Browsing by Subject "Palliative Care"
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- ItemOpen AccessAn audit of referring patterns for cancer patients to the Palliative Care Unit in 2 Military Hospital, by means of a retrospective evaluation of the percentage of referrals adhering to a given standard, and evaluation of possible barriers(2002) Engelbrecht, MariThe 2 Military Hospital Palliative Care unit seeks to provide high quality, holistic palliative care to all patients suffering from life-threatening diseases. This care should be initiated early after diagnosis, to prevent unnecessary suffering and allowing the patient and the family to be part of the decision making process. However, the majority of the cancer patients are either referred very late in the disease process or are not referred at all. The purpose of this study was to enumerate the percentage of patients who were not referred to the palliative care unit; to identify possible barriers to referral within referring doctors and to promote the role of the palliative care unit.
- ItemOpen AccessAn evaluation of factors that contribute to late referral of cancer patients by oncologists and doctors working in oncology to hospice services in the Western Cape(2011) Swart, M Teresa; Barnard, Alan JA survey was done in the City of Cape Town Health District to identify possible barriers and other factors that influence the referral of patients to hospice by oncologists. Factors that influenced referral of patients to hospice included lack of training of oncologists in palliative care, the view of the oncologist's individual role in the care of his patients as well as the ability to communicate comfortably with patients regarding end-of-life care. Reasons for non-referral included hospice not being available in the area or not accessible to patients, the perception of the doctor that he/she is giving up on the patient, previous dissatisfaction with service by hospice and not wanting to lose control of the treatment of the patient.
- ItemOpen AccessAn evaluation of palliative care in rural Tanzania where availability of oral morphine is intermittent or absent(2011) Hartwig, Kristopher; De Vries, ElmaIn Tanzania, palliative care is relatively new, and faces the common challenges of access to services, crucial medications, and education. Since 2004, an initiative within the health system of the Evangelical Lutheran Church in Tanzania (ELCT) began to promote and develop palliative care, using as a model the Selian Hospice and Palliative Care Programme. The hospitals which are the sites for team development and service delivery are widely scattered throughout rural Tanzania. Access to oral morphine was only a dream, as it is for much of the rural population of the world. In 2007, a program called CHAT (Continuum of care for people living with HIV/AIDS in Tanzania), funded by the U.S. government, allowed the up-scaling of these palliative care programs, resulting in 13 strong and mature teams by 2011, though still lacking oral morphine. Part of the monitoring and quality assurance of the program has been use of a tool developed by APCA: the APCA African Palliative Outcome Scale (POS). Hundreds of people living with cancer and HIV were subjected to the questions of the tool, which was always sent on to the core supervising team for assessment and feedback. Tramadol was the strongest analgesic available to the teams throughout the study time. 145 APCA African POS results on cancer patients were assessed, looking at differences in pain scores (0 to 5 scale) over time as well as assessing the other domains of care (psychological, spiritual, social, and family). 11 Palliative care nurses were also interviewed, asked to reflect on specific cases from their experience with both good and bad pain control. 5 of the nurses came from Selian, with access to oral morphine, while 6 of them came from the CHAT hospitals. Significant improvement in pain scores over 4 weeks was noted (3.83 to 2.31, p < 0.0001). All other domains assessed in the POS also improved significantly. Nurse interviews revealed an emphasis on the holistic approach and a strong preference for having access to oral morphine. In this rural Tanzanian environment, effective palliative care services – including pain control - were delivered even in the absence of oral morphine. Such services can become a strong advocacy at the government level for achieving breakthroughs in palliative care, including access to oral morphine.
- ItemOpen AccessAn evaluation to asses [i.e. assess] the holistic care of tuberculosis patients with palliative care needs in the Western Cape, South Africa(2010) Krause, S R; Gwyther, Liz ; Gould, TThis is an evaluation of the holistic care of Tuberculosis patients with palliative care needs in the Western Cape, South Africa.
