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.

Includes bibliographical references. / As palliative medicine is an area only beginning to develop as a speciality in South Africa, it was felt that an investigation into the situation with regard to dying patients in our own private sector hospitals was needed. The objectives were to ascertain whether patient and family needs are met as a means of an index of quality of care and to identify domains of care where improvement is needed most. The validated 'After death Bereaved Family Member interview' from the questionnaire for hospital purposes, as part of the Toolkit of instruments to Measure End-of-life Care (T.l.M.E.), was used as research instrument with the permission of the author Dr JM Teno. Domains that were investigated include the following: physical comfort and emotional support of the patient; focused attention on the individual patient; encouragement of advanced care planning; information and promotion of shared decision-making re care plan; provision of coordinated care of health professions; emotional and spiritual support of the family; and an overall rating for patient focused, family centred care. As a descriptive study with limited numbers this study cannot make any conclusive claims with regard to the care that all terminal patients receive in private hospitals in Port Elizabeth. Results indicate that the single domain with most opportunity to improve for both the oncology group and the general group is attention to the family. The model of patient-focused family-centred care, which is applicable to palliative care, makes this an urgent opportunity for improvement in the care of the dying patients in private hospitals. Control of pain and other symptoms remains an important medical and ethical issue, indicated in this research as needing attention. Information and promotion of shared decision-making is the other domain that warrants attention.

Includes bibliographical references / Aim: Evidence shows high burden of psychosocial problems among orphaned children with HIV. Intervention studies have generally been conducted in developed countries. This mixed methods study aimed to determine whether Memory Work (MWT) Therapy 1 week group intervention improves outcomes for this complex population, in terms of their self-esteem, coping and psychological wellbeing compared to standard care, and to establish mechanisms of action. Method/Issue: An RCT Phase II of 48 Adolescents aged 14-18, full-orphaned AIDS on ART in Tanzania, with a waitlist control. Following (T0) baseline interviews, random allocation was for either intervention experimental condition (EC), or Control Condition (CC). All participated in second round of data collection (T1) at two weeks, and a final (T2) a month later. The EC children and caregivers participated in a focus group at T2. The CC then received the intervention 4 months later. Four questionnaires used, Brief Symptom Inventory (BSI), Rosenberg Self Esteem Scale (SES), Strengths and Difficulties Questionnaire (SDQ), and Self Efficacy Questionnaire (SEQ). Groups were compared at each time-point using multivariable linear regression controlling for baseline characteristics and group as independent variable, with change score as dependent variable. Qualitative data were subjected to thematic analysis to describe the experience of the intervention and how to refine it. Results/Comments: Significant differences favoured the EC at T1: BSI P<0.001, B=44.985, CI=25.5, 64.4), SDQ P=0.010, B=4.811, % CI 1.226, 8.396), SEQ both social scale P=0.015, B=-4.539, % CI-8.161,-0.918) and emotional scale P=0.002, B=-5.803 % CI-9.434, 2.171) (no effect for SES). At T2 we found these effects persisted: BSI P=0.001, B=46.668 %CI=21.541, 71.835), SDQ P=0.002, B=5.218 % CI 1.960, 8.476), SEQ both social scale P=<0.001, B=-7.791, % CI-11.320,-4.262) and emotional scale (P=<0.001, B=-9.007, % CI-12.032,-5.983). Additionally, at T2 found an EC effect for SES P<0.001, B=-4.392, %CI=-6.738,-2.046). The children recalled and described enjoying specific tasks within the intervention memory book, (such as "hero book" and the "tree of life") and described becoming "resilient" people. Discussion: The trial demonstrates improved outcomes in all measures for a complex population, i.e., bereaved children on treatment. Importantly, the effect did not attenuate and indeed self-esteem improved over time. The intervention should now be replicated in a fully powered trial.

Background: This study investigated the factors that influence family caregivers of patients receiving palliative care from Island Hospice to seek help at emergency unit. The study was conducted at Island Hospice Service in Harare, Zimbabwe where Palliative care has been practiced in Zimbabwe since 1979 mainly using the home-based care model where patients are cared for by family caregivers with the support of the palliative care teams. Aim:To explore and understand issues that influence family caregivers at Island Hospice to seek help at emergency units for patients who are terminally ill. Method: This was a phenomenological study using semi-structured qualitative interviews with fifteen adult family caregivers who were the main carers of Island Hospice patients who presented at the emergency unit during the January to September 2015 period. Data were collected in Shona language using semi structured digitally recorded interviews. Data analysis through identifying themes that emerged from the transcripts. Results: Family caregivers reported the need for availability of palliative care medicine and other resources in the home setting. The family caregivers reported the need to be given information regarding the patient's diagnosis and prognosis as that would prepare them emotionally. They described challenges as pressure from relatives, witchcraft issues as well as lack of practical skills in providing care. Conclusion Considering the lack of resources and support the respondents do not support the idea of home deaths, they would rather send patients to the emergency rooms. A more organized end of life care and support for family caregivers and patients could be instituted by the hospice organization.

