Abstract
This study focuses on developing models for home- and community-based palliative
care at the end of life, in response to people’s preference to spend their final days in familiar
and supportive environments. The objectives were: (1) to formulate proposals for developing
models of home- and community-based palliative end-of-life care during the transition of
Tambon Health Promoting Hospitals (THPHs) to Provincial Administrative Organizations (PAOs);
and (2) to develop a prototype model of such services during this transfer period.
The research was an Implementation Research project using primarily qualitative
methods, guided by the Generic Implementation Research framework. It was conducted in two
provinces—Phitsanulok and Khon Kaen—and covered six major hospitals, including
Buddhachinaraj Hospital, Naresuan University Hospital, Noen Maprang Hospital, Khon Kaen hospital, Srinagarind
Hospital, and Ubolratana Hospital. Study participants comprised families/households of
terminally ill patients enrolled in the project and stakeholders from all agencies involved in
end-of-life care. Data collection employed multiple methods: in-depth interviews, focus group
discussions, observation, and the FAMCARE-EOL assessment instrument adapted from the
standard FAMCARE scale.
Findings indicate substantial progress in developing effective community-based palliative
care models aligned with the Thai context. Assessment with FAMCARE-EOL showed high family
satisfaction with care in both Phitsanulok and Khon Kaen, with mean scores a cross all
dimensions ranging from 4.6 to 4.9 out of 5. In terms of community network development,
stakeholder engagement has advanced markedly, especially coordination among general
hospitals, THPHs, and local administrative organizations; however, challenges remain in interagency communication and data exchange, as well as shortages of personnel and budget. The
“Ubolratana Model” emerged as the most notable innovation, involving full-time community
caregivers hired with private donations under community hospital supervision, receiving 6,000–
7,000 THB monthly and working Monday through Saturday, with results showing effectiveness
like over 40% glycemic control in diabetic patients and reduced hospital burden for end-of-life
care.
Regarding system strengths, Phitsanulok benefits from suitable infrastructure, with
Buddhachinaraj Hospital as a strong regional referral hub and well-coordinated network, while
Khon Kaen’s strength is its academic center of excellence—the Karunruk Center at Srinagarind
Hospital—serving as an academic hub and learning resource. Key challenges include personnel
shortages; limited and fragmented funding; inequities in service access; coordination difficulties
across agencies under different authorities, especially post-THPH transfer; and gaps in standards
adherence, particularly in Advance Care Planning (ACP).
The study proposes recommendations to improve community-based end-of-life care:
first, scale up the Ubolratana Model to other areas with context-appropriate adaptation,
supported by strong policy and budgetary backing; second, develop an integrated information
system linking Ministry of Public Health agencies and local administrative organizations for
continuity of care; third, strengthen networks via robust inter-agency collaboration mechanisms;
fourth, build workforce capacity through systematic training using centers of excellence; fifth,
reduce disparities by targeting vulnerable groups and proactive case -finding. Policy
recommendations include revising regulations to support community care (e.g., coding for
hospital-to-home transfers and allowing Subdistrict Health Funds for caregiver stipends and
transport); pooling budgets from sources like Health Promotion funds, IMC, Long-Term Care, and
Subdistrict Health Funds for caregiver financing; developing standardized performance and
quality systems across networks; and creating private-sector and community participation
mechanisms.
