Palliative Care Needs Assessment in the Population Living in Mayotte: SPMAYOTTE, a Qualitative Study Conducted with 62 Patients, Caregivers and Healthcare Professionals.

BACKGROUND/AIM: Mayotte is a French island in the Indian Ocean. There is no palliative care structure in this territory. The island and its population have specific characteristics: insularity, poverty, coexistence of modern and traditional medicine, importance of religion (Islam) and the presence of many foreigners without health insurance. The aim of this study is to determine the palliative care needs of the Mayotte population and propose the establishment of an appropriate service. METHODS: A qualitative study was conducted in Mayotte using interviews with patients and their caregivers, and focus groups were conducted with healthcare professionals involved in their care. Patients requiring palliative care were identified and recruited from the hospital or the patient's home by healthcare professionals. RESULTS: A total of 62 people participated in the study between May and June 2019. The needs expressed were analysed and then grouped into categories: access to medical care (especially at home), management of physical symptoms (analgesia) and psychological symptoms, organisation of care (coordination between healthcare professionals) and training of healthcare professionals (pain management, palliative care, interculturality and translation), taking into account cultural and religious aspects. Regarding the foreign population, the categories were: improving access to healthcare, access to the social protection system and daily living conditions (transport, food and accommodation). CONCLUSIONS: The specific needs of the population, assessed through the study, have led to an original proposal, which differs from the usual structures of palliative care in France.

Quelle démarche méthodologique afin d'aboutir à une offre pertinente de soins palliatifs à Mayotte ?

OBJECTIVE: The department of Mayotte is lagging far behind in terms of access to palliative care. We present the methodological approach for assessing the palliative care needs of the population, which led us to make a proposal for a care offer adapted to the local context. METHOD: The main principles of a public health methodology for health needs assessment were followed. The researchers carried out an overall analysis of the situation based on several axes: bibliographical research, collection of quantitative data, qualitative study, interviews with local experts and institutional decision-makers. A summary report of the results was presented to those working in the field at the end of the study in order to support proposals for the creation of a suitable palliative care offer. RESULTS: In view of the paucity of epidemiological data, the qualitative study was decisive in assessing needs. Exchanges with institutional decision-makers enabled a deeper understanding of local specificities and improved the relationship between local actors leading to the emergence of a co-construction process. In December 2019, a palliative care offer resulting from the study’s proposals was funded. CONCLUSION: Our methodology was based on regular exchanges in the field and enabled us to encourage the emergence of a decisive element for the success of the project: the support of carers and institutional decision-makers. This co-construction between the partners allowed interactivity between the different categories of actors involved and reinforced the quality of the work and the emergence of a collective intelligence (study SP Mayotte).