Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-23T17:16:20.536Z Has data issue: false hasContentIssue false
  • English
  • Français

“We never speak about death.” Healthcare professionals' views on palliative care for inpatients in Tanzania: A qualitative study

Published online by Cambridge University Press:  22 August 2017

E. Grace Lewis ,
Lloyd L. Oates ,
Jane Rogathi ,
Ashanti Duinmaijer ,
Aisa Shayo ,
Simon Megiroo ,
Barthlomew Bakari ,
Felicity Dewhurst ,
Richard W. Walker  and
Matt Dewhurst
...Show all authors
E. Grace Lewis*
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
Lloyd L. Oates
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
Jane Rogathi
Affiliation:
Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, United Republic of Tanzania
Ashanti Duinmaijer
Affiliation:
Haydom Lutheran Hospital, Manyara, Mbulu, United Republic of Tanzania
Aisa Shayo
Affiliation:
Haydom Lutheran Hospital, Manyara, Mbulu, United Republic of Tanzania
Simon Megiroo
Affiliation:
Arusha Lutheran Medical Centre, Evangelical Lutheran Church in Tanzania, North Central Diocese in Arusha, United Republic of Tanzania
Barthlomew Bakari
Affiliation:
Nkoaranga Lutheran Hospital, Arusha, United Republic of Tanzania
Felicity Dewhurst
Affiliation:
Health Education North East, Newcastle Upon Tyne, United Kingdom
Richard W. Walker
Affiliation:
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
Matt Dewhurst
Affiliation:
North Tees and Hartlepool NHS Foundation Trust, North Tees and Hartlepool, United Kingdom
Sarah Urasa
Affiliation:
Haydom Lutheran Hospital, Manyara, Mbulu, United Republic of Tanzania
*
Address correspondence and reprint requests to: Grace Lewis, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, United Kingdom. E-mail: grace.lewis@ncl.ac.uk.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Little is known about the current views and practices of healthcare professionals (HCPs) in Sub-Saharan Africa (SSA) regarding delivery of hospital palliative care. The present qualitative study explored the views of nursing staff and medical professionals on providing palliative and end-of-life care (EoLC) to hospital inpatients in Tanzania.

Method:

Focus group discussions were conducted with a purposive sample of HCPs working on the medical and pediatric wards of the Kilimanjaro Christian Medical Centre, a tertiary referral hospital in northern Tanzania. Transcriptions were coded using a thematic approach.

Results:

In total, 32 healthcare workers were interviewed via 7 focus group discussions and 1 semistructured interview. Four major themes were identified. First, HCPs held strong views on what factors were important to enable individuals with a life-limiting diagnosis to live and die well. Arriving at a state of “acceptance” was the ultimate goal; however, they acknowledged that they often fell short of achieving this for inpatients. Thus, the second theme involved identifying the “barriers” to delivering palliative care in hospital. Another important factor identified was difficulty with complex communications, particularly “breaking bad news,” the third theme. Fourth, participants were divided about their personal preferences for “place of EoLC,” but all emphasized the benefits of the hospital setting so as to enable better symptom control.

Significance of results:

Despite the fact that all the HCPs interviewed were regularly involved in providing palliative and EoLC, they had received limited formal training in its provision, although they identified such training as a universal requirement. This training gap is likely to be present across much of SSA. Palliative care training, particularly in terms of communication skills, should be comprehensively integrated within undergraduate and postgraduate education. Research is needed to develop culturally appropriate curricula to equip HCPs to manage the complex communication challenges that occur in caring for a diverse inpatient group with palliative care needs.

