Thesis (MPH)--University of Limpopo, 2009. / Background: An understanding of the effectiveness of the hospital-based palliative care programme and the extent to which it changes the way patients are managed in the general medical wards is required, in order to develop evidence-based palliative care guidelines for Public Hospitals on the management of HIV/AIDS patients. Purpose: The study aimed to identify and describe the effectiveness of the Palliative Care programme on the management of HIV/AIDS patients at Chris Hani Baragwanath Hospital. The objectives of the study included to: • Determine the proportion of HIV positive patients admitted into Chris Hani Baragwanath general medical wards accessing services of a hospital-based palliative care team • Identify the care and support needs experienced by HIV positive patients • Compare the frequency of the met and unmet needs of HIV positive patients in those referred as opposed to those not referred to the hospital-based palliative care team Methods: Non-random quota sampling of 50 HIV positive patients confirmed by an ELISA test, and admitted with HIV related illnesses were selected from admission records of medical wards in Chris Hani Baragwanath Hospital. 8 (16%) of the patients were too ill to communicate, 12 (24%) declined the interview and 30 (60%) gave consent to be interviewed. The data was collected using researcher administered questionnaires, and captured on Microsoft Excel 2003. Descriptive statistics were analyzed using STATA 10. Participants were assessed for enrolment into the hospital-based palliative care programme, common palliative care needs experienced and the frequency of identification and provision of palliative care needs provided for patients in the medical wards with focus on physical symptoms, pain, psychosocial problems, integration of care and counselling needs. The group was further divided into those under a palliative care program and those not under palliative care, for further data analysis. Results: Findings revealed that very few patients (27%) with HIV&AIDS were accessing services of the hospital-based palliative care. Significant proportion (67%-77%) of HIV infected patients were experiencing physical symptoms, pain and psychosocial problems requiring palliative care interventions. Further findings revealed that for those participants who were not referred for the palliative care programme, symptoms and pain complaints were not effectively identified and treated by health personnel. Provision of psychosocial and spiritual support was inadequate and that the quality of life for HIV/AIDS patients was compromised due to lack of comprehensive and integrated holistic care. These components were found to be effectively addressed amongst the referred group. iv Conclusion and recommendations: Hospital-based palliative-care has limited effectiveness due to the small size of the team which is working against demands from increasing numbers of HIV positive patients. All health providers working in medical wards need to be trained in palliative care, to develop a capacity to integrate palliative care principles into the routine medical care of HIV/AIDS patients.

No description available.

Background: Palliative care means improving quality of life along a spectrum of illnesses including cancer. Cancer is one of the leading causes of death. Having the discussion of goals of care including palliative care is important to have with individuals who have advanced cancer. There were limited studies that identify the providers’ attitudes, subjective norms, and perceived behavioral control on discussion of goals of care including palliative care. Purpose/Aim: This Doctoral Project consisted of identifying factors (i.e., attitudes, behaviors and subjective norms) in discussion of goals of care with their terminal cancer patients in the outpatient oncology clinic. Multiple studies have demonstrated the lack of knowledge providers have about palliative care. Through this study, the attitudes, subjective norms, and behaviors of providers were evaluated regarding goals of care for palliative care. Methods: An investigator developed questionnaire with six-point Likert-type scaling was used to measure each dimension (attitudes, subjective norms, and perceived behavioral control) regarding discussion of goals regarding care. These questionnaires were sent electronically to the oncology providers at Arizona Center for Cancer Care in Phoenix, Arizona. The data were collected through Qualtrics. Outcomes: Six providers participated in the survey. Results on the Attitude subscale indicated that the providers regarded discussing goals of care including palliative as very important and beneficial to patients. In comparison to this subscale score, the results on the Subjective Norms and Perceived Behavioral Control subscales were somewhat lower, though still above the mean, indicating that providers regarded the norm and level of resources available for discussing goals of care as somewhat lacking in their work setting. Further research is needed in this area of inquiry, including a quality improvement project to promote quality care in discussing goals of care including palliative care with patients who are diagnosed with advanced cancer.

