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

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What is the problem?People around the world are ageing, especially low and middle income countries. This presents a new challenge- how can we provide care that is focused on the person rather than the multiple illnesses that they are likely to live with? Long term illnesses are becoming more common as people age, and living with these multiple illnesses can present many symptoms, psychosocial and spiritual concerns. Survival can be unpredictable, and cure cannot be achieved for many conditions associated with ageing. What might be a solution? We are a group of researchers, doctors and nurses working in palliative care. Palliative care helps to reduce the burden of symptoms and concerns faced by people whose disease cannot be cured, and which will worsen leading to death. Palliative care focuses on the patient, their family rather than their disease. Because of this, palliative care has been recommended for people who are living within multiple illnesses. Most contact with health staff, especially in rural areas, is with primary care. Primary care offers a strong potential to improve the care of older patients and families who are facing serious multiple illnesses by delivering palliative care. What do we plan to do? We will work with patients, families, health staff and Ministry of Health to design a new way to deliver palliative care from within primary care for older patients with multiple serious illnesses. We will then try delivering this now way to deliver care within primary care, and find out if it is delivered in the way we expected and what patients, families and staff think of the new way of working. This will happen in Ghana, Malawi and Zimbabwe. We will do this in a number of steps. First, we will work with patients and families to find the best way for them to be able to give their thoughts and views on this study. Then we will talk to a range of patients, families and staff to get their views on how the new way of delivering care night look and how it could work. We then hold a meeting for all those people who are relevant to this goal (patients, families, clinical staff, clinical managers, Ministry of Health) to work together to build the new way of caring for patients> The research team will also use the information from patients, families and staff to work on a measure of care costs to ensure it is relevant for older people with multiples serious illness. Once these steps are complete we can then try delivering this model of care at a rural district hospital primary care service. Using questionnaires we will ask patients about their health and wellbeing and the quality of care they receive both before delivery. We will also have in-depth discussions with patients, families and staff to ask their views and experiences of the care, and to try and discover whether it worked in the way we planned. What do we hope will be achieved? We know that palliative care improves patient and family wellbeing and can also be cheaper than care usually received. In Africa, palliative care has not focused on the common diseases of older people. In our three partners countries we will move forward our understanding of how to expand the benefits of palliative care into primary care for older people with multiple serious illnesses. We will deliver a series of new advances: how to work with patients and families to inform work in this field; report the palliative care needs of older patients with multiple serious illnesses and staff views on how to meet them within existing settings; clear understanding and detailed description of how to achieve the care delivery from the views of all needed to engage for success; adapted questionnaire that will allow us to measure the costs of care for patients, families and the health system; views from those delivering and receive the care on what helps it to improve wellbeing and what makes it difficult; a revised "manual" on how to deliver for wider testing and rollout.