Challenges in the provision of palliative care at resource-limited South African hospice settings : palliative and chronic care

Palliative care and pain management is one of the most important challenges faced by resource-limited settings in Africa. In South Africa, the need for palliative care has increased with the growing Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic. A quantitative and descriptive study was conducted at five resource-limited hospice settings for the purpose of investigating the provision of palliative care and pain management, from the perspectives and experience of patients, family carers and palliative care workers. The validated African Palliative Care Association African Palliative Outcome Scale (APCA African POS) was used in structured interviews with 50 patients and 41 family carers, to measure pain experienced and quality of care received. Structured interviews were also conducted with 12 palliative care workers to identify challenges experienced by the hospice in the provision of palliative care and effective pain management. When using the APCA African POS to measure pain, 82% of the patients suffered moderate to very severe pain indicating that pain management was neither adequate nor appropriate. Family carers being worried about the patient correlated with the level of pain experienced by patients. Key challenges to effective provision of palliative care included lack of access to appropriate analgesics, adequately trained health professionals in effective pain management and palliative care and limited human and physical resources. Recommendations offered to overcome these challenges are essential and require action by the management of these facilities.