Healthcare professional’s perspectives on factors influencing integration of primary palliative care into mainstream health service: an exploratory focus group study

Abstract

Low- and middle-income countries (LMIC) are experiencing a surge in non-communicable diseases, with a resultant increase in the demand for palliative care. However, there is a wide gap between the demand for palliative care and its availability in LMIC. On the pretext of bridging this gap, the present study aims to explore factors that facilitate or hinder palliative care provision in the healthcare system in West Bengal, India. The study employed a qualitative focus group discussion to explore the perspectives of Chief Medical Officers of Health (CMOH), medical officers, nurses, and epidemiologists. The participants were responsible for making health care and policy decisions in their organisation. The data were analysed using Charmaz’s constructivist grounded theory. A total of six focus group discussions were undertaken, two each at two sites and one each at two other sites. Three themes and subthemes were generated inductively from the study: 1. clinical teams’ disposition was further influenced by self-actualisation needs, emotionally burdensome care, and perceived patient and family expectations; 2. organisational factors included interprofessional collaboration, reassurance from administration, the need for better infrastructure, community outreach, and the scarcity of opioids; 3. palliative care training and awareness impacting palliative care delivery. Factors that could facilitate better implementation of the programme include good interprofessional collaboration, comprehensive care, continuing education, an uninterrupted supply of essential medications, and engaging patients, their families, and the community in palliative care.