The disease trajectory that characterises dementia is one of progressive neuro-psychiatric, physical and cognitive decline. It is family members who often bear the brunt of the suffering that these sequential 'deaths' and losses bring. As they retain strong bonds, placement of loved ones in an institution is often seen as the ultimate act of betrayal resulting in ongoing guilt. How families perceive care given in these homes, the relationships they form with staff and the new roles they take depends on multiple variables. Although this has been the subject of some studies in the USA, UK and Europe, there is at yet no research on this phenomenon in South Africa and Africa as a whole. This study utilised Interpretative Phenomenological Analysis (IPA) to explore the experience of 10 family members of 8 patients with moderately severe to severe dementia in 5 different old age homes in Cape Town. IPA seeks to give a credible account of the interpretation of the person's experience, by using a deeper analysis whilst remaining firmly anchored in the participants account. The analysis and discussion of this study were conducted by the primary researcher and corroborated by an independent Social Worker experienced in psychoanalysis. The discussion was integrated with the literature review to enhance validity and place this research within the context of broader research on the subject. Analysis of emergent themes revealed that family members enter old age homes with a prior agenda shaped by their experiences prior to admission. Home placement is an extremely traumatic event and carries with it an ongoing heavy burden of guilt. The unwillingness or inability of medical professionals to provide information significantly increases that burden. Perceptions of how staff and administrators may think or function are often negative and distrustful and may well be misconceived. None the less they are believed to be true and heavily influence the integration of families into the home in either a positive or negative way. Old racial divides entrenched during Apartheid still hold sway and influence reactions towards and from nursing staff. Ultimately families still seek to play an active role in their loved ones lives and to seek purpose in their relationships.

Includes bibliographical references (leaves 62-63). / Effective management of pain especially in cancer patients depends on adequate physician knowledge in areas of pain assessment and the use of analgesia. Knowledge, attitudes, practices and beliefs could be a barrier amongst doctors in the management of cancer patients and these attributes were assessed in the greater Durban area by a questionnaire survey by email. 120 questionnaires were sent out bye-mail. 74 questionnaires were analysed giving a 62% response rate.

Background: Clinical and research experience indicates that a high HIV prevalence setting will have a high occurrence of conditions that are associated with HIV. These conditions are not always infectious in nature. General physiological pain, neuropathic pain (NeuP) and anxiety disorders are conditions that have a high prevalence in people living with HIV (PLWHIV). There is, however, a literature gap on the prevalence of these conditions in Nkomazi Sub-district in South Africa’s Mpumalanga Province. This study therefore aimed to serve as a baseline study for the determination of the prevalence of anxiety disorders and neuropathic pain amongst PLWHIV who attended Highly Active Antiretroviral Therapy (HAART) clinics in Nkomazi Sub-district. Aim of the study: To determine the prevalence of anxiety disorders among PLWHIV with neuropathic pain who attended HAART clinics in Nkomazi sub-district. Objectives of the study: 1) To determine the prevalence of Neuropathic Pain among patients attending HIV clinics in Nkomazi Health District; 2) To determine the prevalence of Anxiety disorders among PLWHIV experiencing neuropathic pain who attended HIV clinics in Nkomazi sub-district. 3) To determine the Types of Anxiety Disorder among Nkomazi PLWHIV with NeuP who have one, or more anxiety disorders. Methods: The objectives were achieved through a cross-sectional study using an interviewer administered questionnaire. Three out of 34 facilities were sampled for the study and participants were recruited and interviewed for a month in April 2013. A total of 508 participants were recruited. The questionnaire was adapted from the Structured Clinical Interview DSM IV Axis I Disorders (Clinicians’ Version) or SCID-CV and the DN4 interview tool for neuropathic pain. The questionnaire also sourced demographic data from all participants. Age is summarised using non-parametric statistics. Categorical variables are summarised using percentages and a bar graph. The Chi-squared and the Fisher’s exact tests are used to compare binary categorical variables. The Prevalence Ratio is the relative measure of association used. The p-value is set at ≤0.05 for statistical significance. The 95% confidence interval (95 =% CI) depicts the precision of estimates. Ethical and access approval were granted by the University of Cape Town Research Ethics Committee and the Mpumalanga Department of Health respectively. Results: Participants were recruited at kaMhlushwa clinic (n = 203 or 39.96%; 95% CI: 35.67 – 44.37), Naas clinic (n = 126 or 24.80%) and Mangweni clinic. There were more females (77.56%; 95% CI: 73.68 – 81.12; n = 394) than males (22.44%; 95% CI: 18.88 – 26.32; n = 114). Pain prevalence was 46.06%; 95% CI: 41.66 – 50.51 (n = 234). The prevalence of neuropathic pain was 17.72%; 95% CI: 14.49 – 21.32 (n = 90) and that of anxiety disorders among those participants with Neuropathic pain was 80%; 95% CI: 70.25 – 87.69 (n = 72). Conclusion: This study confirmed the high prevalence of a complex disease burden in a high HIV prevalent Primary Care setting. The community has high prevalence of pain, anxiety disorders and neuropathic pain amongst PLWHIV patients on HAART.

