Hospice and palliative care development in India: A multimethod review of services and experiences
Hospice and palliative care development in India: A multimethod review of services and experiences
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DOI：
10.1016/j.jpainsymman.2007.07.012
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发表时间：
2008-06-01
影响因子：
4.7
通讯作者：
Clark, David
中科院分区：
文献类型：
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作者：
McDermott, Elizabeth;Selman, Lucy;Clark, David
自 20 世纪 80 年代中期以来，印度一直在发展姑息治疗，但缺乏可作为国家政策和实践基础的服务提供的证据。这项研究的目的是评估印度姑息治疗的现状，绘制各邦服务的存在情况，并记录相关人员的观点和经验。采用多种方法进行审查，包括综合已发表文献和灰色文献的证据、人种学实地考察、对来自 12 个州的 87 名个人进行定性访谈，以及对现有公共卫生数据的整理。审查确定了 16 个州和中央直辖区的 138 个临终关怀和姑息治疗服务。这些大多集中在大城市，但喀拉拉邦除外，那里的情况更为普遍。非政府组织、公立和私立医院以及临终关怀医院是主要的供给来源。我们无法确定 19 个州/联邦属地的姑息治疗服务。服务发展不平衡，南方的服务供给明显多于北方，但对于大多数州来说，覆盖率较差。姑息治疗发展的障碍包括：贫困、人口密度、地理位置、阿片类药物的供应、劳动力发展和有限的国家姑息治疗政策。存在开发负担得起的、可持续的基于社区的姑息治疗服务的成功模式。这些都是在印度文化背景下采用西方临终关怀和姑息治疗模式而产生的。需要开展进一步的工作，以确保利用印度对临终关怀和姑息治疗日益增长的兴趣来增加进步的势头。
Palliative care has been developing in India since the mid-1980s, but there is a dearth of evidence about service provision on which to base national policy and practice. The aim of this study was to assess the current state of palliative care in India, mapping the existence of services state by state, and documenting the perspectives and experiences of those involved. A multimethod review was used, which included synthesis of evidence from published and grey literature, ethnographic field visits, qualitative interviews with 87 individuals from 12 states, and collation of existing public health data. The review identified 138 hospice and palliative care services in 16 states and union territories. These are mostly concentrated in large cities, with the exception of Kerala, where they are much more widespread. Nongovernmental organizations, public and private hospitals, and hospices are the predominant sources of provision. We were unable to identify palliative care services in 19 states/union territories. Development of services is uneven, with greater provision evident in the south than the north, but for the majority of states, coverage is poor. Barriers to the development of palliative care include: poverty, population density, geography, opioid availability, workforce development, and limited national palliative care policy. Successful models exist for the development of affordable, sustainable community-based palliative care services. These have arisen from adapting Western models of hospice and palliative care for implementation in the Indian cultural context. Further work is required to ensure that the growing interest in hospice and palliative care in India is used to increase the momentum of progress.