Developing a Dynamic Conceptual Model of a Home-Based Palliative Care Plan Using the Comprehensive Primary Health Care (PHC) Approach

Authors

  • Mousami Kirtania School of Medical Sciences, University of Hyderabad, Hyderabad, India
  • Ajitha Katta School of Medical Sciences, University of Hyderabad, Hyderabad, India

DOI:

https://doi.org/10.55489/njcm.150420243728

Keywords:

Comprehensive Care, Home-based Care, India, Model, Palliative Care, Primary Healthcare Approach

Abstract

Background: Palliative Care (PC) was a core component of Primary Health Care services during the World Health Assembly Resolution, 2014. The study aims to develop a Comprehensive Palliative Care Model (CPCM) for patients with life-threatening conditions compliant with the local context and unmet needs.

Materials and Methods: A mixed-methods approach will be adopted for the three-phased study in two districts of Telangana. Phase I, a literature review, will be performed to explore globally available PC models, followed by an on-ground observational study. Phase II will address the gaps in existing models while identifying the unmet needs of the patients and caregivers. The outcome of the above phases will help develop a CPCM in Phase III. The developed model will be validated using the Delphi technique.

Results: The expected outcomes of the study are a) Phase-I: Details of the PC models available globally and locally, b) Phase-II: Availability of essential resources in the Health and Wellness Centers (HWCs), Knowledge and Attitude of the PC team, Barriers to provide PC, Unmet needs, and c) Phase-III: CPCM model

Conclusion: The study attempts to provide a holistic PC model, considering the health system, patients, and caregivers and offering policy suggestions to the state.

References

Palliative Care. Available at: https://www.who.int/news-room/fact-sheets/detail/palliative-care. Accessed on June 5th, 2023

Ahmed N, Ahmedzai SH, Collins K, Noble B. Holistic assessment of supportive and palliative care needs: the evidence for routine systematic questioning. BMJ Support Palliat Care. 2014;4(3):238-246. Doi: https://doi.org/10.1136/bmjspcare-2012-000324 PMid:24644199

Roth AR, Canedo AR. Introduction to hospice and palliative care. Prim Care: Clin Off Prac. 2019;46(3):287-302. Doi: https://doi.org/10.1016/j.pop.2019.04.001 PMid:31375182

Yeager, A., LaVigne, A. W., Rajvanshi, A., Mahato B, Mohan R, Sharma R, et al. CanSupport: a model for home-based palliative care delivery in India. Ann Palliat Med. 2016;5(3), 166-171. Doi: https://doi.org/10.21037/apm.2016.05.04 PMid:27481319

Hui D, Bruera E. Models of palliative care delivery for patients with cancer. J Clin Oncol. 2020;38(9):852. Doi: https://doi.org/10.1200/JCO.18.02123 PMid:32023157 PMCid:PMC7082156

Brazil K. A call for integrated and coordinated palliative care. J Palliat Med. 2018;21(S1):S-27. Doi: https://doi.org/10.1089/jpm.2017.0430 PMid:29283874 PMCid:PMC5733653

Kamal AH, Currow DC, Ritchie CS, Bull J, Abernethy AP. Community-based palliative care: the natural evolution for palliative care delivery in the US. J Pain Symptom Manag. 2013;46(2):254-64. Doi: https://doi.org/10.1016/j.jpainsymman.2012.07.018 PMid:23159685

Brumley R, Enguidanos S, Jamison P, Seitz R, Morgenstern N, Saito S. Increased satisfaction with care and lower costs: results of a randomized trial of in‐home palliative care. J Am Geriatr Soc. 2007;55(7):993-1000. Doi: https://doi.org/10.1111/j.1532-5415.2007.01234.x PMid:17608870

Reymond L, Parker G, Gilles L, Cooper K. Home-based palliative care. Aust J Gen Prac. 2018;47(11):747-52. Doi: https://doi.org/10.31128/AJGP-06-18-4607 PMid:31207670

Davis MP, Temel JS, Balboni T, Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Ann Palliat Med. 2015;4(3):99-121.

