Includes bibliographical references (leaves 34-35). / Cancer of the oesophagus,one of the most common cancers amongst the black population in South Africa with "cure" in this condition often considered as a "fortunate accident" by many experts in the field of oncology due to its late presentation and common occurrence of metastasis at presentation. The palliative care team focused their attention on measures to solve the cardinal symptom of this disease, which in most cases was dysphagia. This was also the main determinant of quality of life for these patients. Therefore, the primary objective of the study was to determine the effectiveness of the palliative measures in improving the cardinal symptom of oesophageal carcinoma - dysphagia. Accurate staging in most, if not all of the cancers is paramount, as it determines which options and sequences of treatment are appropriate. Oesophageal carcinoma is no exception. For patients stage III/IV, surgical resection of the tumour was attempted if possible. For advanced stage oesophageal carcinoma, that is stage III/IV, surgical resection with curative intent was not performed. The cardinal symptom of oesophageal carcinoma was then treated mainly with palliative radiotherapy, dilatation of the oesophagus with flexible bougie and oesophageal intubations.

This research study explores the need for palliative care by the patients who are recovering from stroke after an acute event. Stroke survivors need comprehensive care for their physical, psychosocial, spiritual well-being and additional support. The comprehensive total care in all aspect of physical, social and spiritual well-being can only be offered by the holistic approach of palliative care focusing, as it does, on the rehabilitation for stroke survivors to improve their quality of life. A literature review was conducted to investigate how palliative care can help to change the quality of life for stroke survivors. There has been little research on the topic of providing palliative care to stroke patients in South Africa. This research study explores the need and understanding of palliative care management for a stroke survival. The aim of the study is: "To investigate the Need for Palliative care in Cerebrovascular Accident (stroke) patients at Ladysmith Regional Hospital". The objectives of the study were: 1. To identify the holistic care needs of stroke patients. 2. To describe the care provided to stroke patients. 3. To identify the gaps in the care requirements of stroke patients. The study site was Ladysmith Regional Hospital, in UThukela District in Kwa-Zulu-Natal province, South Africa. This is a cross sectional study using mixed methods-both quantitative and qualitative-interviewing patients, and family members of patients who had suffered from a cerebrovascular accident.

Introduction: Palliative care is a core component of comprehensive health care across a person's life span. South Africa is currently in the process of integrating palliative care into all levels of the health care system. Doctors play a vital role in providing these services, but misconceptions about palliative care and who should be providing it, may prevent these services from being offered. Aim: The aim of this study was to discover doctor's perceptions and the current provision of palliative care in a private hospital. Objectives: The objectives of the study were: (1) to explore doctors' experiences of pain and symptom management in palliative care; (2) to explore doctors' perceptions of palliative care, goals of care and teamwork in palliative care; and (3) to explore the doctors' provision of palliative care at the hospital. Methodology: This was a qualitative study using a grounded theory approach. Semi-structured interviews were conducted with 14 participants, made up of doctors in oncology, physicians, surgeons, a cardiologist, an intensivist, a hematologist and a general practitioner. Interviews were recorded, transcribed and an inductive process was used for data analysis which allowed for categories to emerge from the data. Results: Eight themes emerged from the data analysis: improving the quality of life; palliative care as a role for oncologists; late referrals to palliative care, views on the World Health Organisation analgesic pain ladder; morphine a controversial means of pain control; team approach; family involvement and spiritual care. Conclusion: Palliative care was seen as an important intervention for a dying patient, but by introducing these services so late, patients are not benefitting from all that palliative care has to offer. Doctors did not always have a good understanding of when and how to provide palliative care. The following recommendations were made: (1) further research to be conducted in more private hospitals; (2)engage with management and doctors to begin the process of offering more formalised palliative care services at the hospital; (3) networking with available palliative care services, (4) organising palliative care training and workshops and (5) palliative care awareness campaigns.

Home based care is a major intervention in the management of HIV/AIDS and other illnesses in need of palliative care, especially in situations where resources are limited. The challenges associated with HIV/AIDS infection in Botswana resulted in the training of home based care volunteers (HBCV) to assist in the fight against HIV/AIDS. The HBCV regularly visit and assist ill patients at home. They provided support with home activities and basic health care. They are to note changes in their clients' condition, and, if necessary, report to the home based team at the clinics f or further action. The purpose of this study was to explore their knowledge, attitude, and perception in the identification, management, and referral of common symptoms of HIV/AIDS. METHODOLOGY: A cross sectional study of thirty three HBCV participants using a semi - structured interview guide was carried out. Closed and open ended questions were used to collect sociodemographic data and explore their knowledge, attitudes, and perception in relation to the identification, management, and referral of common symptoms of HIV /AIDS. A 5 point Likert scale was used to access their confidence with caring for different symptoms. The response to the open - minded ended question were coded and analysed qualitatively using thematic analysis. RESULTS AND CONCLUSION: Most of the participants were women. The study revealed that fatigue, weakness and pain were the symptoms most identified by HBCV. Other symptoms like diarrhoea were also identified with HBCV demonstrating satisfactory basic knowledge and management of these symptoms. They were aware of common symptoms of opportunistic diseases like tuberculosis and the need to refer such patients. Majority of HBCV were "comfortable" or "very comfortable" with their role of referring patients for symptom management. This study exposed the negative experiences of HBCV, which included stress, fatigue, helplessness, dealing with difficult families, fear of HIV infection, and death of clients. It also highlighted their positive experiences of community appreciation, financial reward, providing symptom relief, spiritual development, increased knowledge, and having a sense of "Botho" (humanness and community responsibility). This study showed the knowledge of the HBCV in relation to HIV/AIDS and associated symptoms. It also presented their attitude and perceptions with the management and referral of these symptoms.

