MAP-care: Multimorbid Ageing Primary Palliative care in Ghana, Malawi and Zimbabwe
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Date
2020-10-20
Authors
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Publisher
Kamuzu University of Health Sciences
Abstract
Type of study
This is a mixed methods study that will recruit older patients (defined as those aged 50 years and
above) with serious multimorbidity including their formal and informal caregivers within a
community setting.
Problem
People around the world are ageing, including those from Low and Middle Income Countries
(LMIC). This presents a new challenge i.e. how can we provide care that is focused on the person
rather than the multiple illnesses that they are likely to live with? Long term illnesses are becoming
more common as people age, and living with these multiple illnesses can present many symptoms;
physical, psychosocial and spiritual concerns. Survival can be unpredictable, and cure cannot be
achieved for many conditions associated with ageing. Palliative care improves the quality of life of
patients and their families and can also be cheaper than care usually received from formal settings.
In Africa, palliative care has not focused on the common diseases of older people. This study seeks
to understandf how to expand the benefits of palliative care into primary care for older people with
multiple serious illnesses.
Objectives
The overall aim of the study is to establish the needs of older people with multimorbidity in a primary
care setting and to evaluate a model of person-centred care for older people with multimorbid serious
illness, delivered within primary care in Sub-Saharan Africa that is feasible and acceptable to patient
and families. The specific objectives are as follows: 1) to determine primary care staff, patient and
family views of costs, barriers, facilitators and necessary support to achieve primary person-centred
palliative care for older patients with multimorbid serious illness, 2) to refine a cost tool to measure
levels of catastrophic expenditure in the context of progressive multimorbidity, suitable for use in
LMIC and 3) to assess stakeholders’ views on acceptability of the novel model of care and ways to
refine to the local context to enhance use
Methodology
This study will use Medical Research Council (MRC) guidelines for development and testing of complex
interventions. The MRC complex intervention process guidance will identify the “interdisciplinary mix”
(professional and lay) of stakeholders in the health system to engage in the development of the logic model to
define and implement the novel care model, and to test fidelity. Qualitative interviews will be conducted
to assess the needs and perspectives of patients and caregivers at baseline and study completion.
Quantitative assessment of outcomes will be completed for a group of older patients and their
caregivers who receive the pilot care model.
qualitative in-depth interviews with staff and patient/family dyads’ views (n≤15) will be conducted before and
after the piloting of a model of care suitable for older people with multimorbity in primary care setting. A
costing tool designed in Malawi for use in households affected by cancerwill be revisedusing the qualitative
data with n=7-10 patient/family dyad cognitive interviews.
Expected findings and dissemination
Qualitative findings will be presented through reports which will be submitted to COMREC and for
peer review publication. An updated costing tool will be presented to the African Palliative Care
Associatwion for consideration. Further output from this study will be manuscripts published in peer
reviewed scientific journals and for conference presentations locally and internationally.
Description
Keywords
Research Subject Categories::INTERDISCIPLINARY RESEARCH AREAS