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Bates, Jane (2021) Palliative care within Universal Health Coverage and Financial Protection Does palliative care have the potential to reduce household poverty in a low-income country? : A mixed methods study in households affected by advanced cancer in Blantyre Malawi, Thesis (Doctoral), Liverpool School of Tropical Medicine.
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MJ Bates - final thesis.pdf - Accepted Version Download (3MB) | Preview |
Abstract
Background
Palliative care aims to improve holistic quality-of-life and reduce serious health-related suffering in the context of life-limiting illness. Although palliative care is integral to Universal Health Coverage, services are widely unavailable for populations in low and middle income countries. This thesis investigates early data and advocacy proposals suggesting that palliative care can support household poverty reduction. Poverty reduction is understood to comprise enhanced wellbeing and reduction in household costs of healthcare. The research was conducted in Blantyre, Malawi in households affected by advanced cancer.
Methods
A capabilities approach led to the use of Photovoice - a community-based visual participatory action research method - to describe household understandings of wellbeing, and the role of palliative care in supporting wellbeing. Data contributed to the development of the Patient and Carer Cancer Cost (PaCCCt) survey to gather healthcare utilisation data and associated costs. Households were then recruited in a prospective observational cohort study. Multiple linear regression models for total household costs of healthcare and risk ratios for catastrophic costs six months following diagnosis were tested by receipt of palliative care.
Results
Thirteen co-researchers (six patients and seven family caregivers) compiled, captioned and analysed photographic images. Wellbeing was understood as being happy, having courage and seeing improvements in the patients’ condition. The ability to work and/or be part of the community were valued. Palliative care supported these capabilties through the provision of medicine and counselling.
In total, 150 households (patients and their primary unpaid caregivers) were recruited. The average age of patients was 50 years. At six months patients in 89 (59%) households were alive, and in 55 (37%) had died. 6 (4%) households were lost to follow up. 21% of households received palliative care. 64% of households experienced catastrophic costs six months after diagnosis, 47% (9/19) of households who received palliative care vs 69% households (48/70) who did not (RR: 0·69, 95% CI 0·42, 1·13). Palliative care was associated with reduced dissaving ($11 vs $34, p=0·005). The mean difference in total household costs of healthcare was 36% (p=0·707).
Conclusions
Patients and family caregivers receiving palliative care for advanced cancer engaged actively and safely as co-researchers, reporting their understandings of wellbeing and the role of palliative care. Palliative care was reported to be of value to stabilise and/or improve function rather than as preparation for dying. Access to palliative care was poor, and larger studies are needed to confirm the reductions in catastrophic costs and dissaving described. Palliative care was found to have potential to support household poverty reduction in Blantyre, Malawi following a diagnosis of advanced cancer .
| Item Type: | Thesis (Doctoral) | ||||
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| Subjects: | WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries WA Public Health > Health Administration and Organization > WA 540 National and state health administration WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services |
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| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department | ||||
| Depositing User: | Lynn Roberts-Maloney | ||||
| Date Deposited: | 08 Dec 2021 14:51 | ||||
| Last Modified: | 08 Mar 2022 02:02 | ||||
| URI: | https://archive.lstmed.ac.uk/id/eprint/19582 |
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