The Physical and Psychosocial Outcomes of a Psychosocial Home-Based end-of-Life Care Intervention in Hong Kong

Abstract

<h3>Objective</h3><p>Living the final days of life being cared for at home is a preference expressed by many. The data on the effectiveness of home-based end-of-life care (EoLC) intervention to improve the holistic conditions of terminally ill patients are scanty. This study sought to evaluate a psychosocial home-based EoLC intervention for terminally ill patients in Hong Kong.</p><h3>Methods</h3><p>A prospective cohort study was conducted, applying the Integrated Palliative Care Outcome Scale (IPOS) at 3 timepoints (service intake, 1-month, and 3-months after enrollment). A total of 485 eligible, consenting terminally ill people (mean age = 75.48, SD = 11.39) were enrolled, with 40.21% (n = 195) providing data at all 3 timepoints for this study.</p><h3>Results</h3><p>Decreasing symptom severity scores were observed for all IPOS psychosocial symptoms, and most physical symptoms, over the 3 timepoints. Improvements in depression and practical concerns had the highest omnibus time effects (<em>F </em>> 31.92, <em>P</em> < .01) and T₀ to T₂ paired comparison effects (<em>Cohen's d</em> > 0.54, <em>P </em>< .01). Physical symptoms of weakness/lack of energy, poor mobility, and poor appetite also showed significant improvements at T₁ and T₂ (<em>Cohen's d</em>: 0.22-0.46, <em>P </em>< .05). Bivariate regression analyses showed that improvements in anxiety, depression, and family anxiety were associated with improvements in physical symptoms of pain, shortness of breath, weakness/lack of energy, nausea, poor appetite, and poor mobility. Patients’ demographic and clinical characteristics were not associated with changes in symptoms.</p><h3>Conclusions</h3><p>The psychosocial home-based EoLC intervention effectively improved the psychosocial and physical status of terminally ill patients, irrespective of their clinical characteristics or demographics.</p>