Includes bibliographical references. / This study was initiated as part of a quality improvement project on pain management at Polokwane/Mankweng Hospital Complex (PMHC). This is the first part of the project, which involved a baseline study to assess the knowledge, attitude and practice of doctors working in the two hospitals in managing pain in HIV/AIDS patients. Admissions due to the AIDS epidemic have continued to rise over the years, with a quarter of admission in medical wards being attributed to AIDS related diseases1. The survey was conducted at Polokwane/Mankweng Hospital Complex. One hundred and twenty questionnaires were distributed, and 52% of the doctors returned the completed questionnaires. The objectives of the study were as follows: 1. To determine the level of knowledge of doctors in PMHC about pain in AIDS patients. 2. To determine the attitudes of doctors in PMHC regarding pain management in AIDS patients. 3. To determine their practice regarding prescribing analgesics for pain in AIDS patients. 4. To determine whether the level of knowledge and their attitudes affect their prescribing practice. The level of knowledge of doctors at PMHC is low compared to previous studies 2,3,4 with a mean of 46.92%. The level of knowledge for Oncologists is not better than other specialties. The oncologists do however have better knowledge of the WHO pain ladder compared to other specialties. The doctors (56.9%) are not familiar with the WHO pain ladder, which has been in existence for over 20 years. The doctors are aware that pain management is major problem (69.2%), and that one has to aim for complete pain relief (83.1%). Community Service doctors have been found to have the lowest mean score for level of knowledge (33.92%, SD=9.44) and level of attitude (52.39%, SD=17.81). Interns on the other hand had the highest mean score for the level of attitude (80.55%, SD=19.47) and knowledge (58.33; SD=17.07). 7 Most doctors still believe that the likelihood of patients developing addiction to morphine when given for chronic pain is moderate to high (67.7%). The demographic variables had no influence on the level of knowledge, level of attitude and the practice pattern. There was a positive correlation in the level of knowledge and the level of attitude (p=0.014), as well as the practice pattern (p=0.001), which is different from what other studies obtained. The level of attitude also correlated with practice pattern (p=0.0004). Although the study has limitations, important and interesting findings have come to the fore, and have to be acted upon. Management of chronic pain and palliative care has not been part of medical training in South Africa until recently, and is still a small part of the curriculum, if at all. The need for training of doctors in pain management and palliative is evident. The Limpopo Provincial Government and PMHC have to develop a strategy on how to address the identified gaps in the knowledge, attitude and practices of doctors.

Background: Optimal pain relief in a healthcare setting relies heavily on actual pain management practices rather than just on the healthcare practitioner’s knowledge of this. Understanding parents' perceptions of pain management practices are very important in identifying areas of concerns and in developing plans and strategies for improvement. Although research has examined these practices in various public healthcare settings, no research has been carried out within the private sector. Aims/Objectives: This study aims to evaluate pain management practices of paediatric healthcare providers and parental perception of these practices within a private hospital in London. Its main objectives to evaluate paediatrics health care providers’ pain management practices against the recommended standard within the UK. Methods: Using a Mixed method study design, 10 healthcare providers were observed and data was collected on pain management of 10 children over a period of 10 months (14 shifts). Interviews were also conducted with the corresponding 10 parents/caregivers of children involved in the study. Results: The median age of child participant and health care providers were 3 and 32years respectively. Greater than half of the parent participants were Arabic while there was a fairly equal representation of white, Asian and black racial distribution among the health care providers. Although all healthcare provider could speak English, almost half of them could speak other languages, while greater than half of parent participant speaks Arabic. Pain assessment is routinely documented when the vital signs are checked, but recorded score may not correlate with the actual pain score of the child. This is due to lack of consistency and appropriate use of a validated pain tool for age. A potential lack of knowledge on how to utilise the various assessment tools may also contribute. Most parents were satisfied with the pain management of their child. They did indicate, however, the need to improve healthcare providers’ competencies and knowledge in the use of pain relieving devices as well as in the provision of supportive information for parents. Conclusion: Overall, pain management practices in Harley Street were found to be satisfactory. Parental satisfaction with care provided could be attributed to the team approach utilised by healthcare providers in pain management. It is recommended that Harley Street Clinic needs to implement a paediatric specific pain management guidelines with regular auditing of pain management practices in the hospital. A review of pain management information given to parents of cardiac patients, as well as the provision of pain management information brochure in relevant languages may help improve care.