Implementation Science

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    MAP-care: Multimorbid Ageing Primary Palliative care in Ghana, Malawi and Zimbabwe
    (Kamuzu University of Health Sciences, 2020-10-20) Harding, Richard
    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.