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

有什么问题吗？世界各地的人口都在老龄化，尤其是中低收入国家。这就提出了一个新的挑战——我们如何才能提供专注于个人的护理，而不是他们可能患有的多种疾病？随着人们年龄的增长，长期疾病变得越来越普遍，患有这些多重疾病的人可能会出现许多症状、社会心理和精神问题。生存是不可预测的，许多与衰老有关的疾病无法治愈。有什么解决办法呢？我们是一群从事缓和医疗的研究人员、医生和护士。姑息治疗有助于减轻那些疾病无法治愈、病情恶化并导致死亡的人所面临的症状和关切的负担。姑息治疗的重点是病人和他们的家庭，而不是他们的疾病。正因为如此，姑息治疗被推荐给患有多种疾病的人。特别是在农村地区，与卫生工作人员接触最多的是初级保健。初级保健通过提供姑息治疗，为改善对面临严重多种疾病的老年患者和家庭的护理提供了巨大的潜力。我们打算做什么？我们将与患者、家属、卫生工作人员和卫生部合作，设计一种新的方式，在初级保健中为患有多种严重疾病的老年患者提供姑息治疗。然后，我们将尝试以这种方式在初级保健中提供护理，并了解它是否按照我们预期的方式提供，以及患者、家属和工作人员对这种新工作方式的看法。这将发生在加纳、马拉维和津巴布韦。我们将分几个步骤来做这件事。首先，我们将与患者和家属合作，找到最好的方式，让他们能够表达他们对这项研究的想法和看法。然后，我们将与一系列病人、家属和工作人员交谈，了解他们对这种提供护理的新方式的看法，以及它是如何运作的。然后，我们为所有与这一目标相关的人（患者、家属、临床工作人员、临床管理人员、卫生部）举行会议，共同努力建立照顾患者的新方式b>研究小组还将利用来自患者、家属和工作人员的信息来制定护理成本措施，以确保它与患有多种严重疾病的老年人相关。一旦这些步骤完成，我们就可以尝试在农村地区医院初级保健服务中提供这种护理模式。通过问卷调查，我们将询问患者的健康和福祉，以及他们在分娩前得到的护理质量。我们还将与患者、家属和工作人员进行深入讨论，询问他们对护理的看法和经验，并试图发现它是否按照我们计划的方式运作。我们希望实现什么目标？我们知道，姑息治疗改善了患者和家庭的福祉，也比通常接受的治疗便宜。在非洲，姑息治疗并未侧重于老年人的常见疾病。在我们的三个伙伴国家，我们将进一步了解如何将姑息治疗的益处扩大到患有多种严重疾病的老年人的初级保健。我们将取得一系列新的进展：如何与患者和家属合作，为这一领域的工作提供信息；报告患有多种严重疾病的老年患者的姑息治疗需求，以及工作人员对如何在现有环境下满足这些需求的看法；清晰地理解和详细地描述如何从所有参与成功所需的角度实现护理提供；经调整的调查问卷，使我们能够衡量病人、家庭和卫生系统的护理成本；提供和接受护理的人对哪些有助于改善健康，哪些使其变得困难的看法；关于如何为更广泛的测试和推出进行交付的修订“手册”。

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.