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Rural Palliative Care in North India: Rapid Evaluation of a Program Using a Realist Mixed Method Approach.

Daniel F Munday¹, Erna Haraldsdottir², Manju Manak³

¹Palliative Care Team, International Nepal Fellowship, Kathmandu, Nepal.

Indian Journal of Palliative Care

|February 15, 2018

Summary

This summary is machine-generated.

The Emmanuel Hospitals Association (EHA) model provides excellent palliative care in rural North India, utilizing home visits and community health integration. This adaptable model, focused on nurse-led teams, shows great potential for expansion to similar underserved regions.

Keywords:

Community health palliative care program evaluation rural healthcare

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Area of Science:

Palliative Care Research
Healthcare Delivery Models
Rural Health Services

Background:

Palliative care access is limited in rural North India.
The Emmanuel Hospitals Association (EHA) developed a community-based palliative care model since 2010.
A UK-funded project (2012-2015) aimed to further develop this model.

Purpose of the Study:

To evaluate the effectiveness and appropriateness of the EHA palliative care project in rural North India.
Assess the implementation and outcomes of the EHA's home-visit-based palliative care model.

Main Methods:

A rapid evaluation employing a mixed-method realist approach across five hospital sites.
Data collection involved document analysis, key informant interviews, questionnaires, staff/patient/relative interviews, and home visit observations.
Quantitative data underwent descriptive analysis, and qualitative data received thematic analysis. Sites were assessed using the Indian Minimum Standards Tool for Palliative Care (IMSTPC).

Main Results:

The EHA model was implemented with local adaptations, featuring nurse-led teams with medical support.
Eighty percent of patients had cancer; staff exhibited strong palliative care skills, and care was highly valued by patients and families.
Most essential IMSTPC standards were met, though morphine access was limited. Synergy between palliative care and community health was noted. Hospitals planned to self-fund services.

Conclusions:

The EHA model delivers excellent, context-appropriate palliative care for rural North India.
The model's success suggests its potential for replication in similar settings.
Integration with community health initiatives enhances palliative care delivery.