigned to two equals groups; • group I (study group): they composed of 57 adult patients receiving the routine hospital in addition to palliative care as developed by the researcher. • group II (control group): they composed of 57 adult patients receiving their usual hospital routine care. Tools: the data were collected using the following tools: Tool 1: Interview questionnaire sheet (Appendix I) Tool 2: Functional Assessment of Cancer Therapy- For patients with Hepatobiliary cancer (FACT-Hep) Version4 (Cella et al., 2013) (Appendix II) Tools 3: Edmonton Symptom Assessment Scale (ESAS) (Appendix III) Tool 4: Center for Epidemiological Study Depression Scale (CES-D) (Moore et al, 2011) (Appendix IIII) Methods: the current study was conducted through three phases; Phase one: assessment phase; Patients who fulfilled the study criteria, attending the study settings and agreed to participate in the study were selected and assigned equally to study and control groups. Both study and control groups were matched as much as possible regarding demographic characteristics and medical data. Patients were interviewed by the researcher to collect the necessary data and implement care after explanation the purpose of the study. Phase two: implementation phase; Based on the data achieved from first assessment and review of literature, the researcher adapted the palliative care depend on (The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines for Quality Palliative Care 4th edition 2013) according to patients and families’ needs and preferences. The palliative care was designed by the researcher (appendix VI). Proposed palliative care: it was implemented to study group individually and refers to the designed interventions that incorporate knowledge and practice regarding health life style modifications that guide patient’s improvement. Phase three; Evaluation phase: The first time of evaluation (pre-test) was conducted immediately on admission using all the study tools for both groups • The second phase of evaluation (post-test) was done after 2 weeks of the admission using (Tool II, III, IV) for both groups. • The third phase (follow up) was conducted after one month of the second phase using (Tool II, III, IV) for both groups. Data were collected and analyzed and comparisons between the data for both the control and study groups findings were performed to evaluate the effectiveness of the conducted palliative care on the quality of life, intensity of the patients’ symptoms and their mood by using the proper statistical analysis. Results: The main results yielded by the current study revealed the following: o Regarding general characteristics as a baseline for comparison, no statistically significant differences were observed between the two groups. o Also, no statistically significant differences were found between the patients in both groups regarding their medical data. o No statistically significant differences were observed between the two groups regarding CES-Dep at pre intervention. o There were highly significant differences between study and control groups regarding FACT-Hep, ESAS and CES-Depression Scale two weeks post implementations of early palliative care. o There were highly significant differences between study and control groups regarding FACT-Hep, ESAS, and CES-Depression Scale at follow up one-month post implementations of early palliative care. o Highly significant correlations between FACT-Hep, ESAS and CES-DEP at pre intervention, 2 weeks post intervention and at follow up one-month post implementations of early palliative care in the study group.