Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa

Kennedy Bashan Nkhoma; Maya Jane Bates; Dorothee van Breevoort; Dickson Dick Chifamba; Catherine J Evans; Duncan Kwaitana; Adwoa Bemah Boamah Mensah; Modai Clement Mnenula; Lovemore Mupaza; Edwina Beryl Addo Opare-Lokko; Richard Harding

doi:10.1136/bmjph-2024-001355

Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa

Kennedy Bashan Nkhoma, Maya Jane Bates, Dorothee van Breevoort, Dickson Dick Chifamba, Catherine J Evans, Duncan Kwaitana, Adwoa Bemah Boamah Mensah, Modai Clement Mnenula, Lovemore Mupaza, Edwina Beryl Addo Opare-Lokko, Richard Harding

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.

METHODS: We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.

RESULTS: The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.

CONCLUSION: Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.

Original language	English
Pages (from-to)	e001355
Journal	BMJ Public Health
Volume	3
Issue number	1
DOIs	https://doi.org/10.1136/bmjph-2024-001355
Publication status	Published - 25 Jan 2025

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10.1136/bmjph-2024-001355Licence: CC BY-ND

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Nkhoma, K. B., Bates, M. J., van Breevoort, D., Chifamba, D. D., Evans, C. J., Kwaitana, D., Mensah, A. B. B., Mnenula, M. C., Mupaza, L., Opare-Lokko, E. B. A., & Harding, R. (2025). Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa. BMJ Public Health, 3(1), e001355. https://doi.org/10.1136/bmjph-2024-001355

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title = "Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa",

abstract = "BACKGROUND: The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.METHODS: We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.RESULTS: The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.CONCLUSION: Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.",

author = "Nkhoma, {Kennedy Bashan} and Bates, {Maya Jane} and {van Breevoort}, Dorothee and Chifamba, {Dickson Dick} and Evans, {Catherine J} and Duncan Kwaitana and Mensah, {Adwoa Bemah Boamah} and Mnenula, {Modai Clement} and Lovemore Mupaza and Opare-Lokko, {Edwina Beryl Addo} and Richard Harding",

note = "Copyright {\textcopyright} Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.",

year = "2025",

month = jan,

day = "25",

doi = "10.1136/bmjph-2024-001355",

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Nkhoma, KB, Bates, MJ, van Breevoort, D, Chifamba, DD, Evans, CJ, Kwaitana, D, Mensah, ABB, Mnenula, MC, Mupaza, L, Opare-Lokko, EBA & Harding, R 2025, 'Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa', BMJ Public Health, vol. 3, no. 1, pp. e001355. https://doi.org/10.1136/bmjph-2024-001355

Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa. / Nkhoma, Kennedy Bashan; Bates, Maya Jane; van Breevoort, Dorothee et al.
In: BMJ Public Health, Vol. 3, No. 1, 25.01.2025, p. e001355.

Research output: Contribution to journal › Article › peer-review

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T1 - Integrating palliative care into primary care for older people with multimorbid serious illness

T2 - a multinational qualitative cross-sectional study in Sub-Saharan Africa

AU - Nkhoma, Kennedy Bashan

AU - Bates, Maya Jane

AU - van Breevoort, Dorothee

AU - Chifamba, Dickson Dick

AU - Evans, Catherine J

AU - Kwaitana, Duncan

AU - Mensah, Adwoa Bemah Boamah

AU - Mnenula, Modai Clement

AU - Mupaza, Lovemore

AU - Opare-Lokko, Edwina Beryl Addo

AU - Harding, Richard

PY - 2025/1/25

Y1 - 2025/1/25

N2 - BACKGROUND: The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.METHODS: We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.RESULTS: The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.CONCLUSION: Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.

AB - BACKGROUND: The WHO primary palliative care strategy states that palliative care is 'an ethical responsibility of health systems' and calls for integration of palliative care into public healthcare systems to achieve universal health coverage. We aimed to determine stakeholders' perspectives on the necessary components of and considerations for a feasible and acceptable model of integrated palliative care and primary care for older people living with serious multimorbid illness in Sub-Saharan Africa.METHODS: We conducted a multicountry cross-sectional qualitative study in Ghana, Malawi and Zimbabwe. In-depth qualitative interviews were conducted with multimorbid older people and family caregivers. Focus groups were conducted with healthcare staff. Verbatim transcripts were subjected to inductive framework analysis to identify stakeholders' needs and preferences for delivering and receiving palliative care in primary care facilities.RESULTS: The coding framework identified five main themes: (i) communication; (ii) coordination of care; (iii) impact of living with chronic illness; (iv) seeking healthcare; and (v) living with chronic illness: coping strategies and resources. The impact of multimorbid illness on older people was multidimensional, including pain and symptom control, catastrophic spending, social exclusion and limitations on activities of daily living. Specific challenges were identified in care pathways and delivery. Communication was sub-optimal, with lack of appropriate information and patient involvement.CONCLUSION: Person-centred approaches are required to deliver palliative care to older multimorbid people in primary care settings. This study informs implementation of the WHO Healthy Ageing Policy intention to deliver person-centred primary palliative care and the WHO primary palliative care guidance.

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DO - 10.1136/bmjph-2024-001355

M3 - Article

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SN - 2753-4294

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JO - BMJ Public Health

JF - BMJ Public Health

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ER -

Integrating palliative care into primary care for older people with multimorbid serious illness: a multinational qualitative cross-sectional study in Sub-Saharan Africa

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