Development of a Care System for End-Stage Chronic Kidney Disease Patients in Na Chaluai District, Ubon Ratchathani Province.

Abstract

     This action research aimed to study, develop, and evaluate a care system for end-stage chronic kidney disease (ESKD) patients who did not receive renal replacement therapy in Na Chaluai District, Ubon Ratchathani Province. The research was conducted from January to December 2024 with the participation of 60 stakeholders including multidisciplinary healthcare teams and local community networks. The objective was to establish a patient-centered palliative care model based on participation and context-appropriate system improvement. Research instruments included a palliative care outcome questionnaire, a perceived peaceful end-of-life scale, and a satisfaction assessment form related to advance care planning. Qualitative data were analyzed using content analysis, while quantitative data were analyzed using frequency, percentage, mean, and paired t-test.

     The development process was implemented through three iterative action research cycles. The resulting care system comprised six essential components: (1) Leadership and governance, through the establishment of a district-level steering committee and action plan; (2) Budget allocation, involving the setup of a medical equipment service center, procurement of additional supplies, and allocation of funds for proactive home visit teams; (3) Human resources and network, focusing on the development of multidisciplinary professionals, village health volunteers (VHVs), and community caregivers to enhance the capacity for end-of-life care; (4) Service delivery system, including the creation of standardized clinical pathways, a palliative care and advance care planning program, and comprehensive care manuals; (5) Medication and supply management, involving the expansion of essential drug lists for effective symptom control; and (6) Health information and communication systems, involving the integration of platforms such as HOSxP, LINE application, and direct phone coordination to ensure timely and accurate service connection.

     The results revealed that all patients received advance care planning. Symptom-related complications were reduced by 75%, and quality of life improved by 50%. The mean palliative care outcome scores, as perceived by both patients and their caregivers, significantly decreased post-intervention, indicating reduced suffering. In contrast, perceived peaceful end-of-life scores reported by caregivers significantly increased after the intervention, confirming the effectiveness of the care model. Moreover, the quality of life of ESKD patients improved significantly from a low to a moderate level (p < 0.01). Both patients and caregivers reported a high level of satisfaction with the care process. These findings suggest that a participatory, context-specific care system can effectively improve outcomes and satisfaction among terminally ill patients and their families.