Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand

• DOI: 10.1186/s12913-021-06623-w
• Publication Date: 2021-06-29T02:02:52Z
• Authors: Parichat Dokmai; Natthani Meemon; Seung Chun Paek; Supakarn Tayjasanant
• Keywords: Dignity Therapy in Palliative Care; Family medicine; FOS: Political science; Health administration; Social Sciences; FOS: Law; Nursing research; Nursing; Epistemology; FOS: Health sciences; Facility-based care; Structural equation model; 03 medical and health sciences; Psychological Impact of Bereavement and Grief; Health Sciences; Humans; Psychology; Operationalization; Political science; Public health; Hospitals, Public; Research; Palliative Care; Public Health, Environmental and Occupational Health; Integration of Palliative Care in End-of-Life; Quality of Dying; Thailand; FOS: Philosophy, ethics and religion; 3. Good health; FOS: Psychology; Clinical Psychology; Philosophy; Cross-Sectional Studies; End-of-life care; Hospice and Palliative Care Nursing; Palliative care; Medicine; Public aspects of medicine; RA1-1270; Donabedian; Dignity; 0305 other medical science; Law

Abstract Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals.

Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand.

Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication.

Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.