Readiness for home-based palliative care among primary caregivers: an explanatory sequential mixed methods study

The number of patients choosing home‑based palliative care (HBPC) has increased. This situation requires both patients and families to be prepared. However, the readiness for HBPC remains underexplored. This study aimed to understand primary caregivers' readiness for HBPC.

An explanatory sequential mixed-methods design was used. Quantitative data were collected from 198 primary caregivers registered at Mae Sot Hospital, Thailand, using validated questionnaires. Quantitative survey results informed the selection of participants and interview questions for the qualitative phase. Qualitative data were obtained through in-depth interviews with 15 caregivers, and trustworthiness was confirmed by credibility and dependability. The quantitative data were analysed using descriptive statistics and multiple logistic regression; the qualitative phase applied content analysis. Both sets of results were then integrated and presented.

Quantitative analysis showed that primary caregivers with full-time employment were 2.4 times more prepared than those without full-time employment. Furthermore, compared with those who perceived caregiving as a burden, primary caregivers who perceived caregiving as nonburdensome were 2.61 times more ready. The interviews identified five themes of readiness at home: (1) awareness and attitudes towards palliative care, (2) end-of-life caregiving skills at home and household readiness, (3) family commitment and shared responsibility in caregiving, (4) the need for assistance in emergency situations at home, and (5) family support after the patient's death. The integration of the data was consistent across most of the themes, whereas theme 5 emerged uniquely from the qualitative results.

The results indicated that health professionals should increase their awareness of palliative services, support their acceptance of death, and engage in shared decision-making. Experiential training programs for caregivers, mobile consultation services, collaboration in the district health system to train caregivers, and the coordination of employment opportunities within communities by setting an appropriate rate for local caregivers, as well as establishing financial advice for families and implementing bereavement care programs, are essential for providing holistic support to families.