Experiences of Volunteers and Patient Satisfaction in Home Based Palliative Care, Puducherry, South India-A Descriptive Qualitative Study

Beneficiary's Satisfaction with Primary Palliative Care Services in Kerala - A Cross-Sectional Survey

Objectives

Kerala was the first state to implement a community-based, sustainable primary palliative care (PC) home care (HC) model. Beneficiary satisfaction, an important indicator to assess the quality of service provision with the HC program, has not been assessed since the programme was launched 14 years ago. This study tried to assess the satisfaction of beneficiaries receiving primary PC services through the Kerala State PC programme and the factors associated with the same.

Materials and Methods

The cross-sectional survey was conducted among 450 patients registered under the Kerala State Primary PC Programme. Data were collected using a semi-structured questionnaire from October 2022 to January 2023. We summarised the data as proportions and performed Chi-square tests to make comparisons wherever applicable.

Results

Most of the beneficiaries (69.1%) were satisfied with HC services. The mean age of the beneficiaries was 65.51 ± 17 years. More than 80% of the participants (88.4%) were married, and the primary caregivers were wives (31.8%) and daughters/daughters-in-law (35.3%). The primary diagnosis of the beneficiaries was a cerebrovascular accident (27.4%), cancer (18.8%), and spinal cord injury (13.2%). The study examined the needs of beneficiaries and found that the top three requirements reported by the patients were the inclusion of doctor visits in HC (71.8%), medicine distribution at home (67.4%), and physical rehabilitation services at home with a minimum of three sessions per month (52.3%). The study found a statistically significant association (P < 0.05) between the Beneficiary's satisfaction and behaviour of PC nurses and certain services, including physiotherapy, procedural care specifically catheterisation and wound dressing, and health check-ups received through the HC program. Satisfaction was reported more in Thiruvananthapuram district, followed by Malappuram.

Conclusion

The overall satisfaction with the Kerala State Primary PC Programme was found to be high at about 69%. Despite the fact that the study identified significant relationships between nurses' behaviour, services provided (physical therapy, procedures, and health checks), and satisfaction, the findings suggested expanding the scope of the HC programme by including doctor visits and medicine delivery at patient's home.

The effectiveness of community-based palliative care programme components: a systematic review

BACKGROUND

There is evidence that community-based palliative care programmes can improve patient outcomes and caregiver experiences cost-effectively. However, little is known about which specific components within these programmes contribute to improving the outcomes.

AIM

To systematically review research that evaluates the effectiveness of community-based palliative care components.

DESIGN

A systematic mixed studies review synthesising quantitative, qualitative and mixed-methods study findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO: ID # CRD42022302305.

DATA SOURCES

Four databases were searched in August 2021 (CINAHL, Web of Science, ProQuest Federated and PubMed including MEDLINE) and a close review of included article references. Inclusion criteria required articles to evaluate a single, specific component of a community-based palliative care programme either within an individual programme or across several programmes.

RESULTS

Overall, a total of 1,674 articles were identified, with 57 meeting the inclusion criteria. Of the included studies, 21 were qualitative, 25 were quantitative and 11 had mixed methods. Outcome measures consistently examined included patient/caregiver satisfaction, hospital utilisation and home deaths. The components of standardised sessions (interdisciplinary meetings about patients), volunteer engagement and early intervention contributed to the success of community-based palliative care programmes.

CONCLUSIONS

Certain components of community-based palliative care programmes are effective. Such components should be implemented and tested more in low- and middle-income countries and key and vulnerable populations such as lower-income and marginalised racial or ethnic groups. In addition, more research is needed on the cost-effectiveness of individual programme components.

Wellbeing of Palliative Care Workers During Covid-19 Pandemic: Implications for Social Work Practice

The present study is aimed at examining the wellbeing of palliative care workers in India (n = 114) with special reference to work related variables. The World Health Organization's five item wellbeing index was used to measure the wellbeing of the respondents. In general, the wellbeing of the respondents was found to be good. Furthermore, the age of the respondent (p < 0.001), gender (p < 0.05), work setting (hospital vs. non-hospital) (p < 0.05), work environment (p < 0.01), recent unemployment (job loss) (p < 0.01), years of experience in palliative care (p < 0.05), number of hours of work per week (p < 0.05), and the number of clients who died in the previous month (p < 0.01), were all found to be associated with the wellbeing of the respondents. Specifically, young and female respondents, those engaged in hospital based palliative care, having a poor work environment, facing recent unemployment, having less experience, working for more number of hours, and having more number of patients dying in the previous month, all had a lower level of wellbeing. The implications for social work practice have also been discussed in detail.