Browsing by Subject "palliative care"

Now showing 1 - 3 of 3
  • No Thumbnail Available
    Item
    Open Access
    An exploration of factors that influence referrals to palliative care in oncology
    (2025) Matsiliza, Nosisa C; Gwyther, Elizabeth
    Background: Globally, cancer is a leading cause of death. The impact of cancer is higher in low-middle income countries, compared to middle-high income countries. In Africa, the WHO projects a 403% increase in cancer between 2016 and 2060. There is convincing evidence that there are benefits to patients in providing palliative care together with oncology treatment. These benefits include understanding of prognosis, improvement in quality of life, and an increase in satisfaction with care for the patients. However, in South Africa, there is a paucity of early referrals to palliative care. Aim: The aim of the study was to determine factors that influence referral of patients with cancer, to palliative care services. Methods: This was a qualitative cross-sectional study allowing for in-depth exploration of participants' views. There were two groups of participants 1) adult patients diagnosed with cancer, and already informed of their diagnosis; 2) medical and radiation oncologists. Purposive sampling was undertaken with planned sample size of 10-14 patient participants and 8-10 oncologist participants The participants were fully informed regarding the research and asked to sign consent to take part in the research. In depth interviews were conducted following interview guides – for patients and for oncologists. Thematic analysis was conducted manually by the researcher with the support of the supervisor, and themes derived from transcripts of the participants' interviews. Results: Participants were twelve patients with cancer and eight practising oncologists. Five major themes were identified: 1) Experiences of care; 2) Relationship between oncology and palliative care; 3) Patient views on referral to palliative care services; 4) triggers for referral to palliative care services; 5) Practical considerations in referral to palliative care services. Key findings were the need for good effective communication, providing enough information to enable patients to make informed choices, a need met by palliative care services but not by oncologists whose communication manner was hurtful, without compassion and empathy and left patients unclear or overwhelmed. There is a difference in the understanding of palliative care by oncologists, while patients saw a need for early referral to palliative care services. Conclusion: The quality of life in patients with advanced cancer is negatively affected by oncologists' lack of effective communication. These patients, referred late to palliative care services, remain with unmet information needs. However, they are highly appreciative of palliative care services even when they are referred to these services near the end of their lives. Patients with advanced cancer may benefit more with early referral to palliative care services, while oncologists' communication skills and understanding of what palliative care is, may benefit from palliative care training.
  • Thumbnail Image
    Item
    Open Access
    An investigation into the management of depression in patients with late-stage cancer by South African oncologists
    (2018) Fourie, Johanna; Gwyther, Liz
    There are currently more people living with cancer than ever before. The management of the heavy symptom burden carried by these patients remain a critical subject. Of these symptoms, depression is one of the most frequently reported and debilitating symptoms in advanced cancer. The negative impact of untreated depression on both the patient and the healthcare system is well documented. The aim of this study was to explore how South African radiation oncologists manage depression in their late-stage cancer patients. The study focussed specifically on the use of screening tools, their choice of drugs and the mental health resources available to them. A convenience sample of 34 South African radiation oncologists that included participants from both the private and government sector completed an online questionnaire. The results from this study showed that these oncologists do encounter depression in their late stage cancer patients confirming the importance of the subject. While the lack of a universally agreed screening tool remains a problem, at least fifty percent of the respondents were already using some form of screening tool and thirty-five percent of the rest indicated their interest in implementing depression screening in their practice. When faced with a depressed patient, Seventy-four percent of these oncologists felt confident in starting antidepressants and all of them had some sort of mental health resources available to them. Unfortunately, the small study sample and self-reporting lead to concerns regarding the generalizability and validity of the study. However, the study remains valuable in its role of raising awareness for depression in our cancer population, identifying the shortcomings in our current management as well as identifying education needs in our health-care personnel.
  • Thumbnail Image
    Item
    Open Access
    Treatment outcomes in palliative care: the TOPCare study. A mixed methods phase III randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy
    (BioMed Central Ltd, 2012) Lowther, Keira; Simms, Victoria; Selman, Lucy; Sherr, Lorraine; Gwyther, Liz; Kariuki, Hellen; Ahmed, Aabid; Ali, Zipporah; Jenkins, Rachel; Higginson, Irene; Harding, Richard
    BACKGROUND: Patients with HIV/AIDS on Antiretroviral Therapy (ART) suffer from physical, psychological and spiritual problems. Despite international policy explicitly stating that a multidimensional approach such as palliative care should be delivered throughout the disease trajectory and alongside treatment, the effectiveness of this approach has not been tested in ART-experienced populations.METHODS/DESIGN:This mixed methods study uses a Randomised Controlled Trial (RCT) to test the null hypothesis that receipt of palliative care in addition to standard HIV care does not affect pain compared to standard care alone. An additional qualitative component will explore the mechanism of action and participant experience. The sample size is designed to detect a statistically significant decrease in reported pain, determined by a two tailed test and a p value of [less than or equal to]0.05. Recruited patients will be adults on ART for more than one month, who report significant pain or symptoms which have lasted for more than two weeks (as measured by the African Palliative Care Association (APCA) African Palliative Outcome Scale (POS)). The intervention under trial is palliative care delivered by an existing HIV facility nurse trained to a set standard. Following an initial pilot the study will be delivered in two African countries, using two parallel independent Phase III clinical RCTs. Qualitative data will be collected from semi structured interviews and documentation from clinical encounters, to explore the experience of receiving palliative care in this context.DISCUSSION:The data provided by this study will provide evidence to inform the improvement of outcomes for people living with HIV and on ART in Africa.ClinicalTrials.gov Identifier: NCT01608802