In the era of growing evidence-based practice, the use of evidence is becoming an imperative for palliative care programmes. On the one hand, funding organisations often want to see measurable outcomes from their financial donations and grants. On the other hand, other stakeholders want to see how evidence generated is used to inform programme improvement and decision making.
The African Palliative Care Association (APCA) has worked with and supported partners across Africa to ensure that evidence is used in improving palliative care services. Below are two examples of how research findings have supported service providers, which used the APCA African Palliative Outcome Scale (POS).
two For example, in South Africa and Uganda, APCA has supported the Hospice and Palliative Care Association of South Africa and Hospice Africa Uganda, respectively) to utilise evidence generated using the APCA African Palliative Outcome Scale (POS).
Since its validation as a quality improvement tool, the APCA African POS has been used extensively by South African hospices. It has been found to be particularly valuable in identifying areas requiring quality improvement activities.
As part of a project funded by the Canadian International Development Agency, the Hospice Palliative Care Association (HPCA) used the APCA African POS to assess what collective difference 50 home-based care programmes were making to the lives of the patients and families they serve. To this end, 336 questionnaires were analysed at the University of Cape Town and the following statistically significant examples of results, reflecting improved physical, psychosocial and spiritual aspects of care, were documented.
- Pain scores dropped from an average of 4 on visit 1 to an average of 1 on visit 6.
- Scores for level of worry identified by the patient dropped from 4 to 1.
- Scores reflecting the family's confidence in caring for the patient increased from 3 to 5.
These results are a clear indication of the success of the holistic palliative care provided by hospices to patients and families throughout the country.
After the development of the APCA Africa POS, the tool was validated through the ENCOMPASS project , a multi-centred study involving 5 centres, 4 in South Africa and one in Uganda. Following validation, the sites piloted the use of the APCA African POS as a quality improvement tool in a clinical audit undertaken in each site in two phases.
The tool was administered during routine care when nurses were visiting patients, who were enrolled across all care settings (e.g. home, hospital, hospice clinic and day care). During phase 1, data was collected weekly for 6 weeks, producing 6 data points, with 100 patients enrolled.
It was discovered that there was good pain and symptom control as these problems kept decreasing steadily and significant differences were seen across the time period. This was attributed to the effective use of oral morphine and the palliative care approach. However, the results were not so good for the non-physical problems and this was the same across all the sites. The data was analysed and the team met to identify strategies on how to handle psychosocial issues.
At phase 2, data collection was repeated amongst different patients of the same services to see if the implemented strategies from phase 1 of the audit had made a difference, with the results showing some improvement.
The process of clinical audit helped Hospice Africa Uganda to be able to identify areas of strength and weaknesses in their provision of care and improve on them as necessary. The hospice continues to use the tool during its audit cycles and has included it in its monitoring and evaluation system.