Impact of Palliative Care Integration on Patient Satisfaction and Symptom Burden in the Oncology Units of Nishtar Hospital, Multan
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Abstract
Background: Palliative care integration is increasingly recommended for patients with advanced cancer, yet implementation remains limited in low- and middle-income settings, including Pakistan. Objective: To evaluate whether nurse-led integrated palliative care was associated with reduced symptom burden and improved patient satisfaction among oncology patients at Nishtar Hospital, Multan. Methods: A quasi-experimental non-equivalent control group study was conducted among 120 adults with stage III or IV solid malignancies, including 60 patients receiving nurse-led integrated palliative care plus standard oncology care and 60 patients receiving standard oncology care alone. The intervention included structured symptom assessment, patient and family education, psychosocial support, care coordination, and repeated follow-up over five months. Symptom burden was measured using the Edmonton Symptom Assessment System, and patient satisfaction was measured using the Patient Satisfaction Questionnaire Short Form at baseline, one month, three months, and five months. Longitudinal outcomes were analyzed using adjusted linear mixed-effects models with missing outcome data handled through multiple imputation. Results: ESAS scores decreased from 52.4 ± 11.8 to 28.6 ± 9.4 in the intervention group and from 51.9 ± 12.1 to 45.3 ± 10.8 in the control group, with a month-5 between-group difference of -16.7 points. PSQ-18 scores increased from 58.3 ± 10.2 to 85.6 ± 8.7 in the intervention group and from 59.1 ± 9.8 to 65.4 ± 10.1 in the control group, with a month-5 between-group difference of 20.2 points. Conclusion: Nurse-led palliative care integration was associated with lower symptom burden and higher patient satisfaction among advanced oncology patients, supporting further multicenter evaluation of this model in resource-constrained settings.
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