Casteli CP, Mbemba GI, Dumont S, Dallaire C, Juneau L, Martin E, et al. Indicators of home-based hospitalization model and strategies for its implementation: A systematic review of reviews. Syst Rev. 2020;9:1-30. Doi: https://doi.org/10.1186/s13643-020-01423-5 PMid:32771062 PMCid:PMC7415182

Prajitha KC, Subbaraman MR, Siddharth Raman SR, Sharahudeen A, Chandran D, Sawyer J, et al. Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India. Palliat Care Soc Pract. 2023;17:1-13. Doi: https://doi.org/10.1177/26323524231196315 PMid:37692560 PMCid:PMC10486217

Flieger SP, Chui K, Koch-Weser S. Lack of awareness and common misconceptions about palliative care among adults: insights from a national survey. J Gen Intern Med. 2020;35:2059-64. Doi: https://doi.org/10.1007/s11606-020-05730-4 PMid:32157652 PMCid:PMC7351936

Hannah E, Dumka N, Bora D, Roy AK, Kotwal A. Rapid assessment of NCD services rollout in Health and Wellness Centres in North-Eastern Indian state: A cross-sectional study. J Family Med Prim Care. 2023;12(3):466. Doi: https://doi.org/10.4103/jfmpc.jfmpc_1178_22 PMid:37122662 PMCid:PMC10131961

Lahariya C. 'Ayushman Bharat' program and universal health coverage in India. Indian Pediatr. 2018;55(6):495-506. Doi: https://doi.org/10.1007/s13312-018-1341-1 PMid:29978817

Operational Guidelines for Palliative Care at Health and Wellness Centers. Available at: https://nhsrcindia.org/sites/default/files/2021-06/Operational%20Guidelines%20for%20Palliative%20Care%20at%20HWC.pdf. Accessed on August 10th, 2023.

WHO Model List of Essential Medicines - 23rd list, 2023. Available at: https://www.who.int/publications/i/item/WHO-MHP-HPS-EML-2023.02. Accessed on August 12th, 2023.

Pruthi M, Bhatnagar S, Indrayan A, Chanana G. The Palliative Care Knowledge Questionnaire-Basic (PCKQ-B): Development and Validation of a Tool to Measure Knowledge of Health Professionals about Palliative Care in India. Indian J Palliat Care. 2022;28(2):180. Doi: https://doi.org/10.25259/IJPC_80_2021 PMid:35673683 PMCid:PMC9168284

Al-Ansari AM, Suroor SN, AboSerea SM, Abd-El-Gawad WM. Development of palliative care attitude and knowledge (PCAK) questionnaire for physicians in Kuwait. BMC Palliat Care. 2019;18(1):1-9. Doi: https://doi.org/10.1186/s12904-019-0430-9 PMid:31170968 PMCid:PMC6555752

Palliative Care Outcome Scale: A resource for palliative care. Available at: https://pos-pal.org/. Accessed on September 20th, 2023.

Stjernswärd J, Foley KM, Ferris FD. The public health strategy for palliative care. J Pain Symptom Manage. 2007;33(5):486-93. Doi: https://doi.org/10.1016/j.jpainsymman.2007.02.016 PMid:17482035

Callaway MV, Connor SR, Foley KM. World Health Organization public health model: a roadmap for palliative care development. J Pain Symptom Manage. 2018;55(2):S6-13. Doi: https://doi.org/10.1016/j.jpainsymman.2017.03.030 PMid:28801003

Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: how to decide its appropriateness. World J Methodol. 2021;11(4):116-129. Doi: https://doi.org/10.5662/wjm.v11.i4.116 PMid:34322364 PMCid:PMC8299905

Vaismoradi M, Jones J, Turunen H, Snelgrove S. Theme development in qualitative content analysis and thematic analysis.2016;6(5):100-110. Doi: https://doi.org/10.5430/jnep.v6n5p100

Roberts B, Robertson M, Ojukwu EI, Wu DS. Home based palliative care: Known benefits and future directions. Curr Geriatr Rep. 2021;10(4):141-147. Doi: https://doi.org/10.1007/s13670-021-00372-8 PMid:34849331 PMCid:PMC8614075

D Sakhare. Advances in Multidisciplinary Research and Development, 1st ed. New Delhi: Scripown Publications; 2023. p 89-98.

