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

Factors Determining Home Death Among Older Adults in Thailand

BackgroundPalliative care services are expanding in Thailand, where dying at home is a key goal and a preference for older adults. However, limited research explores the factors influencing home deaths in this population. This study was the first to identify predictors of home deaths among older adults in Thailand.MethodsWe conducted a secondary data analysis of the Health Aging and Retirement in Thailand (HART) study, encompassing 320 participants. Descriptive statistics, chi-square tests, and Mann-Whitney U tests were used to compare differences in the place of death. Logistic regression was conducted to examine the likelihood of home deaths.ResultsA total of 65.6% of decedents died at home, with an increasing trend in home deaths observed from 65% in 2017 to 70% in 2022. Significant differences were found between home deaths and non-home deaths regarding age at death, marital status, employment status, cause of death, and geographic region. Older adults residing in the North and Northeast regions were more likely to die at home compared to those in Bangkok and its vicinity. Deaths attributed to natural aging were strongly associated with a higher likelihood of home deaths, whereas deaths caused by infectious diseases were less likely to occur at home.ConclusionSocial, environmental, and health-related factors significantly influence home deaths among older adults in Thailand. The health care system should prioritize community-based palliative care services to address the disparities in place of death and support vulnerable populations in achieving their preferred end-of-life outcomes.

Exploring the palliative care ecosystem in Thailand: a protocol for a scoping review and bibliometric analysis

INTRODUCTION

Palliative care is an approach that aims to holistically improve the quality of life, care and death of people living with life-limiting conditions as well as their families. In Thailand, palliative care became one of its national strategies as of 2014. However, the access to as well as the quality of palliative care being delivered still varies across the nation, due to multiple factors spanning multiple levels. Consequently, there is a need to comprehensively understand the current palliative care ecosystem in Thailand. This review aims to explore, map and conceptualise the literature available on the palliative care ecosystem in Thailand, and how the service being delivered influences the quality of life, death and care of people living with life-limiting conditions alongside their families.

METHODS AND ANALYSIS

This review will consist of two stages. First, a scoping review guided by the Joanna Briggs Institute methodology for scoping reviews will be initially conducted. A systematic literature search using Medical Subject Heading and text words related to palliative care will be performed in PubMed, CINAHL and Thai Citation Index from 2013 to 2023. Grey literature will be searched via alternative sources: Google keyword searching and stakeholders consultation. References of included sources will be handsearched to identify further resources.The population, concept and context framework is used to frame the inclusion and exclusion criteria. This will be further refined after the initial search, reflecting the iterative nature of a scoping review. Articles will be independently screened by three reviewers. A Microsoft Excel spreadsheet will be used as the data extraction tool. Data will be extracted and presented using a narrative synthesis approach.Second, included articles from the scoping review will be further analysed and visualised using a bibliometric analysis technique. This stage involves a computational method, including statistical analysis and content analysis of the articles' bibliographic details.

ETHICS AND DISSEMINATION

This paper describes a protocol for a scoping review and bibliographical analysis. As such, ethical approval was not required. Information relating to the review will be stored with Open Science Framework Registries. The findings of this proposed scoping review will be distributed through a peer-reviewed publication, academic seminars, conferences and patients and public involvement groups.

A survey of palliative care domains and the palliative care provision confidence of Thai family practitioners

INTRODUCTION

Despite continuously growing, palliative care in Thailand still needs further development. Many family physicians provide various levels of palliative care. However, there is no information regarding what aspects of palliative care family practitioners provide and how much confidence they have. This study aims to identify gaps between expected care domains and provided care and to reveal the domains in which family physicians are less confident.

METHOD

This study is a cross-sectional survey study. An online questionnaire was publicly published to recruit target participants, Thai family physicians who have received formal residency training and actively practice medicine. The estimated number of actively practising family physicians was 540 persons. Participants were asked which palliative care domains they provide and to rate their confidence in each. A narrative analysis was performed using two relevant frameworks.

RESULT

One hundred and seven responses were received. Forty-six per cent of participants have no further training in palliative care other than during their residency programs. At least 63.6 per cent of participants provide palliative care two half-day per week or less. Grief and spiritual care enjoyed the least percentage of the participant's responses regarding provided care. These two domains also received the lowest percentage of confidence in providing care from the participants.

DISCUSSION

Though they are considered essential domains, there are gaps between expected care and actual care in grief management and spiritual care. Grief and bereavement care are mentioned in the residency curriculum; nonetheless, there is an inconsistency regarding spiritual care. Increasing access to continuous education and integrating it into curriculums should be considered to reduce the gaps. Additionally, a national guideline regarding levels of palliative care and the roles of family physicians will benefit from establishing comprehensive palliative care programmes.

Development and Validation of a Tool to Assess the Structural Quality of Palliative Care Services

CONTEXT

The current gap in access to palliative care requires the expansion of palliative care services worldwide. There is little information about the structural components required by palliative care services to provide adequate end-of-life care. No specific tools have been developed to assess the structural quality of these services.

OBJECTIVE

To develop and validate a tool to assess the structural quality of palliative care services.

METHODS

A scoping review of literature was performed to identify structural quality indicators of palliative care services. National experts participated in a two-round Delphi method to reach consensus regarding the importance and measurement feasibility of each proposed indicator. Consensus was reached for each indicator if 60% or more considered them both important and feasible. The selected indicators were tested among Chilean palliative care services to assess instrument psychometric characteristics.

RESULTS

Thirty-one indicators were identified. Thirty-five experts participated in a two-round Delphi survey. Twenty-one indicators reached consensus and were included in the structural quality of palliative care services tool (SQPCS-21). This instrument was applied to 201 out of 250 palliative care services in Chile. Achievement for each indicator varied between 8% and 96% (mean 52%). The total SQPCS-21 score varied between 3 and 21 points (mean 11 points).

CONCLUSION

The SQPCS-21 tool to assess structural quality of palliative care services, has good content and construct validity and its application provides information about institutions at the individual and aggregated level. This tool can provide guidance to monitor the structural quality of palliative care worldwide.