Effectiveness of a Hospital Based ‘Therapeutic Community’ Approach in Care for Terminally

ill Cancer Patients Singh Naveen Kr., Roy Debabrata, Saini,S

Background:

Prediction of survival in terminally ill cancer patients is an evolving area largely dependent on evidence-based medicine.

Background:

Principles of ‘Therapeutic community’ or ‘Fellowshipping’ are now an integral component of palliative care/ Hospice care for terminally ill patients from various afflictions.

Background:

Documented evidence suggests religious and spiritual forms of coping may provide uniquely meaningful way of dealing with chronic illness and may be more effective at ameliorating affective and cognitive symptoms.

Background

WHO defines palliative care as the ‘ active total care of patients and their families by a multiprofessional team when their disease is no longer curable and life expectancy is predicted short’.

It neither hastens nor postpones death. It integrates psychological and spiritual aspects of care.

Objective:

Specific objective: Study therapeutic effectiveness of the counseling module ‘ASHA’,

Sub objective: To study change in perceived notions on morbidity & QOL among terminally ill cancer patients at HIHT (CRI).

Material and Methods: A case series of all eligible study subjects who

consented to participate and identified for or undergoing ‘post- surgery 18 months’ radiotherapy follow- up’ (50) were recruited for the study.

A well researched group dynamics module for intervention was administered on the study subjects.

Material and Methods:

A structured 11-question KAP evaluation instrument with open-ended answers was applied pre & post intervention to the study group.

Chi square test was applied on respondents pre & post intervention, (providing appropriate / desirable answer for each of the questions) to find level of significance in differences for key parameters.

Study design:

Prospective with a quasi-experimental component

Study tool:

A group dynamics module for intervention and a structured KAP evaluation instrument

Counseling Module: Curriculum Section 1: IEC/ BCC: Clinico- pathological aspects of

cancer- essentialsSection 2: Sensitizing on terminal illness & hospice careSection 3: Concept of ‘Fellowshipping’ along with spiritual

aspects as a therapeutic modality Introducing principles of ’12 steps’ of living

(conceptually similar to AA’s) The road from ‘Denial to Acceptance’ The attendant negative emotions of ‘frustration’, ‘self -

pity ‘, ‘anger’ & ‘abnormal behavior/ cognition’ Structured living Perceptions on ‘religiosity’ and ‘spirituality’ Self love & selfishness Salvation- perceived notions Dissolution of mind and ego Contentment and Bliss

Results: Association between intervention (Counseling Module) and knowledge score

Questions (Evaluation parameters)

Pre-councelingScore

Post-CouncelingScore

p value n=50 n=50

Knowledge on essentials of Carcinogenesis 40 (80%) 45 (90%) P>0.05 

Perceived notions / myth on cancer morbidity 35(70%) 28(56%) P>0.05

Knowledge on prevention of cancer 27 (54%) 37 (74%) P<0.05*

Perceived difficulties from cancer treatment/therapy 43(86%) 33(66%) P<0.05*

Coping skills 27 (54%) 47 (94%) P<0.05**

Attitudinal change (positive) in progressive/advanced cancer 28 (56%) 40 (80%) P<0.05**

Fear of Death from Cancer 38 (76%) 27 (54%) P<0.05**

Sharing information on cancer with others 15 (30%) 45 (90%) P<0.05**

Optimistic/positive about life post treatment/therapy 19 (38%) 39 (78%) P<0.05*

Pessimistic/negative about life post treatment/therapy 27 (54%) 15 (30%) P<0.05*

Interest/pro-activeness in knowing the above information 28 (56%) 40 (80%) P<0.05**

Knowled

ge o

n es

sent

ials

of C

arcin

ogen

esis

Perce

ived

notio

ns /

myt

h o

n c

ance

r mor

bidity

Knowled

ge o

n pr

even

tion

of c

ance

r

Perce

ived

diffic

ulties

from

can

cer t

reat

men

t/the

rapy

Coping

skil

ls

Attitud

inal c

hang

e (p

ositiv

e) in

pro

gres

sive/

adva

nced

can

cer

Fear o

f Dea

th fr

om C

ance

r

Sharin

g inf

orm

ation

on

canc

er w

ith o

ther

s

Opt

imist

ic/po

sitive

abo

ut lif

e po

st tr

eatm

ent/t

hera

py

Pessim

istic/

nega

tive

abou

t life

pos

t tre

atm

ent/t

hera

py

Inte

rest

/pro

-act

ivene

ss in

kno

wing th

e ab

ove

infor

mat

ion

0

10

20

30

40

50

60

70

80

90

100

80

70

54

86

54 56

76

30

38

54 56

90

56

74

66

94

80

54

90

78

30

80

Results: Association between intervention (Counseling Module) and knowledge score

Pre-counceling Score n=50 Post-Counceling Score n=50

Pe

rce

nta

ge

Conclusion:

Chi square test on study respondents pre & post counseling for choosing appropriate options for each of the questions, showed significant differences for key parameters.

Evidently the counseling module( ASHA) is an effective intervention tool to bring about changes in perceived notions in morbidity and thus enhance QOL.