Continuing Hospital-to-Home Palliative Care: A Southern Thai Context
Keywords:
palliative care, continuing hospital-to-home palliative care, southern Thai contextAbstract
Objective: To describe 1) continuing hospital-to-home palliative care services in southern Thailand; and 2) supportive factors for, and obstacles to, provision of continuing hospital-to-home palliative care in southern Thailand.
Design: Qualitative multiple-case study.
Methodology: The research sites were purposively selected, based on these criteria, namely, 1) being tertiary care centres or regional hospitals; 2) providing continuing hospital-to-home palliative care services; and 3) serving as healthcare centres with links to secondary care hospitals, primary care units or sub-district health-promoting hospitals. In total, four regional or tertiary hospitals were selected. The participants were (1) terminal patients and their family caregivers and (2) stakeholders involved in palliative care services, totalling 92. Interviews, focus-group discussions, and observation were data collection methods. The data were analysed using content analysis.
Results: Three models of continuing hospital-to-home palliative care were identifed in the southern Thai context: (1) hospital-based palliative care; (2) integrated community-based palliative care; and (3) volunteer-supported palliative care. Voluntary assistance, support from organisations’ administrators, and collaborative community networking were identifed as major supporting factors. Limited access to the use of analgesics, compartmentalisation without coordination, lack of knowledge and skills , insuffciency and workload of palliative care personnel and shortage of medical equipment were identifed as major obstacles.
Recommendations: To provide patients and their families with continuing services and improve their quality of life, it is necessary that healthcare organisation administrators actively integrate palliative care as one major healthcare service provided by each hospital, support healthcare personnel at all levels and in all felds of specialisation to optimise their palliative care expertise, promote coordination through effcient communication to ensure uninterrupted flow of information, and systematically improve medication and medical equipment management at all levels of service. Also, further research on effects of different palliative care models is recommended.
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