Impact of volunteer-integrated palliative home visits on psychological well-being among metastatic breast cancer patients in northern Malaysia.

Abstract

12090 Background: Metastatic breast cancer patients face overlooked psychosocial challenges, mitigated through home visits. Universiti Sains Malaysia's volunteer-integrated palliative home visits bridge access gaps, support mental health (SDG 3), and foster partnerships (SDG 17). As Malaysia's most common female cancer (2017–2021: 16,430 cases, 22.2% stage IV), breast cancer highlights early palliative integration, yet local home-based outcomes remain unstudied. Methods: This prospective cross-sectional study (October 2024 to January 2026) in Northern Malaysia (Penang, Kedah) evaluated the impact of volunteer-integrated palliative home visits on Psychological Well-Being (Ryff 42-item scale, baseline and after 12 weeks). Healthcare professionals provided symptom and psychosocial care, while trained volunteers focused on emotional and practical support. Mixed teams (professionals and volunteers) conducted visits 1 and 6, with flexible staffing for intervening visits. Of 94 recruited patients, 81 completed the study and domain changes analyzed via descriptives, paired t-tests, and Cohen's d. Results: Participants were predominantly female (99%), aged 40 to 49 years (34.6%), low-income B40 group (64%) and multi-racial (78% Malay, 15% Chinese, 7% Indian). All had ECOG 0-3 at baseline, but 38% in ECOG 4 post-intervention. High-score groups (>30 on Ryff's subscale sums) increased for positive relations (70% to 95%), environmental mastery (47% to 69%), self-acceptance (45.5% to 68%), and personal growth (70% to 85%), but declined for autonomy (55.6% to 54.3%) and purpose in life (74% to 35%). Paired t-tests (Table 1) revealed significant small-to-moderate improvements in environmental mastery (p<0.001, d=0.46), positive relations (p<0.001, d=0.41), self-acceptance (p=0.042, d=0.23), and purpose in life (p=0.016, d=0.27). Changes in autonomy and personal growth were not statistically significant. Purpose-in-life declines reflect disease progression. Conclusions: The volunteer-integrated palliative care significantly improved environmental mastery, positive relations, self-acceptance, and purpose in life among breast cancer patients, despite ECOG deterioration. Findings support that the home visit enhanced psychological well-being amid disease progression, though refinement is needed for domains with non-significant changes. Paired t-test results for Ryff Psychological Well-Being (PWB) domains (pre- vs. post-intervention). PWB domains Mean Difference (SD) t(80) p value Cohen’s d Effect Size Autonomy 1.10 (6.51) 1.52 0.133 0.17 Small Self-Acceptance 1.99 (8.66) 2.07 *0.042 0.23 Small Positive Relations with Others 3.00 (7.31) 3.7 *0.000 0.41 Small to Medium Personal Growth 1.07 (8.75) 1.11 0.272 0.12 Small Environmental Mastery 3.27 (7.10) 4.15 *0.000 0.46 Medium Purpose in Life 1.59 (5.84) 2.46 *0.016 0.27 Small