MAP-care: Multimorbid Ageing Primary Palliative Care in Ghana, Malawi and Zimbabwe.

Lead Research Organisation: King's College London

Abstract

Palliative care is a neglected field of global health research, therefore our impact strategy aims to develop methods, generate evidence and build capacity.

For patients and families, we will work with them to move their role in health care from recipients to partners in care development. The PPI methods will facilitate their engagement in the conduct interpretation and dissemination of the research, with a focus on sustained palliative care PPI for benefit across the field.

For academics, we will advance PPI methods and publish our approach for wider LMIC adaptation and replication. The application of the MOREcare guidance will be the first use of this MRC-funded guidance on the development and testing of palliative care complex interventions in an LMIC setting, to stimulate an academic response to the current lack of intervention studies. The adapted costing tool will be made freely available to enable robust measurement of outcomes in future studies of patients and families living with serious comorbid illness. Given the paucity of evidence, the published protocol will offer a replicable study design for intervention development and piloting. For the research field in each partner country (Ghana, Malawi, Zimbabwe) the research capacity building for local investigators and research staff will advance capacity to undertake palliative care research. Each country will lead a component of the analysis, and research staff will co-develop a personal development plan with the local investigator, supported by resources at KCL. The pan-African palliative care research methods seminar, and the local methods seminar in each country, will advance palliative care research in Africa from hospice and acute settings to primary care.

For clinicians, we will train and support them to take an integrated person-centred approach with weekly clinical supervision. Staff will be supported to identify and utilise strategies to sustain change. The data on patient and family need will be disseminated through clinics to give greater understanding of patient and family symptoms and concerns.

For policy makers, the lobbying and advocacy activities of our partners we will use official relations with WHO and the United Nations alongside our responsibility to WHO to provide palliative care policy briefs, to ensure uptake of our outputs. Importantly the provision of the costing tool will enable policy makers to meet the new UHC goal fo palliative care. UHC which requires palliative care with end-user protection from financial hardship, and the freely available tool will enable measurement of costs to ensure that the UHC goal is achieved.

Technical Summary

PHASE 1 DEVELOPMENT (Months 0-12)
i) To establish an African patient and public involvement palliative care network to inform research procedures and dissemination throughout the programme.
ii) To determine primary care staff, patient and family views of costs, barriers, facilitators and necessary support to achieve primary person-centred palliative older care for multimorbid serious illness.
iii) To develop a logic model and novel model of care to integrate value-based care, patient-centred outcome measurement, a decision support tool and staff mentorship.
iv) To refine a cost tool to measure levels of catastrophic expenditure in the context of progressive multimorbidity, suitable for use in LMIC.
PHASE 2 FEASIBILITY (Months 13-18)
v) To assess stakeholders' views on acceptability of the novel model of care and ways to refine to the local context to enhance use.
vi) To appraise implementation and sustainability of the novel model of care.

Sequential mixed-methods cross-national study applying MRC guidelines for development and testing of complex interventions (Phase 1 development and Phase 2 early testing procedures). 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.
Phase 1 will apply Photobox methods for PPI development ,and qualitative in-depth interviews to gain staff (n=10-12 per country) patient/family dyads' views (up to n=15). The costing tool will be revised using the qualitative data and n=7-10 dyad cognitive interviews. Phase 2 will deliver the model of care at 1 rural primary care clinic in each country with before/after data questionnaire data collected from n=36 patients per site, and up to n=15 patient/family dyads in-depth interviews and focus group with n=10 staff.

Publications

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