A recent study found that a team-based palliative care model, involving registered nurses (RNs) and nursing technicians (NTs) providing home care, is an effective and affordable way to support patients with advanced cancer.
Palliative care is crucial for managing symptoms and enhancing the quality of life in patients nearing the end of their lives. A program in Brazil, called “Better at Home,” enables interdisciplinary teams to deliver palliative care in patients’ homes, with nurses playing a crucial role, especially in areas with limited health care resources.
This study, published in the American Journal of Hospice and Palliative Medicine, examined the clinical and functional profiles of patients receiving home-based palliative care for advanced-stage cancer. It also evaluated the scope and coordination of nursing interventions carried out by the SAD-Caratinga Program (SAD-CP) in Brazil.
Researchers from Faculdade de Ciências Médicas de Minas Gerais in Belo Horizonte, Brazil, the University of Texas MD Anderson Cancer Center in Houston and Independent Biostatistics Consulting in San Francisco analyzed 10 years of medical records from 471 cancer patients treated through SAD-CP. The patients averaged 70 years old. About 95% experienced pain, and 77% reported dyspnea as their primary symptom. The typical length of their stay in the program was 48 days.
In the SAD-CP program, RNs handled complex procedures, supervised NTs and trained caregivers, while NTs managed routine clinical tasks and daily care. Throughout the study period from 2013 to 2023, structured caregiver education based on the comfort, airway management, restlessness and delirium, emotional and spiritual support and self-care (CARES) model was required before patient admission. The primary goals of the CARES model are to promote a peaceful death, help families understand the difference between a normal progression of the dying phase and suffering and to encourage all parties involved to practice self-care.
One RN was consistently assigned to patients in the program to ensure continuity in nursing supervision. The number of NTs varied. The team worked 40-hour weeks, in rotating shifts, to provide full coverage for patients.
Almost all patients died at home, aligning with palliative care objectives. These results underscore the crucial role of RNs in coordinating and delivering home-based palliative cancer care within a multidisciplinary team.
Researchers found that an interdisciplinary, intensive, home-based palliative care program enhanced symptom management for patients and decreased hospital deaths. The SAD-CP model, which integrates RN and NT caregivers through structured training, demonstrates feasibility and has a positive impact in resource-limited environments, according to the study.
“The SAD-CP model, structured around the leadership of the [RN] and supported by a trained NT workforce, offers a scalable and resource-efficient framework that could be adapted to other under-resourced regions,” the researchers wrote. “It illustrates how even in the face of structural constraints, multidisciplinary care, when strategically organized, can ensure continuity, safety and dignity at the end of life.”
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