Organizing palliative care in the rural areas of Iran: are family physician-based approaches suitable?

Abstract

IntroductionThe provision of palliative end-of-life care (P/EOLc) for patients, wherever they live, is an increasingly important service, particularly given the increasing rates of cancer and other life-threatening diseases in Iran. However, unfortunately, those living in the rural areas of Iran are greatly disadvantaged with respect to this type of care. Therefore, the present study explored the feasibility of organizing P/EOLc in the rural areas of Iran.MethodsIn this qualitative study, two focus group (FG) discussions were held in Tabriz (Iran) with rural family physicians (FPs, n=23) and key P/EOLc stakeholders (n=13). The FG sessions were recorded, transcribed, and the transcriptions checked by participants before the data were subjected to content analysis.ResultsWhile most FPs indicated that they did not have sufficient involvement in providing P/EOLc, they emphasized the necessity of providing P/EOLc through four main themes and 25 subthemes. The four main themes were labeled as “structures and procedures,” “health care provider teams,” “obstacles,” and “strategies or solutions.” Furthermore, according to the main themes and subthemes identified here, the key stakeholders believed that the Iranian health system and the FPs’ team have the potential to provide P/EOLc services in rural areas.ConclusionThe most feasible strategy for providing P/EOLc in Iranian rural areas would be to use the current health care framework and base the process around the FP.

Current state of palliative care in iran and related issues: A narrative review

“…The important components and findings of final included articles are presented in Table 2 . Results of the study showed that included studies had a focus on different patients/participants including cancer,[ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 ] hemodialysis,[ 45 ] heart failure,[ 46 47 ] chronic disease,[ 48 ] chronic pain,[ 49 ] and with anonymous groups. [ 50 51 52 53 54 55 ] Several provinces/cities were engaged in the studies including Tehran,[ 12 13 14 15 17 20 21 24 25 26 29 30 31 32 33 34 35 37 39 40 41 42 43 48 , 51 , 52 Isfahan,[ 22 27 28 …”

“…[ 23 ] Majority of studies had quantitative approach, including interventional,[ 17 18 19 22 23 29 31 33 35 44 47 49 54 ] descriptive,[ 20 39 41 42 50 53 ] and correlational-analytical. [ 37 45 46 51 ] This was then followed by qualitative[ 12 13 14 15 16 21 24 25 26 27 30 32 34 36 40 43 48 52 ] and mixed methods. [ 28 38 55 ] In quantitative interventional PC studies, a range of medical-surgical,[ 17 18 19 23 29 31 33 37 ] educational,[ 44 49 54 ] and psycho-spiritual[ 22 35 ] managements were used as an independent variable.…”

“…Qualitative research was also an important portion of palliative research recognized in this review either in the shape of a single study or in combination with a quantitative arm as a mixed-methods research. This indicates the growing interest of researchers particularly nurse's researchers to qualitatively explore palliative concept and related components,[ 12 14 24 25 52 ] current and future challenges,[ 13 16 34 36 48 ] or physio-psycho-spiritual/symptom palliation[ 32 40 43 ] in an Iranian context. Also, attempts were made to mine health care perceptions[ 15 30 ] and even empower them.…”

Psychometric Properties of the ‘Patients’ Perspective of the Quality of Palliative Care Scale’

“…Similar to the results of Dy et al, Guirimand et al and Vedel et al, 'availability of the caregivers' and 'serenity' were two important subscales of Quali-Palli-P and the essential components of palliative care quality. [47][48][49] Another subscale was 'providing cure and care information and the patient's involvement in decisions, ' which was emphasised in the studies conducted by Ansari et al, Khoshnazar et al and Jabbari et al [17,50,51] Moreover, Teno et al indicated that patient's participation in carerelated decision-making caused a higher quality of care. [43] Pain management, as well as proper prescribing and applying treatment and care techniques, is other important dimensions of palliative care.…”

“…and Jabbari et al . [ 17 , 50 , 51 ] Moreover, Teno et al . indicated that patient’s participation in care-related decision-making caused a higher quality of care.…”