The palliative care (PC) approach aims to holistically improve the quality of life of terminally ill individuals and their caregivers. This holistic approach ensures the comfort of both the individual, their family, and their carer in all aspects (biological, psychological, social, and mental). Despite the fact that PC is an integral part of care in terminal conditions, this does not necessarily exclude the use of PC within other, non-life-threatening medical conditions (Mondejar-Pont et al, 2019). According to WHO (2019) it is estimated that 40 million people are in need of PC every year, while only 14% receive it.
Research has revealed an increase in tumor-related diseases and consequently an increase in the need for further support for cancer patients' healthcare services (Bray et al, 2018; Jordan et al, 2018; Pennbrant et al, 2020; Saunders et al, 2021).
Furthermore, current cancer treatments increasingly use PC as it can improve the quality of life of the patient and prevent the excessive use of healthcare services (for example, by limiting hospital admissions), especially when it is applied in a timely manner (Maher, 2012).
PC is implemented according to the needs of the patients and their families through the help of a group of healthcare professionals consisting of a trainee doctor, nurse, social worker, psychologist, physiotherapist and specialist in mental healthcare, as well as an in-home healthcare provider (Kahveci et al, 2020). For the vast majority of patients who need PC, the home is the most preferable space for care as it preserves the patient's sense of being and maintains control of one's life. However, the continuity and coordination of care of individuals in their home can often involve several challenges for home care nursing (HCN) (Sandsdalen et al, 2015).
Considering the aforementioned positive impact of PC and recognising that there is no relevant research activity in Cyprus, the current study aims to evaluate the quality of home PC among cancer patients in Cyprus, with the goal to outline how exactly PC is being offered in the interdisciplinary care of cancer patients. In the literature, the specific research area presents several gaps on a national level. Therefore, this research aims to provide evidence on the state of PC and highlight any impacting prognostic factors that healthcare organisations and professionals should consider. More specifically, to assess the quality of the patient's home palliative care programmes and their quality of life, the patients' satisfaction with the psychological support and communication they receive from their PC plan, as well as the feeling of security and satisfaction they gain and the respect and recognition they receive for their needs, will be measured. This research and data is expected to contribute to the evaluation of the quality of health services in Cyprus, and help design interventions aimed at the development of community health care in the region. This will potentially enhance the government's newly established general health system performance.
Methods
Study design and setting
This cross-sectional quantitative research follows the STROBE cross-sectional study checklist (von Elm et al, 2008). The choice of this method was based on the lack of quantitative data in Cyprus and the need for an initial collection of information that can be used as the basis of future research. Additionally, the collection of quantitative data would be a relatively quick process that could offer the possibility of linking all data to other similar international surveys. The study took place in the Republic of Cyprus and data collection was completed between 1 November and 30 November 2021. After ensuring that all necessary licensing for carrying out and implementing the study was acquired, the questionnaire, together with an empty self-adhesive folder, was distributed to the nursing staff, employed in in-home care nursing of the Cyprus Anti-Cancer Society. The questionnaire was returned sealed inside the folder to the nursing staff, during the nurse's next scheduled home visit.
Sampling and sample size
The studied population were individuals who received HCN, either because of cancer treatment or palliative home care. Participants were found after the cooperation of the research team with the services of the Cyprus Ministry of Health, and were approached through the home nursing palliative care services. Furthermore, following the guidelines of Campbell et al (2020), to be included in the study, participants had to be older than 18 years old, have an active tumour history, received home healthcare services for a significant amount of time in Cyprus and have knowledge of the Greek language.
The exclusion criteria were individuals who had a reduced intellectual ability that could impair their judgment and individuals who were unable to participate because of illness.
Given that a known list of cancer patients who received home healthcare services were not available, the sample was chosen using convenient sampling.
To establish a research question among the population of interest (>500 000 people), and to make a statistically accurate generalisation from the results, the minimum sample size was estimated to be 138 individuals. The specific number of individuals was derived using the mathematical formula E = Sqrt [(N - n)x/n(N-1)], with an error range of α = 5%, a confidence interval of 95%, and a response allocation of 10%.
Study instrument
The data collection instrument was a questionnaire in Greek, which consisted of eight demographic and HCN data questions and a scale of 42 questions that measured the quality of the care provided within HCN via three dimensions (Ioannidis, 2018). The initial dimensions of the scale were reviewed after the data collection took place, following consultation with the research team of the present study and statistical controls. Statements in the scale are answered in a five-point Likert scale that was encoded for statistical reasons as 1 = Strongly disagree up to 5 = Strongly agree. However, 12 statements used reverse encoding (5 = Strongly disagree and 1 = Strongly agree) owing to a negative concept.