Includes bibliographical references. / The aims of this dissertation were: (a) To review the records of all patients 21 years and younger with cancer who were treated at a single institution (b) To examine the complications that occurred due to the VAD. (e) To measure the quality of life of those patients at serial intervals and to determine the financial cost of the VAD.

Background: The palliative care literature continually supports the view that home remains the preferred place of death of most patients with terminal illness. However, it also reports that in many countries, palliative care patients sometimes change their minds with regard to this preference. A variety of factors appears to intervene preventing patients from dying at home. The socio-demographics of patients presenting to St. Luke's Hospice, and how this relates to place of death, has never been evaluated. It is believed that in this setting, there is ironically more likelihood of many patients from poorer socio-economic circumstances dying at home. This could be as a result of living with larger families, more difficulty in obtaining access to institutional beds and cultural beliefs. Aim: To determine factors which influence the place of death of patients referred to St. Luke's Hospice over a one-year period. Method: This is a prospective, descriptive, quantitative study of the place of death of new patients referred to St Luke's Hospice, a palliative care service with an inpatient unit and home care programme, between 1 May 2001 and 30 April 2002. Only those patients who died within this time frame were analysed. A "teleform" was designed with the assistance of the Alberta Cancer Board Palliative Care Research Initiative. This form allowed the information to be entered directly into a database for analysis. The variables to be analysed with regard to place of death include: - • Age • Gender • Race • Social Structure • Category of Patient i.e. State or Private • Formal Educational Level • Duration of Illness • Palliative Performance Scale Result This study suggests that. almost two-thirds of patients with a terminal illness can be supported in their homes by a home care programme, without referral to an institution. These statistics correlate well with death statistics of other palliative home care services in industrialised countries. Variables such as age, gender, category of patient, palliative performance scale and duration of illness bore no significant relationship to place of death. However, place of death was strongly associated with race, social structure and socio-economic status. Interestingly, black patients were more likely to die in an institution. Conclusion: Studying socio-demographic factors related to place of death is only one aspect of evaluating and determining the needs of the terminally ill and their families in South Africa. Should or can more people die at home? Are home deaths feasible, and if so how? The task that lies ahead of us in South Africa is to decide what kind of palliative care or other service is optimal. cost effective and appropriate to meet the needs of our multi-cultural society.

Background For patients to have a dignified death, their wishes should be known and respected. The challenge is that, if conversations about death are avoided by patients, their families and health professionals because talking about death is taboo, it becomes hard to plan and implement preferred care for such patients. The researcher undertook an exploration of patients’ preferences and priorities for end-of-life care at Tiyanjane Clinic for palliative care, Queen Elizabeth Central Hospital, Blantyre, Malawi. The topic is regarded as sensitive and taboo in Malawi because discussing end-of-life care preferences and priorities is taken as prophesying death. Methodology This was a qualitative, descriptive study. Equal opportunity to participate in the study was provided to all adult patients diagnosed with life-threatening illnesses at the Clinic. Most participants were infected with the HIV virus. Data was collected by means of semi-structured interviews that were recorded and afterwards transcribed verbatim. A thematic framework was used to inform the systematic approach to data analysis. Results In December 2015 and January 2016, interviews were conducted with 14 adults (six men and eight women). The following 10 themes emerged from the data: Awareness of reason for being at Tiyanjane; reluctance to mention HIV; psychosocial concerns, expressed emotions; legacy; receiving information; decision-making; place of care; place of death; and spiritual concerns. Conclusion This research shows that, although choices are limited in Malawi due to a lack of resources, patients need to be given an opportunity to make their own healthcare choices. This research has shown that it is not as hard to start end-of-life care conversations as previously thought. Further research needs to explore whether advance directives or legal wills should be offered as part of care for palliative patients in Malawi, as most of the participants highlighted the need to be heard in regard to their wishes being upheld after death.

