Palliative care model 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.

Palliative care interventions used by village health volunteers in Thailand

BACKGROUND

Palliative care (PC) is described by the World Health Organization (WHO) as an interprofessional approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-threatening illness. One strategy for increasing access to PC services is to integrate village health volunteers (VHVs) into community-based palliative care teams in Thailand.

AIMS

The study had two specific aims: (1) to describe the cultural context of death and dying in a southern province in Thailand, and (2) to identify palliative care interventions used by VHV to promote dying in a southern province in Thailand.

METHODS

The study was conducted using a qualitative, explorative descriptive design. Descriptive statistics were used to describe the sample's characteristics, such as means for continuous variables and frequencies for categorical variables. The transcripts from the interviews and field notes were the data sources for analysis. A 6-step thematic analysis method was used in this study to analyse transcripts from the focus group discussion (FGD) interviews and the field notes. A total of 77 VHV participants from two community hospitals and one rural health promoting hospital participated in the FGD. Of the participants, 96% were women. The mean age was 47.13 years, and the mean number of years spent in their current position was 11.24 years.

RESULTS

Five major themes emerged, the importance of the Thai cultural context, VHVs are the point of connection, basic physical care, supporting spiritual care and providing emotional support.

CONCLUSION

Future studies should explore how to integrate the findings of this study into culturally-tailored palliative care programmes and to provide training for VHV on effective interventions to provide emotional and spiritual support. Having the VHV on the interprofessional team could be a way to ensure compassionate end-of-life care for palliative care patients and their circles of support.

Model for an International Case Sharing Program to Enhance Global Palliative Care Education

CONTEXT

In Thailand, the field of palliative medicine is growing but access and training remain limited. We sought to expand education of resident physicians at Chiang Mai University (CMU) in Thailand through development of an international case sharing program.

OBJECTIVES

The goals of this project were to increase knowledge of core palliative care topics, to cultivate a culture of reflective clinical practice, and to create a model for collaboration in international palliative care education that can be replicated by other institutions.

METHODS

We used a virtual case conference platform, in which two Family Medicine residents from CMU selected a challenging palliative care case. They prepared the case using an outline that included reflections on ethics, compassion and social responsibility. The residents presented the case in English to palliative care faculty from Thailand and Minnesota. Each case was followed by unstructured discussion.

RESULTS

Over the course of 5.5 years (Nov 2018-Mar 2024), 14 cases were presented. Each case discussion included at least 3 to 7 core palliative care topics. The program was adopted as one of the core activities of the Department of Family Medicine at CMU and led to clinical practice changes.

CONCLUSION

We present a sustainable, convenient, low-cost, cross-cultural palliative care case conference model that has the potential to enrich palliative care education globally.

Identifying cancer patients who received palliative care using the SPICT-LIS in medical records: a rule-based algorithm and text-mining technique

BACKGROUND

Due to limited numbers of palliative care specialists and/or resources, accessing palliative care remains limited in many low and middle-income countries. Data science methods, such as rule-based algorithms and text mining, have potential to improve palliative care by facilitating analysis of electronic healthcare records. This study aimed to develop and evaluate a rule-based algorithm for identifying cancer patients who may benefit from palliative care based on the Thai version of the Supportive and Palliative Care Indicators for a Low-Income Setting (SPICT-LIS) criteria.

METHODS

The medical records of 14,363 cancer patients aged 18 years and older, diagnosed between 2016 and 2020 at Songklanagarind Hospital, were analyzed. Two rule-based algorithms, strict and relaxed, were designed to identify key SPICT-LIS indicators in the electronic medical records using tokenization and sentiment analysis. The inter-rater reliability between these two algorithms and palliative care physicians was assessed using percentage agreement and Cohen's kappa coefficient. Additionally, factors associated with patients might be given palliative care as they will benefit from it were examined.

RESULTS

The strict rule-based algorithm demonstrated a high degree of accuracy, with 95% agreement and Cohen's kappa coefficient of 0.83. In contrast, the relaxed rule-based algorithm demonstrated a lower agreement (71% agreement and Cohen's kappa of 0.16). Advanced-stage cancer with symptoms such as pain, dyspnea, edema, delirium, xerostomia, and anorexia were identified as significant predictors of potentially benefiting from palliative care.

CONCLUSION

The integration of rule-based algorithms with electronic medical records offers a promising method for enhancing the timely and accurate identification of patients with cancer might benefit from palliative care.

Palliative care programmes for people with conditions other than cancer in Thailand: a literature review

BACKGROUND

Thailand has few studies on palliative care programmes for people with conditions other than cancer.

OBJECTIVE

The objective of this review was to investigate and discuss existing studies of palliative care programmes for non-cancer patients in Thailand.

METHODS

A literature review was conducted using CINAHL, PubMed, Scopus, Science Direct and Google Scholar to find research conducted from 2000 to 2020. The search found 29 articles, eight of which met the inclusion criteria.

RESULTS

The eight articles included in this review were focused on four end-stage renal disease (ESRD) programmes, two congestive heart failure (CHF) programmes, one chronic obstructive pulmonary disease (COPD) programme and one stroke programme.

CONCLUSIONS

There have been few studies of existing palliative care programmes for non-cancer patients in Thailand. These programmes were developed for persons with ESRD, CHF, COPD and stroke, whereas none were available for people with dementia. More palliative care programmes are needed for non-cancer patients.