RESULTS
Statistical analysis
The results of the study came from the validation of the research instrument of Ioannidis (2018), which was constructed for the evaluation of palliative home care for cancer patients. All reported p values are two-tailed. Statistical significance was set at p<0.05. Descriptive data are presented as mean values with standard deviation for numerical variables and as frequencies and percentages for categoric variables. Furthermore, the Sullivan and Artino (2013) rule was applied, with mean values between 1.00–1.49 being considered as non-satisfactory, 1.50–2.49 as relatively satisfactory, 2.50–3.49 as medium satisfactory, 3.50–4.49 satisfactory and above 4.50 as extremely satisfactory.
Correlations between instrument dimensions were analysed with the Pearson correlation factor r. The correlations between variables were examined with the Welsch t-test for independent samples in cases where one of the variables consisted of two categories (for example, sex) and with the ANOVA test in cases where the variable categories were more than two. Statistical analysis was completed using the statistical system, IBM Statistical Package for the Social Sciences (IBM SPSS v27).
Questionnaire validity and reliability
The construct validity was evaluated using exploratory factor analysis (EFA) where the individual dimensions of the scale were analysed. The factor analysis method used was a maximum likelihood and axis rotation was done using the oblimin method. Internal consistency reliability was measured using the internal consistency reliability factor-Cronbach's alpha. The internal consistency was measured for the total scale and for each of the dimensions as determined by EFA.
Construct validity
The data was sufficient for factor analysis (Kaiser-Meyer-Olkin=0.868) and the correlations between the scale points have adequate correlation size (Bartlett's Test of Sphericity: X2(861) = 2516, p <0.00).
A total of 42 statements load to five factors that justify 43% of the total distribution with only 34 statements having a loading of >0.40 (Table 1). The remaining eight statements have a weak loading (<0.30) in all factors. In particular, the loadings of points in the first factor, fluctuate between 0.49 to 0.77, in the second factor fluctuate between 0.42 to 0.81, in the third factor fluctuate between 0.56 to 0.78, and in the fourth factor fluctuate between 0.41 to 0.65. The fifth factor has extremely low loadings (<30), where the statement ‘HCN offers services which would burden me financially’ is the only exception where cross-loadings between the fourth and fifth factors are observed.
Table 1. Factor analysis results – Loadings statement tool
| Factors | ||||||
|---|---|---|---|---|---|---|
| Dimensions | Statements | F1 | F2 | F3 | F4 | F5 |
| Psychological support and communication | Q1 | 0.05 | 0.20 | 0.12 | 0.54 | -0.12 |
| Q2 | 0.01 | -0.03 | 0.14 | 0.65 | 0.03 | |
| Q3 | 0.15 | -0.06 | 0.02 | 0.46 | 0.08 | |
| Q4 | 0.24 | 0.08 | -0.15 | 0.50 | 0.14 | |
| Q5 | -0.06 | -0.13 | 0.04 | 0.62 | 0.00 | |
| Q6 | 0.15 | 0.03 | 0.12 | 0.43 | -0.07 | |
| Q7 | 0.17 | 0.12 | 0.01 | 0.64 | 0.10 | |
| Q8 | -0.21 | -0.11 | 0.34 | 0.41 | 0.40 | |
| Q9 | 0.22 | 0.15 | 0.02 | 0.54 | -0.39 | |
| Respect and recognition of needs | Q1 | -0.03 | 0.77 | -0.12 | 0.14 | 0.02 |
| Q2 | 0.00 | 0.59 | 0.08 | 0.16 | 0.17 | |
| Q3 | -0.16 | 0.57 | 0.13 | 0.13 | 0.14 | |
| Q4 | -0.02 | 0.68 | 0.08 | 0.23 | -0.29 | |
| Q5 | 0.00 | 0.81 | -0.08 | -0.17 | -0.17 | |
| Q6 | 0.25 | 0.43 | -0.14 | 0.12 | 0.28 | |
| Q7 | -0.08 | 0.81 | 0.17 | 0.00 | 0.14 | |
| Q8 | 0.09 | 0.77 | -0.05 | -0.21 | -0.03 | |
| Q9 | 0.20 | 0.42 | 0.02 | 0.17 | 0.21 | |
| Feeling of security and satisfaction | Q1 | 0.57 | 0.00 | 0.05 | 0.15 | 0.01 |
| Q2 | 0.64 | -0.02 | 0.01 | 0.11 | 0.12 | |
| Q3 | 0.49 | 0.02 | 0.06 | 0.23 | 0.13 | |
| Q4 | 0.55 | 0.11 | -0.12 | 0.15 | 0.19 | |
| Q5 | 0.77 | -0.16 | 0.04 | 0.00 | 0.03 | |
| Q6 | 0.81 | 0.01 | 0.11 | -0.09 | -0.11 | |
| Q7 | 0.70 | 0.05 | 0.18 | -0.07 | -0.14 | |
| Q8 | 0.62 | 0.02 | 0.20 | 0.10 | -0.03 | |
