Background: Accessibility and quality of hospital-based palliative care in Thailand have received scant attention. Objective: To determine the prevalence of inpatients who require in-hospital palliative care, to identify the proportion with access to specialist palliative care, and to define the factors associated with accessibility to specialist palliative care. Design: A cross-sectional analysis of a multicenter survey. Setting/Subjects: We surveyed all hospitalized patients from Thailand's four regions admitted to 14 tertiary care hospitals. Measurements: We used the Supportive and Palliative Care Indicators Tool to identify palliative care patients then reviewed their medical records. We categorized hospitalized palliative care patients into a palliative care consultation group and a nonconsultation group. The odds ratio (OR) between patient characteristics and patient groups was estimated using binary logistic regression. Results: One-fifth (18.7%) of hospitalized patients were palliative care patients, whereas only 17.3% received a specialist palliative care consult. Of these, one-third (28.4%) received advance care planning (ACP) documentation. One-quarter of patients in pain were not prescribed analgesics. The logistic regression analysis revealed that palliative care consultations were associated with patients >65 years (OR = 1.830, 95% confidence interval [CI]:
End-of-life decision-making is a complex process and more challenging when decisions are made for others. Little is known about Thai family members’ involvement in decision-making to withdraw life-sustaining treatments (LSTs) from loved ones with serious illnesses. This qualitative study explores the experiences of family caregivers in Southern Thailand regarding decisions related to LST withdrawal. In-depth interviews were used to gather data from fifteen primary caregivers, who were involved in LST withdrawal decision-making. Content analysis was applied, and several techniques, such as member-checking and peer debriefing, were used to enhance trustworthiness. Four main themes were identified: facing dilemmas, weighing up options, making a consensual decision, and accepting the reality of life. The findings pointed out the significant roles played by family meetings and early end-of-life discussion in the process of decision-making to withdraw LSTs from loved ones. Further research on communication among patients’ family members and health care providers is recommended.
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