A multi-professional patient-centred approach is needed to provide the necessary palliative care to people who suffer from life-threatening illnesses.
This is one of the major findings of a study by a group of researchers from Stellenbosch University (SU), Thames Valley and Wessex Leadership Academy in the United Kingdom, the Western Cape Department of Health and the Department of Palliative Care at Knysna Sedgefield Hospice. The study was published in the African Journal of Primary Health Care & Family Medicine recently.
“A multi-professional patient-centred approach and improved communication between different components of the health system provides a more seamless service that supports palliative patients when they need it most," says lead author Prof Louis Jenkins, Head of Family Medicine at George Hospital and also Associate Professor in the Division of Family Medicine and Primary Care in the Faculty of Medicine and Health Sciences at SU. He is also affiliated with the Division of Primary Health Care at the University of Cape Town.
Highlighting the importance of their study, which focused on palliative care in the Western Cape, Jenkins says, “caring for people with life-threatening illnesses is a key part of working in health care. Although we have a National Policy Framework and Strategy for Palliative Care 2017–2022, there is a need to integrate palliative care into existing public health care."
Pointing to statistics of the World Health Organisation, he says each year approximately 40 million people worldwide need palliative care, with only 14% receiving it. Of these, 78% live in low- or middle-income countries.
According Jenkins, the Western Cape has several metropolitan hospital-based palliative care services and in the Garden Route district, Knysna Sedgefield Hospice provides an exceptional service to patients. But apart from these, however, very little other comprehensive end-of-life care exists in the province, especially for people in rural areas, he adds.
“Most patients in rural areas who face problems associated with life-threatening illnesses don't have proper access to palliative care services that can improve their quality of life as well as that of their families."
Helping to address this shortcoming, Jenkins and his fellow researchers developed a palliative care model that has been shared with the rural districts and the chief director for rural health in the province.
Multi-professional palliative care
As part of the study, a multi-professional team consisting of a palliative care trained family medicine doctor, medical officer, physiotherapist, psychologist and social worker was formed to improve communication between George Regional Hospital and the sub-district.
“The fact that a multi-professional team listened and planned together at the patient's bedside has restored some of the dignity and ethos of patient-centred care, which is a core principle of the provincial Health Care 2030 vision.
“There's a greater appreciation for how the patient experiences the illness, allowing for patient autonomy, fostering respect and caring with competence and empathy.
“Establishing regular multi-professional palliative care ward rounds has changed the way patients needing palliative care are managed, particularly in challenging the mind-sets of specialist departments."
Jenkins says they developed a Palliative Care Plan as a standardised tool for the hospital and sub-district which is shared with patients and regularly updated.
“We also developed an electronic booklet of local community resources involved in the care of terminally ill people for staff and patients to refer to. For monitoring and evaluation of the ward rounds, we used a free, mobile web-based application that the team utilises to collect data in real time efficacy and efficiency during ward rounds.
“Referrals are made to the team from the hospital, clinics and community health workers who visit homes in the surrounding areas. The team keeps a database of palliative patients in the area, ensuring patients are not lost in the system and building a profile of local palliative care needs."
Jenkins says they've managed to build a palliative care service that could improve care for patients in rural areas, adding that their model has received widespread support, which is an acknowledgement of the need for high-quality palliative care.
“Our study has initiated a discussion on palliative care, challenging misconceptions and asking questions, which are ultimately benefitting patients.
“We hope that all palliative patients will have access to a holistic, high-quality assessment, including adequate pain control and symptom management."
Jenkins adds that their findings could be applicable to other parts of the country, with similar contexts, namely within the district health system.
- Source: O'Brien V, Jenkins LS, Munnings M, et al. Palliative care made visible: Developing a rural model for the Western Cape Province, South Africa. African Journal of Primary Health Care & Family Medicine. 2019:11(1), a2147. https://doi.org/10.4102/phcfm.v11i1.2147
FOR MEDIA ENQUIRIES ONLY
Prof Louis Jenkins
Family Medicine, George Hospital
Eden District, Department of Health
Western Cape Government
Tel: 044 802 4528
Tel: 021 808 4921