| Q9 | 0.49 | 0.06 | 0.28 | -0.02 | -0.07 | |
| Q10 | 0.59 | 0.03 | 0.06 | 0.23 | -0.01 | |
| Quality of life | Q1 | -0.09 | 0.02 | 0.78 | 0.18 | -0.19 |
| Q2 | -0.12 | -0.04 | 0.78 | 0.08 | -0.10 | |
| Q3 | 0.21 | 0.01 | 0.71 | 0.07 | 0.13 | |
| Q4 | 0.13 | 0.11 | 0.77 | -0.10 | 0.09 | |
| Q5 | 0.23 | 0.03 | 0.77 | -0.18 | 0.14 | |
| Q6 | 0.34 | -0.13 | 0.56 | 0.21 | -0.01 | |
Implementing the EFA application while taking into account only statements with loadings >0.40 and following the removal of the exceptional cross-loadings statement, 33 statements are preserved and four individual dimensions are formed as follows: 1) psychological support and communication, 2) respect and recognition of needs, 3) feeling of security and satisfaction, and 4) quality of life.
Internal consistency reliability
The entire tool consisting of 42 questions has a high internal reliability coefficient score (α=0.92). Individual dimensions formed after the EFA application have either a satisfactory score (psychological support and communication, α=0.79) or a high internal reliability coefficient (respect and recognition of needs, α=0.87; feeling of security and satisfaction, α= 0.89and quality of life, α=0.91) (Table 2).
Table 2. Internal consistency reliability Cronbach's alpha
| Individual dimensions | Cronbach's alpha | N |
|---|---|---|
| Psychological support and communication | 0.79 | 8 |
| Respect and recognition of needs | 0.91 | 6 |
| Feeling of security and satisfaction | 0.87 | 9 |
| Quality of life | 0.89 | 10 |
| Home Care Program quality (Σ) | 0.92 | 42 |
Characteristics of the respondents and scale means
Table 3 presents the demographic and HCN data of the respondents. A total of 80 cancer patients who participated in HCN in Cyprus were involved in this study. The majority of respondents were women (n=43, 54%), and all patients were above the age of 40 years with the most common age group lying between the ages of 60-69 years (n=31, 39%). Furthermore, most participants were graduates of secondary education (n=32, 40%) with 50 (62%) participants stating to be married. A total of 61 (76%) participants were retired or unemployed, with the most common yearly income recorded as <15 000 euros (n=50, 62%). Regarding the period of participation in HCN, there is a relatively equal time frame among participant categories. Lastly, the majority of participants stated that they were visited by a healthcare professional either once a week (n=27, 34%) or 2–3 times a week (n=25, 31%).
Table 3. Demographic and home care nursing data
| Variable | Category | N (%) |
|---|---|---|
| Gender | Male | 37 (46%) |
| Female | 43 (54%) | |
| Age | 40–59 | 16 (20%) |
| 60–69 | 31 (39%) | |
| 70–79 | 21 (26%) | |
| 80+ | 12 (15%) | |
| Educational Background | Primary education | 19 (24%) |
| Secondary education | 32 (40%) | |
| Diploma/Degree | 29 (36%) | |
| Marital Status | Single | 3 (3.8%) |
| Married | 50 (62%) | |
| Widowed | 17 (21%) | |
| Divorced | 10 (12%) | |
| Employment | Occasional/Part-time | 8 (10%) |
| Full-time | 11 (14%) | |
| Retirement/Unemployed | 61 (76%) | |
| Annual Income | €0–15 000 | 50 (62%) |
| €15 000–25 000 | 22 (28%) | |
| €25 000 and above | 8 (10%) | |
| Period of participation in the home care nursing | Up to 6 months | 16 (20%) |
| 7–12 months | 13 (16%) | |
| 13–18 months | 12 (15%) | |
| 19–24 months | 11 (14%) | |
| 2–3 years | 14 (18%) | |
| 3–4 years | 14 (18%) | |
| Frequency of Nurse visits | Once a week | 27 (34%) |
| 2–3 times a week | 25 (31%) | |
| 4–5 times a week | 14 (18%) | |
| 1–2 times a month | 14 (18%) |
Table 4 illustrates the mean ± standard deviation of the scale and its dimensions. The satisfaction level on the Likert scale is found on average at 4.4±0.5 as far as psychological support and communication is concerned, whereas, respect and recognition of needs is at 4.2±0.8. Additionally, the feeling of security and satisfaction yields a mean satisfaction value of 4.5±0.5 and the quality of life dimension has a mean value of 4.2 ±0.7. Within the tool altogether (home care programme quality), the mean satisfaction amounts to 4.3±0.4.
