Abstract / Summary
Abstract Background The global need for palliative care is substantial and continues to grow, with the rising burden of chronic illnesses, ageing population and emerging and re-emerging diseases. The burden is particularly high in Low- and Middle-Income Countries, including India, where access to palliative care remains limited despite substantial unmet need. Nurses play a vital role in delivering palliative care. However, variations in the healthcare system, training, and scope of practice highlight the need for a contextually relevant nursing competency framework for palliative care. This study aims to develop a contextually relevant nursing competency framework for palliative care in India using a modified e- Delphi approach. Methods Informed by findings from the literature review and a qualitative inquiry, an initial list of competency statements was developed towards this framework. A modified three-round e-Delphi process was conducted involving experts in palliative care across India to refine and achieve consensus. Consensus was predefined as median ≥ 4, IQR ≤ 1, and percentage agreement ≥ 70%. Inter-round across Rounds 2 and 3 were examined for directly comparable competency statements using Wilcoxon signed-rank tests with Benjamini–Hochberg correction for multiple comparisons. Results Health professionals from 15 states in India contributed to the framework. High levels of agreement were observed across all rounds. In round 1, most items were retained, while expert feedback guided merging, modification, deletion, and addition of items. In the final round, 76 out of 77 statements met all predefined consensus criteria. The remaining statement was retained considering its median rating and the qualitative expert feedback from the preceding round that led to its inclusion. The final framework comprised nine domains and seventy-seven competency statements. The domains included: Foundations of palliative care, Therapeutic communication, Physical comfort and Symptom management, Multidisciplinary collaboration, Psychosocial, emotional and spiritual support, End-of-life care, Family and Caregiver support, Ethical and Legal aspects of care, Nurse self-care and Professional development. Conclusion The Delphi process enabled the development of a competency framework in palliative care for the Indian context. This is intended to support nursing education, clinical practice, and policy. Further work and commitments are needed for its implementation in real-world practice. Trial registration Registered under Clinical Trials Registry of India (CTRI/2023/07/055216) dated 14/07/2023 with reference number (REF/2023/06/069316).