Development of a Palliative Care System for Patients with End-Stage Chronic Kidney Disease and Cancer toward Palliative Reality through Integration of the Kongkrailas Model with Community, Kongkrailat Hospital, Sukhothai Province.

Abstract

      This study employed Participatory Action Research (PAOR) with the objectives of developing and evaluating a palliative care system for patients with end-stage chronic kidney disease and terminal cancer toward Palliative Reality, through integration of the "Kongkrailas Model" with community participation, at Kongkrailat Hospital and its network of 16 sub-district health-promoting hospitals, Sukhothai Province. The study was conducted between January 2023 and September 2024, a total duration of 21 months, divided into 3 cycles following the PAOR process. The sample in the model development phase comprised an interprofessional team and network partners, totaling 20 members, while the sample in the evaluation phase comprised 36 patients with CKD Stage 5 together with 36 primary caregivers, and 34 terminal cancer patients together with 34 primary caregivers, totaling 160 participants, selected through purposive sampling. A one-group pretest-posttest design was employed. Research instruments included the integrated "Kongkrailas Model," a knowledge assessment on palliative care, the Edmonton Symptom Assessment System (ESAS) and the Palliative Performance Scale (PPS), an advance care planning assessment form, and a satisfaction assessment form.

      The results showed that following implementation of the developed system, patients with end-stage chronic kidney disease had significantly decreased ESAS symptom distress scores, from 42.50±10.80 to 24.30±8.20 out of a total of 110 points (t = 13.62, p < .001), and terminal cancer patients had decreased symptom distress scores from 42.18±8.65 to 24.35±6.92 (p < .001). Regarding system-level indicators, the rate of complete ACP/Family Meeting increased from 75.00% to 91.67% in the CKD group and from 70.59% to 97.06% in the cancer group. The rate of dignified death (Good Death) increased from 69.44% to 91.67% in the CKD group and from 67.65% to 91.18% in the cancer group. The rate of death occurring in the patient's desired location increased from 61.11% to 88.89% in the CKD group and from 58.82% to 85.29% in the cancer group. When considering the integrated system overall, the overall rate of dignified death increased from 68.57% to 91.43%, and only a small proportion of patients required unplanned initiation of renal replacement therapy or unnecessary hospital transfer. Patient and family satisfaction after using the system was at the highest level in both disease groups (𝑥̅ = 4.62±0.38 for the CKD group and 𝑥̅ = 4.58±0.35 for the cancer group), and the expert evaluation of the appropriateness of the system yielded an overall mean score of 4.58±0.41 out of 5, rated at the highest level of appropriateness.