Table 4. Mean±standard deviation of the scale and its dimensions
| Individual dimensions | Mean±SD | Range | IQR |
|---|---|---|---|
| Psychological support and communication | 4.4±0.5 | 1–5 | 2.4–5.0 |
| Respect and recognition of needs | 4.2±0.8 | 1–5 | 1.4–5.0 |
| Feeling of security and satisfaction | 4.5±0.5 | 1–5 | 2.5–5.0 |
| Quality of life | 4.2±0.7 | 1–5 | 2.0–5.0 |
| Home Care Program quality | 4.3±0.4 | 1–5 | 3.3–5.0 |
Note: IQR=interquartile range; SD=standard deviation
Correlations and statistic differences between means
The mean ± standard deviation of the scale and its dimensions between demographics & HCN data are presented in Table 5. Analysis of results shows only one circumstance of significant statistical difference between the dimension of respect and recognition of needs and the employment variable (P=0.008). In particular, participants with occasional or part-time occupations (3.5±1.2), have scored the lowest satisfaction level in relation to participants occupied in other employment types.
Table 5. HCN quality mean scores by demographic and HCN data (M±SD1)
| Variable | Psychological support and communication | Respect and recognition of needs | Feeling of security and satisfaction | Quality of life | Home care programme quality |
|---|---|---|---|---|---|
| Gender*** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Male | 4.4±0.5 | 4.3±0.8 | 4.4±0.5 | 4.2±0.7 | 4.3±0.5 |
| Female | 4.4±0.5 | 4.2±0.7 | 4.5±0.5 | 4.2±0.6 | 4.3±0.4 |
| Age** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| 40–59 years | 4.6±0.3 | 4.3±0.5 | 4.6±0.5 | 4.3±0.5 | 4.5±0.3 |
| 60–69 years | 4.4±0.5 | 4.2±0.9 | 4.5±0.4 | 4.3±0.6 | 4.4±0.5 |
| 70–79 years | 4.3±0.6 | 4.3±0.6 | 4.4±0.4 | 4.2±0.8 | 4.3±0.5 |
| 80+ years | 4.3±0.5 | 4.0±1.0 | 4.2±0.8 | 3.9±0.7 | 4.1±0.5 |
| Educational background** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Primary education | 4.2±0.4 | 4.1±0.8 | 4.3±0.6 | 4.0±0.6 | 4.2±0.4 |
| Secondary education | 4.3±0.6 | 4.3±0.6 | 4.5±0.4 | 4.1±0.7 | 4.4±0.4 |
| Diploma/degree | 4.6±0.4 | 4.2±0.9 | 4.5±0.4 | 4.4±0.5 | 4.4±0.4 |
| Marital status** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Single | 4.6±0.4 | 4.4±0.2 | 4.0±1.3 | 4.0±1.0 | 4.3±0.7 |
| Married | 4.5±0.4 | 4.3±0.8 | 4.5±0.5 | 4.3±0.7 | 4.4±0.4 |
| Widowed | 4.3±0.5 | 3.9±0.7 | 4.4±0.4 | 3.9±0.6 | 4.1±0.4 |
| Divorced | 4.2±0.8 | 4.6±0.5 | 4.6±0.4 | 4.4±0.5 | 4.5±0.5 |
| Employment ** | 4.4±0.5 | 4.2±0.8* | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Occasional/part-time | 4.4±0.4 | 3.5±1.2* | 4.6±0.5 | 4.7±0.4 | 4.3±0.5 |
| Full-time | 4.6±0.3 | 4.2±0.4 | 4.5±0.5 | 4.1±0.5 | 4.4±0.2 |
| Retirement/unemployed | 4.3±0.5 | 4.3±0.7 | 4.5±0.5 | 4.2±0.7 | 4.3±0.5 |
| Annual Income** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| €0–15000 | 4.3±0.6 | 4.3±0.7 | 4.5±0.5 | 4.2±0.7 | 4.3±0.5 |
| €15000–25000 | 4.5±0.4 | 4.2±1.0 | 4.5±0.4 | 4.3±0.7 | 4.4±0.4 |
| €25000 and above | 4.4±0.4 | 3.8±0.4 | 4.4±0.3 | 4.2±0.3 | 4.2±0.2 |
| Period in HCN** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Up to 6 months | 4.2±0.7 | 4.0±0.8 | 4.4±0.4 | 4.0±0.5 | 4.2±0.4 |
| 7–12 months | 4.5±0.3 | 4.4±0.4 | 4.3±0.7 | 4.0±0.9 | 4.3±0.4 |
