Khoshnazar Tahereh Alsadat Khoubbin, Rassouli Maryam, Akbari Mohammad Esmaeil, Lotfi-Kashani Farah, Momenzadeh Syrus, Haghighat Shahpar, Sajjadi Moosa
Department of Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Indian J Palliat Care. 2016 Oct-Dec;22(4):459-466. doi: 10.4103/0973-1075.191828.
To establish a palliative care system (PCS) in Iran, it is necessary to identify the potential barriers.
This study aims to highlight the views of stakeholders to know the challenges of providing palliative care for women with breast cancer.
Semi-structured in-depth interviews are used with purposeful sampling conducted in Tehran, Iran; from January to June 2015. Twenty participants were included in the study: nine patients with breast cancer and ten health-care providers. The interviews were analyzed using qualitative directed content analysis based on Donabedian model. Data credibility was examined using the criteria of Lincoln and Guba.
Based on the pattern of Avedis Donabedian model, two main categories were identified: (1) palliative care services in the health system still remain undefined and (2) lack of adequate care providers. The subcategories emerged from the main categories are: (1) Inexistent home care, (2) specialized palliative care being in high demand, lack of: (a) Rehabilitation program and guidelines, (b) treatment/training protocols, (c) inefficient insurance and out-of-pocket costs, (d) patient referral system, (e) nontransparency of job description, and (f) weakness of teamwork.
The findings of the study identify views and perceptions of patients as well as the health professionals around the challenges of providing palliative care. To establish a structured PCS, we need to meet the challenges and remove perceived barriers to, including but not limited to, building up knowledge and awareness of health professionals, educating professional, and developing updated, well-defined, and standard treatment protocols, tailored to local conditions.
要在伊朗建立姑息治疗体系（PCS），有必要识别潜在障碍。
本研究旨在突出利益相关者的观点，以了解为乳腺癌女性提供姑息治疗的挑战。
2015年1月至6月在伊朗德黑兰进行了半结构化深度访谈，并采用了目的抽样法。该研究纳入了20名参与者：9名乳腺癌患者和10名医疗服务提供者。访谈采用基于多纳贝迪安模型的定性定向内容分析法进行分析。数据可信度依据林肯和古巴的标准进行检验。
基于阿维迪斯·多纳贝迪安模型的模式，确定了两个主要类别：（1）卫生系统中的姑息治疗服务仍未明确界定；（2）缺乏足够的护理提供者。从主要类别中衍生出的子类别包括：（1）家庭护理不存在；（2）对专业姑息治疗需求高，但缺乏：（a）康复计划和指南；（b）治疗/培训方案；（c）低效的保险和自付费用；（d）患者转诊系统；（e）工作描述不透明；（f）团队合作薄弱。
该研究结果确定了患者以及卫生专业人员对提供姑息治疗挑战的看法和认知。要建立一个结构化的PCS，我们需要应对这些挑战并消除感知到的障碍，包括但不限于增强卫生专业人员的知识和意识、开展专业教育以及制定适合当地情况的更新、明确且标准化的治疗方案。
