Palliative Care and Social Practice

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Palliative Care and Social Practice

The influence of context on the implementation of integrated palliative care in an academic teaching hospital in South Africa

Abstract

Background: Palliative care has been integrated to a limited extent in the South African healthcare system. Contextual factors may be a pivotal influence in this integration. Objectives: This study aims to explore contextual factors that are possibly influencing the integration or lack thereof in an academic teaching hospital.

Design: A mixed-method study was conducted in a large academic teaching hospital in South Africa. Methods: The mixed methods were conducted in parallel and then merged. Findings were integrated to describe the contextual factors influencing palliative care integration, to develop a timeline of implementation and assess the probable influence of context on the integration process. The mixed-methods phases included a narrative review of published literature related to health systems, integration of health interventions and palliative care in teaching hospital settings; followed by interviews, documentary and routine data analyses. Semi-structured interviews with purposively sampled participants provided the qualitative data. Primary national, provincial and organizational documents expanded the contextual phenomena and corroborated findings. Routine hospital admission and mortality data was statistically analysed to expand further and corroborate findings. All qualitative data was thematically analysed using deductive coding, drawing from the aspects of the contextual dimensions of integration.

Results: Enabling contextual factors for local palliative care integration were global and local advocacy, demonstrated need, palliative care being a human right, as well as the personal experiences of hospital staff. Impeding factors were numerous misconceptions, palliative care not valued as a healthcare priority, as well as limitations in functional elements necessary for palliative care integration: national and regional political support, leadership at all levels and sustainable financing.

Conclusion: The normative and functional contextual aspects interplay at macro, meso and micro levels positively and negatively. How stakeholders understand and value palliative care directly and indirectly impacts on palliative care integration. Strategic interventions such as mandatory education are required to ensure palliative care integration. The health system is dynamic, and understanding the context in which the health system functions is core to the integration of palliative care. This may assist in developing integration strategies to address palliative care integration and the transferability of these strategies.

Plain language summary

Original Research

The interconnectedness of context

Brief background to the context of PC integration in a South African ATH

The PC context in an ATH in South Africa

Methodology

Macro environment

Micro

Results

PC integration in GSH in relation to provincial, national and global PC integration

The PC context at a meso level in South Africa

The PC context at a micro level in South Africa

Discussion

Policy

Financial resources

Current situation

PC education

The gap in clinical leadership for PC and accountability structures

Siloed approach a barrier to integration

PC diplomacy

Conclusion

Limitations

Declarations

Consent for publication

Author contributions

Competing interests

Availability of data and materials

Overview

The document explores how various contextual factors impact the integration of palliative care within a South African academic teaching hospital. It aims to identify both enabling and impeding factors affecting the implementation process and suggests strategic interventions for improvement.

Key Points

1Contextual factors significantly influence palliative care integration in South Africa
2Enabling factors include advocacy and personal experiences of staff
3Impeding factors consist of misconceptions and lack of political support
4The study emphasizes understanding the complexity of integration at multiple levels
5Strategic interventions such as mandatory education are recommended to improve integration efforts.

Details

Authors: Rene Krause, Liz Gwyther, Jill Olivier
Category: Health and Medicine

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