Department of Internal Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
Palliative Care Education and Research Consortium (PcERC), Deans Building Makerere University Medical School, Kampala, Uganda.
Palliat Med. 2024 Sep;38(8):818-829. doi: 10.1177/02692163241269129. Epub 2024 Sep 9.
Palliative care is seldom integrated in healthcare in fragile, conflict affected and vulnerable settings with significant refugee populations.
This study aimed to evaluate the integration of palliative care into a fragile, conflict affected and vulnerable community in Northern Uganda.
Consecutive Rapid Participatory Appraisals were conducted to evaluate the integration of palliative care in Adjumani District. The first established a baseline and the second, 4 years later, evaluated progress. Data collection included documentary review, key informant interviews and direct observation.
SETTING/PARTICIPANTS: A rural district in Uganda with equal numbers of refugees and host populations living side-by-side. 104 key informants were interviewed, and practice observed in 11 health facilities.
At baseline, palliative care was not routinely integrated in the health system. Barriers included health system challenges, cultural beliefs, understanding and trust, mental health issues, gaps in palliative care provision, the role of the community and beliefs about illness impacted care with the village health teams being a trusted part of the health system. Following integration activities including training, mentorship and community sensitisation, the repeat rapid appraisal after 4 years showed a significant increase in palliative care delivery. New themes identified included increased provision of palliative care, the impact of training and community engagement and ownership of palliative care.
Community engagement and participation, training interventions and referral pathways enabled the integration of palliative care. Rapid Participatory Appraisal provides a useful framework to evaluate activities aimed at integration of palliative care in a community.
在脆弱、受冲突影响和脆弱的环境中，以及在难民人口众多的情况下，姑息治疗很少融入医疗保健中。
本研究旨在评估姑息治疗在乌干达北部一个脆弱、受冲突影响和脆弱的社区中的整合情况。
连续进行快速参与式评估，以评估在阿朱马尼地区姑息治疗的整合情况。第一个评估建立了基线，第二个评估在四年后评估了进展情况。数据收集包括文件审查、关键知情人访谈和直接观察。
地点/参与者：乌干达的一个农村地区，难民和当地居民人数相等，他们并肩生活。采访了 104 名关键知情人，并在 11 个卫生设施观察了实践情况。
在基线时，姑息治疗并未常规纳入卫生系统。障碍包括卫生系统挑战、文化信仰、理解和信任、心理健康问题、姑息治疗提供方面的差距、社区的作用以及对疾病的看法影响了护理，乡村卫生团队是卫生系统中值得信赖的一部分。在整合活动（包括培训、指导和社区宣传）之后，四年后的重复快速评估显示，姑息治疗的提供显著增加。新确定的主题包括姑息治疗的提供增加、培训和社区参与的影响以及对姑息治疗的所有权。
社区参与和参与、培训干预措施以及转诊途径使姑息治疗得以整合。快速参与式评估为评估旨在在社区中整合姑息治疗的活动提供了一个有用的框架。