Introduction. A life-threatening illness impacts profoundly not only the patient but also the family. As the spouse or partner is often the primary caregiver for patients with a life-threatening illness it especially affects the couple as a unit, rather than isolated individuals. The Aim of this study. To explore and describe and describe the experience of primary caregivers of patients at end of life receiving care from Hospice Bloemfontein. Objectives. 1. To obtain an in-depth description of the experience of primary caregivers of patients within hospice care. 2. To explore and describe primary caregivers' coping mechanism while providing care. 3. To explore and describe support structures and resources that assist the primary caregiver. Methods. A qualitative study was conducted through individual semi-structured interviews, to explore the experiences of primary caregivers taking care of their partners with a life-limiting disease in hospice care in Bloemfontein, Free State. Results. The findings of this study reflect on the complex experiences and emotional responses of primary caregivers taking care of their partners with a life-limiting disease in hospice care. It also reflects on the demands that are placed on those caregivers to meet all the different and multidimensional needs of their ill partners, which include the effect it has on them financially, physically, and personally. The study further reflects on their emotional reaction to the illness, their caregiving and the impending death of their partners in a context where they are often isolated. Certain factors added to and others relieved caregivers' distress. Although there were common themes, the reactions and experiences of all participants were unique and individual. As a consequence of these demands some of the caregivers in the study experienced exhaustion, physical complaints, isolation, sleeplessness, spiritual distress, and unmet needs. Conclusions. This study reflects on the importance of the role of caregivers as an active participant in providing care and comfort during the final stages of the illness of a patient, but also reinforces the critical need to provide the necessary and adequate support to those caregivers. A thorough assessment is necessary to respond holistically to the unique and individual needs, challenges, and concerns of families.

BACKGROUND: Palliative chemotherapy is cancer-directed therapy, which aims at stopping or slowing down the progression of the malignancy even though it may not have any potential for remission or cure. In South Africa, delayed diagnosis of childhood cancer is a common problem for a variety of reasons including lack of health care facilities, transport, information about the disease and delayed presentation due to traditional healer visits or other cultural issues. In patients who present with advanced cancer, or in patients with relapsed cancer without realistic hope of cure, palliative chemotherapy can be offered in an attempt to manage symptoms, improve quality of life and prolong meaningful survival. OBJECTIVES: This research study evaluated South African paediatric oncologists' perspectives and practices regarding the use of chemotherapy in patients with cancer with no realistic hope of cure. The second part of the study described the use of palliative chemotherapy in patients who received treatment at the Steve Biko Academic Hospital Paediatric oncology unit. DESIGN & METHOD: An online survey was conducted among paediatric oncologists in South Africa. The main aims of the questionnaire were to assess paediatric oncologists' considerations around the use of palliative chemotherapy, and then focus on the most recent patients treated with palliative chemotherapy. For the second part of the study, a file review was done of deceased patients who died in the period from January 2012 to December 2018 and who had received palliative chemotherapy as part of their cancer management. We reviewed diagnoses, palliative chemotherapy regimens, timing of initiation and stopping palliative chemotherapy, and whether end of life decisions and discussions were documented. RESULTS: A total of 41 participants completed the survey, giving a response rate of 89%. The majority of the paediatric oncologists were either neutral or agreed that palliative chemotherapy should be considered. The most important treatment aim was to improve quality of life of the patient (92.7% of respondents). The most important considerations when prescribing palliative chemotherapy was to minimise toxicity of the chemotherapy regimen (4.56 mean, SD=0.5 utilising a 5 point scale where 1=not important to 5=very important), and the effectiveness of the chemotherapy (4.37; SD=0.48). Only 19.5% of patients received treatment primarily because parents requested it. According to the oncologists polled, the key considerations were largely achieved in the most recent patient treated with palliative chemotherapy. Individual opinions and preferences concerning recommending palliative chemotherapy differ between paediatric oncologists. Of the 305 patient deaths recorded in the study period, a total of 74 patients had received palliative chemotherapy and were included in the file review. The most common diagnoses were neuroblastoma (18.2%), retinoblastoma (15.6%) and osteosarcoma (14.3%). At the time of diagnosis, the median age of the patients was 6.0 years (range 0.3 to 17.6 years). In 47 patients (63.5%) the disease was deemed incurable at first diagnosis and palliative chemotherapy given from the onset of treatment, while 27 patients (36.5%) were given palliative chemotherapy at relapse. The median time from last palliative chemotherapy to death was 30 days (range 0-742 days). The main documented aim of palliative chemotherapy was to improve symptom control (97.3%) while parents' opinion played an important role in 32.9% of cases. About half of the patients (41 of 74, 55.4%) had documentation of symptomatic improvement. CONCLUSION: Although the overall attitude towards the use of palliative chemotherapy is positive, there is great inter-individual variation between oncologists in opinions and experience. The lack of empirical data to justify recommendations about palliative chemotherapy remains a problem, and the researcher hopes that this study will spark productive discussion and planning towards more structured use of palliative chemotherapy in children with cancer in South Africa. This study shows that many decisions around end of life care and decision-making could be better researched using a quantitative, prospective, interview-based approach. Repeated measurements of the child and family's quality of life and its associations with palliative chemotherapy should be a research priority in future.