| 13–18 months | 4.4±0.4 | 4.2±0.9 | 4.6±0.4 | 4.2±0.6 | 4.4±0.4 |
| 19–24 months | 4.4±0.4 | 4.2±0.8 | 4.5±0.5 | 4.4±0.6 | 4.4±0.5 |
| 2–3 years | 4.6±0.5 | 4.4±0.8 | 4.5±0.6 | 4.3±0.7 | 4.5±0.6 |
| 3–4 years | 4.3±0.5 | 4.3±0.7 | 4.5±0.4 | 4.3±0.6 | 4.4±0.4 |
| Frequency of nurse visits** | 4.4±0.5 | 4.2±0.8 | 4.5±0.5 | 4.2±0.7 | 4.3±0.4 |
| Once a week | 4.3±0.6 | 4.1±0.9 | 4.5±0.5 | 4.1±0.8 | 4.3±0.5 |
| 2–3 times a week | 4.4±0.4 | 4.2±0.8 | 4.3±0.5 | 4.3±0.5 | 4.3±0.4 |
| 4–5 times a week | 4.5±0.4 | 4.5±0.7 | 4.8±0.3 | 4.4±0.6 | 4.6±0.4 |
| 1–2 times a month | 4.4±0.5 | 4.3±0.4 | 4.4±0.5 | 4.0±0.7 | 4.3±0.4 |
Note:
*P-value <0.05;
**One-way ANOVA;
***Welch Two Sample t-test; 1Mean±Standard Deviation; HCN =home care nursing
Table 6 illustrates the Pearson linear correlation between questionary dimensions. Results show that the dimension of psychological support and communication has a moderately positive correlation with the dimension of respect and recognition of needs (r=0.7, p<0.01), as well as a moderately to highly positive correlation to quality of life (r=0.44, p<0.01). Similarly, respect and recognition of needs appears to be moderately positively correlated to the feeling of security and satisfaction(r=0.33, p<0.01), but there is no substantial correlation to quality of life (r=0.16, p>0.05).
Table 6. Pearson linear correlation between dimensions
| Psychological support and communication | Respect and recognition of needs | Feeling of security and satisfaction | Quality of life | |
|---|---|---|---|---|
| Respect and recognition of needs | 0.4* | 0.33* | 0.16 | |
| Feeling of security and satisfaction | 0.57* | 0.33* | 0.58* | |
| Quality of life | 0.44* | 0.16 | 0.58* |
Note:
*p< 0.01
Discussion
The results provide data related to the objectives set during the design of this study. More specifically, data was collected evaluating the quality of home PC among cancer patients in Cyprus. Data about patients' satisfaction, psychological support and communication, respect and recognition of patients' needs, and patients' feeling of security and satisfaction were collected. All those data constitute their quality of life, which is directly related to the quality of their home palliative care programme. The research instrument that has been used was also tested and validated. The scale of the present study has been evaluated for both its validity and its reliability. During the evaluation of its validity, four individual scale dimensions have occurred, all of which have yielded a high internal consistency reliability score.
The current research involved a total of 80 cancer patients who participated in HCN in Cyprus, of which, the majority were women with the most common age group lying between the ages of 60–69 years. Moreover, most participants were graduates of secondary education, married, retired or unemployed, with a yearly income of <15 000 euros. Most participants stated that they were visited by a healthcare professional once a week. Comparing with similar research in other countries, the number of participants on this study is representative of the population of Cyprus and offers reliable data (Sandsdalen et al, 2019; Taber et al, 2019; Trivedi et al, 2019).
