Development Challenges and Economic Evaluation on Community-based Palliative Care Service in Thailand’s Rural Area
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Abstract
Background and Objectives: Despite the growing recognition of palliative care in Thailand, further development is needed to address differences in lifestyles, social relationships, and care needs across urban and rural communities. Community based palliative care is particularly relevant in rural areas, where family and community networks play an important role in long-term care. The involvement of families, community volunteers, local authorities, and health care providers can support continuity of care and facilitate the use of available community resources. Strengthening these local networks may contribute to the sustainability of palliative care and improve coordination between community-based and formal health-care services. This study aimed to identify key factors supporting sustainable community-based palliative care in Kalasin Province, Thailand.
Methods: A mixed methods approach was conducted in Kalasin Town Municipality and Kamalasai Subdistrict Municipality. Participants included family members and primary caregivers of older patients receiving long-term care, together with stakeholders involved in community-based palliative care. Qualitative data were collected through in-depth interviews and focus group discussions. Quantitative data were obtained from questionnaires assessing palliative care expenditures incurred by patients, families, and caregivers. The qualitative and quantitative findings were considered together to provide a comprehensive understanding of factors supporting sustainable community based palliative care and the potential benefits of community-based care for patients, families, and caregivers.
Results: The findings identified social capital, strong local leadership, and community health coordinators as key drivers of sustainable community-based palliative care. Collaboration among families, volunteers, local authorities, and health-care providers facilitated care coordination and resource mobilization. These collaborative relationships also supported the connection between community resources and the care needs of patients and caregivers. Quantitative findings also suggested that community-based palliative care can reduce the financial burden of health care by lowering expenditures associated with hospital-based services and travel. The findings indicate that community resources and social relationships can play an important role in supporting both the continuity and sustainability of community-based palliative care.
Application of This Study: The findings provide guidance for local governments and health-care organizations in strengthening community networks, local leadership, and coordination mechanisms. These findings can support the development of community-based palliative care approaches that utilize existing social relationships and resources while responding to the specific needs and context of each community. Strengthening collaboration among families, community volunteers, local authorities, and health-care providers may also help complement existing formal health-care services.
Conclusions: Sustainable community-based palliative care depends on strong social relationships and effective local coordination. The Compassionate Community approach can complement formal health services and should be adapted to local social structures and available community resources. Strengthening community participation, local leadership, and coordination among relevant stakeholders may contribute to continuity of care and the sustainable development of community-based palliative care.
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