Document Type : Original Article
Authors
- . Mohammad Salimi Amroud
- . Pouran Raeissi
- . Seyed‑Masoud Hashemi 1
- . Nahid Reisi 2
- . Seyed‑Ahmad Ahmadi
1 Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pediatric Hematology and Oncology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Palliative care and terminal patients care centers have an important role in improving the physical
and psychological state of the patient and their families and increasing their satisfaction and care
providers. A literature search of online databases (PubMed, Scopus, Web of science, Cochrane
library, and Google Scholar) was searched from January 1, 2000, to the end of April 2019, by using
the appropriate English keywords. Furthermore, IranMedex, Barkat, and Magiran databases were
searched for the Persian articles. We used Standards for Reporting Qualitative Research checklist
to evaluate the articles quality. From 1328 articles, 166 were reviewed in depth with 13 satisfying
our inclusion criteria. The findings of this study revealed a wide range of barriers and challenges to
palliative care delivery. The identified barriers were: Cultural, social and organizational barriers, lack
of resources, equipment and financing, attitudes and cultures, barriers related to the patient and the
patient’s family, related barriers providers, time and money, education, communication challenges,
policies, insurance problems, safety, and crisis management. The results of the studies showed that
there are various barriers and challenges such as economic, cultural, social, organizational, and
communication related to palliative care. Given the identified barriers and challenges, it is suggested
that to improve the delivery of palliative care, the health system policy‑makers and planners consider
a resource‑appropriate and culturally appropriate framework for palliative care delivery.
Keywords
Acta Med Iran 2014;52:24‑8.
2. Pad B, Alavi K, Hajebi A. A randomized controlled trial of
telephone follow‑up in patients with severe mental illness: Study
protocol. Iran J Psychiatry Clin Psychol 2017;23:108‑17.
3. Hadian M, Raeissi P, Shali M, Khalilabad TH, Niknam N.
Investigating the effects of human health resource changes on
the basic health indicators in Iran: An econometric study. J Educ
Health Promot 2019;8:207.
4. Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP,
et al. The World report on ageing and health: A policy framework
for healthy ageing. Lancet 2016;387:2145‑54.
5. World Health Organization. Cancer Control: Knowledge Into
Action. WHO Guide for Effective Programmes. Palliative Care.
Cancer Control: Knowledge Into Action WHO Guide for Effective
Programmes Palliative Care. World Health Organization; 2019.
6. Meier DE. Increased access to palliative care and hospice services:
Opportunities to improve value in health care. Milbank Q
2011;89:343‑80.
7. Clark D. From margins to centre: A review of the history of
palliative care in cancer. Lancet Oncol 2007;8:430‑8.
8. Higginson IJ, Sen‑Gupta GJ. Place of care in advanced cancer:
A qualitative systematic literature review of patient preferences.
J Palliat Med 2000;3:287‑300.
9. Norton SA, Hogan LA, Holloway RG, Temkin‑Greener H,
Buckley MJ, Quill TE. Proactive palliative care in the medical
intensive care unit: Effects on length of stay for selected high‑risk
patients. Crit Care Med 2007;35:1530‑5.
10. Campbell ML. Palliative care consultation in the intensive care
unit. Crit Care Med 2006;34:S355‑8.
11. Busolo D, Woodgate R. Palliative care experiences of adult cancer
patients from ethnocultural groups: A qualitative systematic
review protocol. JBI Database System Rev Implement Rep
2015;13:99‑111.
12. Oishi A, Murtagh FE. The challenges of uncertainty and
interprofessional collaboration in palliative care for non‑cancer
patients in the community: A systematic review of views from
patients, carers and health‑care professionals. Palliat Med
2014;28:1081‑98.
13. Choy CH. International access to palliative care: The need to
improve. Ann Palliat Med 2017;6:S99‑101.