Keywords

Palliative careInpatientSub-Saharan AfricaQualitativeHealthcare professionals
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 5 , October 2018 , pp. 566 - 579
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. Available from http://eprints.uwe.ac.uk/11735/2/thematic_analysis_revised_-_final.pdf.Google Scholar
Buckman, R. (1984). Breaking bad news: Why is it still so difficult? BMJ (Clinical Research Ed.), 288(6430), 1597–1599.Google Scholar
Campbell, L.M. & Amin, N.N. (2014). A qualitative study: Potential benefits and challenges of traditional healers in providing aspects of palliative care in rural South Africa. Rural and Remote Health, 14, 2378. Available from http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=2378.Google Scholar
Desrosiers, T., Cupido, C., Pitout, E., et al. (2014). A hospital-based palliative care service for patients with advanced organ failure in Sub-Saharan Africa reduces admissions and increases home death rates. Journal of Pain and Symptom Management, 47(4), 786–792.Google Scholar
Downing, J., Gomes, B., Gikaara, N., et al. (2014). Public preferences and priorities for end-of-life care in Kenya: A population-based street survey. BMC Palliative Care, 13(1), 4. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936799/.Google Scholar
Gade, C.B.N. (2011). The historical development of the written discourses on Ubuntu. South African Journal of Philosophy, 30(3), 303–329.Google Scholar
Ganca, L.L., Gwyther, L., Harding, R., et al. (2016). What are the communication skills and needs of doctors when communicating a poor prognosis to patients and their families? A qualitative study from South Africa. South African Medical Journal, 106(9), 940–944.Google Scholar
Gomes, B., Calanzani, N., Gysels, M., et al. (2013). Heterogeneity and changes in preferences for dying at home: A systematic review. BMC Palliative Care, 12, 7. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623898/.Google Scholar
Graham, N., Gwyther, L., Tiso, T., et al. (2013). Traditional healers' views of the required processes for a “good death” among Xhosa patients pre- and post-death. Journal of Pain and Symptom Management, 46(3), 386–394.Google Scholar
Harding, R. & Higginson, I.J. (2005). Palliative care in Sub-Saharan Africa. Lancet, 365(9475), 1971–1977.Google Scholar
Harding, R., Selman, L., Powell, R.A., et al. (2013). Research into palliative care in Sub-Saharan Africa. The Lancet. Oncology, 14(4), e183–e188.Google Scholar
Hartwig, K., Dean, M., Hartwig, K., et al. (2014). Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania. African Journal of Primary Health Care & Family Medicine, 6(1), E1–E8.Google Scholar
Higginson, I.J., Gomes, B., Calanzani, N., et al. (2014). Priorities for treatment, care and information if faced with serious illness: A comparative population-based survey in seven European countries. Palliative Medicine, 28(2), 101–110.Google Scholar
Hindley, G., Kissima, J., Oates, L.L., et al. (2016). The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age and Ageing, 46(1), 130–137.Google Scholar
Jacinto, A., Masembe, V., Tumwesigye, N.M., et al. (2015). The prevalence of life-limiting illness at a Ugandan National Referral Hospital: A 1-day census of all admitted patients. BMJ Supportive & Palliative Care, 5(2), 196–199.Google Scholar
Jang, J. & Lazenby, M. (2013). Current state of palliative and end-of-life care in home versus inpatient facilities and urban versus rural settings in Africa. Palliative & Supportive Care, 11(5), 425–442.Google Scholar
Kamwangamalu, N.M. (1999). Ubuntu in South Africa: A sociolinguistic perspective to a pan-African concept. Critical Arts, 13(2), 24–41.Google Scholar
Kikule, E. (2003). A good death in Uganda: Survey of needs for palliative care for terminally ill people in urban areas. BMJ (Clinical Research Ed.), 327(7408), 192–194.Google Scholar
Lowther, K., Selman, L., Simms, V., et al. (2015), Nurse-led palliative care for HIV-positive patients taking antiretroviral therapy in Kenya: A randomised controlled trial. The Lancet. HIV, 2(8), e328–e334.Google Scholar