- ItemOpen AccessThe incidence of burnout in health care professionals working in Pretoria oncology centres(2004) De Klerk, Era; Collins, Kathleen; Gwyther, LizBurnout is a syndrome of emotional exhaustion, depersonalisation and reduced personal accomplishment that may occur amongst individuals who work primarily with people. Nurses and doctors working in oncology must care for many critically ill and dying patients. Pretoria is a city with a high concentration of oncology institutions. The aim of this research is to evaluate the incidence of burnout amongst health care professionals in Pretoria oncology centres, to assess whether certain variables have an influence on the levels of burnout and to compare the situation in Pretoria to the rest of the world. A questionnaire was distributed to all health care professionals working in oncology centres in Pretoria. The questionnaire consisted of an informed consent, demographic data and the Maslach Burnout Inventory. The participants included doctors, nursing staff, radiographers and social workers in both state and private health care institutes, involving radiotherapy, chemotherapy and palliative care units. 240 questionnaires were distributed and 156 were returned. Results show that 24.65% - 32 .87% of participants experienced a high degree of burnout, which is average compared to the rest of the world. Burnout in cancer care workers has been reported to be 22.1 - 53.3% in the rest of the world. Young, single participants appeared to experience a greater incidence of burnout, which is consistent with the literature. The incidence of burnout amongst healthcare professionals, in Pretoria oncology centres appear to be average when compared to the rest of the world. However, language problems, cultural differences and other limitations of the burnout scale may have played a role and warrants further research.
- ItemOpen AccessThe knowledge, attitudes, beliefs and practices towards palliative care of family physicians in the Boland and Northern Suburbs of Cape Town(2012) Loftus, Cornelius; Gwyther, LizPalliative care, for those dying from a life-threatening disease, has developed to become a definite discipline in mostly developed countries. Through this palliative care has become accepted as a human right to all in need of end-of-life care. The stark reality in developing countries is that palliative care is in the early stages of development, with the result that if it is available at all, it usually is very basic. These countries which have restricted resources available are faced with an increased and overwhelming demand for palliative care because of the AIDS pandemic and also an expected massive increase in the incidence of cancer and non-communicable diseases. This raises the question how this demand will be met? The WHO is again looking at primary care as the way of meeting increased health care demands, including palliative care. The importance of the role of the general practitioner in delivering palliative care is widely accepted. The greatest majority of general practitioners in South Africa have never received official palliative care training. The question to be answered then is how well are they equipped to meet this increasing demand for end-of-life care. The study was designed as a descriptive cross-sectional KABP study. The study population was defined as all practising GPs working in a particular area in the northern suburbs of Cape Town and a number of Boland towns. The data collection tool used was a self-administered questionnaire that was developed through a process of review and through a pilot process. The questionnaire was then posted to all identified GPs with a return envelope with follow-up of non-respondents to ensure a better response rate. The response rate was 34,7%. Overall 69,45% of the questions were answered correctly and 30,55% incorrectly. The respondents showed good knowledge on morphine use and respiratory depression, the dangers of addiction to morphine, emergencies in palliative care and spinal cord compression. The greatest majority of respondents do not understand the holistic approach to pain management and also do not have knowledge about the use of syringe drivers. A high percentage of participants have a positive attitude towards palliative care in general, feel comfortable with their own emotions in end-of-life care and acknowledge their need for further training. On the questions on belief, respondents believe that the family must be involved in decision-making and that the GP must be doing bereavement care. Unfortunately most participants believe the management of physical symptoms ensures quality of life and seem not to grasp the holistic approach followed in palliative care. In practice only a few respondents understand the routine use of anti-emetics with initial opioid prescriptions. There is a significant number of GPs uncertain about the use of combinations of analgesics, the use of intravenous fluids in end-of-life care and the use of the subcutaneous route to administer drugs and fluids. The importance of the role of the GP in palliative care has to be recognized and acknowledged by all involved in such care. Programmes have to be initiated to train and educate practising GPs in palliative care to empower them and also to spread the end-of-life care message.
- ItemOpen AccessManagement of cancer pain : knowledge and attitudes of healthcare professionals(2004) Rodrigues, S D SThe control of pain is an important aspect of patient care for physicians who deal with cancer and has significant impact on the quality of life of patients. With appropriate care, pain can be controlled in 90% of patients who have advanced malignant conditions.
