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Development of Palliative Care Model Using Thai Traditional Medicine for Treatment of End-Stage Liver Cancer Patients in Thai Traditional Medicine Hospitals

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Development of Palliative Care Model Using Thai Traditional Medicine for Treatment of End-Stage Liver Cancer Patients in Thai Traditional Medicine Hospitals DEVELOPMENT OF PALLIATIVE CARE MODEL USING THAI TRADITIONAL MEDICINE FOR TREATMENT OF END-STAGE LIVER CANCER PATIENTS IN THAI TRADITIONAL MEDICINE HOSPITALS By MR. Preecha NOOTIM A Thesis Submitted in Partial Fulfillment of the Requirements for Doctor of Philosophy (SOCIAL AND ADMINISTRATIVE PHARMACY) Graduate School, Silpakorn University Academic Year 2019 Copyright of Graduate School, Silpakorn University - โดย นายปรีชา หนูทิม วทิ ยานิพนธ์น้ีเป็นส่วนหน่ึงของการศึกษาตามหลกั สูตรเภสัชศาสตรดุษฎีบณั ฑิต สาขาวิชาเภสัชศาสตร์สังคมและการบริหาร แบบ 1.1 เภสัชศาสตรดุษฎีบัณฑิต บัณฑิตวิทยาลัย มหาวิทยาลัยศิลปากร ปีการศึกษา 2562 ลิขสิทธ์ิของบณั ฑิตวทิ ยาลยั มหาวิทยาลัยศิลปากร DEVELOPMENT OF PALLIATIVE CARE MODEL USING THAI TRADITIONAL MEDICINE FOR TREATMENT OF END-STAGE LIVER CANCER PATIENTS IN THAI TRADITIONAL MEDICINE HOSPITALS By MR. Preecha NOOTIM A Thesis Submitted in Partial Fulfillment of the Requirements for Doctor of Philosophy (SOCIAL AND ADMINISTRATIVE PHARMACY) Graduate School, Silpakorn University Academic Year 2019 Copyright of Graduate School, Silpakorn University Title Development of Palliative Care Model Using Thai Traditional Medicine for Treatment of End-stage Liver Cancer Patients in Thai Traditional Medicine Hospitals By Preecha NOOTIM Field of Study (SOCIAL AND ADMINISTRATIVE PHARMACY) Advisor Assistant Professor NATTIYA KAPOL , Ph.D. Graduate School Silpakorn University in Partial Fulfillment of the Requirements for the Doctor of Philosophy Dean of graduate school (Associate Professor Jurairat Nunthanid, Ph.D.) Approved by Chair person (Assistant Professor SURASIT LOCHIDAMNUAY , Ph.D.) Advisor (Assistant Professor NATTIYA KAPOL , Ph.D.) Co advisor (Assistant Professor WARANEE BUNCHUAILUA , Ph.D.) Committee (Assistant Professor PANOOPAT POOMPRUEK , Ph.D.) External Examiner (Assistant Professor PARUNKUL TUNGSUKRUTHAI , Ph.D.) D ABST RACT 57354802 : Major (SOCIAL AND ADMINISTRATIVE PHARMACY) Keyword : end-stage liver cancer, palliative care, Thai Traditional Medicine MR. PREECHA NOOTIM : DEVELOPMENT OF PALLIATIVE CARE MODEL USING THAI TRADITIONAL MEDICINE FOR TREATMENT OF END- STAGE LIVER CANCER PATIENTS IN THAI TRADITIONAL MEDICINE HOSPITALS THESIS ADVISOR : ASSISTANT PROFESSOR NATTIYA KAPOL, Ph.D. Current cancer modern medical treatment in mainly a treatment for inhibition of hepatocellular carcinoma proliferation in different stage, however, liver cancer is the still most diseases with high incidence and mortality rate. Moreover, modern medical treatment has several side effects. Thai traditional medicine is an alternative for the treatment of end-stage liver cancer patients. This research aimed to develop a palliative care model using Thai Traditional Medicine (TTM) for treatment of end-stage liver cancer patients in TTM Hospitals. Five TTM hospitals implemented the model comprised of 1) Thai Traditional and Integrated Medical hospital 2) Uthong hospital 3) Wattana Nakhon hospital 4)Khun Han hospital and 5)Sawang Daen Din Crown Prince Hospital. The methods were conducted in 3 phases including 1) the study of situations, problems, and obstacles in the care of end-stage liver cancer patients in TTM hospitals, 2) the development of the model of palliative care for end-stage liver cancer patients with TTM, and 3) the implementation and assessment of the possibility of using a palliative treatment model for liver cancer patients with TTM at TTM hospitals. The results showed that the palliative care model for end-stage liver cancer patients composed of 1) the roles of healthcare professional team 2) treatment of end-stage liver cancer patients guidelines 3) holistic care guidelines, and 4) guidelines for referral system and home visit. The model was applied to TTM hospitals with 3 different platforms, which were stand alone, paralleled and integrated services. After the implementation, the evaluations were conducted in 3 groups of participants; healthcare team, patients and caregivers. Data were analyzed by descriptive statistics such as frequency, percentage, mean, standard deviation and compare the evaluation score between before and after implementation with paired t-test statistics. Regarding possibility evaluation, all health care providers agreed that the palliative care model using TTM for treatment of end-stage liver cancer patients was possible at a high level for implementation. The satisfaction of health care team and the patients’ symptom were significantly changed after the implementation. Clinical outcomes in physical and mental aspects of patients were improved significantly (p<0.05). Patients and their caregivers’ satisfaction toward palliative care services were at highest level (M=4.38;SD=0.46) and (M=4.22;SD=0.38); respectively. In conclusion, the developed palliative care model using TTM for treatment of end-stage liver cancer patients can be implemented in the TTM Hospitals. The TTM model should be adjusted according to resources and policy of each hospital. However, outcome evaluation for testing the effectiveness of the model in the long term is highly recommended for further study. E ACKNOWLEDGEMENTS ACKNOWLEDGEMENTS I would like to thank the Thai Tradition Medicine Wisdom funding through the project of researcher’ s capability development in Thai Traditional and Alternative Medicine system for providing monetary support to complete this thesis. More importantly, I would like to extend my sincere appreciation to the following individuals and their contribution from the beginning to the complete of this Thesis as Doctor Wattana Panmuang, Director of Thai Traditional and Integrated Medicine Hospital, for the opportunity to pursue Doctoral program, Assistant Professor Nattiya Kapol as a major advisor and Assistant Professor Waranee Bunchuailua as co- advisor for their knowledge, advice, and encouragement during my doctoral study program, Chief of thesis defend committee Assistant Professor Surasit Lochid-amnuay, Assistant Professor Parankul Tungsukruthai, and Assistant Professor Panoopat Poompruek for comprehensive recommendations, Instructor, staff and friends at the Department of Community Pharmacy, Faculty of Pharmacy, Silpakorn University, Neurologists, Internal medicine doctors, rehabilitation doctor , nurse leaders, nurses, pharmacist leaders, pharmacist, Thai traditional medicine practitioner leader, Thai Traditional Medicine practitioner at Thai traditional and Integrated Medicine in Bangkok, Uthong Hospital in Suphanburi, Khunharn Hospital in Sisaket, Swang Dan Din Crown Prince Hospital in Sakon nakhon and Wattananakorn Hospital in Sa kaeo. Last, but not least, I am truly grateful to have had tremendous support, advice and encouragement from my parent and wife throughout the entire study program. Preecha NOOTIM TABLE OF CONTENTS Page ABSTRACT .................................................................................................................. D ACKNOWLEDGEMENTS .......................................................................................... E TABLE OF CONTENTS ............................................................................................... F LIST OF TABLES ......................................................................................................... I CHAPTER I INTRODUCTION .................................................................................... 1 Importance and Background ...................................................................................... 1 Research questions ..................................................................................................... 6 Objectives .................................................................................................................. 6 Scope of study ............................................................................................................ 6 Definition of Terms ................................................................................................... 6 Benefits of the study .................................................................................................. 7 Research Framework ................................................................................................. 8 CHAPTER II LITERATURE REVIEW ....................................................................... 9 1. Cancer .................................................................................................................... 9 2. Thai traditional medicine theory .......................................................................... 19 3. Thai traditional medicine and the last phase of life ............................................. 24 4. WHO 2010 palliative care concepts..................................................................... 24 5. Palliative care concepts for end-stage liver cancer patients ................................. 28 6. Thai Traditional Medicine Hospitals ................................................................... 47 7. Researchers related to the development of end-stage cancer care ....................... 57 CHAPTER III METHODOLOGY .............................................................................. 63 G Phase I: The study of situations, problems, and obstacles of palliative treatment of end-stage liver cancer patients with Thai traditional medicine ......................... 65 Phase II: The development of a palliative model for end stage liver cancer patients with Thai traditional medicine. .......................................................................... 68 Phase III: The implementation
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