Laabar TD, Saunders C, Auret K, Johnson CE. Socially, Culturally and Spiritually Sensitive Public Health Palliative Care Models in the Lower-income Countries: An Integrative Literature Review. Indian J Palliat Care. 2023;29(1):15-27. Doi: https://doi.org/10.25259/IJPC_92_2022 PMid:36846282 PMCid:PMC9944658

Moetlo GJ, Pengpid S, Peltzer K. An evaluation of the implementation of integrated community home-based care services in Vhembe District, South Africa. Indian J Palliat Care. 2011;17(2):137-142. Doi: https://doi.org/10.4103/0973-1075.84535 PMid:21976854 PMCid:PMC3183603

Hannon B, Zimmermann C, Knaul FM, Powell RA, Mwangi-Powell FN, Rodin G. Provision of palliative care in low-and middle-income countries: overcoming obstacles for effective treatment delivery. J Clin Oncol. 2016;34(1):62-68. Doi: https://doi.org/10.1200/JCO.2015.62.1615 PMid:26578612

Patel A, Deo SV, Bhatnagar S. A survey of medical professionals in an apex tertiary care hospital to assess awareness, interest, practices, and knowledge in palliative care: A descriptive cross-sectional study. Indian J Palliat care. 2019;25(2):172-180. Doi: https://doi.org/10.4103/IJPC.IJPC_191_18 PMid:31114100 PMCid:PMC6504741

Tay J, Compton S, Phua G, Zhuang Q, Neo S, Lee G, et al. Perceptions of healthcare professionals towards palliative care in internal medicine wards: a cross-sectional survey. BMC Palliat Care. 2021;20:1-8. Doi: https://doi.org/10.1186/s12904-021-00787-2 PMid:34193142 PMCid:PMC8247075

Chan HY, Lee DT, Woo J. Diagnosing gaps in the development of palliative and end-of-life care: A qualitative exploratory study. Int J Environ Res Public Health. 2020;17(1):151. Doi: https://doi.org/10.3390/ijerph17010151 PMid:31878235 PMCid:PMC6982034

Ghoshal A, Joad AK, Spruijt O, Nair S, Rajagopal MR, Patel F, et al. Situational analysis of the quality of palliative care services across India: a cross-sectional survey. Ecancermedicalscience. 2022;16:1-19. Doi: https://doi.org/10.3332/ecancer.2022.1486 PMid:36819806 PMCid:PMC9934966

Higginson IJ, Hart S, Koffman J, Selman L, Harding R. Needs assessments in palliative care: an appraisal of definitions and approaches used. J Pain Symptom Manage. 2007;33(5):500-5. Doi: https://doi.org/10.1016/j.jpainsymman.2007.02.007 PMid:17482037

Harasym P, Brisbin S, Afzaal M, Sinnarajah A, Venturato L, Quail P, et al. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians' experiences, perceptions and perspectives. BMJ Open. 2020;10(8):1-7. Doi: https://doi.org/10.1136/bmjopen-2020-037466 PMid:32759247 PMCid:PMC7409966

Harding R, Nair S, Ekstrand M. Multilevel model of stigma and barriers to cancer palliative care in India: a qualitative study. BMJ Open. 2019;9(3):1-9. Doi: https://doi.org/10.1136/bmjopen-2018-024248 PMid:30837250 PMCid:PMC6429952

Downloads

Published

2024-04-01

How to Cite

1.
Kirtania M, Katta A. Developing a Dynamic Conceptual Model of a Home-Based Palliative Care Plan Using the Comprehensive Primary Health Care (PHC) Approach. Natl J Community Med [Internet]. 2024 Apr. 1 [cited 2024 Nov. 21];15(04):307-13. Available from: https://njcmindia.com/index.php/file/article/view/3728

Issue

Section

Study Protocol