Includes bibliographical references. / Terminal illness affects the family as a social group severely, impacting on all aspects of the family's functioning. The burdens and stressors experienced by families coping with terminal illness has been well described, and included physical, emotional and spiritual components. Recognising the interconnectedness of the patient and his/her family and friends, and facilitating the process of coping is the challenge and privilege of Palliative Care Teams. Family Conferences are an intervention with which to aid and facilitate the recovery of 'balance' within a family, by providing for their needs for information, support, good communication from and relationship with the Palliative Care Team.

Includes abstract. / Includes bibliographical references (leaves 62-68). / To determine the demographics and the physical, psychosocial and spiritual needs and expectations for the palliative care of a homeless community in an HIV Care Centre, located in the inner city of Johannesburg.

Includes bibliographical references (leaves 100-105). / Includes abstract. / The aim of the research was to determine changes in quality of life over the first six months of anti-retroviral therapy.

Includes bibliographical references. / This is an evaluation of the holistic care of Tuberculosis patients with palliative care needs in the Western Cape, South Africa.

Includes bibliographical references. / Do any validated dementia screening tools exist for use in palliative care populations in sub-Saharan Africa? Around the world populations have increased life expectancies. The tendency to develop dementia increases with age. By 2040, it is projected that more than 80 million people worldwide will suffer from dementia. Effective and validated dementia screening tools are used for screening and identifying people with dementia at an early stage, allowing for the possibility of earlier intervention. Validated tools are used internationally, but there is a need to determine if such tools have been validated for use in a sub-Saharan African palliative care population, which presents with the distinct challenges of literacy, language and culture. There is also a high incidence of HIV in sub-Saharan Africa, with a concomitant high prevalence of HIV-associated dementia. Sub-Saharan Africa therefore needs a unique, validated dementia screening tool for use in a palliative care population. Dementia causes a high burden of suffering for patients, their families, and communities. There is a similarity between many of the symptoms of cancer and dementia, although patients with dementia have a longer life expectancy. Palliative care is the cornerstone in the management of cancer patients and is therefore clearly ideal for people suffering from dementia. The World Health Organization, in their publication: "Palliative Care for Older People: Better Practices", state that people who suffer from dementia are in urgent need of improved palliative care services 2.2. Aim The aim of this systematic review was to identify validated dementia screening tools, and of those tools, to determine, specifically, whether they had been validated in a palliative care population in sub-Saharan Africa. This was done by following 3 objectives: Page 14 1. To identify which validated dementia screening tools are available. 2. To identify and isolate those tools which have been validated in sub-Saharan Africa. 3. To determine from those tools validated in sub-Saharan Africa, which have been validated in a palliative care population. To clarify, the aim of the study was to identify the validated tools, for dementia screening in sub-Saharan Africa, in a palliative care population. This study did not endeavor to conduct an in-depth analysis of the psychometric properties of the identified tools. 2.3. Methods The EBSCO, PUBMED, SCOPUS, Medline, Psych INFO, CINAHL and Africa-Wide Information databases were searched to identify dementia screening tools. The comprehensive search strategy focused on search terms in the categories of dementia, screening tools and subSaharan Africa. Included were all tools used to screen dementia in an adult population, provided the tools met one of the following validity criteria: face validity, or content validity, or concurrent validity as well as internal consistency. An abstract had to be available. The tool had to be peer reviewed, for use with human subjects, and in English. Exclusion criteria for the validated tools were: grey literature and the screening of children. 2.4. Results Stage 1 was to identify validated dementia screening tools internationally using the electronic databases listed above under methods. This search identified 116 articles written on global dementia screening tools. Stage 2 was performed on the same electronic databases to determine if any tools had been validated in sub-Saharan Africa. This search identified 8 articles on dementia screening tools validated in sub-Saharan Africa. The 3rd stage was to determine if any of the dementia screening tools from stage 2 had been validated in a palliative care population. In stage 3, 3 articles were identified all pertaining to the same dementia screening tool. The International HIV Dementia Scale (IHDS) was the only validated dementia r a g " I s screening tool found that had been validated in sub-Saharan Africa in an HIV population but not in a palliative care population. HIV can be seen as being included in a palliative care population. 2.5. Conclusion No validated tool was identified for the broad-based screening of dementia in sub-Saharan Africa in a palliative care population. The IHDS has been validated for use in screening for HIV-associated dementia in this region. This tool can still be used in the HIV population, but the author is of the opinion that the IHDS, as a screening tool for dementia, is not adequate in the general palliative care population. In the current clinical setting, the international gold standard tool for dementia screening, the Mini Mental State Examination (MMSE), is regularly used, and despite certain limitations associated with its use in the sub-Saharan Africa setting, the author recommends its continued use. The author recommends that the MMSE be revalidated for use in the sub-Saharan Africa palliative care population.

Includes bibliographical references (leaves 69-71). / To assess the need for spiritual care in a multicultural population of patients with life threatening illnesses in South Africa and to evaluate the usefulness of a spiritual assessment tool in introducing spiritual care into the consultation.

Bibliography: leaves 101-108. / The study was prompted by nursing concern at St Francis Hospice that, in HIV-positive patients, the use of opioids for symptom-control may shorten life, while I felt that pain was not recognized and therefore analgesia was withheld until the HIV-positive patients were close to their natural death. Objective: To compare pain control and sedation practices for terminally ill patients with HIV or cancer.

Background: With the introduction of 'highly active antiretroviral therapy' (HAART) HIV/AIDS has been transformed into a more manageable, chronic disease in our days. Despite the advent of effective antiretroviral therapy and its availability in many parts of the world, patients with HIV disease still present many palliative care challenges and problems. These patients continue to have a high burden of pain, other physical and psychological symptoms. The main role of palliative care is to minimize and prevent suffering and maximize physical function and quality of life in patients with serious illness such as HIV/AIDS. AIM: To explore the palliative care needs of adult HIV patients at Philp Moyo clinic Methods: This study utilized a quantitative cross sectional descriptive design which was carried out at Philp Moyo clinic, Ekurhuleni District, Gauteng province. Simple random sampling was used to recruit 162 adult participants. Data was collected using questionnaire by interviewers. Data was analyzed using STATA software version 13 and the analyzed data was presented by means of charts, graphs, and frequency tables. Results. Detail assessment of each symptom at a point of interview using ESAS (0=best and 10=worst) indicated mean score of physical pain was (7), physical symptoms (6), emotional problems such as depression (6) and Anxiety (5) were noted. The prevalence of pain symptoms was the highest (90.7%) followed by depression (87.04%) and anxiety (80.86%). In this study only 30% of respondents were prescribed pain medications for 80% of participants' pain was not treated appropriately. Conclusion: The study showed there is high prevalence of pain and other symptoms indicating a high symptom burden experienced by the participants highlighted the needs of palliative care for ambulant patient population already receiving HAART. It is crucial to understand that palliative care approach is so important to address physical and psychological symptoms experienced by HIV patients.

Includes bibliographical references (leaves 69-74). / The study combined both qualitative and quantitative methods and it involved eight HIV/AIDS adolescents who knew their HIV status. The adolescents were purposively sampled from a total of 87 adolescents who complained of pain during the period of four weeks. Eight subjects out of the 87 adolescents met the selection criteria and were therefore eligible for the study.

Includes bibliographical references (leaves 60-63). / An evaluation of the degree of involvement of family physicians in the care of patients with terminal illness was conducted. The outcome of this care was correlated with the degree of involvement. The background to the clinical situation, ethical issues and the context of the study in South Africa is explored, with special reference to the private practice milieu of medical practice.