Patients' and nurses' perception of the Hospice-On-Wheels service in Kazakhstan: a qualitative study

Background: In Kazakhstan, the Comprehensive Cancer Control Plan has led to the establishment of 214 mobile teams funded by the Ministry of Health to offer in-home palliative care for terminal cancer patients. However, due to a shortage of trained and dedicated personnel, only about 25% of these teams provide high-quality, specialised care in the comfort of patient's homes, with the majority offering only consultative services. Given the country's sparse population, ensuring dedicated care is challenging and many staff members continue as part-time primary care workers. In this landscape, the'Amazonka' Foundation's Hospice-On-Wheels initiative emerges as the sole NGO non-government organisation (NGO)-based service delivering in-home palliative care of comparable quality. Distinguished by its contract with the Ministry of Labour and Social Protection, Hospice-On-Wheels enjoys greater organisational flexibility and provides a broader spectrum of services, all while maintaining rigorous standards of multidisciplinary care. Aims: The aims of this study are to assess the effectiveness and sustainability of an NGO-based in-home palliative care service in Kazakhstan and to discuss the qualitative methodology and its characteristics to Kazakhstani nurses, unfamiliar with quality nursing research. Methods: The study commenced with a descriptive phenomenological approach and a service design methodology, later transitioning from phenomenological thematic analysis to content analysis. Results: These rapid research findings highlight the exceptional effectiveness, customer satisfaction and cost-saving advantages of the NGO-based initiative. These benefits extend not only to the government and health authorities but also to patients and their families. The 'Amazonka' service significantly enhances the quality of life for incurable cancer patients through improved palliative care. Consequently, expanding their infrastructure and educational initiatives is essential to promote better palliative care in Kazakhstan, particularly in rural areas. Discussion: The insights from this study can advocate for the home-based palliative care model employed by the'Amazonka' team, encouraging its adoption by both governmental organisations and NGOs in Kazakhstan and beyond, thus opening new opportunities for local funding in resource-limited conditions.