A Clinical Data Mining Study of the Psychosocial Status of Chinese Cancer Patients in Palliative Care

This dissertation, "A Clinical Data Mining Study of the Psychosocial Status of Chinese Cancer Patients in Palliative Care" by Chi-ho, Chan, 陳智豪, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract of thesis entitled A Clinical Data Mining Study of the Psychosocial Status of Chinese Cancer Patients in Palliative Care Submitted by Chan Chi Ho for the degree of Doctor of Philosophy at the University of Hong Kong in August 2007 Psychosocial studies of Chinese cancer patients in palliative care of Hong Kong are limited. Little has been known on the psychosocial issues of Chinese cancer patients in palliative care of Hong Kong. As a professional who is responsible for managing the psychosocial needs of cancer patients and families in palliative care, social workers are in pressing need of local research to inform indigenous social work practice. Thus, this study attempts to answer the research questions that emerge from the social work practice in palliative care, and aims at integrating social work research with practice. Clinical Data Mining (CDM), which emphasizes the use of the existing clinical data in conducting practice-based research, is adopted as the research approach in this study. Research gaps and research questions are proposed in relation to the clinical concerns in social work practice in palliative care, and the availability of clinical data. Based on the clinical data of patients who died in 2002 to 2005, a total of 935 Chinese cancer patients in palliative care are included in this study. Findings are discussed under five major themes, including 1) moving towards good death, 2) family and patient, 3) body-mind connection, 4) search for meaning, 5) psychosocial assessment. Findings may reflect the benefits of palliative care in managing physical and psychosocial symptoms of cancer patients. Patients who were at initially higher psychosocial risk level, experienced significant improvement in most of the psychosocial symptoms from the time of admission to palliative care to final days before death. This may imply palliative care, and social work interventions in palliative care may facilitate patients to move towards good death Family shows its unique importance on the patient outcomes. Chinese cancer patients may experience a cultural phenomenon of "support paradox," in which patients may desire for and benefit from family support, but also worry about and are influenced by the family distress in receiving support from family. Inter-relationship between body and mind is reflected from the findings. Inevitable physical deterioration, such as the "anorexia-cachexia" syndrome, may bring psychosocial distress to patients. "Negative somatization" is conceptualized to illustrate the impact of psychosocial distress on patients' under-reporting of physical symptoms. Findings also show the universal need for meaning among Chinese cancer patients in palliative care, despite many of them are atheists. Making sense of the illness, and searching for meaning in life with terminal illness may play an important role on the patient outcomes. Importance of psychosocial assessment on admission to palliative care is also highlighted. It shows to be an essential component in understanding patients' needs, comparing differences, identifying protective and risk factors, as well as monitoring changes of patients. Implications for social work practice and social work research are discussed. Cultural sensitivity in psychosocial intervention is particularly emphasized. Recommendations are proposed to enhance service improvemen