Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

Abstract

Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication. Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.

Navigating Disharmony

“…The role of nurses in the provision of primary palliative and EOL care is vital. However, nurses continue to express discomfort and a lack of knowledge when providing this crucial service 1 . To address these concerns, AACN has elevated primary palliative and EOL care to be included as 1 of the 4 spheres of care within the new Essentials 5 .…”

“…However, nurses continue to express discomfort and a lack of knowledge when providing this crucial service. 1 To address these concerns, AACN has elevated primary palliative and EOL care to be included as 1 of the 4 spheres of care within the new Essentials. 5 Nursing education has an obligation to ensure that new graduates are trained in the principles of primary palliative and EOL care.…”

“…Although nurses recognize that communication is central when caring for patients at EOL, it is often inadequate or delayed until a patient's status has already deteriorated, leading to a poor EOL experience for patients and families 14 . Additional communication challenges arise when navigating emotions present among patients and families at EOL 1,11 . To address these EOL communication challenges, Wittenberg and colleagues developed and tested the COMFORT model to train nurses and other members of the health care team in palliative and EOL communication strategies 15,16 .…”

“…Nurses are integral to providing holistic care for patients and families at end of life (EOL), because nurses, when compared with other disciplines, spend the most time with patients 1 . Despite their key role in EOL care, nurses practicing in hospital settings report several barriers in the provision of palliative and EOL care: time constraints, limited palliative and EOL care knowledge and skills, and communication challenges 2,3 .…”

“…14 Additional communication challenges arise when navigating emotions present among patients and families at EOL. 1,11 To address these EOL communication challenges, Wittenberg and colleagues developed and tested the COMFORT model to train nurses and other members of the health care team in palliative and EOL communication strategies. 15,16 Studies using COMFORT have identified increased nurse confidence and competence in EOL communication 17 and family reports of improved quality of conversations.…”