Aim: The study describes the population (and care needs) of children admitted to the facility, the experiences of their primary caregivers and the health care workers caring for them. Methodology: This was a descriptive study that utilised elements of both prospective and crosssectional design. The health records of 25 patients were reviewed and matched caregivers partook in a three-part questionnaire. Focus group discussions were conducted with 15 health care workers at a single point during the study. Results: The majority (48%) of patients were referred to the facility for transitional care, the average length of stay was calculated at 97 days and pain was identified as the most prevalent symptom. Despite significant degrees of worry, most primary caregivers derived emotional strength and spiritual meaning from the experience of caring for their child. Health care workers valued access to training, appropriate resources, and support to meet the challenge of caring for children and families with specific care needs. Conclusion/Recommendations: These results conclude that children living with LL or LTC's and their families have complex holistic care needs that require a comprehensive approach. In order to best meet these needs, at ICF level, health care workers need to be assured access to a range of skills, resources and support.

No / Sheila Payne and colleagues examine the differences and similarities in end-of-life care provided in different countries which, while broadly based on the same models, varies according to resources, cultural attitudes and public health policies This article introduces palliative care and palliative care nursing. It goes on to consider models of palliative care delivery and provide a more detailed account of the three elements of palliative care nursing–working directly with patients and families, working with other health and social care professionals to network and co-ordinate services, and working at an organisational level to plan, develop and manage service provision in local, regional and national settings. It concludes by detailing the challenges for palliative care nursing and outlines a possible way ahead.

Purpose: Examine outpatient providers' perceptions of palliative care education in increasing their understanding, knowledge of resources, and intent to refer. Research questions/goals: 1) Increase provider understanding about palliative care and the benefits that patients can receive as a result of early referral; 2) Increase provider knowledge of palliative care facilities and resources within VHSO; 3) Increase provider intent to use the referral process for patients in need of palliative care. Setting: Veterans Healthcare System of the Ozarks, Fayetteville, Arkansas. Participants: 14 outpatient providers within VHSO; 8 MDs, 4 NPs, and 2 PAs. Methods: Descriptive research study consisting of an education session, discussion, and completion of a demographics form and evaluation questionnaire. Results: Questionnaire scores: Goal 1) 4.9 (SD=1.27)/6; Goal 2) 5.07 (SD=1.1)/6; Goal 3) 5.1 (SD=1.1)/6. Open ended question themes: 1) 21.4%: palliative care was an "umbrella"; 35.7%: early referral improves outcomes; 21.4%: treatment plan can include curative therapies; 2) 28.6%: open group discussion; 14.3%: training opportunities; 21.4%: multidisciplinary team approach. 3) 35.7%: screenshots of the referral process; 14.3%: individual comments for the care plan; 21.4%: open discussion regarding referrals. 4) 14.3%: more about how to accommodate homebound Veterans; 28.6%: more about telehealth opportunities; 21.4%: more information on communication tactics. Conclusions: There is a knowledge deficit among outpatient care providers in regards to palliative care. The providers found this education session informative, beneficial, and increased their intent to initiate palliative care referrals.

This population-based, retrospective descriptive analysis was conducted to study a cohort of decedents who died between January 2004 and December 2005 who were referred to the Regina QuAppelle Palliative Care Services (RQPCS). Demographics, diagnostic information and palliative service utilization were collected and analyzed. <p>The first step of the analysis included interviewing the program director and clinical consultant of the RQPCS. They provided the program vision and philosophy of the RQPCS as well as a comprehensive description of the program, including descriptions of the services offered and the staff of the palliative care team.<p>The second step of the research described in detail the demographics, palliative care service use and diagnostic background of the patients of the RQPCS. The variables of interest were age, gender, marital status, living arrangements, area of residence and diagnosis. Analysis also included determining which services the decedents accessed and how many of the services were used by each decedent. Timing of referrals and location of death were also analyzed. Frequencies and percentages were used to describe categorical variables. Means, median and range were used for continuous variables. <p>The third step of this thesis tested for associations between patient attributes and palliative care services utilization, timing of referral and location of death using chi-square analyses. <p>This research determined each of the patient characteristics under investigation to be associated with palliative care utilization. Similar findings were also evident in the literature. In particular, age, marital status, living arrangements, area of residence and diagnosis appeared to be significantly associated with accessing palliative care services. <p>When analyzing the associations between patient attributes and timing of referrals for the RQPCS, no significant results were found. Previous research indicated strong associations between marital status and diagnosis on the timing of referrals into hospice and palliative care programs.<p>Finally, there were two significant associations found between location of death and patient characteristics (gender and living arrangements). However, no clear conclusion could be reached on whether age, gender, marital status, living arrangement, area of residence or diagnosis had any effect on place of death in previous literature.

