Exploring health care providers’ perceptions about home-based palliative care in terminally ill cancer patients

Abstract

Background According to the World Health Organization, palliative care is one of the main components of healthcare. As the incidence of cancer is increasing in the world, home-based palliative care can be beneficial for many patients. This study was designed to explore health care providers’ perceptions about home-based palliative care in terminally ill cancer patients. Methods This qualitative study was carried out using the conventional content analysis from October 2016 to September 2018 in Iran. Participants were home care providers who were selected using purposive sampling. The data were collected through 18 individual interviews, and a focus group meeting. Data were analyzed based on the method proposed by Lundman and Graneheim. Results from the data analysis, 511 initial codes were extracted, which were categorized into the two main categories of challenges and opportunities for home-based palliative care and 10 subcategories. The subcategories of challenges included deficiencies in inter-sectoral and inter-professional cooperation, lack of infrastructures for end-of-life care, challenges related to the management of death, challenges of transferring patients to home, providing non-academic palliative care, lack of political commitment of the government and Spiritual vacuum . The category of opportunities included subcategories of cost-effectiveness, moving towards socializing health, and structure of the health system. Conclusions Home-based palliative care requires government and health system support. Structural and process modification in the healthcare can provide conditions in which terminally ill cancer patients receive appropriate care in home and experience death with dignity through support of family, friends and healthcare.

An examination of home-based end-of-life care for cancer patients: a qualitative study

“…Some home-based palliative care programs in the United States have also encountered similar challenges [38]. Despite the good intentions behind the call to establish home-based end-of-life care, the government should also devise supportive policies and provide financial support to facilitate the delivery of such care and meet the needs of the patients and their families [39, 40].…”

Identifying Core Domains to Assess the “Quality of Death”: A Scoping Review

“…Sub-domain 1, priority-setting and strategic planning of EoLC system, highlights the importance of EoLC prioritization, including policymaking, resource allocation, and coordination, particularly on structural and institutional aspects. [60][61][62][63][64][65] This includes adoption and implementation of National Palliative Care Plans to address different facets of EoLC. 66 Sub-domain 2, laws, regulations, and standards, focuses on the regulatory framework, including laws, regulations, and rules establishing standards of EoLC around quality, safety, and efficacy.…”

“…34,84,89 Sub-domain 4, environment, pertains to the EoLC built environment. This includes factors related to physical environment (e.g., infrastructure related both in terms of equipment and to create a private, personalized, and comfortable space such as a single room with a window and less visible technology), 49,53,64,[103][104][105][106][107][108][109] organizational environment (e.g., healthcare setting and design characteristics that promote familiarity and openness), 69,76,110 and social environment (e.g., environmental facilitation of social interactions that allow closeness to others such as with regular caregiver visits, stimulating activities that are 'positive distractions', and activities of daily living including the practice of spirituality). 108,109,111,112 These resource elements account for the influence of environment on facilities functioning, including safety.…”

“…Financial assistance through cost-effective and targeted schemes can reduce the financial burden and distress on patients and families due to direct and indirect costs. 43,61,64,68,76,114,120,[130][131][132] Assistance to access financial resources was especially noted by studies focused on indigenous communities. 120,133…”

Home Based Palliative Care

“…i. One of the limitations is to convince the patients and their families to call the care team when they experience a health crisis, for which, the Home PAL team need to build trust and rapport with the patients and their families [20].…”