14. Silbermann M, Fink RM, Min SJ, Mancuso MP, Brant J, Hajjar R,
et al. Evaluating palliative care needs in Middle Eastern countries.
J Palliat Med 2015;18:18‑25.
15. Lynch T, Connor S, Clark D. Mapping levels of palliative
care development: A global update. J Pain Symptom Manage
2013;45:1094‑106.
16. Wasserman LS. Respectful death: A model for end‑of‑life care.
Clin J Oncol Nurs 2008;12:621‑6.
17. Finestone AJ, Inderwies G. Death and dying in the US: The barriers
to the benefits of palliative and hospice care. Clin Interv Aging
2008;3:595‑9.
18. Esmaili BE, Stewart KA, Masalu NA, Schroeder KM. Qualitative
analysis of palliative care for pediatric patients with cancer at
bugando medical center: An evaluation of barriers to providing
end‑of‑life care in a resource‑limited setting. J Glob Oncol
2018;4:1‑10.
19. Stajduhar KI, Mollison A, Giesbrecht M, McNeil R, Pauly B,
Reimer‑Kirkham S, et al. “Just too busy living in the moment
and surviving”: Barriers to accessing health care for structurally
vulnerable populations at end‑of‑life. BMC Palliat Care
2019;18:11.
20. Brooks LA, Manias E, Nicholson P. Barriers, enablers and
challenges to initiating end‑of‑life care in an Australian intensive
care unit context. Aust Crit Care 2017;30:161‑6.
21. Kilcullen M, Ireland S. Palliative care in the neonatal unit:
Neonatal nursing staff perceptions of facilitators and barriers in
a regional tertiary nursery. BMC Palliat Care 2017;16:32.
22. den Herder‑van der Eerden M, Ewert B, Hodiamont F, Hesse M,
HasselaarJ, Radbruch L. Towards accessible integrated palliative
care: Perspectives of leaders from seven European countries on
facilitators, barriers and recommendations for improvement.
J Integr Care (Brighton) 2017;25:222‑32.
23. Rhodes RL, Batchelor K, Lee SC, Halm EA. Barriers to end‑of‑life
care for African Americans from the providers’ perspective:
Opportunity for intervention development. Am J Hosp Palliat
Care 2015;32:137‑43.
24. Horlait M, Chambaere K, Pardon K, Deliens L, Van Belle S.
What are the barriers faced by medical oncologists in initiating
discussion of palliative care? A qualitative study in Flanders,
Belgium. Support Care Cancer 2016;24:3873‑81.
25. Azami‑AghdashS, GhojazadehM, AghaeiMH, Naghavi‑BehzadM,
Asgarlo Z. Perspective of patients, patients’ families, and
healthcare providers towards designing and delivering hospice
care services in a middle income Country. Indian J Palliat Care
2015;21:341‑8.
26. Keall R, Clayton JM, Butow P. How do Australian palliative care
nurses address existential and spiritual concerns? Facilitators,barriers and strategies. J Clin Nurs 2014;23:3197‑205.
27. Yoshida S, Shimizu K, Kobayashi M, Inoguchi H, Oshima Y,
Dotani C, et al. Barriers of healthcare providers against end‑of‑life
discussions with pediatric cancer patients. Jpn J Clin Oncol
2014;44:729‑35.
28. Johnson C, Girgis A, Paul C, Currow DC, Adams J, Aranda S.
Australian palliative care providers’ perceptions and experiences
of the barriers and facilitators to palliative care provision. Support
Care Cancer 2011;19:343‑51.
29. Gardiner C, Cobb M, Gott M, Ingleton C. Barriers to providing
palliative care for older people in acute hospitals. Age Ageing
2011;40:233‑8.
30. Turner J, Clavarino A, Yates P, Hargraves M, Connors V,
Hausmann S. Oncology nurses’ perceptions of their supportive
care for parents with advanced cancer: Challenges and
educational needs. Psychooncology 2007;16:149‑57.
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