Introduction: 

Bhutan, a tiny Himalayan Kingdom of 800,000 people, has virtually no palliative care. Our research aimed to develop a socially, culturally and spiritually appropriate palliative care model for Bhutan. 

Methods: 

A multi-method research program. In Phase 1, an integrative literature review explored palliative care models utilizing public health strategies in lower-income countries, describing how social, cultural and spiritual components were integrated. Needs for palliative care were assessed using surveys, in-depth interviews and focus groups among patients with advanced illnesses, family members and healthcare professionals. In Phase 2, a Delphi consensus process developed a national framework for palliative care. 

Results:

The literature review found lower-income countries faced challenges integrating public health strategies, with few highlighting integration of socio-cultural and spiritual components into palliative care. 

A patient survey found low-moderate levels of functional support needs (physical, role, emotional, cognitive, social functioning); moderately high levels of symptom support needs (pain, fatigue, insomnia, loss of appetite); and high levels of financial support needs. Family members reported high needs around understanding illness, managing symptoms, providing personal care, and financial and legal issues. Support was needed in knowing what to expect into the future, whom to contact if the patient deteriorated, dealing with feelings and emotions, understanding and reflecting on their own beliefs and spirituality and getting practical home help. In-depth interviews among patients and families indicated an urgent need for palliative care.

Only 14% of healthcare professionals had any palliative care training, and overall awareness was low. 

The Delphi study demonstrated a high level of consensus (>80%) for the framework for palliative care in Bhutan. 

Conclusion:

We have developed a contextually appropriate palliative care model for Bhutan based on public health strategies and the contextual realities of the country.