Browsing by Author "Odell, Shannon"

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    A study to determine the palliative care needs of patients with drug resistant tuberculosis in the Southern sub-district of Cape Town
    (2018) Odell, Shannon; Krause, René; Gwyther, Liz
    Introduction: The Palliative Care needs of patients with Drug-Resistant Tuberculosis (DR-TB) are under-researched, yet pertinent in the management and control of DR-TB. Most literature reviewed focused on treatment schedules, outcomes, transmission, drug adherence, drug side effects and further drug-resistance. Aim: The aim was to determine the palliative care needs of patients infected with DR-TB living in the Southern sub-district of Cape Town. The Objectives The objectives were to determine the quality of life and symptom burden of DR-TB patients and to assess for correlation between these variables and palliative care needs. Methodology: In this cross-sectional study, twenty-eight participants were posed a culturally sensitive questionnaire designed by the researcher, that comprised: demographic questions, Likert-type questions for the African Palliative Care Association – Palliative Outcome Score (APCA-POS) tool, Eastern Co-operative Oncology Group (ECOG) score, a symptom checklist and open patient dignity questions. Quantitative and qualitative data of the respondents’ quality of life, functional status and burden of symptoms in the preceding week were ascertained. Pre-determined numerical scores in the Likert-type questions were deemed indicative of palliative care need. Results: Quantitative and qualitative analysis of the data showed that each participant had a palliative care need: be it either (or a combination of) unmet clinical, psychological, social and/or spiritual needs - despite being at differing stages of the DR-TB disease trajectory. These needs required contextualizing within the respondents’ communities where socio-economic issues were prevalent. Predominant physical complaints were tiredness (79%), joint pain (64%), confusion (61%) and shortness of breath (51%). Respondents’ also experienced a loss of autonomy, poor self-value and financial insecurity. Fifty percent of patients interviewed required urgent further management and referral to the local clinic. Conclusion: Despite the small cohort of patients and possible recruitment bias, this research concurred that a palliative care approach be adopted from the point of DR-TB diagnosis and throughout the treatment period – regardless of treatment outcome; and that DR-TB patients had significant unmet palliative care needs that affected their quality of life, functional status and dignity, regardless of whether pain was present.
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    A Study to Identify the Burden of Chronic Disease on a Private Emergency Medical Service in the Southern Sub-District of Cape Town, and if there is a Need for Palliative Care Provision in the Pre-Hospital Healthcare Sector
    (2023) Holmes, Linley; Odell, Shannon; Gwyther Elizabeth
    Introduction Paramedics are often the first healthcare personnel to provide contact and care to patients with exacerbation of their chronic, non-communicable disease. Many of these patients will call for assistance multiple times during the trajectory of disease, and may benefit from a palliative care program. Currently, paramedics are not trained to manage patients requiring palliative care, nor provided with specialist palliative care consultation resulting in many patients being transported to hospital unnecessarily. Aim This study aims to describe the burden placed on Emergency Medical Services due to the number of patients with chronic Non-Communicable Diseases experiencing acute symptoms, and to assess whether palliative care in the pre-hospital sector should be considered. The objectives of the study include understanding whether patients with non-communicable disease symptoms were transported to a medical facility or remained at home, what clinical management they received, and whether there is a need for education, inter-disciplinary consultation, and provision of palliative care, in the pre-hospital environment. Methods This was a retrospective descriptive analysis of de-identified patient PRFs of adult patients, attended to by a private Emergency Medical Service (EMS) between January 1st, 2019, up until 30th April 2019. Results Of the 283 patients included in the study, many had more than one NCD, often experiencing more than one of the primary symptoms of pain, SOB, cognitive changes, and N&V simultaneously. The majority of these patients were likely to go to hospital with ambulance transport and frequently there was no appropriate clinical intervention by paramedics. Clinical advice was seldom sought by paramedics for patients with NCDs (cancer, chronic heart disease, chronic lung disease, dementia, and chronic kidney disease) experiencing symptoms of pain, SOB, cognitive changes and N&V, and it was evident that palliative care access, and availability, for patients was minimal. Conclusion Palliative care is a necessary approach to patient-centred care, with specifically trained EMS and paramedics being an available resource to assist with this approach. Access to available palliative/ home care networks, in conjunction with education and EMS support, will facilitate care for patients that have a need for palliative care support in the out of hospital context, and will limit the inappropriate transport of patients to already over-burdened Emergency Departments.