- ItemOpen AccessQuality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study(BioMed Central Ltd, 2011) Selman, Lucy; Higginson, Irene; Agupio, Godfrey; Dinat, Natalya; Downing, Julia; Gwyther, Liz; Mashao, Thandi; Mmoledi, Keletso; Moll, Tony; Sebuyira, Lydia; Ikin, Barbara; Harding, RichardBACKGROUND:Quality of life (QOL) is a core outcome of palliative care, yet in African settings there is a lack of evidence on patients' levels of QOL. We aimed to describe QOL among patients with incurable, progressive disease receiving palliative care in South Africa and Uganda, to compare QOL in cancer and HIV, to determine how domains of QOL correlate with overall QOL, and compare levels of QOL in this population with those in other studies using the same tool. METHODS: A cross-sectional survey was conducted using the Missoula Vitas Quality of Life Index (MVQOLI), a 26-item QOL questionnaire with five subscales (Function, Symptom, Interpersonal, Well being, Transcendent) covering physical, social, psychological and spiritual domains and one global QOL item. One item in each subscale assesses the subjective importance of the domain on a score from 1 (least important) to 5 (most important), used to weight the contribution of the subscale towards the Total QOL score. The tool was translated into 6 languages and administered to consecutively recruited patients at four facilities in South Africa and one in Uganda. RESULTS: 285 patients were recruited, with a mean age of 40.1; 197 (69.1%) were female. Patients' primary diagnoses were HIV (80.7%), cancer (17.9%) and other conditions (1.4%). The mean global QOL score was 2.81 (possible range 0 (worst) to 5 (best)); mean Total score 17.32 (possible range 0 to 30). Patients scored most poorly on Function (mean 0.21), followed by Well being (2.59), Symptoms (5.38), Transcendent (5.50), Interpersonal (9.53) (possible range for subscale scores -30 to 30). Most important to patients were: close relationships (mean 4.13), feeling at peace (4.12), sense of meaning in life (4.10), being active (3.84), physical comfort (2.58). Cancer patients were predominantly recruited at three of the sites; hence comparison with HIV-infected patients was restricted to these sites. HIV+ patients (n = 115) scored significantly worse than cancer patients (n = 50) on Well being (Z = -2.778, p = 0.005), Transcendence (Z = -2.693, p = 0.007) and Total QOL (Z = -2.564, p = 0.01). Global QOL score was most weakly correlated with Total QOL (r = 0.37) and the Transcendent subscale was most highly correlated (r = 0.77) (both p < 0.001). Patients receiving palliative care in South Africa and Uganda exhibited significantly poorer QOL compared to similar populations in the USA. CONCLUSIONS: Feeling at peace and having a sense of meaning in life were more important to patients than being active or physical comfort, and spiritual wellbeing correlated most highly with overall QOL. It is therefore vital to identify and meet the psychological and spiritual care needs of patients, as well as to assess and treat pain and other symptoms. Our finding that patients scored most poorly on the Function domain warrants further research.
- ItemOpen AccessA retrospective study to determine changes in quality of life over the first 6 months period of antiretroviral therapy, as measured by the MOS-HIV questionnaire(2008) Malan, Daniel Rudolf; Gwyther, LizThe aim of the research was to determine changes in quality of life over the first six months of anti-retroviral therapy.
- ItemOpen AccessValidation of a core outcome measure for palliative care in Africa: the APCA African Palliative Outcome Scale(BioMed Central Ltd, 2010) Harding, Richard; Selman, Lucy; Agupio, Godfrey; Dinat, Natalya; Downing, Julia; Gwyther, Liz; Mashao, Thandi; Mmoledi, Keletso; Moll, Tony; Sebuyira, Lydia; Panjatovic, Barbara; Higginson, IreneBACKGROUND: Despite the burden of progressive incurable disease in Africa, there is almost no evidence on patient care or outcomes. A primary reason has been the lack of appropriate locally-validated outcome tools. This study aimed to validate a multidimensional scale (the APCA African Palliative Outcome Scale) in a multi-centred international study. METHODS: Validation was conducted across 5 African services and in 3 phases: Phase 1. Face validity: content analysis of qualitative interviews and cognitive interviewing of POS; Phase 2. Construct validity: correlation of POS with Missoula-Vitas Quality of Life Index (Spearman's rank tests); Phase 3. Internal consistency (Cronbach's alpha calculated twice using 2 datasets), test-retest reliability (intraclass correlation coefficients calculated for 2 time points) and time to complete (calculated twice using 2 datasets). RESULTS: The validation involved 682 patients and 437 family carers, interviewed in 8 different languages. Phase 1. Qualitative interviews (N = 90 patients; N = 38 carers) showed POS items mapped well onto identified needs; cognitive interviews (N = 73 patients; N = 29 carers) demonstrated good interpretation; Phase 2. POS-MVQoLI Spearman's rank correlations were low-moderate as expected (N = 285); Phase 3. (N = 307, 2nd assessment mean 21.2 hours after first, SD 7.2) Cronbach's Alpha was 0.6 on both datasets, indicating expected moderate internal consistency; test-retest found high intra-class correlation coefficients for all items (0.78-0.89); median time to complete 7 mins, reducing to 5 mins at second visit. CONCLUSIONS: The APCA African POS has sound psychometric properties, is well comprehended and brief to use. Application of this tool offers the opportunity to at last address the omissions of palliative care research in Africa.