Date of Award

2017

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Kathleen Cartmell

Second Advisor

Suparna Qanungo

Third Advisor

Lynne S. Nemeth

Fourth Advisor

Guatam Bhattacharjee

Abstract

Purpose: The purpose of this compendium is to identify strategies to extend the reach and effectiveness of palliative care in low resource countries by 1) examining palliative care interventions, outcomes, and outcome measures, 2) evaluating a home-based palliative care program in rural India, and 3) exploring the concept of acceptability of rural medical practitioners in rural India. Problem: Limited access to effective palliative care services remains an urgent global concern for the over 19 million people requiring palliative care, the majority of whom live in low resource countries. An accompanying lack of research into palliative care interventions in resource-poor areas to support the development of feasible, acceptable, and useful context-specific interventions also exists. This dissertation is a compendium of three manuscripts that represent studies designed to offer information about improving the reach and effectiveness of palliative care in low resource countries. Design: The research designs used to carry out these studies included a systematic review of the literature that identified palliative care interventions and patient outcomes in low resource countries and the outcome measures used to evaluate the interventions (manuscript 1); the qualitative evaluation using a grounded theory approach of a pilot palliative care program in a rural area outside Kolkata, India, from the perspective of key stakeholder (manuscript 2) using a grounded theory approach, and dimensional concept analysis of the acceptance of rural medical practitioners (RMPs) as health care providers in rural India (manuscript 3). Findings: Findings from the systematic review characterize the types of palliative care models available in low resource areas while highlighting the need for more rigorous research to help guide the development of effective palliative care programs. It also reports the need for validation of palliative care outcome measures that are designed for and validated in low resource settings. Findings from the qualitative evaluation of the palliative care program indicated the value of the program for stakeholders in terms of the delivery of palliative care to rural cancer patients. The palliative care program incorporating the training of RMPs as CHWs is a model worthy of consideration by other low resource areas of India. The results of the dimensional concept analysis revealed five dimensions and two sub-dimensions for acceptability: accessibility with two subdimensions of availability and proximity; affordable, familiar, satisfactory, and trusted. The findings suggest that using RMPs in health care interventions in rural India may be feasible because of their acceptability across stakeholders. Conclusion: The reach and effectiveness of palliative care in low resource countries may be expanded by additional rigorous research on palliative care interventions to support the development of context-specific programs. The evaluation of home-based palliative care programs from the perspective of key stakeholders will help identify strengths of the program and opportunities for improvement. The concept of acceptability may be used to design interventions that employ RMPs to deliver health care in rural areas of India.

Rights

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