Nkhoma Kennedy Bashan, Bates Maya Jane, van Breevoort Dorothee, Chifamba Dickson Dick, Evans Catherine J, Kwaitana Duncan, Mensah Adwoa Bemah Boamah, Mnenula Modai Clement, Mupaza Lovemore, Opare-Lokko Edwina Beryl Addo, Harding Richard
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, London, UK.
Family Medicine, Kamuzu University of Health Sciences, Blantyre, Southern Region, Malawi.
BMJ Public Health. 2025 Mar 23;3(1):e001355. doi: 10.1136/bmjph-2024-001355. eCollection 2025 Jan.
The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.
We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.
The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.
Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.
世界卫生组织的初级姑息治疗战略指出，姑息治疗是“卫生系统的一项道德责任”，并呼吁将姑息治疗纳入公共卫生保健系统，以实现全民健康覆盖。我们旨在确定利益相关者对于撒哈拉以南非洲地区患有严重多种疾病的老年人可行且可接受的姑息治疗与初级保健综合模式的必要组成部分及考量因素的看法。
我们在加纳、马拉维和津巴布韦开展了一项多国横断面定性研究。对患有多种疾病的老年人和家庭护理人员进行了深入的定性访谈。与医护人员进行了焦点小组讨论。对逐字记录进行归纳框架分析，以确定利益相关者在初级保健机构提供和接受姑息治疗方面的需求和偏好。
编码框架确定了五个主要主题：（i）沟通；（ii）护理协调；（iii）慢性病生活的影响；（iv）寻求医疗保健；以及（v）慢性病生活：应对策略和资源。多种疾病对老年人的影响是多方面的，包括疼痛和症状控制、灾难性支出、社会排斥以及日常生活活动受限。在护理途径和提供方面发现了具体挑战。沟通效果欠佳，缺乏适当信息且患者参与度不足。
在初级保健环境中为患有多种疾病的老年人提供姑息治疗需要以人为本的方法。本研究为世界卫生组织关于提供以人为本的初级姑息治疗的健康老龄化政策意图及世界卫生组织初级姑息治疗指南的实施提供了参考。