This population-based, retrospective descriptive analysis was conducted to study a cohort of decedents who died between January 2004 and December 2005 who were referred to the Regina QuAppelle Palliative Care Services (RQPCS). Demographics, diagnostic information and palliative service utilization were collected and analyzed. <p>The first step of the analysis included interviewing the program director and clinical consultant of the RQPCS. They provided the program vision and philosophy of the RQPCS as well as a comprehensive description of the program, including descriptions of the services offered and the staff of the palliative care team.<p>The second step of the research described in detail the demographics, palliative care service use and diagnostic background of the patients of the RQPCS. The variables of interest were age, gender, marital status, living arrangements, area of residence and diagnosis. Analysis also included determining which services the decedents accessed and how many of the services were used by each decedent. Timing of referrals and location of death were also analyzed. Frequencies and percentages were used to describe categorical variables. Means, median and range were used for continuous variables. <p>The third step of this thesis tested for associations between patient attributes and palliative care services utilization, timing of referral and location of death using chi-square analyses. <p>This research determined each of the patient characteristics under investigation to be associated with palliative care utilization. Similar findings were also evident in the literature. In particular, age, marital status, living arrangements, area of residence and diagnosis appeared to be significantly associated with accessing palliative care services. <p>When analyzing the associations between patient attributes and timing of referrals for the RQPCS, no significant results were found. Previous research indicated strong associations between marital status and diagnosis on the timing of referrals into hospice and palliative care programs.<p>Finally, there were two significant associations found between location of death and patient characteristics (gender and living arrangements). However, no clear conclusion could be reached on whether age, gender, marital status, living arrangement, area of residence or diagnosis had any effect on place of death in previous literature.

This dissertation explores the question “how does a person who is a cancer patient finds their way to being a dying person?” Through the lens of modernism (Giddens), discourse analysis (Foucault), and philosophical hermeneutics (Gadamer) the author examines how the institution of cancer control is constituted, and how the cancer patient is co-constructed by this system and people entering into it as people needing cancer treatment. Language is explored to uncover meanings and discourses which help shape this experience and self-narrative of the cancer patients who face leaving the cancer control system and do or do not find their way to palliative care systems. From this perspective the more solitary and less shaped experience of ‘unbecoming a cancer patient’ is explored for those cancer patients whose treatment has failed. The liminal space between the expert systems of cancer control and palliative care is what is revealed and problematized. What is explored is what this liminal space between these two systems is, and how people who find or lose themselves in this space at this time might be met, without succumbing to the modernist temptation to create yet another expert system to manage what is explored. What is at stake for people at this time is their own self-narrative going on, and it was found for some people in a liminal space this self-narrative faltered. It is revealed that nurses are best positioned epistemologically to support people at this time, and the question of where this support ought to happen is explored in terms of the ideological fit within current health system alignments. This work adds an important theoretical rendering of the term liminality and has important implications for person centred nursing care and health system redesign. / Graduate

Magister Scientiae (Physiotherapy) - MSc(Physio) / Palliative care is a vague and often confusing term used to describe a type of treatment model for chronic and life-threatening illnesses. WHO describes palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness by: early identification, impeccable assessment, and treatment of pain, physical, psychosocial and spiritual. The aim of this study is to explore the perceptions of physiotherapists on palliative care in order to contribute to the understanding of the role of physiotherapists to the care of stroke patient in Zambia. The objectives of this study are to explore physiotherapists’ knowledge on palliative care, their perceptions on management of palliative care as well as explore its application in the rehabilitation of stroke patients; and lastly to make recommendations on guidelines based on the outcomes of this study. Method: an exploratory study, using qualitative design was used. Data collection techniques were in-depth individual interviews and FGDs that consisted of purposively sampling of physiotherapists working; at four selected hospitals and a rehabilitation centre in Lusaka. Audio recording from the interviews was transcribed verbatim for each session by an independent person. The study employed thematic content analysis for data analysis. The data was classified systematically by means of coding to identify key factors or issues such as concepts, categories, themes and the relationship between them. Results indicated that all participants in the current study perceived palliative care as a medical care for the chronic and terminal ill patient in whom stroke patient and family will benefit if it is applied in the early stages of the disease trajectory; as well as it does improve the patient and family quality of life. Furthermore they emphasized on multidisciplinary team and holistic approaches in order to achieve all its tenets. Conclusion: the study had succeeded in exploring the physiotherapists’ perceptions on palliative care and contributed to the understanding of the role of physiotherapy to the care of stroke patients in general.