<p>Den palliativa vården innefattar inte bara patienten utan i många fall också de anhöriga. Syftet med studien var att undersöka anhörigas informationsbehov inom den palliativa vården. För att besvara syftet gjordes en litteraturstudie där vetenskapliga artiklar användes. Genom databas- och manuellsökning valdes elva kvalitativa och kvantitativa artiklar ut. En innehållsanalys av artiklarna gjordes utifrån en kvalitativ ansats. Resultatet visar att anhörigas informationsbehov främst består av medicinsk-, omvårdnads- och organisationsinformation. De två viktigaste fynden när det gäller upplevelser av information var att de individuella behoven måste bejakas och att källan till informationen ansågs viktig. Resultatet visar dessutom att god information minskar ovisshet och stress hos anhöriga. Genom att få sitt informationsbehov tillfredsställt skapas förutsättningar till mental förberedelse. Författarna kan utifrån studien se att god information kan kopplas samman med välbefinnande hos anhöriga i den palliativa vården.</p>

No description available.

<p><em>Bakgrund</em>: När en familjemedlem blir svårt sjuk har det en stor påverkan på hela familjen. Närstående har och känner ofta ångest, depression och maktlöshet. Familjemedlemmens sjukdom kan också leda till att rollerna i familjen ändras, och en förändring i den ekonomiska situvationen och en ökad påfrestning för familjen. <em>Syfte</em>: Syftet med studien var att belysa behov som närstående till patienter inom palliativ vård kan ha. <em>Metod</em>: En litteraturstudie genomfördes med sökningar i Pubmed och Cinahl. Innehållsanalys gjordes av de 11 inkluderade artiklarnas huvudresultat. Tydliga framträdande fenomen i texten kondenserades, kodades och katogoriserades i underkategorier och kategorier. <em>Resultat</em>: I studiens resultat framkom att närstående till patienter inom palliativ vård har ett stort behov av kommunikation, information och stöd. <em>Diskussion</em>: Att ha en fungerande kommunikation fanns var något som var viktigt för de närstående, då det gav dem en känsla av trygghet. Det var även viktigt att rätt infomation gavs till de närstående, att den gavs vid rätt tillfällen och att de närstående kunde förstå informationen.För att stödja närstående spelar vårdpersonal en viktig roll, då de kan bidra med uppmuntran och hopp i en svår situation.</p>

<p><strong>BAKGRUND: </strong>En konfrontation och möte med döden sker för de flesta genom ens egen eller en närståendes svåra sjukdom. Att vara anhörig till en svårt sjuk person är inte en enkel roll och för många anhöriga kan detta vara en ny och skrämmande situation. Samtidigt som den anhörige förväntas finnas där och stödja den sjuke, bär denne också på en egen sorg. <strong>SYFTE: </strong>Att belysa närståendes upplevelser vid vård i livets slutskede av en anhörig i hemmet. <strong>METOD: </strong>Litteraturstudie med 15 artiklar inkluderade, materialet analyserades med innehållsanalys. <strong>RESULTAT: </strong>Analysen mynnade ut i fem kategorier samt 21 subkategorier. Resultatet visade på att anhöriga upplevde en rad negativa känslor i samband med vårdandet av en svårt sjuk eller döende anhörig, men också positiva känslor som till exempel tillfredställelsen av att veta att ha gjort allt för den sjuke. Stöd var en viktig komponent i vårdandet av en anhörig, stödet kunde både komma från vårdpersonal, familj och vänner. <strong>DISKUSSION/SLUTSATS: </strong>Att se även den anhörige i vårdandet av en svårt sjuk i hemmet, borde vara av stor vikt för sjukvårdspersonal för att kunna lindra både den sjukes och dess anhörige lidande.</p>