Access to hospice care: multi-professional specialist perspectives in South Africa

Ens, Carla; Gwyther, Liz; Chochinov, Harvey Max; Moses, Stephen; Jackson, Catherine A.; Harding, Richard

doi:10.12968/ijpn.2008.14.4.29227

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…Hospice care initiatives are still a recent development and an evaluation of the hospice referral process was reported to promote improved access in South Africa [53]. One study in a cancer palliative care setting addressed the related issue of information behaviour, pointing to its complexity and the need for further investigation [54].…”

Section: Resultsmentioning

confidence: 99%

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

et al. 2011

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BackgroundEnd of life (EoL) care in sub-Saharan Africa still lacks the sound evidence-base needed for the development of effective, appropriate service provision. It is essential to make evidence from all types of research available alongside clinical and health service data, to ensure that EoL care is ethical and culturally appropriate. This article aims to synthesize qualitative research on EoL care in sub-Saharan Africa to inform policy, practice and further research. It seeks to identify areas of existing research; describe findings specifically relevant to the African context; and, identify areas lacking evidence.MethodsRelevant literature was identified through eight electronic databases: AMED, British Nursing Index & Archive, CINAHL, EMBASE, IBSS, MEDLINE, PsycINFO, and the Social Sciences Citation Index; and hand searches. Inclusion criteria were: published qualitative or mixed-method studies in sub-Saharan Africa, about EoL care. Study quality was assessed using a standard grading scale. Relevant data including findings and practice recommendations were extracted and compared in tabular format.ResultsOf the 407 articles initially identified, 51 were included in the qualitative synthesis. Nineteen came from South Africa and the majority (38) focused on HIV/AIDS. Nine dealt with multiple or unspecified conditions and four were about cancer. Study respondents included health professionals, informal carers, patients, community members and bereaved relatives. Informal carers were typically women, the elderly and children, providing total care in the home, and lacking support from professionals or the extended family. Twenty studies focused on home-based care, describing how programmes function in practice and what is needed to make them effective. Patients and carers were reported to prefer institutional care but this needs to be understood in context. Studies focusing on culture discussed good and bad death, culture-specific approaches to symptoms and illness, and the bereavement process.ConclusionsThe data support or complement the findings from quantitative research. The review prompts a reconsideration of the assumption that in Africa the extended family care for the sick, and that people prefer home-based care. The review identifies areas relevant for a research agenda on socio-cultural issues at the EoL in sub-Saharan Africa.

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Section: Resultsmentioning

confidence: 99%

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

et al. 2011

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“…Although the study was conducted in the United States, it highlights one of the most common barriers to end‐of‐life care in rural communities across the globe: physician availability. In many parts of the world, physician availability is severely limited because people are widely distributed across large geographic regions, and palliative care and hospice services, including written prescriptions for symptom management medications, must be initiated by a physician's order (Ens, Gwyther, Chochinov, Moses, Jackson, & Harding, 2008; Jagwe & Merriman, 2007).…”

Section: Nursing Implicationsmentioning

confidence: 99%

Factors That Influence the Presence of a Hospice in a Rural Community

Campbell

Merwin

Gao

2009

J of Nursing Scholarship

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Purpose The purpose of this study was to identify socioeconomic, physician-related, and rural-urban factors that may influence the presence of a Medicare-certified hospice in three rural-urban areas. Design This was secondary analysis of selected socioeconomic, physician-related, and rural-urban data from 3,140 counties using the 2005 Area Resource File, a county-level database. The county was the unit of analysis. Methods Descriptive statistics were calculated for selected socioeconomic, physician, and rural-urban variables for the data set of 3,140 counties. Logistic regression was used to identify variables that influenced the presence of a Medicare-certified hospice across three rural-urban areas. Findings As the rural-urban classification progressed from metropolitan (least rural) to rural-nonadjacent (most rural), the physician rate, racial-ethnic diversity, and number of counties with at least one Medicare-certified hospice decreased. However, in all three rural-urban areas only the physician rate was consistently significantly associated with the presence of a Medicare-certified hospice. Conclusions Given the increasing numbers of patients and families who will be facing end-of-life care issues across the globe, access to hospice care is a significant end-of-life outcome. The most rural communities are least likely to have a Medicare-certified hospice. The higher the physician rate, the more likely a county is to have a Medicare-certified hospice. The Medicare Hospice Benefit’s regulations requiring a physician’s certification of terminal illness may be creating a barrier to hospice care, especially in rural communities. In this study, racial-ethnic diversity decreased as the rural-urban classification progressed from metropolitan (least rural) to rural-adjacent to metro to rural-nonadjacent (the most rural). The availability of Medicare-certified hospices in the metro and rural nonadjacent counties was influenced by the minority composition of the county. More research is needed on how the interaction of rurality, race-ethnicity, and physician access may affect access to hospice in rural communities. Clinical Relevance Increasing numbers of patients and their families across the globe will be facing end-of-life care. One of the most common barriers to end-of-life care in rural communities all over the world is physician availability. People living in rural communities with few physicians may experience less access to the comprehensive services of hospice than people living in metropolitan communities and therefore not realize important end-of-life outcomes such as symptom management, improved quality of life, financial support, and bereavement support.

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Palliative and end of life care

Stroebel

Moynihan

2009

Information Knowledge Systems Management

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Health care provided in the final year of life is typically costly and often delivers unintended outcomes. High value can be defined for end of life care. High value clinical practices exist for end of life care and a common set of high value processes can be identified. The current system structure of healthcare delivery does not consistently support those high value processes. An improved organizational schema could foster sustained delivery of high value delivery operations. The healthcare ecosystem needs to evolve to provide appropriate incentives and support for an appropriately designed care system. Robert Stroebel, MD, is chair of the Division of Primary Care Internal Medicine at Mayo Clinic Rochester and an Assistant Professor of Medicine, Mayo Clinic College of Medicine. He has practiced Internal Medicine for the past 17 years with a career focus in practice redesign. Timothy J. Moynihan, MD, is education chair for the Department of Medical Oncology, Director of the Palliative Care program at Mayo Clinic Rochester, Associate Medical Director for Mayo Clinic Hospice, and an Associate Professor of Oncology, Mayo Clinic College of Medicine. He has practiced in Medical Oncology for 17 years with a focus on brain and breast cancer, symptom management, palliative and end of life care.

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Access to hospice care: multi-professional specialist perspectives in South Africa

Cited by 3 publications

References 21 publications

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

End of life care in sub-Saharan Africa: a systematic review of the qualitative literature

Factors That Influence the Presence of a Hospice in a Rural Community

Palliative and end of life care

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