Exploring stakeholder perspectives on nursing competencies in palliative care in India: a qualitative inquiry

BACKGROUND: India faces a growing need for Palliative Care due to its ageing population, rising cancer burden, and high prevalence of chronic illnesses. Unfortunately, less than 4% of the population has access to Palliative services, and the country ranks 59th in the 2021 Quality of Death Index. Contextually relevant and culturally sensitive nursing competencies are crucial to address this gap. However, there is no structured, evidence-based palliative nursing competency framework tailored to India's sociocultural and healthcare realities. This study explored stakeholder perspectives to identify core nursing competencies required for palliative care in the Indian context. METHODS: A qualitative design was employed, comprising seven Focus Group Discussions with nurses involved in delivering care to patients with life-limiting illnesses, and thirty five In-Depth Interviews with patients and caregivers at various stages of the disease trajectory, from diagnosis to terminal illness and end-of-life. Data were analysed using Braun and Clarke's thematic analysis approach. Line-by-line coding was conducted using Open Code 4.02 version to systematically identify themes and subthemes. These were synthesized into competency domains and statements that reflect the essential skills, knowledge, and attitudes required for palliative nursing in India. To ensure the rigor and trustworthiness of the findings, measures such as member checking and peer debriefing were undertaken throughout the research process. RESULTS: Thematic analysis yielded seven distinct competency domains. These domains captured a wide range of nursing roles, including understanding foundations of Palliative Care, communication, ethical, legal, and professional responsibilities, symptom management and enhancing comfort, psychosocial, cultural, and spiritual aspects of care, and team collaboration. The findings emphasized the importance of culturally grounded, holistic, and compassionate care tailored to the needs of Indian patients and their families. Importantly, region-specific factors, such as Indian family dynamics, cultural attitudes towards death, and spiritual beliefs, emerged prominently during the thematic analysis. Interestingly, there was a notable convergence between the views expressed by nurses in focus group discussions and those of participants in in-depth interviews regarding essential palliative care competencies. CONCLUSIONS: This study presents an empirically derived set of thematic domains and insights for palliative care nursing competencies, grounded in stakeholder perspectives and tailored to the Indian context. The identified domains can inform curriculum development, training programs, and policy formulation to strengthen palliative care services across India. TRIAL REGISTRATION: The study is registered in the Clinical Trials Registry of India CTRI/2023/07/055216) dated 14/07/2023.