Effectiveness of the D-METHOD-P Discharge Plan Model for Palliative Care Patients on managing distressing symptoms in the In-Patient Department, Chiang Khan Hospital, Loei Province.

Abstract

The increasing elderly population and end-of-life patients in Thailand presents significant challenges for palliative care delivery. A contextual analysis of end-of-life care at Chiang Khan Hospital revealed that the existing discharge planning model lacked critical components for communicating disease understanding and prognosis. The researcher developed the
D-METHOD-P discharge planning model by integrating the D: Diagnosis component into the original METHOD-P framework, creating a comprehensive 8-component approach. This study aimed to compare knowledge and behaviors in managing distressing symptoms among patients and caregivers before and after implementing the D-METHOD-P model, and to examine satisfaction with the care model. A quasi-experimental, one-group pretest-posttest design was conducted with 30 end-of-life patients and 30 caregivers in the inpatient department of Chiang Khan Hospital, Loei Province, between March and May 2025. Instruments included the D-METHOD-P model, knowledge and behavior questionnaires, and satisfaction assessment tools. Data were analyzed using descriptive statistics and paired t-test.

        The results showed that (1) end-of-life patients' mean knowledge scores for managing distressing symptoms increased from 9.37±2.84 to 17.83±1.66 (t = 16.89, p < .001, Cohen's
d = 3.91), and behavior scores increased from 8.63±3.12 to 18.27±1.44 (t = 18.42, p < .001, Cohen's d = 4.27); (2) caregivers' mean knowledge scores increased from 10.23±2.67 to 18.47±1.28 (t = 19.47, p < .001, Cohen's d = 4.52), and behavior scores increased from 9.47±2.95 to 18.90±1.06 (t = 20.18, p < .001, Cohen's d = 4.68), with all variables demonstrating very large effect sizes; and (3) both patients and caregivers reported the highest level of satisfaction with the D-METHOD-P model (4.68±0.34 and 4.73±0.31, respectively).

        In conclusion, the D-METHOD-P discharge planning model demonstrated high effectiveness in improving knowledge and behaviors for managing distressing symptoms among end-of-life patients and their caregivers. The integration of disease understanding components with holistic care promoted patients' and families' readiness for continuous home-based care. This model can be adapted for implementation in community hospitals to enhance the quality of palliative care for end-of-life patients and improve their quality of life in the final stages of life.