Results analysis illustrates that participants evaluate the quality of palliative home care as overall satisfactory. Similarly, a satisfactory score has been achieved by all scale dimensions, including psychological support and communication, respect and recognition of needs and quality of life. The exception to this was security and satisfaction, which was evaluated as excellent. According to Garg et al (2018), those participants who have learned to use more emotion-focused coping responses to deal with stressful situations may respond positively. Another reason for their positive responses might be the relationship that has been built between healthcare providers and the patient.
Furthermore, results analysis revealed that employment type was the only demographic characteristic that seems to have an effect on the patients' experience of the quality of palliative home care. This result is aligned with the Kochovska et al (2018) study that investigates the impact of employment, finances and lifestyle of people with cancer. Particularly, participants who had an occasional or part-time occupation scored the lowest satisfaction level in relation to participants with other occupation types. The number of participants in this category is very small (n=8). Therefore, the results of this study are limited.. In addition, similar studies have shown contradicting results where the female sex correlated to lower percentages in the quality of life (Barbu et al, 2018; Argyriadi and Argyriadis, 2019). Another similar study conducted by Oh et al (2021), indicates that the most significant prognostic factors for a lower perception of the quality of one's life was the individual's financial state, their cancer stage and the effectiveness of undergoing treatments.
The present study also reveals that enhanced psychological support and communication is correlated to increased respect and recognition of one's needs, as well as improved quality of life. Newer research into psychological interventions in cancer has used cognitive behavioural therapy or mindfulness-based interventions. A smaller number of tr ials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged. While these findings are promising, additional trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions. In all cases, the positive effect of psychological support and efficient communication skills provided by caregivers needs to be highlighted (Hulbert-Williams et al, 2018).
Similarly, increased respect and recognition of one's needs correlate to an enhanced feeling of security and satisfaction. A systematic review conducted by Ventura et al (2014) concluded that patients receiving home care report unsatisfied PC needs while revealing that communication and feeling of security are the most significant prognostic factors for low satisfaction.
Limitations
A small sample size affects the reliability of the study's data since it results in a larger variability, which, in-effect, could lead to significant bias. Non-response bias is a particular issue in questionnaire studies (Sedgwick, 2015). Consequently, the study sample can be characterised as small because of a low response level among the studied population, which results in limitations regarding the generalization of results. Furthermore, volunteer bias cannot be reported since the sample of the study was affected by the specific bias as well. According to Sedgwick (2015), participants are expected to deviate from an actual representation of the wider population in their socio-demographic and behavioral characteristics as well as their attitude to their actual health condition. Moreover, the collection of data in this study was prone to ascertainment bias, as some participants may have possibly completed the questionnaire with the suspicion of the questionnaire's sealed folder being opened. Additional research and qualitative data are needed to fill in possible gaps and shortcomings that arose during the presentation of this study. It would also be particularly helpful to clarify the participants' perceptions of the emotional values of satisfaction and respect with mixed methods.
CONCLUSIONS
The analysis of the results illustrates that participants of this study evaluate the quality of palliative home care as satisfactory. Despite employment type, no other demographic or HCN data were found to significantly affect the quality of palliative home care. Data related to employment are possibly connected to the holistic emotional condition of the participants as it only consists of one element of their quality of life.
Moreover, psychological support and communication have been found to play a pivotal role in enhancing the quality of one's life, as well as their perceived levels of respect and recognition of one's needs. Additionally, the feeling of security and satisfaction is found to be affected by an environment of respect and recognition of patients' needs. Specifically, the absence of communication with a healthcare professional on a regular basis, the absence of coordination in HCN, and the uncertainty in relation to the type of emergency and the ideal person to call upon in such emergencies, were some of the most important findings of this study. The results of the study provided new data from the region of Cyprus and demonstrated a significant level of quality of the palliative health care provided at home. At the same time, weaknesses were identified, both in the level of staff training and issues related to women that need to be further investigated. Finally, new data on the values of respect and psychological support of patients come to highlight the subjectivity of patients' evaluation of the care provided.
Key points
- Palliative home care offers the potential to significantly improve the patients' quality of life since care in their own private space preserves the feeling of control over their life
- To improve the quality of the individual's life, home care nurses must have good psychological and communication skills
- Organisations should invest in the training of district nurses to develop their psychological and communication skills.
CPD reflective questions
- How do you manage palliative patients in community settings?
- Do you think your communication skills are adequate for providing palliative care in community settings?
- How do you think organizations can ensure the appropriate communication and psychological training that nurses need?