Objectives: This study was conducted to understand the dignity experience of patients with advanced disease from diverse socio-economic and cultural backgrounds in a South African context. In addition, the psychotherapeutic interventions, Dignity Therapy and Guided Imagery (focused on intrinsic dignity), were implemented to enhance the dignity experience of these patients and its impact explored. Method: This was a qualitative study where a semi-structured interview guide was used in the exploration of the understanding of the dignity experience of patients with advanced diseases, receiving home care from two hospices in the North of Durban, KwaZulu-Natal. Interviews were audiotaped and transcribed verbatim. Data was analysed using thematic analysis. Dignity Therapy and Guided Imagery were subsequently implemented with these patients. Dignity therapy is an appreciative enquiry into the lives of patients to allow them to discuss aspects of their life that matter most, and the legacy and words of advice they would want most remembered. The sessions are audiotaped, transcribed and edited to produce a legacy document that can be given to their family or loved ones, if they so wish. Guided Imagery was implemented to affirm a practical experience of patients' intrinsic dignity and worth as beings. A post intervention patient feedback questionnaire, which involved a quantitative and qualitative component, was used to explore the impact of these interventions on different aspects of psychosocial and existential distress. The qualitative feedback was analysed using content analysis to determine the themes and sub-themes of benefit derived from the bundled interventions. Results: Four major themes defined the dignity experience: physical concerns, psychological concerns and coping mechanisms, social concerns and spiritual concerns and coping mechanisms. These themes and the numerous sub-themes provide an understanding of the total dignity experience of South African patients living with advanced disease. This study provided quantitative and qualitative data illustrating the impact of Dignity Therapy and Guided imagery, which proved to enhance the dignity experience of patients with advanced disease. The beneficial impact of Dignity Therapy and Guided Imagery on the dignity experience of dying patients was documented with confirmations on measures of helpfulness (100%), satisfaction (100%), a heightened sense of dignity (75%), purpose (100%) and meaning in life (92%). Further endorsements were expressed in terms of 83% sharing that it had lessened their sense of suffering, and feelings of anxiety and depression (92%) and improved their will to live (83%). The participants also expressed that the beneficial impact of interventions would spread beyond themselves to help their families (92%) and to benefit their relationship with their healthcare providers (92%). The interventions were shown qualitatively to have a beneficial impact on the Physical, Psychological, Social and Spiritual Domains of the participants' lives and these emerged as the four themes with various sub-themes. Conclusion: With this awareness of the biopsychosocial and existential concerns and psycho-existential coping mechanisms that affect the total dignity experience, healthcare providers can optimise dignity conserving care to improve the quality of lives of patients living with advanced disease. In this small study, Dignity Therapy and Guided Imagery are shown to be relevant, feasible and acceptable, short psychotherapeutic interventions that can be conducted at the bedside by healthcare providers to enhance the dignity experience of patients. A Guided Imagery focused on intrinsic dignity is shown to be a novel beneficial 5-minute intervention that can augment Dignity Therapy, or be used on its own, to affirm and strengthen the experience of the intrinsic worth of patients with advanced disease. Healthcare professionals have an influence in the area of the extrinsic sources of dignity in advanced disease, and can enhance dignity in providing respectful compassionate care. To add to the knowledge on dignity research, this study specifically highlights the need to affirm intrinsic dignity in dying patients, to affirm their personal worth.

Includes bibliographical references (leaves 86-89). / Aim of study: to analyze the profile and management of patients admitted to the pilot paediatric unit in order to make recommendations for the further development of the unit.

Includes bibliographical references. / This study intended to identify the professional development needs of palliative care programme managers in hospices in Kenya, Malawi and South Africa. The findings reveal that palliative care programme managers have professional development needs related to their management function that include an on-going professional development programme, training in management functions and palliative care training for non-clinical managers and staff.

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.