Lynch, T., Connor, S. & Clark, D. (2013). Mapping levels of palliative care development: A global update. Journal of Pain and Symptom Management, 45(6), 1094–1106.Google Scholar
Mshana, G., Plummer, M.L., Wamoyi, J., et al. (2006). “She was bewitched and caught an illness similar to AIDS”: AIDS and sexually transmitted infection causation beliefs in rural northern Tanzania. Culture, Health & Sexuality, 8(1), 45–58.Google Scholar
Murray, S.A., Grant, E., Grant, A., et al. (2003). Dying from cancer in developed and developing countries: Lessons from two qualitative interview studies of patients and their carers. BMJ (Clinical Research Ed.), 326(7385), 368–371.Google Scholar
Nanney, E., Smith, S., Hartwig, K., et al. (2010). Scaling up palliative care services in rural Tanzania. Journal of Pain and Symptom Management, 40(1), 15–18.Google Scholar
Ntizimira, C.R., Ngizwenayo, S., Krakauer, E.L., et al. (2016). Addressing end-of-life care in cancer patients through “Ubuntu”: Lessons learned from Rwanda in global health perspective of humanity. Current Obstetrics and Gynecology Reports, 5(4), 273–278.Google Scholar
Rawlinson, F., Gwyther, L., Kiyange, F., et al. (2014). The current situation in education and training of health-care professionals across Africa to optimise the delivery of palliative care for cancer patients. Ecancermedicalscience, 8, 492. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303614/.Google Scholar
Selman, L., Higginson, I.J., Agupio, G., et al. (2009). Meeting information needs of patients with incurable progressive disease and their families in South Africa and Uganda: Multicentre qualitative study. BMJ (Clinical Research Ed.), 338, b1326. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273778/.Google Scholar
Selman, L.E., Higginson, I.J., Agupio, G., et al. (2011). Quality of life among patients receiving palliative care in South Africa and Uganda: A multi-centred study. Health and Quality of Life Outcomes, 9, 21. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3094195/.Google Scholar
Selman, L., Speck, P., Gysels, M., et al. (2013). “Peace” and “life worthwhile” as measures of spiritual well-being in African palliative care: A mixed-methods study. Health and Quality of Life Outcomes, 11, 94. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3687576/.Google Scholar
Selwyn, P.A. & Forstein, M. (2003). Overcoming the false dichotomy of curative vs. palliative care for late-stage HIV/AIDS: “Let me live the way I want to live, until I can't.” The Journal of the American Medical Association, 290(6), 806–814.Google Scholar
Sepulveda, C., Habiyambere, V., Amandua, J., et al. (2003). Quality care at the end of life in Africa. BMJ (Clinical Research Ed.), 327(7408), 209–213.Google Scholar
Stanford, J., Sandberg, D.M., Gwyther, L., et al. (2013). Conversations worth having: The perceived relevance of advance care planning among teachers, hospice staff, and pastors in Knysna, South Africa. Journal of Palliative Medicine, 16(7), 762–767.Google Scholar
Stangeland, T., Dhillion, S.S. & Reksten, H. (2008). Recognition and development of traditional medicine in Tanzania. Journal of Ethnopharmacology, 117(2), 290–299.Google Scholar
Uwimana, J. & Struthers, P. (2008). What is the preferred place of care at the end of life for HIV/AIDS patients in countries affected by civil war and genocide: The case of Rwanda? Progress in Palliative Care, 16(3), 129–134.Google Scholar
World Health Organization (2013). WHO Traditional Medicine Strategy, 2014–2023. Geneva: World Health Organization. Available from http://www.who.int/medicines/publications/traditional/trm_strategy14_23/en/.Google Scholar
Worldwide Hospice Palliative Care Alliance (2014). Universal Health Coverage and Palliative Care. London: Worldwide Hospice Palliative Care Alliance.Google Scholar
Supplementary material: File

Lewis et al supplementary material

Appendices 1-2

Download Lewis et al supplementary material(File)
File 20.9 KB