Development of a Health Service Delivery Model for End-of-Life Care Using Palliative Care Centers as a Driving Mechanism in Maha Sarakham Province.

Abstract

      This action research aimed to develop and evaluate a healthcare service delivery model for end-of-life patient care using palliative care centers as a driving mechanism in Maha Sarakham Province, Thailand. The study was conducted from September 2023 to September 2024 in 12 community hospitals in Maha Sarakham Province. The research applied the action research framework of Kemmis and McTaggart in conjunction with the World Health Organization's Six Building Blocks of a Health System framework. A total of 122 participants were involved in developing the model, comprising 50 hospital-based multidisciplinary healthcare professionals, 24 registered nurses from subdistrict health promoting hospitals, 24 representatives of village health volunteers, community leaders, and local administrative organizations, and 24 representatives of end-of-life patients, family caregivers, and other caregivers. Care outcomes were evaluated among 3,376 end-of-life patients. The research was conducted in three phases: 1) research preparation and situational analysis; 2) model development and implementation through two action research cycles, each consisting of planning, action, observation, and reflection; and 3) evaluation. Research instruments included in-depth interview and focus group discussion guides, a standardized assessment form for palliative care center operations in hospitals, and end-of-life patient care reporting forms. Quantitative data were analyzed using descriptive statistics, including frequencies and percentages, while qualitative data were analyzed using content analysis.

      The findings revealed that the post-implementation evaluation demonstrated that standardized palliative care centers had been established and were operational in community hospitals across all 12 districts of Maha Sarakham Province, achieving 100% coverage. All multidisciplinary healthcare team members received competency development training (100%). Family Meetings were conducted for 95.47% of families, while 90.28% of patients receiving palliative care received quality care in accordance with Advance Care Planning (ACP). Furthermore, 95.73% of patients achieved care outcomes consistent with the concept of a Good Death.