EXECUTIVE SUMMARY

Background: Community-based palliative care has been advocated to improve the continuity of care between hospital and home care and support care in place for patients with life-limiting conditions and their family members. This study aims to evaluate the effects of a community palliative care support project guided by a medical-social collaboration model on the symptom experience of patients with advanced disease and the caregiving experience of their family members.

Methods: A mixed-method approach was adopted, including a prospective cohort study and individual qualitative interviews. The Integrated Palliative Care Outcome Scale was used for monthly assessment to monitor their condition. Wilcoxon signed-rank test was employed to examine changes in the outcomes over time. The interviews were audiotaped for qualitative content analysis.

Results: Forty-eight patients, with a predominance of cancer diagnoses, enrolled in the project. They reported anxiety, hardly feeling at peace, and neither receiving information as wanted nor being able to share their feeling with family/friends as more overwhelming than physical symptoms. Improvements were noted in emotional symptoms and concerns about communication/practical issues amongst patients at follow up, but changes in caregiving experience were not obvious amongst their family members. Three themes about recommendations for the project services were identified from the qualitative data, namely, maintaining sustainability of the service, strengthening the communication between care sectors and providing additional support for rehabilitation.

Conclusions: The findings demonstrate the positive effects of this community-based palliative care support project in meeting the complex care needs of patients with advanced diseases. Improvements were noted in their emotional and information needs despite their deteriorating health conditions. Meanwhile, greater efforts should be devoted to supporting their family members throughout the disease journey. Another noteworthy point is that non-cancer patients were underrepresented in the study sample. Further work is needed to strengthen the medical-social partnership to support end-of-life care in place albeit health deterioration.