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“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: [email protected].
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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 

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