Toward enhanced decentralized palliative care services in Neno District, Malawi. A qualitative study

Abstract

Background: Palliative care is a method that enhances the well-being of patients, both adults and children and their families who are dealing with life-threatening diseases. Its goal is to alleviate and prevent suffering by identifying and treating pain and other problems, whether physical, emotional, or spiritual, as early as possible. We document the results of a qualitative research study that assessed the impact of decentralising palliative care services to peripheral health facilities in Neno District, Malawi. Methods: We conducted a qualitative study between November 2021 and June 2022 in Neno district, southern Malawi. We conveniently selected two facilities where palliative care services had been decentralized and conducted two Focus Group Discussions (FGDs) with all 14 healthcare workers and three with 15 patients receiving the services. We transcribed the recordings of FGDs and applied thematic analysis to analyse the data. Results: We identified four key themes: (1) patient experience with medical personnel: participants described the development of rapport and trust with the healthcare system over time, (2) perceived benefits of palliative care programme decentralisation: participants recognized and emphasised improved accessibility of services, resulting in better patient outcomes and increased satisfaction, (3) challenges in accessing palliative care services: participants shared personal experiences and identified obstacles faced when seeking palliative care; and (4) facility responsiveness to patient needs: participants appreciated the step-by-step care processes, additional support beyond medical assistance, and timely coordination of services. They highlighted the presence of follow-up mechanisms that ensured ongoing support and addressed their evolving needs. Conclusions: Our study demonstrated that the decentralization of palliative care services has provided effective delivery of quality care that patients appreciate. This information can be used by program planners, resource allocators, and implementers to improve service delivery in remote facilities. However, more research is needed to explore the impact of demographic and socioeconomic characteristics of patients and distance to health facilities on palliative care services.